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At least 1,531 records · Page 85Linked to original sources
PubMed1997

Left ventricular cavity-to-myocardium count ratio in technetium-99m-sestamibi SPECT in the detection of resting left ventricular dysfunction.

UNLABELLED: The aim of this study was to assess the value of the cavity-to-myocardium count ratio (C/M ratio) calculated in resting 99mTc-sestamibi SPECT images to identify patients with depressed left ventricular ejection fraction (LVEF). METHODS: In the 95 patients studied, the C/M ratio was calculated from the midventricular short-axis slice using regions of interest drawn in the center of the cavity and in the most active area of the ventricular wall; its value was compared with LVEF measured using two-dimensional echocardiography. RESULTS: The C/M ratio correlated with LVEF (r = 0.6, p < 0.000001) and was significantly lower in patients with abnormal LVEF than those with normal LVEF: 0.026 +/- 0.028 versus 0.125 +/- 0.093, p < 0.000001. In the entire patient population, a C/M ratio < 0.07 identified the patients with depressed LVEF with a 94% sensitivity, 71% specificity and 82% accuracy. CONCLUSION: The resting 99mTc-sestamibi C/M ratio is a useful parameter in identifying patients with depressed LVEF directly from the SPECT perfusion images.

Echocardiography↗
PubMed2006

Quantitative measures of right ventricular dysfunction by echocardiography in the diagnosis of acute nonmassive pulmonary embolism.

BACKGROUND: Transthoracic echocardiography (TTE) is used in the risk assessment of patients with pulmonary embolism (PE), but the incremental diagnostic information from quantitative measures of right ventricular (RV) size, pressure, and function by TTE has yet to be fully evaluated. METHODS: In 300 consecutive patients with suspected first nonmassive PE, TTE and ventilation/perfusion scintigraphy were performed. RESULTS: Among measures of RV anatomy, RV pressure estimates, and estimates of global and regional RV function with significant diagnostic information in a logistic regression analysis, the acceleration time of RV outflow less than 89 milliseconds, the ratio of RV to left ventricular diameter greater than 0.78, RV outflow tract fractional shortening less than 35%, and signs of RV strain on electrocardiogram had independent, incremental diagnostic information (area under the receiver operating characteristics curve = 0.81). If D-dimer greater than 4.1 mmol/L was included, the area under the curve increased to 0.88. The negative and positive predictive values if any 2 of 3 factors in the final model were present were 88% and 70%, respectively. CONCLUSION: TTE is able to identify differential diagnoses and enhance pretest probability of PE significantly. TTE could therefore be considered as an integral part of the initial diagnostic workup of patients suspected of PE, especially if definitive diagnostic imaging has limited availability.

Acute Disease↗
PubMed1997

[Characteristics of patients hospitalized for myocardial infarction in France with respect to left ventricular dysfunction. Results of the USIK study].

Patients admitted in coronary care units, in november 1995, for confirmed acute myocardial infarction within 48 hours of symptoms onset were included in this study. The choice of measurement of left ventricular ejection fraction (LVEF) was left to the physician in charge. Only investigations performed within the first 8 days were taken into consideration. In cases with multiple investigations, the following order of preference was applied: a) angiographic LVEF, b) isotopic LVEF, c) echocardiographic ejection fraction by Simpson's method, d) echocardiographic ejection fraction by Berning's method, e) semi-quantitative visual echocardiographic evaluation. 2563 patients were included (1827 males and 736 females, mean age 67 years). A quantitative evaluation of LVEF was obtained in 1477 patients (57%) whereas 2 053 patients (80%) underwent at least a semi-quantitative evaluation. The average LVEF was 50% and 17% of patients had an ejection fraction < or = 35%. Patients with LVEF < or = 35% were older, less likely males, non smokers and diabetics. Prior heart failure, previous myocardial infarction and anterior location in infarction were more frequent. Heart failure was more frequent in patients with LVEF < or = 35% (75 vs 23%, p < 0.001). One hundred and ninety-seven patients (7.7%) died in the five first days following the onset of symptoms. A left ventricular ejection fraction < or = 35% multiplied the risk of death by 8.1 (Confidence interval: 5.7-11.4, p < 0.001). The presence of clinical heart failure increased the risk even more.

Aged↗
PubMed1989

Right ventricular dysfunction in human fetal compromise.

Fetal M-mode echocardiography was performed in 13 pregnancies complicated by intrauterine distress. Absent end-diastolic blood velocity in the fetal descending aorta was documented by pulsed Doppler examinations. The right ventricular fractional shortening of these fetuses was decreased and the ratio of the right/left ventricular end-diastolic diameters was increased. The left ventricular size and myocardial contractility did not differ from normal pregnancy. These findings reveal that relative right ventricular heart dysfunction is associated with severe intrauterine distress.

Aorta↗
PubMed2006

[The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction].

OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction < or = 40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-significant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confidence of 95% from 0.05 to 0.85. CONCLUSION: The use of pre-operative IAB can significantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not significantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.

Adult↗
PubMed1987

Volume expansion, dobutamine and noradrenaline for treatment of right ventricular dysfunction in porcine septic shock: a combined invasive and radionuclide study.

The purposes of the present study were 1) to explore if volume loading in combination with dobutamine or noradrenaline would be superior to volume loading alone in the treatment of right ventricular (RV) dysfunction in septic shock complicated by acute pulmonary hypertension and 2) to determine whether noradrenaline would be superior to dobutamine because of its vasoconstrictor effects on the peripheral circulation, resulting in increased RV coronary perfusion pressure. Experiments were performed on 21 anesthetized, ventilated pigs. Gated blood pool studies and hemodynamic measurements were performed simultaneously. All animals were given 3-4 X 10(8)/kg live E. coli bacteria, resulting in an abrupt increase in pulmonary arterial pressure and a decrease in arterial pressure, cardiac output, and RV ejection fraction. Right ventricular end-systolic volume was unchanged; RV end-diastolic volume and RV coronary perfusion pressure fell. After randomization, the control group (I, n = 5) was subjected to volume loading, and treatment groups (each n = 8) received volume loading in combination with dobutamine (group II, 5-10 micrograms/kg/min) or noradrenaline (group III, 0.25-0.50 micrograms/kg/min). In contrast to volume loading alone, dobutamine and noradrenaline increased cardiac output and RV ejection fraction, but only noradrenaline restored mean arterial pressure. Noradrenaline improved RV contractility, as judged from the RV end-systolic pressure-volume relationship, probably because it increased the RV perfusion. Thus, noradrenaline in combination with volume loading may be the treatment of choice to improve RV performance in porcine septic shock associated with pulmonary hypertension.

Animals↗
PubMed1998

Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension.

OBJECTIVES: This study sought to investigate the influence of right ventricular (RV) hemodynamic variables and function on the secretion of brain natriuretic peptide (BNP) in patients with isolated RV overload. BACKGROUND: Plasma BNP is known to increase in proportion to the degree of left ventricular (LV) overload. However, whether BNP secretion is also regulated in the presence of RV overload remains unknown. METHODS: Plasma BNP and atrial natriuretic peptide (ANP) levels in the pulmonary artery were measured in 44 patients with RV overload: 18 with RV volume overload (RVVO) due to atrial septal defect and 26 with RV pressure overload (RVPO) due to primary or thromboembolic pulmonary hypertension. Right heart catheterization was performed in all patients. RV and LV ejection fraction, myocardial mass and volume of the four chambers were determined by using electron beam computed tomography. RESULTS: Although both plasma BNP and ANP levels were significantly elevated in patients with RV overload compared with values in control subjects, plasma BNP and the BNP/ANP ratio were significantly higher in patients with RVPO than with RVVO (BNP 294 +/- 72 vs. 48 +/- 14 pg/ml; BNP/ANP 1.6 +/- 0.2 vs. 0.8 +/- 0.2, both p < 0.05). Plasma BNP correlated positively with mean pulmonary artery pressure (r = 0.73), total pulmonary resistance (r = 0.79), mean right atrial pressure (r = 0.79), RV end-diastolic pressure (r = 0.76) and RV myocardial mass (r = 0.71); it correlated negatively with cardiac output (r = -0.33) and RV ejection fraction (r = -0.71). Plasma BNP significantly decreased from 315 +/- 120 to 144 +/- 54 pg/ml with long-term vasodilator therapy (total pulmonary resistance decreased from 23 +/- 4 to 15 +/- 3 Wood U). CONCLUSIONS: Plasma BNP increases in proportion to the extent of RV dysfunction in pulmonary hypertension.

Adult↗