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PubMed1981

[Surgical revascularization of infarcted myocardial areas. Its effects on left ventricular function].

The results of twelve patients undergoing revascularisation procedures of infarcted myocardial territory alone were analysed quantitatively by planimetry in the right anterior oblique projection. Patients operated in the acute phase of myocardial infarction (2 cases) were distinguished from those with preinfarction syndromes (8 patients) and those with postinfarction angina (2 patients). Two posterior wall and ten anterior wall revascularisations were carried out by single bypass grafts (8) and double bypass grafts (2) with no operative deaths. The results were assessed 2 months to two years after operation (average: 6 months). Twelve of the fourteen bypass grafts were patent. Only one of the twelve operated patients, an anterior wall revascularisation, was considered a complete surgical failure: global left ventricular function and segmental wall movement progressively deteriorated with reduced contractility and velocity of fibre shortening. Improved contraction of both anterior and posterior walls was observed in the other 11 patients. The ejection fraction of the 9 patients with anterior wall revascularisation rose significantly from 47,1 +/- 10,5% to 56,3 +/- 3,5% and a similar rise was observed in systolic index (29,0 +/- 12,0 to 36,8 +/- 11,0 ml/syst./m2); the average akinetic end diastolic perimeter fell by 17%; segmental wall analysis of mean radial shortening and mean amplitude of excursion on the hemiaxes was improved, especially in the antero apical region: the corrected rates of mean excursion and average systolic work indices (33,2 +/- 15 to 41 +/- 13 gm/syst./m2) also increased. Surgical revascularisation of infarcted zones, made possible by new methods of cardioplagia and reliable circulatory assistance, may lead to improvement in global and segmental left ventricular function with minimal risk to the patient: this is thought to be due to an active mechanism and not to the passive process of scarring. Although a reserved attitude should be adopted in the acute phase of myocardial infarction, preinfarction syndromes and unstable postinfarction angina could well benefit from surgical management.

Adult↗
PubMed2006

PICOT inhibits cardiac hypertrophy and enhances ventricular function and cardiomyocyte contractility.

Multiple signaling pathways involving protein kinase C (PKC) have been implicated in the development of cardiac hypertrophy. We observed that a putative PKC inhibitor, PICOT (PKC-Interacting Cousin Of Thioredoxin) was upregulated in response to hypertrophic stimuli both in vitro and in vivo. This suggested that PICOT may act as an endogenous negative feedback regulator of cardiac hypertrophy through its ability to inhibit PKC activity, which is elevated during cardiac hypertrophy. Adenovirus-mediated gene transfer of PICOT completely blocked the hypertrophic response of neonatal rat cardiomyocytes to enthothelin-1 and phenylephrine, as demonstrated by cell size, sarcomere rearrangement, atrial natriuretic factor expression, and rates of protein synthesis. Transgenic mice with cardiac-specific overexpression of PICOT showed that PICOT is a potent inhibitor of cardiac hypertrophy induced by pressure overload. In addition, PICOT overexpression dramatically increased the ventricular function and cardiomyocyte contractility as measured by ejection fraction and end-systolic pressure of transgenic hearts and peak shortening of isolated cardiomyocytes, respectively. Intracellular Ca(2+) handing analysis revealed that increases in myofilament Ca(2+) responsiveness, together with increased rate of sarcoplasmic reticulum Ca(2+) reuptake, are associated with the enhanced contractility in PICOT-overexpressing cardiomyocytes. The inhibition of cardiac remodeling by of PICOT with a concomitant increase in ventricular function and cardiomyocyte contractility suggests that PICOT may provide an efficient modality for treatment of cardiac hypertrophy and heart failure.

Animals↗
PubMed2005

[Effects of a novel recombinant polypeptide from the sea anemone Anthopleura sp. on left ventricular function in dogs with acute cardiac insufficiency].

OBJECTIVE: To observe the effects of recombinant hk2a, a novel neurotoxin from the sea anemone Anthopleura sp., on left ventricular function of dogs with acute cardiac insufficiency. METHODS: Canine models of acute cardiac insufficiency were established by rapid ventricular pacing, in which the left ventricular ejection fraction (LVEF) was measured by Acuson ultrasound systems (Sequoia 512) at 0, 5, 15, 30 and 60 min, respectively, after intravenous injection of 30 microg/kg recombinant hk2a. The response of the canine models to hk2a treatments was observed in comparison with that of the dogs treated with Cedilanid (as positive control) and saline (as negative control). RESULTS: Intravenous injection of recombinant hk2a caused an immediate and significant increase in LVEF in the canine models of acute cardiac insufficiency (P<0.05), and the effect maintained for more than 30 min without significant effect on heart rate. Recombinant hk2a possessed such merits as quicker onset and greater potency in comparison with Cedilanid. CONCLUSION: Recombinant hk2a may significantly increase LVEF of the dogs with acute cardiac insufficiency.

Animals↗
PubMed2006

Left and right ventricular function is impaired in Behçet's disease.

OBJECTIVES: Subclinical cardiac involvement may occur in patients with Behçet's disease (BD). The purpose of our study was to assess the noninvasive parameters of biventricular function derived from Doppler tissue imaging (DTI) of the tricuspid and mitral annular motion in BD. METHODS: Twenty-one patients with BD and 20 control subjects were enrolled in this study. All subjects were selected to exclude those with cardiovascular risk factors. Standard echocardiography and pulsed DTI were obtained in every patient. RESULTS: Peak systolic (13.71 +/- 2.09 vs 20.01 +/- 1.57, P < 0.001), peak early diastolic (11.26 +/- 2.52 vs 15.35 +/- 2.06, P < 0.001) tricuspid annular velocities were significantly lower in patients than controls. Peak systolic (8.68 +/- 1.4 vs 12.25 +/- 1.7, P < 0.001), peak early diastolic (7.89 +/- 1.07 vs 9.94 +/- 1.12, P < 0.001), and peak end diastolic (8.30 +/- 1.32 vs 9.23 +/- 0.91, P = 0.013) lateral mitral annular velocities were significantly lower in patients than controls. CONCLUSIONS: We demonstrated that myocardial velocities, were affected in patients with BD. Therefore, we conclude that right and left ventricular function is impaired in patients with BD.

Adult↗
PubMed1994

[Echocardiography online quantification of left and right ventricular function by automatic boundary detection: reference values and reproducibility in healthy probands].

UNLABELLED: Automated border detection (ABD) is a new on-line technique that instantaneously calculates cavity areas from automatic tracking of the endocardial-blood interface with a modified ultrasonic integrated backscatter imaging system. After validation of this new method in comparison with off-line echocardiographic, Doppler- and angiographic analyses, we studied dynamic systolic and diastolic function of the left (LV) and right ventricle (RV) in 50 normal volunteers (31 +/- 9 years) in order to establish ranges of normality for the ABD-parameter. The averaged areas of the LV (apical chamber view) were 25.7 +/- 4.9 sq cm in end-diastole and 14.7 +/- 3.3 sq cm in end-systole, resulting in a fractional area change (FAC) of 43.2 +/- 4.8%. The peak filling (PFR) and peak ejection rate (PER) were 69.3 +/- 11.2 and -61.5 +/- 11.1 sq cm/s. Normalization for end-diastolic area (EDA) yielded 2.7 +/- 0.28 and -2.4 +/- 0.42 EDA/s. The areas of the RV (apical chamber view) were 17.1 +/- 3.8 sq cm in end-diastole and 9.0 +/- 2.0 sq cm in end-systole, resulting in a FAC of 47.3 +/- 9.2%. PFR and PER were 58.2 +/- 13.7 and -51.6 +/- 10.1 sq cm/s. Normalization for EDA yielded 3.4 +/- 0.74 and -2.9 +/- 0.62 EDA/s. The interobserver- and day-to-day-variability for all measured values was less than 10%. CONCLUSION: ABD permits reproducible on-line quantification of systolic and diastolic ventricular function and offers a non-invasive approach for longitudinal monitoring of cardiac patients.

Adult↗
PubMed1993

Beneficial effects of the opiate antagonist naloxone on hemodynamics and ventricular function following coronary artery occlusion and reperfusion in the dog.

It has been shown that endogenous opioid peptides (EOP) subserve important roles in cardiovascular regulation and are involved in the pathophysiology of myocardial ischemia, contributing to the deleterious effects. The aim of this study was to evaluate the effects of the opiate antagonist naloxone on the hemodynamics and ventricular function following coronary artery occlusion and reperfusion in the dog, utilizing the technique of cardiac catheterization. During myocardial ischemia and reperfusion, it was found that in the control group, there was reduction in the aortic, left ventricular, right atrial, pulmonary arterial and wedge pressures, and in the left ventricular dP/dt. The reduction in the aortic, left ventricular and pulmonary arterial pressures, and left ventricular dP/dt were significantly attenuated by pretreatment with naloxone. The results indicate a regulatory role of EOP in the cardiovascular function and suggest a possible involvement of EOP in myocardial ischemia and reperfusion causing detrimental effects such as arrhythmias, bradycardia, hypotension and, as shown in this study, impaired hemodynamics and ventricular function. The beneficial effects of naloxone on circulatory dynamics may have clinical implications in the prevention and treatment of ischemic heart disease.

Animals↗
PubMed2002

Myocardial collagen type I and impaired left ventricular function under exercise in hypertrophic cardiomyopathy.

BACKGROUND: Transaortic subvalvular myectomy (TSM) reduces left ventricular outflow tract gradient and improves symptoms and working capacity in patients with hypertrophic obstructive cardiomyopathy (HOCM). Nevertheless, TSM does not completely restore normal ventricular function, and some patients complain of symptoms despite optimal surgical results. Abnormal myocardial collagen structure in hypertrophic cardiomyopathy might be an indicator of impaired cardiac function. METHODS: Nine patients with HOCM were investigated. Myocytic diameter, collagen volume fraction and light absorbance of immunohistochemically stained collagen subtype I and its product (Coll I(prod)) were measured quantitatively in myectomy specimens. Patients underwent symptom-limited bicycle exercise testing with equilibrium radionuclide angiocardiography to determine ejection fraction (EF). Right heart catheterization was performed simultaneously in order to measure pulmonary capillary wedge pressure (PCWP) as a parameter of global ventricular diastolic filling and cardiac index (CI) as a parameter of functional capacity. RESULTS: Postoperatively, CI increased from 3.1 +/- 0.4 to 5.7 +/- 1.3 l/min/m(2) under exercise. EF was normal at rest (64 +/- 9 %) but did not increase significantly under exercise (66 +/- 14 %). Coll I(prod) (13.62 +/- 7.35 Vv%(prod)) correlated inversely with EF under exercise (r = -0.64; p = 0.05). PCWP increased under exercise from 8 +/- 2 mmHg at rest to 22 +/- 9 mmHg (p = 0.01). Coll I(prod) correlated with PCWP under exercise (r = 0.90; p = 0.001). CONCLUSIONS: Increased collagen subtype I is a predictor of diastolic as well as systolic dysfunction under exercise in patients with HCM after successful TSM.

Adolescent↗
PubMed1984

Quantitative analysis of left ventricular function: pre- and postischemic two-dimensional echocardiography in dogs.

A quantitative technique that aligns the diastolic and systolic silhouettes was used to assess left ventricular function (wall thickening and endocardial wall motion) from two-dimensional echocardiographic studies for every 2 degrees of arc of the left ventricular circumference in canines. Thirty-two dogs were studied before and at specific intervals up to 14 days after either temporary or permanent occlusion of the left anterior descending coronary artery. Decreased systolic wall thickening and frank systolic thinning were observed in the ischemic/infarcted region 90 min and 6 hr after occlusion; endocardial motion showed the abnormally contracting segment less clearly. Partial recovery was seen in both groups of animals but to a greater degree in those with temporary occlusion. The technique was useful for assessing sequential changes in wall motion.

Animals↗
PubMedDate not supplied

A system for quantitative evaluation of left ventricular function with two-dimensional ultrasonography.

Phased-array ultrasonic imaging systems produce real-time sectional images of the left ventricle. To quantify left ventricular function, a light-pen-based system was developed using a minicomputer to analyze the geometry of ultrasound images and measure left ventricular volume, ejection fraction, and regional contraction. System accuracy was evaluated by comparing measurements abtained from left ventricular cineangiograms at cardiac catheterization on a series of 25 patients to echocardiographic left ventricular long- and short-axis linear dimensions (r = 0.92, S.E.E. = 0.67 cm), end-diastolic volume (r = 0.84, S.E.E. = 45 cm3), and ejection fraction (r = 0.80, S.E.E. = 0.10). Five patients from the study population with electrocardiographically documented transmural myocardial infarcts had regional contraction abnormalities detected by this analytic approach. Quantitative application of two-dimensional echocardiography appears to be a useful noninvasive method of evaluating left ventricular ejection fraction and has potential to define regional contraction abnormalities objectively.

Cardiac Output↗
PubMed1984

Comparison of the influence of acute transmural and nontransmural myocardial infarction on ventricular function.

In order to assess the relative impact on left and right ventricular function of nontransmural and transmural acute myocardial infarction (AMI), we performed radionuclide ventriculography in 86 patients (54 men and 32 women) within 16 hours after a first infarct. Nontransmural infarction was present in 19 patients (11 anterior and 8 inferior). Transmural infarction was found in 67 patients (30 anterior and 37 inferior). Left ventricular ejection fractions were higher (0.57 +/- .014 vs 0.46 +/- 0.14, p less than 0.005) and left ventricular end-systolic volume lower (29 +/- 11 vs 42 +/- 20 ml/m2, p = 0.013) in patients with nontransmural infarction compared to those with transmural infarction. Right ventricular ejection fraction also may have been different in the two groups (0.63 +/- 0.15 vs 0.55 +/- 0.13, p = 0.057). In patients with inferior infarction, left and right ventricular ejection fractions were similar in patients with nontransmural and transmural infarction (0.60 +/- 0.09 vs 0.55 +/- 0.10, p = 0.119 and 0.58 +/- 0.14 vs 0.51 +/- 12, p = 0.226). On the other hand, patients with anterior transmural infarction had lower left ventricular ejection fractions (0.36 +/- 0.12 vs 0.54 +/- 0.17, p = 0.003) but similar right ventricular ejection fractions (0.60 +/- 0.13 vs 0.66 +/- 0.14, p = 0.14) compared to those with nontransmural anterior infarction. In 29 additional patients with a history of previous infarction, no differences in any of the parameters studied were found between those with transmural and those with nontransmural infarcts.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed2004

Noninvasive, quantitative assessment of left ventricular function in ischemic cardiomyopathy.

BACKGROUND: Coronary artery disease characteristically impacts left ventricular (LV) function on a regional basis, although ultimately global function may be affected as well. Echocardiography is commonly clinically used for the assessment of regional function; however, it is only semiquantitative and in its current iteration is only two-dimensional in nature. Magnetic resonance imaging (MRI) with tissue tagging offers the possibility for noninvasive, three-dimensional (3D) assessment of transmural and segmental left ventricular strain and, thereby, function. Accordingly, we have explored methodologies to accurately and quantitatively characterize regional systolic function in three dimensions in patients with ischemic heart disease using MRI. MATERIALS AND METHODS: MRI radiofrequency tissue tagging was performed at rest and during dobutamine administration (10 mg/kg/min) on 10 normal volunteers (age: 26 +/- 6) and 8 patients with severe ischemic cardiomyopathy (age: 60 +/- 5, EF 26 +/- 11%). Three-dimensional global and regional systolic strain calculations were made based on 3D myocardial point displacements and compared with conventional measures. RESULTS: Global left ventricular strains were significantly decreased in ischemic patients at rest (0.14 +/- 0.04 versus 0.25 +/- 0.02, P < 0.001) and with dobutamine (0.14 +/- 0.03 versus 0.29 +/- 0.03, P < 0.001). In the regional analysis (216 LV wall segments) this methodology accurately differentiated normal from abnormally contracting regions. CONCLUSIONS: Noninvasive dobutamine MRI tissue tagging with calculation of 3D regional strains has significant promise as a clinical tool which is capable of the identification, quantification, and display of regionally varying ventricular function.

Aged↗
PubMed2002

[Assessment of left ventricular function by thallium-201 quantitative gated cardiac SPECT].

PURPOSE: Present study was designed to evaluate the accuracy of the measurement of left ventricular volume by quantitative gated SPECT (QGS) software using 201T1 and the effect of cutoff frequency of Butterworth prereconstruction filter on the calculation of volume. METHODS: The RH-2 type cardiac phantom and 20 patients with ischemic heart disease were studied. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated by the QGS software using the various frequency of Butterworth filter. These parameters were evaluated by Simpson's method using left ventriculography (LVG). RESULTS: The volume of the phantom calculated by QGS was under-estimated by 14%. In the clinical study, EDV and ESV measured by QGS were smaller than those obtained from LVG by 10%. When the cutoff frequency of Butterworth filter was 0.43 cycles/cm, the values measured by QGS were best correlated with those by LVG (EDV: r = 0.80, p < 0.001; ESV: r = 0.86, p < 0.001; EF: r = 0.80, p < 0.001). CONCLUSION: These data suggest that 201Tl quantitative gated cardiac SPECT can estimate myocardial ischemia and left ventricular function simultaneously.

Adult↗
PubMed2003

Significant effects of atrioventricular node ablation and pacemaker implantation on left ventricular function and long-term survival in patients with atrial fibrillation and left ventricular dysfunction.

Control of ventricular rate by atrioventricular node ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation (AF) is associated with improved left ventricular (LV) function. The objective of this study was to determine the effect of atrioventricular node ablation on long-term survival in patients with AF and LV dysfunction. Survival was determined by the Kaplan-Meier method for 56 study patients with LV ejection fraction (EF) < or =40% who underwent atrioventricular node ablation and pacemaker implantation and 56 age- and gender-matched control patients with AF and LVEF >40%, and age- and gender-matched control subjects from Minnesota. Groups were compared using the log-rank test. In study patients (age 69 +/- 10 years; 45 men), LVEF was 26% +/- 8% and 34% +/- 13% (p <0.001) before and after ablation, respectively. During follow-up (40 +/- 23 months), 23 patients died. Observed survival was worse than that of normal subjects (p <0.001) and control patients (p = 0.005). After ablation, LVEF nearly normalized (> or =45%) in 16 study patients (29%), in whom observed survival was comparable to that of normal subjects (p = 0.37). Coronary artery disease, hyperlipidemia, chronic renal failure, previous myocardial infarction, and coronary artery operation were independent predictors for mortality. Near normalization of LVEF occurred in 29% of study patients, suggesting that AF-induced EF reduction is reversible in many patients. Normal survival in patients with reversible LV dysfunction highlights potential survival benefits of rate control. Poor survival in patients with persistent LV dysfunction confirms the importance of optimal medical therapy.

Aged↗
PubMed1988

The effect of different mechanisms of myocardial ischemia on left ventricular function.

Myocardial ischemia may be produced by limitation of blood flow as in abrupt coronary occlusion, termed supply-type ischemia, or by increasing myocardial oxygen demand in the setting of restricted flow, termed demand-type ischemia. To examine the comparative extent and severity of the dysfunction related to both forms of ischemia, we studied anesthetized, open-chest dogs by means of two-dimensional echocardiography and tracer microspheres. Supply-type ischemia was produced by total occlusion of the LCx (n = 7); demand-type ischemia was induced by infusion of dobutamine after creation of a critical LCx stenosis (n = 6). At the time of the production of ischemia, the group with demand-type ischemia had significant increases in both heart rate (p less than 0.05) and mean arterial pressure (p less than 0.05), whereas the group with supply-type ischemia had a decrease in mean arterial pressure (p less than 0.05). Subendocardial blood flow in the LCx region was severely depressed in supply-type ischemia (0.09 +/- 0.04 ml/min/gm) compared to demand-type ischemia (1.04 +/- 0.07 ml/min/gm; p less than 0.01). Although both groups of animals had an abnormality of left ventricular function during ischemia, as determined by two-dimensional echocardiography, the extent of the dysfunction in the group with supply-type ischemia was greater (146 +/- 12 degrees) compared to the group with demand-type ischemia (99 +/- 9 degrees; p less than 0.01). Similarly, the degree of left ventricular dysfunction in the group with supply-type ischemia was greater than that for the group with demand-type ischemia (p less than 0.05). Thus these data suggest that supply-type ischemia produced by coronary occlusion results in a greater extent and degree of left ventricular functional abnormality than pharmacologically induced demand-type ischemia.

Animals↗
PubMed1997

Effects of lidoflazine on left ventricular function in patients.

OBJECTIVE: The present study evaluated the effects of the nucleoside transport inhibitor, lidoflazine, at a dose of 1 mg/kg, on left ventricular function. DESIGN: Patients were randomly assigned to receive either lidoflazine or saline in a double-blind manner. SETTING: A university hospital. PARTICIPANTS: The study was performed in 32 patients scheduled for elective coronary artery bypass surgery. INTERVENTIONS: Left ventricular pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the left ventricle were simultaneously recorded on videotape. Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relationship. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relationship. Cardiac function was assessed at baseline and after administration of either lidoflazine (group A [n = 16]) or placebo (group B [n = 16]). Data were compared using two-factor analysis of variance. MEASUREMENTS AND MAIN RESULTS: At baseline, diastolic and systolic function were comparable in both groups. Lidoflazine increased Kc from 0.079 +/- 0.015 to 0.125 +/- 0.017 mmHg/mL and decreased Ees from 2.481 +/- 0.213 to 1.217 +/- 0.211 mmHg/mL (p = 0.009 and p = 0.004, respectively). None of these changes occurred when placebo was administered. CONCLUSIONS: Administration of lidoflazine before the start of cardiopulmonary bypass impaired left ventricular systolic function but also increased diastolic stiffness.

Aged↗
PubMed1998

Left ventricular function and endomyocardial biopsy in early and advanced dilated cardiomyopathy.

We evaluated left ventricular function and endomyocardial biopsy in 20 patients with early and advanced dilated cardiomyopathy, with the purpose of assessing the correlation between histologic variables and systolic and diastolic filling indexes. Group 1 included 10 patients with no clinical history of heart failure and left ventricular ejection fraction > or = 45% and group 2, 10 patients with a clinical history of heart failure and left ventricular ejection fraction <45%. Group 1 showed lower left ventricular end-systolic and end-diastolic volumes indexes (49+/-14 versus 86+/-23 ml/m2, P<0.001; 98+/-25 versus 127+/-35 ml/m2, P=0.049), higher left ventricular ejection fraction (50+/-4 versus 32+/-4%, P<0.001) and lower coefficient of variation of percentage shortening of left ventricular transverse hemiaxes (0.3+/-0.1 versus 0.5+/-0.1, P=0.001) compared with group 2. Group 1 had higher A wave peak velocity (78+/-18 versus 60+/-20 cm/s, P=0.048), lower E/A ratio (0.9+/-0.3 versus 1.5+/-0.6, P=0.02) and slower E wave deceleration time (204+/-51 versus 155+/-50 ms, P=0.047) compared with group 2. Semiquantitative histologic scores did not differ significantly between groups. There was no significant correlation between histologic variables and left ventricular systolic and diastolic indexes. Thus, dilated cardiomyopathy shows borderline to severe left ventricular systolic impairment and distinct left ventricular diastolic filling abnormalities, according to the clinical stage. This study suggests a marked dissociation between histologic findings and functional abnormalities in early and advanced dilated cardiomyopathy.

Adult↗
PubMed1995

Left ventricular function after mitral valve surgery.

This study examined the effects of various operative procedures on the mitral valve of patients with mitral regurgitation due to degenerative disease of the mitral valve. A randomized clinical trial on the type of annuloplasty ring used at surgery revealed that early postoperative left ventricular systolic function was better in patients who had a flexible ring than in patients who had a rigid ring. Two years after surgery there were no differences between these groups and most patients were found to have fairly normal left ventricular function. The long term results of mitral valve repair in 184 patients revealed a 10-year actuarial survival of 86% +/- 6%. A randomized trial on the effect of preservation of chordae tendineae during mitral valve replacement revealed that the beneficial effect of this procedure on left ventricular function is a lasting one; five years after surgery patients who had mitral valve replacement with preservation of the chordae tendineae have better exercise capacity, and better left ventricular systolic function and performance. The long term results of mitral valve replacement in 154 patients revealed a 10-year actuarial survival of 69% +/- 5%. Logistic regression analysis indicated that age greater than 65 years and complete excision of the native mitral valve were predictors of late mortality. Of those patients, 70 had had chordal preservation during surgery and 84 did not. These two subgroups were remarkably similar preoperatively, but the 10-year actuarial survival was 80% +/- 6% for patients who had chordal preservation and 63% +/- 6% for those who did not. The mitral valve should be repaired whenever possible; if replacement is necessary it should be performed with preservation of the chordae tendineae.

Actuarial Analysis↗
PubMed1989

Limitation of myocardial infarct size and preservation of left ventricular function by early administration of APSAC in myocardial infarction.

In cases of acute myocardial infarction (MI), it has been shown that preserving left ventricular function and limiting infarct size with early reperfusion of the occluded artery by means of a thrombolytic agent could eventually result in a reduced mortality rate. The aim of the APSIM study (anisoylated plasminogen streptokinase activator complex [APSAC] dans l'infarctus du Myocarde) was to demonstrate that early administration of APSAC in patients with recent acute MI could limit the infarct size and preserve left ventricular systolic function. In all, 231 patients with a first acute MI were randomly allocated to either APSAC (30 U over 5 minutes) or to conventional heparin therapy (5,000 IU in bolus injection) within 5 hours of the onset of symptoms. Of these patients, 112 received APSAC and 119 received heparin within a mean period of 188 +/- 62 minutes after the onset of symptoms. The patency rate of the infarct-related artery was 77% in the APSAC group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the APSAC than in the heparin group. This was true for the entire population (0.53 +/- 0.13 vs 0.47 +/- 0.13, p = 0.002) as well as for the subgroups of anterior and inferior wall infarctions (0.47 +/- 0.13 vs 0.4 +/- 0.16, p = 0.004 and 0.56 +/- 0.11 vs 0.51 +/- 0.09, p = 0.02). At 3 weeks, the difference remained significant for patients with anterior MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Anistreplase↗