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PubMedDate not supplied

Effect of ageing on the relationship between early diastolic left ventricular function and mitral valve motion.

OBJECTIVE: The relationships between age and diastolic left ventricular function, and age and mitral valve motion were studied. DESIGN: The maximum velocity of circumferential fibre lengthening (negative peak Vcf) of left ventricular function and mitral valve motions, such as mitral valve E and A wave amplitude, D-E and E-F slopes, and their relationships were assessed. SUBJECTS: Twenty young, healthy persons (10 males and 10 females) from 20 to 47 years old (mean 34.5), and 26 older healthy subjects (five males and 21 females) from 62 to 94 years old (mean 80.0) were studied. INTERVENTION: M-mode echocardiography of left ventricular function and mitral valve motion were recorded and digitized for the assessment. MAIN RESULTS: Age showed a significant (P = 0.0001) correlation with negative peak Vcf (r = -0.62), with E wave amplitude (r = -0.83), with D-E slope (r = -0.71) and with E-F slope (r = -0.83). Negative peak Vcf was correlated with E wave amplitude (r = 0.51, P = 0.0007), with D-E slope (r = 0.31, P = 0.058), with E-F slope (r = 0.53, P = 0.0005). Its relations with mitral valve A wave amplitude was r = -0.30, P = 0.17 in the elderly group and r = 0.003, P = 0.99 in the younger group. A significant (P < 0.001) positive, linear correlation was observed between age and mitral A/E ratio (r = 0.82). CONCLUSIONS: The easily measurable mitral valve E-F slope and E wave amplitude can be used to assess early diastolic left ventricular function in ageing. Left atrial contraction appears to play a more important role in the elderly, compensating for the decline in early diastolic left ventricular function.

Adult↗
PubMed1995

The effects of nisoldipine on carotid artery stiffness and left ventricular functions.

Doppler echocardiographic determination, left ventricular (LV) fractional shortening (FS), cardiac output (CO), diastolic function parameter (E/A ratio) and carotid artery pulse wave velocity and stiffness were evaluated in 36 patients with essential hypertension before and after nisoldipine treatment. Blood pressure decreased significantly, and carotid artery width and fractional shortening increased significantly following nisoldipine administration (p < 0.0001). Carotid artery pulse wave peak velocity did not change following the treatment period (p > 0.05). In conclusion, short term nisoldipine administration improved blood pressure and LV systolic function, whereas LV diastolic function and carotid artery stiffness did not change. Nisoldipine did not alter serum biochemical parameters, including cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol (p > 0.05). Only one patient manifested symptoms of hypotension as an adverse effect of the drug.

Adult↗
PubMed2001

Long-term recovery of left ventricular function after primary angioplasty for acute myocardial infarction.

AIMS: To investigate changes in left ventricular function in the first 6 months after acute myocardial infarction treated with primary angioplasty. To assess clinical variables, associated with recovery of left ventricular function after acute myocardial infarction. METHODS: Changes in left ventricular function were studied in 600 consecutive patients with acute myocardial infarction, all treated with primary angioplasty. Left ventricular ejection fraction was measured by radionuclide ventriculography in survivors at day 4 and after 6 months. Patients with a recurrent myocardial infarction within the 6 months were excluded. RESULTS: Successful reperfusion (TIMI 3 flow) by primary angioplasty was achieved in 89% of patients. The mean ejection fraction at discharge was 43.7%+/-11.4, whereas the mean ejection fraction after 6 months was 46.3%+/-11.5 (P<0.01). During the 6 months, the mean relative improvement in left ventricular ejection fraction was 6%. An improvement in left ventricular function was observed in 48% of the patients; 25% of the patients had a decrease, whereas in the remaining patients there was no change. After univariate and multivariate analysis, an anterior infarction location, an ejection fraction at discharge < or =40% and single-vessel disease were significant predictors of left ventricular improvement during the 6 months. CONCLUSIONS: After acute myocardial infarction treated with primary angioplasty there was a significant recovery of left ventricular function during the first 6 months after the infarction. An anterior myocardial infarction, single-vessel coronary artery disease, and an initially depressed left ventricular function were independently associated with recovery of left ventricular function. Multivessel disease was associated with absence of functional recovery. Additional studies, investigating complete revascularization are needed, as this approach may potentially improve long-term left ventricular function.

Angioplasty↗
PubMed1991

[The effect of nifedipine and diltiazem on left ventricular function in patients with stable angina pectoris and severe left ventricular dysfunction].

In a double blind crossover five-week trial with a randomized onset in 12 patients with normal blood pressure, stable angina pectoris and more severe left ventricular dysfunction (ejection fraction less than or equal to 40%) the effect of placebo nifedipine and diltiazem on left ventricular function and tolerance of exercise was compared. The investigation was done by means of echocardiography after a load with stimulation of the heart by an oesophageal electrode. As compared with placebo, only diltiazem retarded significantly the period before development of stenocardia on stimulation of the heart. There was no significant difference between nifedipine and diltiazem as regards the effect exerted on the ejection fraction and time which elapsed after stimulation before stenocardia developed. The authors observed an unequal response of patients to the administration of nifedipine and diltiazem (some patients had less favourable findings, although they were not subjectively aware of this deterioration). Therefore these drugs must be administered to patients with angina pectoris and more severe left ventricular dysfunction with care and only if other drugs (nitrates or angiotensin convertase inhibitors) do not eliminate ischaemia and pain.

Adult↗
PubMed2006

[Simvastatin inhibits hypertension-induced cardiac hypertrophy in rats through activation of heme oxygenase-1/carbon monoxide pathway].

To investigate the anti-cardiac hypertrophic mechanism of statins, thirty-eight male Wistar rats were randomly allocated to four groups. Rats in model group received nitric oxide synthase inhibitor, N-nitro-L-arginine (L-NNA) 15 mg/(kg.d) by peritoneal injection. Rats in simvastatin treatment groups were given simultaneously L-NNA as those in model group and simvastatin 5 or 30 mg/(kg.d) intragastrically respectively. Rats in control group received the same volume of normal sodium. Left ventricular function, left ventricular mass index (LVMI), the content of brain natriuretic peptide (BNP) in plasma and myocardium, myocardial hydroxyproline and heme oxygenase activity were determined after 6 weeks. The results showed that rats in model group developed significant cardiac hypertrophy associated with reduced left ventricular function compared with the control group. However, compared with the model group, L-NNA-induced cardiac hypertrophy of rats was significantly relieved in simvastatin treatment groups, associated with improved left ventricular function, decreased LVMI, lower BNP levels in plasma and myocardium, lower content of myocardial hydroxyproline, and increased myocardial heme oxygenase (HO) activity. In cultured rat neonatal cardiomyocytes, simvastatin (30 or 100 mumol/L) significantly increased heme oxygenase-1 (HO-1) mRNA expression, HO activity as well as the production of CO in cardiomyocytes. Cultured with zinc protoporphyrin, a HO inhibitor, or simvastatin alone did not change [(3)H]leucine uptake of cardiomyocytes. However, cocultured with simvastatin significantly inhibited the cardiomyocyte [(3)H]leucine uptake induced by angiotensin II in a concentration-dependent manner. Cotreatment with zinc protoporphyrin significantly abolished the suppressive effect of simvastatin on cardiomyocyte [(3)H]leucine uptake. These data suggest that the activation of HO-1/CO pathway may be one of the important mechanisms by which statins inhibit cardiac hypertrophy caused by hypertension.

Angiotensins↗
PubMed2002

Nonexcitatory stimulus delivery improves left ventricular function in hearts with left bundle branch block.

INTRODUCTION: Preliminary data in a heart failure animal model and isolated muscle preparation have suggested that nonexcitatory stimulation (NES) improves left ventricular (LV) function. METHODS AND RESULTS: We compared biventricular (BV) pacing with NES in an animal model with left bundle branch block (LBBB). The left bundle branch (LBB) was ablated in eight normal heart pigs and led to >50% increase in QRS duration (mean 100 +/- 15 msec). End-diastolic LV pressure, end-systolic LV pressure, LV pressure (LV dP/dtmax), aortic pulse pressure, and LV ejection fraction were measured before pre-LBB ablation and compared with post-LBB ablation (AAI pacing), BV pacing, NES delivery, and BV+NES. Moreover, to evaluate LV diastolic function, we measured the early (E wave) and late flows (A wave) through the mitral valve using spectral Doppler. Compared with post-LBB ablation, NES led to a significant increase in LV dP/dtmax (1,047 +/- 224 mmHg/sec vs 897 +/- 116 mmHg/sec; P < 0.05), LV ejection fraction (64% +/- 18% vs 49% +/- 17%; P < 0.05), and aortic pulse pressure (18 +/- 3.6 mmHg vs 16 +/- 2.8 mmHg; P < 0.05). Moreover, improvement in LV hemodynamic parameters was significantly higher during NES delivery when compared with BV pacing. No significant changes in E wave, A wave, and E/A were recorded during NES, NES+BV, and BV pacing. CONCLUSION: Our preliminary data demonstrate that NES is superior to BV pacing in improving LV function in an animal model with LBBB. Moreover, we demonstrated that NES does not affect transmitral valve flow and subsequently LV diastolic function.

Animals↗
PubMedDate not supplied

Quantitative angiocardiography--evaluation of left ventricular function in mitral stenosis.

Investigations of left ventricular function were carried out in 59 patients with mitral stenosis and 8 healthy subjects by means of one-plane quantitative angiocardiography. A statistically significant increase of the left-ventricular systolic volume was observed in patients (x=74.9 +/- 29,8 ml) as compared with the control group (x=35.2 +/- 12,7 ml), the systolic ejection fraction decreased (patients: x=49% +/- 12, controls: x=74% +/-3), similarly as the stroke volume (patients x=74.8 +/- 29.6 ml, controls: x=104 +/- 42 ml). The diastolic volume of the left ventricle was similar in both groups (patients: x=143 +/- 43 ml, controls: x=134 +/- 47.9 ml). A significant decrease of the systolic ejection fraction and an increase of the systolic volume of the ventricle were observed with higher grades of mitral stenosis evaluated according to the classification of the New York Heart Association. A negative correlation was demonstrated between the systolic volume of the left ventricle and the systolic ejection fraction (r=-0.707) and the work of the left ventricle (r=-0.237). On the other hand, a positive correlation was found between the left-ventricular work and the systolic ejection fraction (r=+0.227). The results indicate unequivocally impairment of left ventricular function in mitral stenosis and a considerable role played in it by the myocardial factor.

Adolescent↗
PubMed2000

Outcome of geometric endoventricular repair in impaired left ventricular function.

BACKGROUND: Traditionally, repair of left ventricular aneurysms has been limited to patients with large localized ventricular aneurysms. Repair of dyskinetic segments in the setting of poor left ventricular function is still contentious. METHODS: Forty patients underwent geometric endoventricular repair, a new technique of ventricular aneurysm repair, over a 2-year period. Two groups of patients undergoing coronary artery bypass grafting (CABG) for left ventricular dysfunction in the same time period were reviewed. Group 1 comprised 23 consecutive patients who underwent geometric endo-ventricular repair along with CABGs, whereas group II consisted of 22 patients who underwent CABG alone. RESULTS: The early mortality was 9.1% in group I (1 cardiac, 1 noncardiac) and 0 in group II (NS). New York Heart Association class was remarkably improved from 3.4 to 1.4 (p < 0.05) in group I and to a lesser extent in group II (3.7+/-0.5 versus 2.3+/-0.5). Diastolic dimension of left ventricle was significantly reduced from 5.6 cm to 4.4 cm (p < 0.05) in group I and virtually unchanged in group II. There was one late death in each of the groups. CONCLUSIONS: This technique of geometric left ventricular aneurysm repair is useful in patients with dyskinetic segments and may help in reducing cardiac size.

Aged↗
PubMedDate not supplied

Left ventricular function: MRI assessment.

Biplane left ventricular (LV) angiography has always been considered the standard of reference to measure LV volumes and ejection fraction (EF): however, angiographic measurements depend on the assumption of geometric models derived from two-dimensional information. MRI is the best technique to evaluate cardiac volumes and mass providing direct non geometric analysis of the ventricles with a high contrast resolution. Standard cine MRI is considered a time-consuming technique for acquisition and measurements; breath hold cine MRI and echoplanar imaging (EPI) non gated sequences are useful to reduce the acquisition time from a few minutes to a few seconds. The evaluation of the heart linear parameters (diameters, thickness), areas, volumes and mass is essential in the diagnosis of many heart diseases and in the assessment of the ventricular function. The modalities to evaluate LV measurements and to obtain functional parameters, the acquisition technique and flow analysis were analyzed in this study.

Angiography↗
PubMed1991

Improved left ventricular function after renal transplantation.

Patients with severely impaired left ventricular function are known to have a poor prognosis. We describe a 20-year-old man with end-stage renal failure, on dialysis, with severely impaired left ventricular function which dramatically improved after renal transplantation. This suggests that poor left ventricular function need not preclude renal transplantation and may, in fact, offer an alternative to combined renal and cardiac transplantation.

Adult↗
PubMed1989

Coronary angioplasty and left ventricular function in single vessel coronary artery disease.

Left ventricular function was investigated in 86 patients with single vessel coronary artery disease before and three to six months after successful angioplasty. Before angioplasty thallium-201 perfusion scintigraphy and technetium-99m gated equilibrium ventriculography in most patients showed that stress testing (exercise and ice water stimulation and isometric handgrip respectively) induced myocardial perfusion defects that were associated with a mean (SD) drop in left ventricular ejection fraction from 64 (6)% to 56 (7)%. After angioplasty there was residual coronary stenosis of less than or equal to 20% of the diameter of the vessel in 78 patients (group 1) and of between 20 and 50% in eight patients (group 2). After the procedure the perfusion defects seen during stress resolved in 86% of group 1 and in 87% of group 2. Despite the apparent improvement in myocardial perfusion left ventricular dysfunction persisted in group 2--that is during stress the left ventricular ejection fraction fell from 65% (6) to 56% (5). In group 1, on the other hand, the improvement in myocardial perfusion was associated with significant improvement in left ventricular function with a normal increase in ejection fraction from 63 (5) at rest to 67 (6) during stress. Radionuclide studies, one to six weeks after angioplasty in 30 group 1 patients showed continuing left ventricular decompensation during stress in nine (30%) of them despite correction of perfusion defects. But reinvestigation three to six months after the procedure showed recovery of left ventricular function with an increase in ejection fraction from 66 (5) at rest to 69 (7) during stress. These data indicate that coronary angioplasty procedures that give a residual stenosis of </= 20% improve myocardial perfusion and the response of the left ventricle to stress. The functional improvement may be delayed for up to three months, however, possibly because arterial healing at the angioplasty site is delayed. On the other hand, when the residual stenosis is between 21 and 50% of the diameter of the vessel subclinical left ventricular dysfunction during stress may persist indefinitely.

Adult↗
PubMed1991

[Multiparametric analysis using radionuclide ventriculography in the assessment of left ventricular function following heart transplantation].

Left ventricular systolic and diastolic performance was evaluated by radionuclide angiography in 17 patients following cardiac transplantation and compared with normal persons. Both groups performed supine bicycle exercise during the investigation, the control group at 102 +/- 73 W and the transplanted patients at 61.2 +/- 15 W. The ejection fraction increased in the normal persons from 61 +/- 8 to 69 +/- 10% whereas in the transplanted patients it did not increase significantly. There were no relevant changes in systolic parameters during exercise in the transplant recipients. The changes in diastolic parameters were significantly smaller in transplant patients than in normals. After correction for heart rate-induced changes a significantly different time course of the systolic-diastolic sequence during the cardiac cycle became evident in the transplanted group at rest. During exercise the systolic-diastolic sequence during the cardiac cycle became similar in both groups. It is concluded that the reduced exercise capacity of patients in the late phase after cardiac transplantation is partially due to the absence of an EF increase and a limitation of diastolic reserve during exercise.

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↗
PubMed1988

Effect of isolated right ventricular outflow obstruction on left ventricular function in infants.

Resting left ventricular (LV) function was evaluated in 29 infants with isolated right ventricular (RV) outflow obstruction. Age-corrected cardiac index was significantly inversely correlated with the degree of obstruction (r = 0.59, p = 0.0001). Right ventricular hypertension resulted in septal displacement and altered LV geometry. The magnitude of RV outflow obstruction related closely to the degree of LV distortion. Septal displacement toward the LV free wall was associated with lower values for cardiac index, indexed LV end-diastolic volume, ejection fraction, ratio of early to atrial LV diastolic inflow and with a higher RV ejection fraction. The LV end-diastolic volume index and the ratio of early to atrial LV diastolic inflow correlated with the degree of obstruction and amount of septal displacement. Four infants evaluated during the development of supravalvar pulmonary stenosis demonstrated decreasing cardiac index during development of obstruction and significant increase in cardiac index after surgical relief. These findings indicate that significant RV outflow obstruction in infants is associated with a reversible alteration in LV function related to abnormal LV geometry and impaired LV diastolic filling.

Cardiac Output↗
PubMed1978

[The influence of meproscillarin on human left ventricular function (author's transl)].

Left ventricular (LV) function was assessed by echocardiography in 11 cardiac patients before and after treatment with 14-hydroxy-3beta-[(4-O-methyl-alpha-L-rhamnopyranosyl)-oxy]-14beta-bufa-4,20,22-trienolide (meproscillarin, Clift). This drug was given during 7 days in a dose of 4 X 0.25 mg/d. During a placebo period of 7 days the LV function parameters percent systolic shortening of the transverse LV diameter and mean velocity of circumferential fiber shortening did not change significantly but increased significantly (P less than 0.001) after meproscillarine. Heart rate and end-diastolic LV diameter remained unchanged throughout the study. It is concluded that peroral meproscillarin induced a true increase of LV inotropic state.

Adult↗
PubMed1970

Experimental myocardial infarction. II. Acute depression and subsequent recovery of left ventricular function: serial measurements in intact conscious dogs.

Acute myocardial infarction causes depression of left ventricular function, but the capacity of the ventricle to recover from such an injury remains unknown. This problem was explored by measuring left ventricular function in eight intact conscious dogs before, 1 hr after, and again 6-8 days after myocardial infarction. Acute myocardial infarction was produced using a technique which entails gradual inflation over an average period of 1 hr of a balloon cuff previously implanted around the left anterior descending coronary artery. Occurrence of anterior wall infarction was detected electrocardiographically and later confirmed by postmortem examination. Left ventricular function was evaluated from the relationship between left ventricular developed pressure (left ventricular peak systolic pressure minus left ventricular end-diastolic pressure) and left ventricular end-diastolic pressure during transient aortic occlusion with a balloon catheter. Left ventricular function curves were obtained by plotting left ventricular-developed pressure at increasing left ventricular end-diastolic pressures up to 50 mm Hg. Acute myocardial infarction caused marked depression of left ventricular function measured 1 hr after onset of infarction, but 1 wk later all eight animals showed improvement with return of function toward the control levels. A small but significant descending limb was noted at left ventricular end-diastolic pressures above 35 mm Hg. Quantitatively, the descending limb was similar before, 1 hr after, and 1 wk after myocardial infarction. Hemodynamic data revealed evidence of left ventricular failure in all animals, but variability in individual hemodynamic parameters was noted. The data indicate that the marked depression of left ventricular function observed immediately after experimental acute myocardial infarction undergoes considerable resolution within 1 wk, but that functional recovery remains incomplete.

Acute Disease↗
PubMed1988

Determinants of left ventricular function one year after cardiac transplantation.

Left ventricular systolic function was assessed by radionuclide angiography in 107 consecutive transplant recipients who were alive one year after operation. Mean (SEM) ejection fraction was 62.4 (4.6) at rest and 68.8 (5.4) on exercise. The influence of donor-related factors (donor age and sex, ischaemia time), recipient-related factors (recipient age and sex, frequency of acute rejection), type of immunosuppression (cyclosporin/azathioprine or prednisolone/azathioprine), and frequency of hypertension on left ventricular function one year after operation was examined by univariate and multivariate analysis. There was a close association both at rest and on exercise between a higher ejection fraction and treatment with cyclosporin/azathioprine. There was a trend for lower donor and recipient age, shorter ischaemia time, and fewer rejection episodes to be associated with better left ventricular function, but this was not statistically significant. Left ventricular systolic function was well maintained in most patients a year after cardiac transplantation. The type of immunosuppression used had a strong influence on the left ventricular systolic function of the transplanted heart.

Adolescent↗