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PubMed1988

Systolic and diastolic alterations of left ventricular function: prevalence in ischaemic heart disease and importance in the management of individual patients.

Myocardial perfusion and contractile performance are strictly interrelated. Conclusive experimental data show that changes in perfusion cause immediate changes in function, and conversely, that changes in contraction affect both total and regional myocardial blood flow. In ischaemic heart disease, both transient and permanent changes in global and/or regional left ventricular (LV) function have been described. In myocardial ischaemia, an impairment of LV relaxation, as indicated by a reduction of negative dP/dt, is the first appreciable haemodynamic event. When ischaemia is sustained, impairment of LV contraction follows, as indicated by a drop of positive dP/dt, reduction of systolic LV pressure, rise of end-diastolic LV pressure. Unrestricted reperfusion, as in experimental coronary occlusion and in Prinz-Metal angina, is associated with a transient rebound in regional systolic function. Spontaneous and/or induced changes of regional ventricular function provide relevant information for the management of the individual patient. In PTCA candidates monitoring regional contractile performance by mono and two-dimensional echocardiography during dypiridamole infusion has proven to be a sensitive and specific test for (1) assessing the haemodynamic significance of a coronary stenosis in patients with single-vessel disease, (2) identifying the 'culprit' lesion in patients with multiple-vessel disease. During PTCA, right and left ventricular function assessed by radionuclide angiography both at rest and during atrial pacing appears to be a sensitive method for the immediate evaluation of the efficacy of the procedure.

Angioplasty, Balloon↗
PubMed2005

Assessing fetal cardiac ventricular function.

Fetal echocardiography has been used primarily to identify fetuses with structural malformations of the heart. Evaluation of fetal ventricular function, however, has received minimal attention since the inception of fetal echocardiography in the early 1980s. This communication reviews the use of M-mode, B-mode and pulsed Doppler ultrasound to examine cardiac function. M-mode ultrasound is used to determine the size of the fetal heart, the end-diastolic and end-systolic dimensions of the ventricular chambers, and the thickness of the ventricular walls and the interventricular septum, and to measure the diameter of the mitral and tricuspid valves as well as the diameter of the aorta and pulmonary artery. B-mode evaluation of the fetal heart includes measurement of atrial and ventricular dimensions as well as dimensions of the outflow tracts. This modality is useful when M-mode measurements cannot be made due to fetal position. Once measurements of cardiac structures are obtained using either M-mode or B-mode ultrasound, pulsed Doppler recording of mitral valve, tricuspid valve, aortic valve and pulmonary artery waveforms can be used to compute cardiac output as well as stroke volume. In addition, pulsed Doppler can be used to evaluate diastolic and systolic cardiac functions by examining the components of each waveform.

Echocardiography↗
PubMed2000

Target-controlled intravenous anaesthesia with bispectral index monitoring for thoracotomy in a patient with severely impaired left ventricular function.

The anaesthetic management of an elderly patient with severely impaired left ventricular function undergoing thoracotomy and lobectomy is described. Total intravenous anaesthesia (TIVA) with remifentanil and target-controlled infusion of propofol titrated according to the bispectral index (BIS) was used, with thoracic epidural anaesthesia commenced at the end of surgery providing postoperative analgesia. Avoidance of intraoperative epidural local anaesthetics and careful titration and dose reduction of propofol using the BIS was associated with excellent haemodynamic stability. The rapid offset of action of remifentanil and low-dose propofol facilitated early recovery and tracheal extubation. The BIS was a valuable monitor in optimal titration of TIVA.

Aged↗
PubMed1996

Percutaneous transvenous mitral commissurotomy for rheumatic mitral stenosis with impaired left ventricular function: an echocardiographic follow-up study.

Sixty consecutive patients of rheumatic mitral stenosis who underwent percutaneous transvenous mitral commissurotomy were evaluated and followed up for 3 months in order to study the effect of the procedure on left ventricular ejection fraction and to elucidate the pathophysiology of impaired left ventricular function. The response in 16 patients (26.7%) with left ventricular dysfunction (ejection fraction less than 50%) was compared to that in 44 patients with normal left ventricular ejection fraction. Patients with left ventricular dysfunction had relatively larger left ventricular end-diastolic (84 +/- 15 vs. 76 +/- 14 ml) and end-systolic (45 +/- 11.5 vs. 35 +/- 12 ml) volumes. Percutaneous transvenous mitral commissurotomy was successful in all patients. Mitral valve area increased in all patients, from 0.8 +/- 0.2 cm2 to 1.82 +/- 0.37 cm2. After commissurotomy there was a trend towards increase of the left ventricle end-diastolic volumes in both groups of patients. Left ventricular ejection fraction also marginally increased in both groups. A reduced left ventricular compliance due to thickened and fibrotic mitral valve apparatus and excessive afterload due to increased systemic vascular resistance because of low output are possible mechanisms for left ventricular dysfunction in patients with mitral stenosis.

Adolescent↗
PubMed1983

Assessment of ventricular function by combined noninvasive measures: factors accounting for methodologic disparities.

We studied the predictive accuracy and disparities among cineventriculographic ejection fraction, pre-ejection period over left ventricular ejection time (PEP/LVET) obtained from the systolic time intervals and the percent shortening of the internal echocardiographic diameter (% delta D) in assessing left ventricular performance in 453 consecutive patients without valvular heart disease. In 308 patients all three tests were normal, and in 78 patients all three tests were abnormal. Overall agreement (predictive accuracy) among ejection fraction (normal greater than or equal to 57), % delta D (normal greater than or equal to 28%) and PEP/LVET (normal less than or equal to 0.42) was 85%. In 67 patients disparities among the tests as measures of global left ventricular performance were found. The major mechanisms accounting for such disparities were: (a) large segmental contraction abnormalities which selectively distort the % delta D and ejection fraction and (b) diminished isovolumic pressure (less than 45 mmHg) which distorts PEP/LVET. When patients with segmental contraction abnormalities and low isovolumic pressure were excluded the agreement between PEP/LVET and ejection fraction was 97%, ejection fraction and % delta D 98% and PEP/LVET and % delta D 97%. The combined uses of systolic time intervals and echocardiogram minimizes error due to segmental contraction abnormalities and isovolumic pressure. If both PEP/LVET and % delta D are concordant the agreement with ejection fraction is 94% for normal and 99% for abnormal left ventricular function.

Adult↗
PubMed1980

The effect of graded coronary flow reduction in the left anterior descending and septal arteries on left ventricular function in the canine heart.

WE quantitatively analyzed the effect of graded left anterior descending and septal coronary flow (LAD + septal flow) reduction on left ventricular function with a left ventricular end-diastolic pressure (LVEDP) of 6 mm Hg and 12 mm Hg. We used an isolated, ejecting, canine heart preparation ( n = 8), the coronary flow of which could be controlled independently of the aortic pressure. We kept the other hemodynamic variables - heart rate, left circumflex coronary flow, right coronary flow and aortic input impendance - constant within their normal physiologic range. We considered this reduction in LAD + septal flow to be analogous to that of the most frequent lesion in ischemic heart disease. There was no plateau in the left ventricular work caused by this reduction of the regional coronary flow. Therefore, the plateau commonly reported in previous studies may be partially a result of the compensatory elevation of LVEDP, which is necessary to maintain the left ventricular work.

Animals↗
PubMed1998

Nongeometric quantitative assessment of right and left ventricular function: myocardial performance index in normal children and patients with Ebstein anomaly.

Assessment of ventricular systolic function has been based on the geometric models of ventricular shape. This study was designed to define normal values for a nongeometric myocardial performance index (MPI) in children and to evaluate the utility of MPI in congenital heart disease. The MPI measures the ratio of total time spent in isovolumic activity (isovolumic contraction time and isovolumic relaxation time) to the ejection time. The right ventricular (RV) and left ventricular (LV) MPI were measured in 152 normal children (ages 3 to 18 years) and 45 preoperative patients with Ebstein anomaly (age 1 week to 52 years). In normal children, the RV MPI was 0.32+/-0.03 and the LV MPI was 0.35+/-0.03. In the Ebstein group, both RV and LV MPI were abnormally increased compared with age-matched normal subjects (Ebstein group: RV MPI=0.49+/-0.12, LV MPI=0.42+/-0.09, P < .001). Increasing RV dysfunction was associated with progressively increasing (abnormal) values of RV MPI (P < .001). The myocardial performance index quantitatively reflects ventricular performance in patients with complex ventricular geometry (ie, Ebstein anomaly). In the absence of a geometric solution, this nongeometric index is particularly appealing for the assessment of RV or LV performance.

Adolescent↗
PubMed1993

[Correlations between arrhythmias and left ventricular function at rest and during stress in patients with postinfarct aneurysm].

The results (clinical, hemodynamic, and angiographic data) of 197 patients with left ventricular anterior wall aneurysm were evaluated at rest and during exercise (bicycle ergometer) 6 months after the acute infarction. Using the technique of digital subtraction angiography, left ventricular volumes were estimated after injection of contrast medium into the pulmonary artery and measuring of pulmonary artery pressure. In 136 patients a programmed right ventricular stimulation was performed additionally. The patients were divided into the following groups: patients with (VT+) and without (VT-) ventricular arrhythmias in history. Group VT- was subdivided in patients with positive (RV+) or negative (RV-) result of right ventricular stimulation. In group VT+ chamber volumes were greater and ejection fraction was smaller than in group VT-. At rest the results of subgroup RV+ were similar to group VT+, but during exercise similar to group RV-. These results show that left ventricular function at rest and during exercise is much more impaired in patients with spontaneous and by stimulation-induced arrhythmias than in patients without these arrhythmias. The conclusions for clinical practice of these findings are not yet clear, concerning, for example, the prophylactic use of antiarrhythmic measurements in patients without spontaneous but with induced arrhythmias. Further investigations (long-term follow-ups of these patients) will be necessary.

Arrhythmias, Cardiac↗
PubMed2000

Magnetic resonance imaging and echocardiography in assessment of ventricular function in atrially corrected transposition of the great arteries.

OBJECTIVE: Patients with atrial correction of transposition of the great arteries (TGA) may develop right ventricular (RV) failure with time. A reliable non-invasive method for assessment of ventricular function is therefore needed. To evaluate the accuracy of echocardiography in assessment of ventricular volumes and function in these patients we compared echocardiography with magnetic resonance imaging (MRI) in 10 patients late after the Mustard and Senning procedures. DESIGN: Prospective echocardiography and MRI examinations were performed on the same day. Two different echocardiography technicians examined all patients. All echocardiography and MRI examinations were performed at the university hospital outpatient clinic and MRI department respectively. Ten patients, age 14.0+/-2.9 years, who had been operated on with atrial correction of TGA at 8 (2-60) months of age (median and range) were examined. Echocardiography RV and left ventricular (LV) end-systolic volumes (ESVs), end-diastolic volumes (EDVs), stroke volumes (SVs) and ejection fractions (EFs) were calculated, using the modified Simpson method, and compared with the same measurements obtained from MRI. RESULTS: For RV function there was good agreement between echocardiography- and MRI-derived measurements. Both echocardiography and MRI revealed reduced RV function with EFs of 42.6+/-9.1% and 46.4+/-7.2% respectively. For RV volumes there were no significant differences between echocardiography and MRI. LV function was significantly overestimated by echocardiography (EF with echocardiography = 72.7+/-4.4% vs. MRI = 50.5+/-7.6%) while all LV volumes were greatly underestimated. Echocardiography measurements of volumes in repeated examinations by different technicians showed large variations, 13-50%, for different variables in individual patients. CONCLUSION: Echocardiography can provide clinically important information concerning RV function in follow-up of patients late after atrial correction of TGA. It has limited value in assessment of LV function in these patients. Volume measurements by echocardiography are, however, highly user-dependent and interobserver variation is high. MRI may accordingly serve as an important reference method in individual patients.

Adolescent↗
PubMed1999

The use of Doppler and atrioventricular plane motion echocardiography for the detection of changes in left ventricular function after training.

In this study we compared the efficacy of Doppler and atrioventricular plane motion echocardiography in detecting the changes in left ventricular function caused by moderate-intensity training. Fifty-nine healthy men and women (aged 40-68 years) were divided into either a group of walkers (n = 32) or controls (n = 27). Pre-intervention, there were no significant differences between the groups for gender, age, height, mass or predicted maximal oxygen consumption. The walkers completed a progressive 18-week walking programme that resulted in an estimated mean gross energy expenditure whilst walking of 4.0 (1.3) MJ x week(-1) for the duration of the study, and 5.9 (1.7) MJ x week(-1) during the final 6 weeks. After the 18-week programme there were no significant changes in Doppler measures of early or late filling velocities. However, the walkers showed an increase in the velocity of relaxation (1.2 cm x s(-1)) (P < 0.02) of the left free wall, as measured using atrioventricular plane motion echocardiography, while the controls showed no significant changes. The findings suggest that atrioventricular plane motion echocardiography is more sensitive than Doppler echocardiography in detecting the left ventricular changes caused by exercise intervention.

Adult↗
PubMedDate not supplied

Anomalous origin of the left coronary artery from the pulmonary artery in a premature infant with preserved left ventricular function.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare condition. The majority of cases present with impaired left ventricular function. We report on a premature infant who was diagnosed at a gestational age near term with ALCAPA during routine cardiac examination. The patient showed no signs of myocardial ischemia and is doing well after corrective surgery. This is the youngest patient reported with ALCAPA and preserved myocardial function.

Coronary Vessel Anomalies↗
PubMed2006

The prognostic value of contrast echocardiography in the prediction of the recovery of left ventricular function in patients with acute anterior myocardial infarction.

INTRODUCTION: The immediate and complete restoration of perfusion in patients with acute myocardial infarction (MI) leads to the survival of myocardial cells in the initially ischaemic risk area and makes the recovery of left ventricular contractile function possible. AIM: The goal of the study was to assess the utility of contrast echocardiography (CE) in the prediction of left ventricular function recovery in patients with AMI treated by percutaneous coronary intervention (PCI). METHODS: Eighty six patients (aged 58.4+/-11.2) with anterior AMI, treated by PCI of the left anterior descending coronary artery, were included in the study. Two-dimensional and contrast (Optison) echocardiography were performed immediately before and after PCI, and three days post-PCI. Myocardial contrasting was assessed using the following criteria: 0 -- lack of perfusion; 0.5 -- partial perfusion; 1 -- normal perfusion. On the third day post-PCI, the regional myocardial contrast index was evaluated as the mean value in dyssynergic left ventricular segments (LVRCstI). After three months, the left ventricular regional contractility index (LVRCtrctI) was calculated as the sum of points in the segments which were dyssynergic in the initial study, divided by their number. RESULTS: 90% of segments with perfusion defects three days post-PCI demonstrated contractility defects (hypokinesia or akinesia) three months post-PCI. LVRCstI three days post-PCI correlated strongly with LVRCtrctI three months post-PCI (R2=0.7696). The sensitivity, specificity and accuracy of EC three days post-PCI in the prediction of recovery of left ventricular function were 88%, 80% and 86%, respectively. CONCLUSIONS: The presence of myocardial perfusion in the region supplied by the infarct-related artery three days post-MI is indicative of myocardial survival and predicts the recovery of contractile function in this region in long-term observation.

Adult↗
PubMed1985

Epicardial wall motion and left ventricular function during coronary graft angioplasty in humans.

Epicardial wall motion and left ventricular function changes during temporary coronary artery occlusion were assessed in a patient at the time of percutaneous transluminal angioplasty performed on a previously placed stenotic coronary artery bypass graft. Epicardial wall motion was analyzed using biplane cineradiography with frame to frame measurements of distances between pairs of radiopaque epicardial markers placed at the time of previous cardiac surgery. Bypass graft occlusion after initial dilation led to the early onset of a biphasic epicardial late systolic lengthening and early diastolic shortening similar to the regional wall motion abnormality preceding the procedure.

Angioplasty, Balloon↗
PubMed1980

Echocardiographic assessment of cardiac chamber size and left ventricular function in aerobically trained athletes.

We compared the echocardiographic assessment of left ventricular function in 20 aerobically trained male athletes (VO2 max 61 ml/kg/min) with 20 control subjects of similar age and size (VO2 max 37 ml/kg/min). On average, the left ventricle was larger in athletes and the extent of myocardial contraction (fractional shortening) was reduced. In nine athletes, fractional shortening was less than our laboratory lower limit of normal (26%) and in four athletes the left ventricle was enlarged and fractional shortening was reduced. However, the peak rate of circumferential shortening was not reduced in athletes. We concluded that athletes have normal myocardial contractility but some have a reduced extent of myocardial contraction which could be mistaken for the effects of myocardial disease.

Adolescent↗
PubMed1985

Factors that determine recovery of left ventricular function after thrombolysis in patients with acute myocardial infarction.

The coronary and ventricular angiograms of 47 patients with acute myocardial infarction in whom reperfusion was achieved by intracoronary streptokinase were quantitatively analyzed to determine the factors that affect recovery of regional left ventricular function after reperfusion. Hypokinesis in the infarct region was measured by the centerline method and expressed in terms of standard deviations (SDs) from normal. Severity of coronary artery stenosis was measured quantitatively. Hypokinesis showed more significant improvement after thrombolysis in patients with minimum stenosis diameter of greater than 0.4 mm than in those with severe residual stenosis, i.e., stenosis producing a minimum diameter of 0.4 mm or less (1.0 +/- 1.3 SD/chord, n = 31, vs 0.0 +/- 0.9 SD/chord, n = 7; p less than .05). Improvement in hypokinesis was greater in patients who received thrombolytic therapy within 2 hr than in those treated later (2.1 +/- 1.1, n = 8, vs 0.7 +/- 1.0 SD/chord, n = 28; p less than .001). These results indicate that angiographic reperfusion alone may not be sufficient: reperfusion must provide adequate flow and be achieved early to salvage myocardial function.

Adult↗
PubMed1976

[Left ventricular function in mitral valve stenosis].

In 12 patients with mitral stenosis left ventricular performance was assessed by pharmacologically (Methoxamine) induced increased afterload. At rest ventricular enddiastolic pressure (6.2 +/- 3.1 mm Hg), left ventricular enddiastolic volume (68 +/- 20 ml/m2), endsystolic volume (26 +/- 11 ml/m2) and left ventricular ejection fraction (0.63 +/- 0.06) were normal in each subject. Methoxamine induced a mean increment in peak systolic atrial pressure of 65 mm Hg. Left ventricular stroke volume, stroke work, stroke power, enddiastolic pressure and volume increased with Methoxamine in each patient. The mean left ventricular ejection fraction remained unchanged for the group and remained within the normal range for all patients. No difference was observed between the response of the mitral stenosis group and a control group of 10 normal subjects with the exception of the account of mitral regurgitation during the pressure load in 9 mitral stenosis patients. This study indicates the left ventricle in mitral stenosis is capable of a normal response to a pressure load. No evidence of impaired left ventricular function was detected in this group of patients.

Adult↗
PubMed1994

Prevention of complement-induced pulmonary hypertension and improvement of right ventricular function by selective thromboxane receptor antagonism.

The effect of complement activation on the pulmonary vascular system and on right ventricular function was studied in sheep (n = 12) by injection of cobra venom factor. Animals were instrumented for measurement of pulmonary flow, mean pulmonary artery pressure, right ventricular stroke work, arterial blood gases, and systemic vascular resistance. Blood was sampled from the left atrium and pulmonary artery to measure thromboxane B2, the metabolite of thromboxane A2, by radioimmunoassay. After baseline measurements, animals were randomly assigned to receive a selective thromboxane receptor antagonist SQ30741 as a 10 mg/kg bolus with an infusion of 10 mg/kg per hour or else to receive vehicle. Cobra venom factor was then injected (30 U/kg) in all animals, and data were recorded at 15, 30, 60, 90, and 120 minutes. In control animals there was a 2.4-fold increase in mean pulmonary artery pressure and a 76% increase in right ventricular stroke work at 15 minutes from baseline (p < 0.05); these values remained elevated for 30 minutes and returned to baseline by 1 hour with no change in systemic vascular resistance. Arterial oxygenation decreased by 124% at 15 minutes and remained depressed through the experiment, but in treated animals oxygen tension remained unchanged from baseline. Thromboxane B2 increased 95% from baseline in the control group and 1.5 fold in treated animals and followed a similar time course as the functional measurements (p < 0.05). A pulmonary vascular thromboxane B2 gradient of approximately 1000 pg/ml was measured at 15 and 30 minutes in both control and treated groups. (p < 0.05) We conclude that after complement activation in this model pulmonary hypertension and decreased oxygen tension are mediated by thromboxane release from the pulmonary vascular bed. This increased afterload causes a stress on the right ventricle as demonstrated by the increased right ventricular stroke work. Selective thromboxane receptor antagonism may be a beneficial therapy for pulmonary hypertension in patients after cardiopulmonary bypass.

Animals↗
PubMed1993

Cardiac output and left ventricular function in response to exercise in older men.

Studies of the cardiovascular response to exercise in older subjects have presented conflicting data regarding left ventricular function, the cardiac output-oxygen consumption (Q-VO2) relationship, and the pattern of change in Q, stroke volume (SV), and arteriovenous O2 difference. We have examined the cardiovascular response to submaximal and strenuous exercise in 96 men of mean age 63 years during an incremental treadmill test with Q determined by CO2 rebreathing, and in 12 subjects studied during incremental supine exercise with left ventricular volumes evaluated by radionuclide angiocardiography. During treadmill exercise the Q was approximately 10% lower than reported for younger samples, with a lower intercept of the Q-VO2 relationship. During near-maximal exercise Q was approximately 15 L.min-1, with SV of 95 mL plateauing or showing a small decline in heavy work. Peak arteriovenous O2 difference (150 + mL.L-1) approached values of the young. During the supine exercise SV increased from rest to exercise, with a consistent increase in ejection fraction (rest, 66%, to peak exercise, 76%). In contrast to a prior report, the end-diastolic volume was constant, with the increase of SV attributable to a reduced end-systolic volume. Also, in contrast to a number of reports in older subjects, our findings show only small losses in cardiovascular response, and in left ventricular performance during light through strenuous exercise.

Aged↗