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At least 1,531 records · Page 85Linked to original sources
PubMed2006

Maximum oxygen uptake at peak exercise in elderly patients with coronary artery disease and preserved left ventricular function: the role of inflammation on top of tissue Doppler-derived systolic and diastolic function.

BACKGROUND: Several studies have shown that longitudinal systolic function and left ventricular filling pressures, as assessed with tissue Doppler imaging, predict exercise capacity. AIM: The aim of this study was to evaluate whether natriuretic peptides and inflammatory parameters can independently predict maximum oxygen uptake at peak exercise (VO2max) on top of tissue Doppler imaging-derived markers. METHODS: We evaluated 142 patients (age 70 +/- 6 years, 77% men) with known or suspected coronary artery disease and a preserved left ventricular ejection fraction (> or = 50%). All patients underwent bicycle spiroergometry, and N-terminal pro-B-type natriuretic peptide levels were determined. Cytokines (IL-6 and soluble tumor necrosis factor receptors 1 and 2) and high-sensitivity C-reactive protein were measured as inflammatory markers. Tissue Doppler imaging was applied to evaluate peak long axis systolic velocities (Sm) and early mitral annulus velocities (E'). Ratio of early transmitral flow (E) to E' was assessed as marker of left ventricular filling. Analysis of variance, comparing VO2max quartiles, was used to determine univariate predictors and linear regression to determine multivariate VO2max predictors. RESULTS: Average VO2max was 18.5 +/- 5.7 mL/kg per minute (range 6-36.6). Compared with the highest quartile, patients with low VO2max were more frequently women (P < .0001). N-terminal pro-B-type natriuretic peptide and cytokine levels were significantly higher in the lower VO2max categories. Longitudinal myocardial velocities increased, and E/E' decreased along with increasing VO2max. In multivariate linear regression analysis, VO2max was independently predicted by sex, glucose, Sm, E/E', and cytokine levels. CONCLUSION: Maximum oxygen uptake at peak exercise in patients with known or suspected coronary artery disease and preserved systolic function was independently predicted by inflammatory makers on top of tissue Doppler-derived systolic and diastolic function.

Aged↗
PubMed2005

Relation of terminal QRS distortion to left ventricular functional recovery and remodeling in acute myocardial infarction treated with primary angioplasty.

The association between admission electrocardiogram and 6-month change in left ventricular function and volume was assessed in 200 patients who had acute myocardial infarction that was treated with primary percutaneous coronary intervention. Logistic regression analysis indicated peak creatine phosphokinase-MB, number of Q-wave leads, QRS interval distortion, wall motion score index, and angiographic Thrombolysis In Myocardial Infarction flow grade as predictors of no functional recovery and QRS interval distortion and Thrombolysis In Myocardial Infarction flow grade as predictors of left ventricular remodeling.

Aged↗
PubMed1983

Trimazosin in chronic congestive heart failure: improved left ventricular function at rest and during exercise.

The hemodynamic effects of the oral vasodilator trimazosin were evaluated in patients with chronic congestive heart failure (CHF), initially over a 72-hour period (13 patients), and after 3 months of maintenance therapy (seven patients). During the initial evaluation, cardiac index and stroke work index increased an average of 24% and 37% respectively, and pulmonary capillary wedge pressure decreased by 26%. These beneficial hemodynamic effects were maintained during supine bicycle exercise. After 3 months of maintenance therapy, cardiac index (+30%) and stroke work index (+38%) remained elevated, and pulmonary capillary wedge pressure was lower (-38%). Improved hemodynamics during exercise were also seen after maintenance therapy. Withdrawal of trimazosin was associated with deterioration in hemodynamics and left ventricular function. Thus trimazosin has the potential to cause sustained improvement in left ventricular function, both at rest and during exercise, in patients with chronic CHF.

Adrenergic alpha-Antagonists↗
PubMed1992

Radionuclide assessment of left ventricular function in patients with myocardial infarction and diabetes mellitus.

The aim of this study was to compare left ventricular function, assessed by radionuclide angiocardiography, in 54 diabetics and 194 non-diabetics with acute myocardial infarction (AMI). The most meaningful results concern the inferior AMI group, whose left ventricular ejection fraction (LVEF) and regional wall motion were significantly lower in diabetics than in non-diabetics (LVEF was 44.2 +/- 11 vs. 51.6 +/- 9%, P less than 0.005; the regional wall motion score was 0.46 +/- 1 vs. 1.56 +/- 1, P less than 0.01, respectively), while no significant difference was observed in the anterior AMI group. However, in the group as a whole, the LVEF was 41 +/- 13% in diabetics and 47 +/- 13% in non-diabetics (P less than 0.01), the number of abnormally contracting segments was 2.0 +/- 0.9 and 1.5 +/- 1, respectively, and the wall motion score was 0.2 +/- 1.1 and 1.0 +/- 1.4, respectively (P less than 0.01). These data could be explained by an underlying cardiac dysfunction in diabetes, in addition to AMI. The more marked difference between diabetics and non-diabetics in inferior AMI might be related to the smaller infarct size in this group.

Adult↗
PubMed1990

Is pulsed Doppler echocardiography an adequate method to evaluate left ventricular function during filling in hypertensive patients?

Pulsed Doppler tracings of the mitral inflow are often proposed to describe left ventricular function during filling in hypertensive patients. The tracings are determined by the complex interaction of left atrial pressure and left ventricular relaxation, diastolic compliance and contractility of the left atrium. They strongly depend on preload and, thus, do not allow precise characterization of the left ventricle. In addition, they vary with age, heart rate and the site of measurement. The modifications caused by the presence of hypertensive hypertrophy are not specific: similar changes are seen for example, in the presence of hypertrophic cardiomyopathy or coronary heart disease, but are absent in highly trained athletes in spite of very significant physiologic hypertrophy.

Aging↗
PubMed1983

Limitations of electrocardiographic scoring systems for estimation of left ventricular function.

Four electrocardiographic scoring systems for the assessment of left ventricular function or presence of myocardial infarction were evaluated in 231 patients with coronary artery disease. Electrocardiographic scores were compared with radionuclide ejection fraction and thallium perfusion studies. The correlation between Wagner's modified QRS score and ejection fraction was only fair (r = -0.60). Askenazi's sum of R wave voltage score correlated poorly with ejection fraction (r = 0.44), as did Gottwik's sum of voltage score from the Frank lead electrocardiogram (r = 0.44). Rautaharju's Cardiac Infarction Injury Score did not reliably predict presence of infarction in the patient group, nor did it correlate well with ejection fraction (r = -0.49). None of the correlations were significantly improved when only patients with a history of a myocardial infarction, a thallium defect compatible with a scar or a diagnostic Q wave were considered. Although Wagner's QRS score correlated best with ejection fraction, all scoring systems had limited clinical usefulness for estimating ejection fraction.

Cardiac Output↗
PubMed1981

Left ventricular function during exercise before and after bypass surgery.

Biplane left ventricular cineangiograms and pressure measurements were performed in 44 patients with coronary heart disease at rest and during submaximal or symptom-limited supine bicycle exercise before and 7 +/- 3 months after bypass surgery. Revascularization was complete in 12 (group I) and incomplete in 32 patients (group II). Preoperative left ventricular ejection fraction (EF) was within normal limits at rest and declined similarly during exercise in both groups (group I from 59 to 51%, p less than 0.01; group II from 61 to 48%, p less than 0.001). Postoperative EF at rest was nearly identical to preoperative EF in both groups (group I, 65%; group II, 58%) and remained unchanged during exercise (group I, 63%; group II, 56%). Peak systolic pressure to end-systolic volume index ratio (LVSP/ESVI in mm Hg/ml . m-2) also decreased during exercise in both groups preoperatively (group I from 3.7 to 3.2, NS; group II from 3.4 to 2.6, p less than 0.005). Postoperative LVSP/ESVI at rest was again unchanged as compared to preoperative LVSP/ESVI. During exercise, however, it increased in both groups reaching higher values in patients of group I than of group II (5.1 versus 3.7, p less than 0.05). Whereas both parameters indicate an improvement in global left ventricular function following surgery, LVSP/ESVI even suggests a more sizable recovery of function in patients with complete as compared to those with incomplete revascularization.

Adult↗
PubMed1982

Assessment of right ventricular function during supine bicycle exercise after Mustard's operation.

Right ventricular (RV) performance during supine bicycle exercise was evaluated by gated equilibrium nuclear angiography in 19 clinically well children with d-transposition of the great arteries (d-TGA), 6.4 +/- 2.7 years after Mustard's operation. Comparisons were made between rest and peak exercise. The mean resting ejection fraction was 44 +/- 12% (range 30-75%) and was unchanged at peak exercise. Eight children had a normal ejection fraction response, whereas 11 children had either no increase or a decrease in ejection fraction. Relative end-diastolic volumes decreased from resting values in all patients who had an abnormal ejection fraction response. Among patients whose ejection fraction increased, the end-diastolic volume increased in three, decreased in four and was unchanged in one at peak exercise. Heart rate increased 84% (range 52-135%) and systolic blood pressure increased 16% (range 0-28%) at peak exercise. There was no correlation between exercise response and age at surgery or interval since surgery. These data indicate that clinically well children after Mustard's procedure may have abnormal right ventricular function under stress, raising concerns about the ability of the right ventricle to function as the systemic ventricle.

Adolescent↗
PubMed1990

[Ventricular function in dilated cardiopathy].

Global and regional systo-diastolic ventricular function evaluation is of primary importance in the study of patients suffering from heart disease. The finding of intact global systolic function in subjects with documented heart disease is not rare. However a variety of cardiovascular diseases can alter, at an early stage, the characteristics of the diastolic function. Functional alterations during the initial diastolic phase can be found in patients with early stage heart disease and with normal regional systolic function suggesting that regional and global diastolic evaluation could be useful in the diagnostic approach to patients with still normal global and regional systolic function.

Cardiomyopathies↗
PubMed2000

Magnetic resonance imaging assessment of left ventricular function and wall motion.

Assessment of left ventricular (LV) function is essential for the diagnosis and treatment of cardiac patients. A reliable and noninvasive tool for quantifying global and local LV function is needed. Magnetic resonance (MR) imaging has several unique features that are well suited to clinical examinations: it is noninvasive, does not expose the patient to ionizing radiation, and provides images of high spatial resolution and excellent soft tissue contrast without the need for contrast medium injection. In this paper, I review the reported evidence concerning the validity of MR imaging assessment of LV volume, including end-diastolic volume, end-systolic volume, and ejection fraction, and the validity of using MR imaging to monitor LV wall motion. Abundant evidence from phantom, animal, and human studies supports that MR imaging provides accurate and reproducible information that is substantially superior to that from conventional modalities such as angiographic ventriculography, radionuclide scintigraphy, and echocardiography. A fast MR imaging technique, cine MR imaging, further enhances the clinical feasibility of MR imaging by reducing the scanning time to about 20 minutes. Today, cine MR imaging is widely accepted as a reliable clinical tool. It may be considered an in vivo standard for quantification of LV volume and wall motion. Faster MR imaging techniques, such as TurboFLASH and echo-planar imaging, decrease the examination time to several seconds. This allows evaluation of transient functional changes during pharmacologically or physically induced stress tests.

Humans↗
PubMed1981

Acute effects of haemodialysis on left heart dimensions and left ventricular function: an echocardiographic study.

Carotid pulse tracings and M-mode echocardiography were recorded in 25 patients on maintenance haemodialysis pre- and post-dialysis. Myocardial function, as assessed by fractional shortening and velocity of circumferential fibre shortening, was depressed in 7 out of 25 patients pre-dialysis (28%). Acute Haemodialysis resulted in significant changes in body weight, mean arterial pressure, urea, creatinine and packed cell volumes in all patients. Left ventricular function, however, improved significantly only in that group of patients in which it was depressed prior to dialysis. Echocardiography provides a simple means for evaluating left ventricular function in patients on chronic haemodialysis and shows that cardiac performance improves with acute dialysis when it is depressed pre-dialysis.

Adolescent↗
PubMed1989

Quantitative radionuclide assessment of regional ventricular function after thrombolytic therapy for acute myocardial infarction: results of phase I Thrombolysis in Myocardial Infarction (TIMI) trial.

In Thrombolysis in Myocardial Infarction (TIMI) Phase I,290 patients with acute myocardial infarction were randomized to either intravenous recombinant tissue-type plasminogen activator (rt-PA) or intravenous streptokinase. Two hundred twenty-nine patients had radionuclide ventriculograms at discharge for assessment of global and regional left ventricular ejection fraction. Among these 229 patients 185 had totally occluded infarct-related arteries, and angiographic reperfusion of the infarct-related artery occurred in 69% of patients treated with rt-PA and 28% of patients treated with streptokinase (p less than 0.001). Mean global left ventricular ejection fraction was not different for rt-PA-treated patients compared with streptokinase-treated patients (0.46 versus 0.45). However, the average regional ejection fraction of the regions subtended by the infarct-related artery showed a trend toward better average infarct region ejection fraction in patients treated with rt-PA than in patients treated with streptokinase (0.40 versus 0.36; 0.05 less than p less than 0.06). Analysis of data according to perfusion status of the infarct-related artery showed no difference in mean global left ventricular ejection fraction between patients with sustained versus nonsustained reperfusion (0.47 versus 0.44). However, there was better average regional ejection fraction of the region subtended by the infarct-related artery in patients with sustained reperfusion (0.40 versus 0.36; p less than 0.01). Thus, quantitation of regional left ventricular function by radionuclide techniques provides a noninvasive means for evaluating the effects of thrombolysis. This study suggests a direct relation between improvement of regional left ventricular function and the greater infarct-related artery patency rate achieved by rt-PA compared with streptokinase.

Aged↗
PubMedDate not supplied

Left ventricular function in coronary disease: serial studies in the absence of myocardial infarction or coronary artery surgery.

Fifteen patients with coronary artery disease underwent repeat cardiac catheterization (R) 7-45 months (mean 19.4) after the initial study (I) because of increasing angina. No patient sustained a myocardial infarction between I and R or underwent coronary artery surgery. Left ventricular function exhibited variability between the two studies with 6 patients demonstrating deterioration in ejection fractions (I = 65.6 = +/- 14.0 vs R = 50.5 +/- 15.4 p less than 0.01); 5 patients had a slight increase and the remainder showed no change. Changes in left ventricular volumes were not significant. Eight patients demonstrated progression of their coronary artery disease. The remaining 7 patients did not demonstrate progression. All 8 patients with progression and 5 of 7 patients without coronary artery progression demonstrated left ventricular asynergy. There was no difference in left ventricular function in the group of patients with coronary progression vs. those without progression. We conclude that changes in LV function are variable in patients with coronary artery disease in the absence of myocardial infarction or coronary surgery, and the relationship to progression of coronary artery disease or increasing angina is unclear.

Cardiac Catheterization↗
PubMed1994

Bi-ventricular function assessed intraoperatively before and after anatomical correction of transposition of the great arteries.

After anatomical correction of transposition of the great arteries (TGA), the left ventricle (LV) is forced to develop systemic pressures without having had time for adaptation. Thus, one might expect dilatation of the LV at least in the very early intraoperative period following the operation. In nine patients with TGA aged 8-24 days (median 9.5 days) which were selected for arterial switch operation (ASO), Dacron-patch mounted thin piezoceramic transducers were attached intraoperatively by fibrin glue to opposite epicardial surfaces of the right (RV) and/or LV for continuous assessment of external minor diameters (RVD, LVD; sonomicrometry) before and after correction. Right and left ventricular pressures (RVP, LVP) were measured simultaneously and pressure-diameter loops were generated. Right and left ventricular power indices (RVPi, LVPi: = HRxVPxVsD) was calculated from heart rate, ventricular pressures, and systolic shortening of the respective ventricular diameter (RVsD, LVsD). Data obtained during circulatory steady-state immediately before extra-corporeal circulation (ECC) and up to 45 min after ECC were compared. By avoiding volume overload (CVP < or = 10 mmHg) at weaning off ECC and by lowering the systemic vascular resistance and, thus, LV afterload (approximately 8 micrograms.kg-1 min-1 dobutamine), the LV developed systemic pressure (70 +/- 7 vs. 41 +/- 4 mmHg) at unchanged diastolic LV end-diastolic pressure (LVedP) (10 +/- 3 mmHg). Left ventricular power index increased by 45 +/- 25%, although the extent of systolic shortening of LVD was reduced by 20 +/- 10%. Simultaneously, the RV was effectively unloaded (RVedP: 8 +/- 3 vs 11 +/- 6 mmHg; RVP: 39 +/- 7 vs 53 +/- 9 mmHg; RVPi: -42 +/- 27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Extracorporeal Circulation↗
PubMed1992

On-line assessment of ventricular function by automatic boundary detection and ultrasonic backscatter imaging.

To provide an approach suitable for on-line analysis of ventricular function, a conventional two-dimensional ultrasound imaging system was modified to detect and track blood-tissue interfaces in real time based on their quantitative acoustic properties. This modification permitted on-line display of the left ventricular cavity area, fractional area change, volumes and ejection fraction on a beat by beat basis. Images were obtained from 54 patients and 12 normal subjects with broad ranges of ventricular dimensions and systolic function. On-line measurements of cavity areas were compared with off-line measurements of cavity areas (analysis of videotaped conventional images). Left ventricular cavity areas measured on-line from short-axis views correlated closely with off-line views as did areas from apical views. On-line fractional area change correlated well with ejection fraction calculated off-line. More than 70% of patients could be studied adequately with the approach developed. Thus, automatic boundary detection based on quantitative assessment of tissue acoustic properties permits on-line quantitation of ventricular cavity areas and indexes of function.

Algorithms↗
PubMed1975

[Evaluation of the left ventricular function in patients with coronary disease by means of atrial pacing].

In 18 patients with coronary artery disease and in 12 control subjects, left ventricular function was studied by means of rapid artial pacing. The results were compared with the cardiac dynamics, as determined by left ventricular dysfunction although the angiograms portrayed normal contractility at rest. It has to be assumed, that abnormal myocardial function was only evident during the pacing stress. On the other hand, if the angiogram showed local hypokinesis, the hemodynamic effect of this slightly abnormal contraction could be determined by atrial pacing. Moreover, rapid atrial pacing often produced myocardial ischemia and anginal pain in patients with coronary heart disease. In these cases the transient "anginal" depression of left ventricular function could be separated from the chronic hypoxic "preanginal" dysfunction. This may be of vale in terms of surgical revascularisation.

Adult↗
PubMed2001

Residual stress produced by ventricular volume reduction surgery has little effect on ventricular function and mechanics: a finite element model study.

OBJECTIVES: Residual stress is the stress (force per unit area) that remains when all external loads (eg, left ventricular chamber and pericardial pressures) are removed. It has been suggested that ventricular volume reduction surgery can reconstitute the residual stress-strain state of the left ventricle. To determine the extent to which residual stress is involved, we used a mathematical (finite element) model to simulate the effect of volume reduction operations on left ventricular stroke volume/end-diastolic pressure (Starling) relationships, as well as on regional distributions of stress in the local muscle fiber direction (fiber stress). METHODS: The nonlinear stress-strain relationship for the diastolic myocardium was anisotropic with respect to the local muscle fiber direction. An elastance model for active fiber stress was incorporated in an axisymmetric geometric model of the dilated, poorly contractile left ventricular wall. RESULTS: When residual stress is implemented in the model simulation of volume reduction operations, the additional decrease in stroke volume at fixed left ventricular end-diastolic pressure is small (10% volume reduction: 2.0% at 1 mm Hg and 2.0% at 20 mm Hg; 20% volume reduction: 2.2% at 1 mm Hg and 3.1% at 20 mm Hg). Furthermore, there is little change in the mean fiber stress throughout the left ventricular wall (10% volume reduction: +1.0% at end-diastole and -0.3% at end-systole; 20% volume reduction: +2.1% at end-diastole and -1.0% at end-systole). CONCLUSIONS: These results suggest that residual stress produced by volume reduction operations has little effect on left ventricular function and the mean fiber stresses at end-diastole and end-systole.

Anisotropy↗