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Results for “Ventricular Function, Left”

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At least 235 records · Page 13Linked to original sources

PubMed1999

Left ventricular function in adults with mild pulmonary insufficiency late after Fallot repair.

OBJECTIVE: To assess left ventricular function in adult Fallot patients with residual pulmonary regurgitation. SETTING: The radiology department of a tertiary referral centre. PATIENTS: 14 patients with chronic pulmonary regurgitation and right ventricular volume overload after repair of tetralogy of Fallot and 10 healthy subjects were studied using magnetic resonance imaging. MAIN OUTCOME MEASURES: Biventricular volumes, global biventricular function, and regional left ventricular function were assessed in all subjects. RESULTS: The amount of pulmonary regurgitation in patients (mean (SD)) was 25 (18)% of forward flow and correlated significantly with right ventricular enlargement (p < 0.05). Left ventricular end diastolic volume was decreased in patients (78 (11) v 88 (10) ml/m(2); p < 0.05), ejection fraction was not significantly altered (59 (5)% v 55 (7)%; NS). No significant correlation was found between pulmonary regurgitation and left ventricular function. Overall left ventricular end diastolic wall thickness was significantly lower in patients (5.06 (0.72) v 6.06 (1.06) mm; p < 0. 05), predominantly in the free wall. At the apical level, left ventricular systolic wall thickening was 20% higher in Fallot patients (p < 0.05). Left ventricular shape was normal. CONCLUSIONS: Adult Fallot patients with mild chronic pulmonary regurgitation and subsequent right ventricular enlargement showed a normal left ventricular shape and global function. Although the left ventricular free wall had reduced wall thickness, compensatory hypercontractility of the apex may contribute to preserved global function.

Adult↗

PubMed1995

Improvement of global and regional left ventricular function by percutaneous transluminal coronary angioplasty after myocardial infarction.

OBJECTIVES: This study was designed to evaluate how elective percutaneous transluminal coronary angioplasty of the infarct-related vessel after acute myocardial infarction affects global ejection fraction and regional wall function. BACKGROUND: The severity of the residual stenosis of the infarct-related artery after thrombolysis is an important predictor of changes in left ventricular function; however, the optimal time to restore complete perfusion in the infarct area has not been determined. METHODS: We prospectively evaluated patients with a first myocardial infarction, postinfarction ischemia and residual high grade stenosis with reduced flow in the infarct-related artery who underwent successful coronary angioplasty. The group comprised 74 patients (61 men, 13 women with a mean age +/- SD of 55.9 +/- 9.9 years). Global ejection fraction and infarct region function (expressed as area ejection fraction) were angiographically measured before coronary angioplasty (3.9 +/- 2.1 weeks after infarction) and on routine follow-up study 6 +/- 1 months after angioplasty. RESULTS: Restenosis with reduced flow occurred in 15 patients (20%). The global ejection fraction in patients with complete flow at follow-up increased significantly from 56.8% +/- 12% to 62.3% +/- 12.5% (p < 0.001). Regional wall motion of the infarct area increased from 12.1% to 22.5% (p = 0.001) in patients with anterior wall infarction and from 20.4% to 28.5% (p = 0.002) in those with inferior wall infarction. In patients with restenosis there was no difference at follow-up either in global ejection fraction (from 47.7% +/- 7.7% to 47.1% +/- 12.7%, p = 0.57) or in regional wall motion of the infarct area. CONCLUSIONS: Global and regional myocardial dysfunction due to postinfarction ischemia lessens significantly after successful coronary angioplasty of the infarct-related coronary artery with long-term sustained normal, complete flow. In contrast, restenosis with reduced flow prevents long-term improvement of left ventricular function.

Aged↗

PubMed2006

Myocardial systolic activation delay in patients with left bundle branch block and either normal or impaired left ventricular function.

AIM OF THE STUDY: to evaluate determinants of myocardial activation delay of both left (LV) and right (RV) ventricle in patients with left bundle branch block (LBBB) and either normal or impaired LV ejection fraction (EF). METHODS: From an initial cohort of patients with LBBB, 42 patients with dilated cardiomyopathy (group A) and 33 with normal global LV systolic function (group B), all comparable in age and sex, underwent standard Doppler echo, pulsed Doppler myocardial imaging (DMI), and coronary angiography. Using DMI, the following regional parameters were evaluated in five different basal myocardial segments (LV anterior, inferior, septal, lateral walls-RV lateral wall): systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. As index of myocardial systolic activation was calculated: precontraction time (PCTm) (from the beginning of Q-wave of ECG to the onset of Sm). Intraventricular systolic dyssynchrony was analyzed by difference of PCTm in different LV myocardial segments. Interventricular activation delay was calculated by the difference of PCTm between the most delayed LV segment and RV lateral wall. RESULTS: Patients of group A showed increased heart rate (HR), QRS duration and LV end-diastolic diameter, and reduced LV EF. By DMI, patients of group A showed reduced myocardial peak velocities and a significant intraventricular delay in activation of LV lateral wall, with increased regional PCTm (P < 0.001). In addition, patients with dilated cardiomyopathy showed a more pronounced interventricular dyssynchrony, even after adjustment for HR and QRS duration. By receiver operating characteristic (ROC) curve analysis, a cut-off value of 55 msec of interventricular delay showed 86% sensitivity and 92% specificity in identifying patients with impaired EF. In the overall population, by use of stepwise forward multivariate linear regression analyses, LV end-diastolic diameter (beta coefficient = 0.52; P < 0.001) and LV EF (beta coefficient =-0.58; P < 0.0001) were the only independent determinants of interventricular activation delay. CONCLUSIONS: Pulsed DMI is an effective noninvasive technique for assessing the severity of regional delay in activation of LV walls in patients with LBBB. The impairment of interventricular systolic sychronicity is strongly related to LV dilatation and to the degree of global systolic dysfunction. Therefore, patients with dilated cardiomyopathy suitable for cardiac resynchronization therapy may be better selected.

Bundle-Branch Block↗

PubMed2006

Usefulness of mitral annular velocity in predicting exercise tolerance in patients with impaired left ventricular systolic function.

Left ventricular (LV) diastolic function is 1 of the determinants of exercise tolerance. However, the relation between early diastolic velocity of the mitral annulus (Ea) obtained by tissue Doppler imaging and exercise tolerance is unknown in patients with impaired LV systolic function. To investigate the feasibility of evaluating exercise tolerance using tissue Doppler imaging, we studied 53 consecutive patients (mean age 58 +/- 14 years) with a LV ejection fraction of <50% (mean 37 +/- 9%). We measured the peak early diastolic velocity of transmitral flow (E) and Ea at the lateral border of the mitral annulus and then calculated the E/Ea ratio. After echocardiography, we measured the peak oxygen consumption and anaerobic threshold (AT) by cardiopulmonary exercise testing. Of all the echocardiographic parameters, the best correlation for AT was the E/Ea ratio (r = -0.74, p <0.001). Peak oxygen consumption correlated well with Ea and the E/Ea ratio (r = 0.64 and r = -0.68, respectively, p <0.001). The AT and peak oxygen consumption did not correlate with conventional Doppler indexes. Using an AT of 8 ml/min/kg as the cutoff to separate severe exercise intolerance from normal, mild, or moderate exercise intolerance, a receiver-operating characteristic curve showed that an E/Ea ratio of >11.3 had the best combination of sensitivity (88%) and specificity (86%). Exercise tolerance correlated with the E/Ea ratio in patients with impaired LV systolic function. In conclusion, the evaluation of LV diastolic function using tissue Doppler imaging is useful for predicting exercise tolerance in patients with heart failure.

Adult↗

PubMed1998

Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function.

INTRODUCTION: We hypothesized that simultaneous right and left ventricular apical pacing would result in improvement in left ventricular function due to improved coordination of segmental ventricular contraction. Structural changes in ventricular muscle present in dilated cardiomyopathy compromise ventricular excitation and mechanical contraction. METHODS AND RESULTS: Eleven patients with depressed left ventricular function having cardiac surgery underwent epicardial multisite pacing with continuous transesophageal echocardiographic imaging. Quantitative measurement of percent fractional area change was performed, and segmental changes in contraction sequence resulting from simultaneous right and left ventricular pacing were assessed by application of phase analysis to recorded transesophageal images. There was no statistically significant difference between the paced QRS duration achieved with simultaneous right and left ventricular apical pacing and the native QRS duration (139+/-39 msec vs 106+/-18 msec, P = NS), but all other paced modes resulted in longer QRS durations. Percent fractional area change improved with simultaneous right and left ventricular apical pacing but not with other paced modes (41.5+/-11.9 vs 34.3+/-9.7, P < 0.01). Phase analysis demonstrated a resequencing of segmental left ventricular activation/contraction when compared to baseline ventricular activation. CONCLUSION: Simultaneous right and left ventricular apical pacing results in acute improvements in global ventricular performance in patients with depressed ventricular function. Improvements may result from pacing-induced global coordination through recruitment of left and right ventricular apical and septal segments critical to effective ventricular contraction.

Cardiac Pacing, Artificial↗

PubMed1991

[Signal-averaged ECG and left-ventricular function in patients with severe ventricular arrhythmia in ischemic heart disease].

In 35 patients with ischemic heart disease we evaluated the incidence of ventricular late potentials and left ventricular function. The patients were divided into two groups: group A consisting of 15 patients (14 men, 1 woman) aged from 40 to 71 years (mean age 56) with previously documented ventricular tachycardia or fibrillation, and into group B comprising 20 subject (16 men, 4 women) aged from 35 to 62 years (mean age 50) with ischemic heart disease without the above-mentioned arrhythmias. Time from the development of ventricular tachycardia or fibrillation was 3 weeks to 4 years. The incidence of arterial hypertension and previous myocardial infarction was similar in both groups. Body surface late potentials were recorded by signal averaging technique according to Simson using Frank's orthogonal XYZ lead system. In addition, in all the patients 24-hour ECG monitoring was performed to reveal any ventricular rhythm disturbances and echocardiography was used to evaluate left ventricular function. The presence of the ventricular late potentials meeting at least two of the Simson's--Dene's criteria was found in 13 (87%) patients in group A and in 2 (10%) patients from group B. In the patients after ventricular tachycardia or fibrillation the mean values of th total QRS duration (QRS-D) and the low amplitude signal duration (LAS40) were higher whereas the root mean square voltage of the last 40 ms of th vector magnitude QRS (RMS) was lower (154 ms, 56 ms, 15 muV, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗

PubMed1989

Enhanced regional left ventricular function after distant coronary bypass by means of improved collateral blood flow.

To determine whether coronary artery bypass surgery can improve function in left ventricular regions not amenable to direct revascularization, 24 patients with multivessel coronary artery disease were studied by radionuclide angiography and coronary arteriography before and 6 months after coronary artery bypass surgery. All had proximal stenosis of the left circumflex artery or a major obtuse marginal branch. Left ventricular regional function was assessed by dividing the left ventricular region of interest into 20 sectors; the 8 sectors corresponding to the posterolateral free wall were used to assess function in the left circumflex artery distribution. Change in function in the left anterior descending territory was not analyzed because of the non-specific septal hypokinesia that develops postoperatively. For the total group, coronary artery bypass surgery significantly increased both global left ventricular ejection fraction during exercise (43 +/- 13% to 50 +/- 14%, p less than 0.001) and the change in ejection fraction from rest to exercise (-7 +/- 10% to 0 +/- 6%, p less than 0.001). Such improvement was observed in 9 of 10 patients with all stenoses bypassed, and to an equivalent degree in 9 of 10 patients in whom the left circumflex artery either could not be bypassed or the bypass graft was occluded (but bypass grafts to other coronary arteries were patent). Similarly, regional ejection fraction in posterolateral segments during exercise also increased comparably after operation in patients with a patent (from 57 +/- 18% to 70 +/- 19%, p less than 0.001) or nonpatent (from 51 +/- 14% to 68 +/- 14%, p less than 0.001) left circumflex graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1985

[Effect of aortocoronary bypass surgery on left ventricular function and coronary sinus blood flow in patients with severe left ventricular dysfunction].

Left ventricular function and coronary sinus blood flow were evaluated in 7 patients with severe left ventricular dysfunction at rest before and after aortocoronary bypass surgery, and during exercise after surgery. Same evaluations were performed in 8 normal subject (G-C). Cardiac index (CI) at rest (2.09 +/- 0.55 l/min/m2) significantly increased after operation (2.94 +/- 0.59 l/min/m2) (p less than 0.02). There was no difference between CI during exercise after operation (5.94 +/- 1.51 l/min/m2) and that in G-C. Left ventricular end-diastolic pressure (LVEDP) at rest before operation (16 +/- 8 mmHg) was significantly higher than that in G-C (p less than 0.05). This difference disappeared after operation. LVEDP during exercise after operation (25 +/- 10 mmHg) was significantly higher than that in G-C (p less than 0.01). Coronary sinus blood flow (CSF) at rest (73 +/- 15 ml/min) significantly increased after operation (123 +/- 44 ml/min) (p less than 0.02). There was no difference between CSF during exercise after operation (282 +/- 99 ml/min) and that in G-C. These data indicated that the aortocoronary bypass surgery was effective on left ventricular function and coronary sinus blood flow in patients with severe left ventricular dysfunction.

Adult↗

PubMed1999

RETRACTED: Total intravenous anesthesia with remifentanil and propofol for implantation of cardioverter-defibrillators in patients with severely reduced left ventricular function.

OBJECTIVE: To determine the cardiocirculatory effects of total intravenous anesthesia (TIVA) using remifentanil and propofol in high-risk cardiac surgical patients. DESIGN: Prospective study of 20 patients undergoing first-time implantation of a cardioverter-defibrillator (ICD). SETTING: Major, community, university-affiliated hospital. PARTICIPANTS AND INTERVENTIONS: In 20 patients with severely reduced left ventricular function (left ventricular ejection fraction <30%) undergoing first-time implantation of an ICD, TIVA using remifentanil and propofol was performed. MEASUREMENTS AND MAIN RESULTS: Extensive hemodynamic monitoring using a pulmonary artery catheter was performed: (T1) before induction of anesthesia, (T2) after intubation, (T3) after skin incision, (T4) after first defibrillation, and (T5) 10 minutes after extubation. Propofol, 3.0 +/- 0.6 mg/kg/h (range, 1.9 to 4.4 mg/kg/h), and remifentanil, 0.30 +/- 0.05 microg/kg/min (range, 0.21 to 0.40 microg/kg/min), were used. Total costs added up to US $44.60 per patient. Patients could be extubated within 12.5 +/- 4.2 minutes after stopping anesthesia. There were significant decreases in heart rate (HR; from 77 +/- 12 to 57 +/- 10 beats/min [T3]), mean arterial blood pressure (MAP; from 98 +/- 14 to 70 +/- 12 mmHg [T2]), and systemic vascular resistance (from 1,551 +/- 309 to 1,233 +/- 274 dyne x s x cm(-5) [T2]). Cardiac index (CI) slightly decreased only at T3 (from 2.46 +/- 0.42 to 1.92 +/- 0.29 L/min/m2; p = 0.04). The decrease in MAP could easily be treated by volume infusion in most patients (17 patients). Sixty-five percent of the patients needed dobutamine to increase CI to greater than 2.0 L/min/m2 (mean dose, 2.2 +/- 1.8 microg/kg/min). Dobutamine could be stopped before extubation in all patients. No patient needed sustained inotropic or ventilatory support and intensive care therapy could be avoided. CONCLUSION: TIVA using remifentanil and propofol in patients with severely reduced left ventricular function is safe, well-controllable, and allows early extubation after implantation of an ICD. Because patients without complications did not need a postoperative intensive care stay, costs may be considerably reduced.

Aged↗

PubMed2001

Effects of carvedilol on left ventricular function, mass, and scintigraphic findings in isolated left ventricular non-compaction.

A four month old infant with isolated left ventricular non-compaction was treated with carvedilol. Haemodynamic studies and various types of imaging-including echocardiography, radiographic angiography, magnetic resonance imaging, and single photon emission computed tomography with (201)Tl, (123)I-beta-methyliodophenylpentadecanoic acid (BMIPP), and (123)I-metaiodobenzylguanidine (MIBG)-were performed before and 14 months after treatment. Left ventricular ejection fraction increased from 30% to 57%, and left ventricular end diastolic volume, end systolic volume, and end diastolic pressure showed striking reductions during treatment. Left ventricular mass decreased to about two thirds of the baseline value after treatment. Per cent wall thickening increased after carvedilol in the segments corresponding to non-compacted myocardium. A mismatch between (201)Tl and BMIPP uptake in the area of non-compaction observed before carvedilol disappeared after treatment. Impaired sympathetic neuronal function shown by MIBG recovered after treatment. Thus carvedilol had beneficial effects on left ventricular function, hypertrophy, and both metabolic and adrenergic abnormalities in isolated left ventricular non-compaction.

3-Iodobenzylguanidine↗

PubMed2001

Target-controlled infusion or manually controlled infusion of propofol in high-risk patients with severely reduced left ventricular function.

OBJECTIVE: To compare hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) with manually controlled infusion (MCI) of propofol in high-risk cardiac surgery patients. DESIGN: Prospective, randomized. SETTING: Major community university-affiliated hospital. PARTICIPANTS: Twenty patients undergoing first-time implantation of a cardioverter-defibrillator with severely reduced left ventricular function (left ventricular ejection fraction <30%). INTERVENTIONS: Anesthesia was performed using remifentanil, 0.2 to 0.3 microg/kg/min, and propofol. Propofol was used as TCI (plasma target concentration, 2 to 3 microg x mL; n = 10) or MCI (2.5 to 3.5 mg/kg/hr; n = 10). MEASUREMENTS AND MAIN RESULTS: Hemodynamics were measured at 6 data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the 2 groups. Dobutamine was required to maintain cardiac index >2 L/min/m(2) in significantly more patients of the TCI group than of the MCI group. Mean dose of propofol was higher in the TCI patients (6.0 +/- 1.0 mg/kg/hr) than in the MCI patients (3.0 +/- 0.4 mg/kg/hr) (p < 0.05), whereas doses of remifentanil did not differ. Time to extubation was significantly shorter in the MCI (11.9 +/- 2.4 min) versus the TCI group (15.6 +/- 6.8 min). Costs were significantly lower in MCI patients (34.73 dollars) than in TCI patients (44.76 dollars). CONCLUSIONS: In patients with severely reduced left ventricular function, TCI and MCI of propofol in combination with remifentanil showed similar hemodynamics. TCI patients needed inotropic support more often than MCI-treated patients. Although extubation time was longer in TCI patients and costs were higher, both anesthesia techniques can be recommended for early extubation after implantation of a cardioverter-defibrillator.

Anesthesia, Intravenous↗

PubMed2000

Left ventricular function in adolescents and adults with restrictive ventricular septal defect and moderate left-to-right shunting.

BACKGROUND: The long-term haemodynamic effects of a restrictive ventricular septal defect permitting moderate left-to-right shunting are not known. PATIENTS AND METHODS: Echocardiographic measurements of left heart dimensions and function were compared between a group of 9 older children and adults (median age 21 years, range 12-24.5 years) having restrictive ventricular septal defects (median Qp/Qs 1.7, range 1.4-2.1) and a group of 10 age matched controls. RESULTS: Left ventricular mass indexed to body surface area was significantly greater in subjects than in controls (102+/-29 vs. 75+/-13 g/m2, p=0.02), although there was no significant difference in the ratio of mass to volume. There were no significant differences between indexes of left ventricular systolic function. Ratios of peak early to late diastolic ventricular filling were lower in those with septal defects (1.5+/-0.3 vs. 1.8+/-0.3, p=0.03), but there were no differences in other indexes of diastolic function. CONCLUSIONS: Resting left ventricular function does not appear to have deteriorated by early adult life in patients with restrictive ventricular septal defects and moderate volume loading. This would support a continued conservative approach to management in these patients.

Adolescent↗

PubMed1984

[Clinical advantages of echocardiography in evaluating the left ventricular function].

This communication reported the present understanding on clinical advantages of echocardiography in evaluating practically left ventricular function. To evaluate the global function of the left ventricle, Sarnoff's function curve is clinically applicable, although it is quite difficult to change the preload in most clinical situations. Instead of the plotted function curve, only one functioning point is commonly used for the evaluation, the address of which is determined by the parameters related to preload and cardiac output, respectively. Echocardiography has been the most acceptable method for the clinical evaluation of left ventricular function as the noninvasive nature. The left ventricular size, shape, and function are not independent, but interrelated parameters. In estimating left ventricular volume based on the M-mode echocardiographically measured short axis, several calculation methods have been proposed. Various parameters of left ventricular pump function, such as ejection fraction, percent fractional shortening rate, and mean velocity of circumferential fiber shortening are basically calculated using left ventricular dimensions. However, these calculations are valid only when the dimensions are determined appropriately in the presence of symmetric and uniform contractions of the left ventricle. All these are satisfied, then, ejection fraction and fractional shortening are the most practical parameters for the global function. In ischemic diseases, problems of regional left ventricular function and segmental wall motion analysis are particularly indispensable. The regional function should be differentiated from the global function. It is extremely difficult to display the entire left ventricle in one echocardiographic section, and a combination of the parasternal and apical views can provide an adequate segmental wall motion analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗

PubMed1993

Early effects of right latissimus dorsi cardiomyoplasty on left ventricular function.

BACKGROUND: We hypothesized that left ventricular function could be improved with cardiomyoplasty using the right latissimus dorsi. METHODS AND RESULTS: Five dogs underwent cardiomyoplasty using the right latissimus dorsi. Left ventricular volume and pressure were measured using sonomicrometry and a micromanometer catheter, respectively. Pressure volume loops were recorded with the muscle stimulated at 1:2 and with transient caval occlusion. During stimulated beats, there were significant increases in stroke work (13.90 +/- 4.49 vs 9.78 +/- 3.81 g/m, P < .01), preload recruitable stroke work (0.766 +/- 0.110 vs 0.594 +/- 0.207 g.m-1 x m-3, P < .05), and stroke volume (15 +/- 4 vs 10 +/- 3 mL, P < .05) when compared with unstimulated beats. There were no changes in diastolic filling. This operation was done in 11 patients, with no operative deaths. Six weeks after surgery, resting left ventricular ejection fraction (LVEF) increased from 25 +/- 1.6% to 35 +/- 3% (P < .05), and left ventricular end-diastolic volume (LVEDV) decreased from 365 +/- 18 to 307 +/- 24 mL, (P < .05). Nine patients were alive at 6 months. Preoperative and 6-month LVEF and LVEDV for those 9 patients were 26 +/- 2% and 29 +/- 2% (P = NS) and 316 +/- 23 and 261 +/- 22 mL (P < .05), respectively. CONCLUSIONS: Long-term studies are needed to determine if these changes will improve patient survival.

Animals↗

PubMed1997

PET scan predicts recovery of left ventricular function after coronary artery bypass operation.

BACKGROUND: Viable but hypocontractile myocardium can show functional improvement after revascularization (hibernation). It is sometimes difficult, however, to predict viability and recovery in patients with severe left ventricular function. This study sought to identify possible predictive factors of recovery of cardiac function after revascularization in patients with three-vessel disease. METHODS: Positron emission tomography (fluoro-18-deoxyglucose uptake for metabolism; nitrogen 13-labeled ammonia for flow) and equilibrium-gated nuclear angiography (for the global ejection fraction) were performed in 59 patients with three-vessel disease before and after undergoing coronary artery bypass grafting. The positron emission tomographic data were expressed as match normal (flow and metabolism normal), mismatch (low flow, high metabolism), match viable (moderate decrease in flow and metabolism), and match necrosis (low flow and metabolism). RESULTS: Stepwise logistic regression analysis showed that only mismatch regions played a significant role in predicting postoperative improvement in function (p = 0.019). There were 1.7 +/- 1.5 mismatch regions in 31 patients who showed an improvement in their ejection fraction (0.47 +/- 0.14 versus 0.58 +/- 0.11; mean +/- standard deviation) versus 0.8 +/- 1.0 mismatch regions (p = 0.017) in patients who did not show recovery. There was more pronounced functional improvement with increasing numbers of mismatch regions, and patients with at least one mismatch region had a high likelihood of recovery (p < 0.001). In patients with a very low preoperative ejection fraction and two or more mismatch regions, there was early significant recovery (0.27 +/- 0.08 versus 0.46 +/- 0.06; p = 0.009). CONCLUSIONS: At least one mismatch region must be present for there to be a postoperative functional benefit. When a low left ventricular ejection fraction is associated with mismatch, early recovery is substantial.

Adult↗

PubMed1993

Left ventricular function after coronary artery reperfusion.

Left ventricular dysfunction and dilation after reperfusion relate to the amount of infarcted and dysfunctional myocardium and will continue to be important determinants of morbidity and mortality. There is marked heterogeneity in the anatomic and pathophysiologic presentation of patients with acute myocardial infarction prior to thrombolysis, and many of these individual settings resemble those in animal species with various degrees of collateral formation. Three major determinants of infarct size are responsible for this heterogeneity and include the risk area, the duration of the coronary occlusion, and the level of the residual coronary blood flow via collaterals or a partially patent artery. All 3 of these determinants will influence the initial and late results of reperfusion therapy on infarct size and ventricular function. However, in addition to late or unsuccessful thrombolysis, there are other important factors determining outcome: inadequate reflow, residual coronary stenosis, and coronary reocclusion, factors that can be associated with late progressive left ventricular dilation and dysfunction. The risk factors for left ventricular dysfunction and dilation after reperfusion can now be identified, and such patients should undergo coronary angiography prior to hospital discharge and, if appropriate, revascularization of the infarct-related artery (and perhaps other vessels). In other patients, if serial studies reveal progressive left ventricular failure and dilation late after reperfusion, despite therapy with an angiotensin-converting enzyme (ACE) inhibitor, and if repeat coronary angiography identifies significant coronary stenoses and areas of hibernating or stunned myocardium, revascularization may limit progression of dilation and improve left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function.

Recent studies suggest that preoperative left ventricular function may no longer be an important determinant of survival or functional results after operation for aortic regurgitation because of improved operative techniques. To assess the effect of left ventricular function on prognosis in the current surgical era, we performed echocardiographic and radionuclide angiographic studies in 80 consecutive patients undergoing valve replacement from 1976 to 1983. No patient had associated coronary artery disease. For all patients, 5 year survival was 83 +/- 5%, significantly better than the 62 +/- 9% 5 year survival in our patients operated on from 1972 to 1976. Preoperative resting left ventricular ejection fraction (p less than .001), fractional shortening (p less than .001), and end-systolic dimension (p less than .01) were the most significant predictors of survival (univariate life-table analysis). Five year survival was 63 +/- 12% in patients with subnormal ejection fraction (n = 50) compared with 96 +/- 3% in those with normal ejection fraction (n = 30). Patients with subnormal left ventricular ejection fraction and poor exercise tolerance or prolonged duration of left ventricular dysfunction (greater than 18 months) comprised the high-risk subgroup (5 year survival 52 +/- 11%). Patients in this subgroup also had persistent left ventricular dysfunction after operation, with greater left ventricular end-diastolic dimensions and reduced ejection fraction (both p less than .001) compared with patients with normal preoperative left ventricular ejection fraction or a brief duration of left ventricular dysfunction (less than 14 months). Cold hyperkalemic cardioplegia was used for myocardial preservation in 46 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1978

Left ventricular function studies in constrictive pericarditis.

Left ventricular function studies were performed on five patients with constrictive pericarditis. Functional data were obtained from intracardiac pressure measurements and cineangiocardiographic films. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), ejection fraction (EF), stroke work index (SWI), circumferential fiber shortening, and percent circumferencial shortening were significantly below normal values in the five cases. These changes are reflected mainly in the degree of pericardial restriction. Reduction in mean Vcf was also observed. Theoretically, the velocity of ventricular internal circumferential shortening is also affected by changes in ventricular volume or resting myocardial fiber length, however, in patients with constrictive pericarditis, reduction in mean Vcf suggests left ventricular dysfunction. Our clinical studies indicate that evaluation of mean Vcf is valuable in the assessment of postoperative prognoses.

Adolescent↗