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PubMed1991

Effects of immunosuppressive therapy in biopsy-proved myocarditis and borderline myocarditis on left ventricular function.

Twenty patients with decreased left ventricular (LV) function and endomyocardial biopsy-proved myocarditis (9 patients) or borderline myocarditis (11 patients) were studied to determine whether these 2 histologic subsets of patients with inflammatory heart disease differed in their response to a 6- to 8-week course of immunosuppressive therapy. All patients received a regimen of prednisone, 1.0 mg/kg/day, and azathioprine, 1.5 mg/kg/day, followed by repeat endomyocardial biopsy and reevaluation of LV function. LV function improved significantly in the group with borderline myocarditis, as assessed by LV stroke work--end-diastolic volume ratio (0.26 +/- 0.17 to 0.54 +/- 0.31 kg.m.ml-1, p less than 0.02), heart rate corrected velocity of circumferential shortening (0.49 +/- 0.30 to 0.80 +/- 0.29 circ.s-1, p less than 0.05), and LV ejection fraction (0.30 +/- 0.15 to 0.47 +/- 0.13, p less than 0.05). LV end-diastolic and end-systolic volume indexes also decreased significantly from 129 +/- 40 to 94 +/- 38 (p less than 0.05) and 90 +/- 37 to 49 +/- 26 ml (p less than 0.02), respectively. No significant change in these indexes of LV function or volume occurred in the myocarditis group. Whereas salutory improvements in cardiac output and filling pressures were found in both groups, objective improvement in LV function assessed by complementary indexes of contractility was greatest in the borderline myocarditis group. It is concluded that short-term immunosuppressive therapy improves LV contractile function and appears to be associated with regression of ventricular dilatation in patients with borderline myocarditis to a greater extent than patients with myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Differences of lateral and septal mitral annulus velocity by tissue Doppler imaging in the evaluation of left ventricular diastolic function.

Left ventricular diastolic dysfunction (LVDD) was investigated in 276 outpatients at a university cardiology practice by tissue Doppler imaging of mitral valve annular velocity. The well-investigated parameters of mitral inflow were used as the standard. Using septal E/Ea ratios, 62 patients (22%) had no LVDD, 44 patients (16%) had mild LVDD, 126 patients (46%) had moderate LVDD, 25 patients (9%) had severe LVDD, and 19 patients (7%) had indeterminate LVDD. Using lateral E/Ea ratios, 131 patients (48%) had no LVDD, 40 patients (14%) had mild LVDD, 62 patients (22%) had moderate LVDD, 9 patients (3%) had severe LVDD, and 12 patients (13%) had indeterminate LVDD. In conclusion, the use of septal tissue Doppler imaging tends to overestimate the severity of LVDD compared with the use of lateral tissue Doppler imaging.

Blood Flow Velocity↗
PubMed1986

Pressure/volume ratio and pressure/volume ratio exercise quotient: an echocardiographic comparative study of left ventricular function indicators.

Noninvasive evaluation of left ventricular function (LVF) has been performed with two-dimensional echocardiography (TDE). Ejection fraction (EF), end systolic volume index (ESVI) and systolic blood pressure/end systolic volume index ratio (PVR)--an indicator which is independent of preload and afterload changes in a wide physiologic range--were assessed at rest and after exercise. Twenty-seven postmyocardial infarction (MI) patients were compared to 27 normal controls in an attempt to examine the above parameters of LVF in each group, measured by TDE. Correlation of TDE EF with radionuclide angiography EF proved the reliability of TDE. Rest and postexercise values of EF and PVR showed highly significant differences between the two groups. Using ESVI, a relatively lesser significant difference was found. PVR values at rest were 4.86 mm Hg/ml/m2 in the study group and 9.51 in the control group. These values increased to 5.34 and 15.15, respectively, after exercise. The ratio of PVR after exercise to PVR at rest, expressed as percentage change (PVREQ), seemed to be an additional tool in separating between both groups. This indicator merges pressure, volume, and the influence of exercise on both; a PVREQ of at least 145% correlated well with absence of MI in most of our patients.

Adolescent↗
PubMed1984

Respiratory augmentation of left ventricular function during spontaneous ventilation in severe left ventricular failure by grunting. An auto-EPAP effect.

A patient with severe congestive cardiomyopathy demonstrated involuntary forceful expiratory grunting that was associated with an elevated intrathoracic pressure and stable hemodynamics. Face-mask administration of 20 cm H2O as continuous positive-airway pressure (CPAP) abolished the grunting without hemodynamic compromise. However, loss of CPAP by mask leak resulted in rapid hemodynamic deterioration and resumption of grunting. Endotracheal intubation with 20 cm H2O of positive end-expiratory pressure restored hemodynamic stability. This suggests that spontaneous ventilatory efforts can augment the failing myocardium.

Adult↗
PubMed1990

[The effects of lorcainide on the ECG pattern and left ventricular function in a patient with recurrent ventricular tachycardia].

The paper presents an adverse effect of Lorcainide on the electrocardiographic pattern and left ventricular function in a patient with recurrent ventricular tachycardia in the course of arterial hypertension and ischemic heart disease. Based upon this case report a relatively new and not well known phenomenon of drug arrhythmogenesis is presented.

Anti-Arrhythmia Agents↗
PubMed1993

Repeatability of haemodynamic responses to cardiac stimulations by ambulatory monitoring of left ventricular function.

Ambulatory monitoring (VEST) of left ventricular (LV) function has been shown to be accurate and repeatable. The aim of this study was to assess VEST repeatability in the evaluation of haemodynamic responses to different cardiac stimulations. Twelve patients (all men, mean age 59 +/- 8 years) underwent two separate VEST studies 5-day apart. In both studies, LV function was continuously monitored at rest and during different cardiac stimulations: 1) changing position from supine to upright (tilt); 2) sustained isometric exercise (handgrip); and 3) sublingual administration of 5 mg of nitroglycerin (NTG). Changes from baseline to peak response (delta) in the heart rate, ejection fraction, end-diastolic volume, end-systolic volume, stroke volume and cardiac output were evaluated. Reproducibility was assessed by computing, the coefficient of repeatability. In addition, the differences between the delta values obtained with the two VEST studies were plotted against their mean. This plot allowed us to detect whether there was any relationship between the error in the measurements and the best estimate of the "true value". No statistically significant differences between the two VEST studies were found in the haemodynamic changes in heart rate, ejection fraction, end-diastolic volume, end-systolic volume, stroke volume and cardiac output induced by handgrip, tilt and NTG. For each parameter the mean difference was not significantly different from zero and no significant relationship between the error and the "true value" was observed. Our results demonstrate that VEST has a good repeatability in measuring cardiac haemodynamic responses to different types of stimulations.

Exercise↗
PubMed2003

Effects of isolated obesity on systolic and diastolic left ventricular function.

BACKGROUND: Obesity is associated with increased cardiovascular morbidity and mortality. A direct effect of isolated obesity on cardiac function is not well established. OBJECTIVE: To determine the direct effect of different grades of isolated obesity on echocardiographic indices of systolic and diastolic left ventricular function. METHODS: 48 obese and 25 normal weight women were studied. They had no other pathological conditions. Obesity was classed as slight (n = 17; body mass index (BMI) 25-29.9 kg/m2), moderate (n = 20; BMI 30-34.9 kg/m2), or severe (n = 11; BMI > or = 35 kg/m2). Echocardiographic indices of systolic and diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or = 2 SD from the normal weight group. RESULTS: Ejection fraction (p < 0.05), fractional shortening (p < 0.05), and mean velocity of circumferential shortening (p < 0.05) were increased in slight and moderate obesity. Left ventricular dimensions were increased (p < 0.001) but relative wall thickness was unchanged. No obese patients met criteria for systolic dysfunction. In obese subjects, the mitral valve pressure half time (p < 0.01) and the left atrial diameter (p < 0.001) were increased and the deceleration slope was decreased (p < 0.01); all other diastolic variables were unchanged. No differences were found between obesity subgroups. Subclinical diastolic dysfunction was more prevalent among obese subjects (p = 0.002), being present in two with slight obesity (12%), seven with moderate obesity (35%), and five with severe obesity (45%). BMI correlated significantly with indices of left ventricular function. CONCLUSIONS: Subclinical left ventricular diastolic dysfunction is present in all grades of isolated obesity, correlates with BMI, and is associated with increased systolic function in the early stages of obesity.

Adolescent↗
PubMed1989

Assessment of left ventricular function from the electrocardiogram in left bundle branch block.

The QRS duration, maximum right precordial S amplitude, sum of amplitudes of the maximum right precordial S and T wave and T wave polarity in lead I have been analyzed in order to identify electrocardiographic predictors of left ventricular end-diastolic volume index and ejection fraction in 165 patients with complete left bundle branch block and various forms of heart disease. Multivariate analysis selected the duration, maximal amplitude of the S wave and polarity of the T wave in decreasing order of discriminatory power, which correctly identify 76.6% of the patients with a normal end-diastolic volume index less than or equal to 90 ml/m2 and a normal ejection fraction greater than or equal to 60% (n = 64) and 73.3% of those with an end-diastolic volume index greater than 90 ml/m2 or an ejection fraction less than 60% (n = 101). The comparisons of the QRS duration with the end-diastolic volume index and the ejection fraction give the best single correlations: r = 0.57 and -0.63, respectively. Multiple correlations lead to no substantial improvement of the r values: 0.06 and -0.65, respectively. A QRS duration less than 140 msec is almost always predictive of the presence of a normal end-diastolic volume index and a normal ejection fraction (sensitivity 100%, specificity 91.9%, positive predictive value 73.3%). A QRS duration greater than 170 msec is most accurate in predicting depressed left ventricular ejection fraction less than 55% (sensitivity 36.5%, specificity 98%, positive predictive value 92%). Thus, only the QRS duration provides a useful reference and guide for the evaluation of left ventricular function in the presence of left bundle branch block.

Adult↗
PubMedDate not supplied

A computer-aided approach for the quantitation of regional left ventricular function using two-dimensional echocardiography.

Quantitation of regional left ventricular function is becoming increasingly important in this era of interventional cardiology. In this article we describe a computer-assisted approach for the assessment of regional left ventricular function that integrates three features. First, it measures left ventricular wall thickening and endocardial motion and curvature during an entire systolic contraction sequence. Second, it allows us to easily define endocardial and epicardial borders without actually having to manually trace the entire border. Third, it displays complex data in a simple format for easy assimilation. We believe that this approach is practical and comprehensive and can be used to quantitate regional left ventricular function with two-dimensional echocardiography.

Color↗
PubMed2005

Effects of ischemia on myocardial function during rapid left ventricular pacing.

INTRODUCTION: Coronary artery disease is often accompanied with deterioration in left ventricular function. Left ventricular pacing has been shown to improve cardiac function in chronic heart failure. However, data are limited about left ventricular pacing during acute ischemia. Therefore, we studied the effects of acute myocardial ischemia on myocardial function during left ventricular pacing. METHODS: In 8 anesthetized dogs, the left ventricle was rapidly paced (180 bpm) from a basolateral and apicoseptal site during normal perfusion and mild and severe ischemia of the left anterior descending coronary artery. Effects on myocardial function were measured at each level of ischemia before and during pacing. RESULTS: Significant differences (p < 0.05) between basolateral and apicoseptal pacing were found for segmental shortening (12.1+/-1.6 vs. 10.8+/-1.6%), and QRS duration (77.3+/-4.1 vs. 85.7+/-3.8 ms) at normal coronary perfusion. During mild ischemia, significant differences (p < 0.05) were seen for myocardial contractility dP/dt(max) (1277+/-197 vs. 1158+/-156 mm Hg/s), segmental shortening (10.3+/-1.9 vs. 8.1+/-1.7%), left ventricular end-systolic pressure (76.9+/-7.5 vs. 69.6+/-7.9 mm Hg), and QRS duration, and for myocardial contractility dP/dt(max) (1033+/-209 vs. 917+/-207 mm Hg/s) and left ventricular end-systolic pressure (69.2+/-13.5 vs. 62.2+/-15.0 mm Hg) during severe ischemia. There were no significant differences in coronary blood flow during pacing from both sites. CONCLUSIONS: During acute myocardial ischemia, depression of left ventricular function was lowest, when pacing from a left ventricular basolateral site. The effects of rapid left ventricular pacing were amplified by reduced coronary perfusion pressures. The choice of pacing site did not relevantly influence coronary blood flow.

Animals↗
PubMed1998

Effect of relatively low dose amiodarone therapy on left ventricular function in patients with ventricular tachyarrhythmias.

The effect of oral amiodarone (AMD) therapy on left ventricular (LV) function was evaluated retrospectively in Japanese patients with ventricular tachyarrhythmias and congestive heart failure. Seventeen patients were treated with oral AMD (maintenance dose 191+/-52mg/day) for more than 12 months. Fractional shortening (FS) on echocardiography revealed a trend towards an increase in the short-term (3 months) (p=0.06), but was not significant in the long-term follow-up period (more than 12 months) after AMD therapy. In 8 patients with 1 episode of myocardial infarction, FS revealed a trend towards an increase (p=0.09). In all of the 4 patients with dilated cardiomyopathy whose LV end-diastolic diameter was increased, FS was decreased in the long-term follow-up. Neither hospitalization frequency nor New York Heart Association classification were reduced by AMD therapy. In conclusion,oral AMD therapy did not cause LV function to recover significantly and could not improve the clinical course in patients with ventricular tachyarrhythmias. However, if the underlying disease is not progressive, AMD therapy may improve LV function.

Administration, Oral↗
PubMed1985

A simple method of predicting left ventricular function in stabilized chronic respiratory failure.

A simple method of assessing left ventricular function in stabilized chronic respiratory failure (CRF) is proposed. 21 patients with CRF were ranked according to the prediction of left ventricular function derived from eight elementary clinical criteria including standard chest X-ray and conventional basal electrocardiography. Equilibrium radionuclide angiocardiography was performed at rest (rERNA) for the evaluation of left ventricular systolic function (ejection fraction, LVEF; peak ejection rate) and diastolic function (peak filling rate). Right ventricular ejection fraction (RVEF) was also measured. The clinical evaluation of the left ventricular function showed a high correlation with rERNA data (p less than 0.01 by Spearman's rank test). No correlation was found between rERNA parameters and PaO2 and between RVEF and LVEF. The clinical criteria proposed can thus predict left ventricular function in stabilized CRF with a high degree of confidence.

Angiocardiography↗
PubMed2007

Poststress left ventricular ejection fraction is an independent predictor of major cardiac events in patients with coronary artery disease and impaired left ventricular function.

AIM: The aim of this study was to investigate the prognostic value of myocardial perfusion and function SPECT imaging in patients with coronary artery disease (CAD) and poor left ventricular (LV) function. METHODS: We studied 261 patients (231 men, age 66+/-10 years) with CAD and a resting LV ejection fraction (LVEF) <or= 40% assessed during myocardial gated SPECT. Perfusion defect extent was calculated using 4D-MSPECT software (Michigan University). Ischemia scoring was performed visually. Considered end points were: 1) major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction or late revascularization), 2) MACE or the need for hospitalization due to heart failure (MACE-HF) and 3) cardiac death or non-fatal myocardial infarction. RESULTS: During a median follow-up of 31 months, 52 patients (20%) died (35 cardiac deaths), 50 (19%) developed a MACE and 69 (26%) a MACE-HF. In a clinical model, diabetes and angina status were the only predictors of MACE (chi-squared=19.3; P<0.001). By multivariate analysis, poststress LVEF (chi-squared-gain of 6.4; P=0.008) and presence of ischemia (chi-squared-gain of 5.8; P=0.018) were predictive of MACE. Similarly, diabetes mellitus (chi-squared=12.1; P<0.001), poststress LVEF (chi-squared-gain of 5.5; P=0.019) and presence of ischemia (chi-squared-gain of 4.3; P=0.044) were independent predictors of MACE-HF. Diabetes mellitus (chi-squared=17.8; P<0.001), presence of angina complaints (chi-squared-gain of 6.8; P=0.028) and poststress LVEF (chi-squared-gain of 6.3; P=0.008) were independent predictors of cardiac death or non-fatal myocardial infarction. CONCLUSION: In patients with impaired LV function and CAD, poststress LVEF is an independent predictor of future cardiac events.

Aged↗
PubMed1998

Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction.

BACKGROUND: Newly discovered circulating peptides, N-terminal pro-brain natriuretic peptide (N-BNP) and adrenomedullin (ADM), were examined for prediction of cardiac function and prognosis and compared with previously reported markers in 121 patients with myocardial infarction. METHODS AND RESULTS: The association between radionuclide left ventricular ejection fraction (LVEF) and N-BNP at 2 to 4 days (r=-.63, P<.0001) and 3 to 5 months (r=-.58, P<.0001) after infarction was comparable to that for C-terminal BNP and far stronger than for ADM (r=-.26, P<.01), N-terminal atrial natriuretic peptide (N-ANP), C-terminal ANP, cGMP, or plasma catecholamine concentrations. For prediction of death over 24 months of follow-up, an early postinfarction N-BNP level > or = 160 pmol/L had sensitivity, specificity, positive predictive value, and negative predictive values of 91%, 72%, 39%, and 97%, respectively, and was superior to any other neurohormone measured and to LVEF. Only 1 of 21 deaths occurred in a patient with an N-BNP level below the group median (Kaplan-Meier survival analysis, P<.00001). For prediction of heart failure (left ventricular failure), plasma N-BNP > or = 145 pmol/L had sensitivity (85%) and negative predictive value (91%) comparable to the other cardiac peptides and was superior to ADM, plasma catecholamines, and LVEF. By multivariate analysis, N-BNP but not ADM provided predictive information for death and left ventricular failure independent of patient age, sex, LVEF, levels of other hormones, and previous history of heart failure, myocardial infarction, hypertension, or diabetes. CONCLUSIONS: Plasma N-BNP measured 2 to 4 days after myocardial infarction independently predicted left ventricular function and 2-year survival. Stratification of patients into low- and high-risk groups can be facilitated by plasma N-BNP or BNP measurements, and one of these could reasonably be included in the routine clinical workup of patients after myocardial infarction.

Adrenomedullin↗
PubMed2003

Usefulness of quantitative echocardiographic techniques to predict recovery of regional and global left ventricular function after acute myocardial infarction.

The left ventricular response to dobutamine may be quantified using tissue Doppler measurement of myocardial velocity or displacement or 3-dimensional echocardiography to measure ventricular volume and ejection fraction. This study sought to explore the accuracy of these methods for predicting segmental and global responses to therapy. Standard dobutamine and 3-dimensional echocardiography were performed in 92 consecutive patients with abnormal left ventricular function at rest. Recovery of function was defined by comparison with follow-up echocardiography at rest 5 months later. Segments that showed improved regional function at follow-up showed a higher increment in peak tissue Doppler velocity with dobutamine therapy than in nonviable segments (1.2 +/- 0.4 vs 0.3 +/- 0.2 cm/s, p = 0.001). Similarly, patients who showed a >5% improvement of ejection fraction at follow-up showed a greater displacement response to dobutamine (6.9 +/- 3.2 vs 2.1 +/- 2.3 mm, p = 0.001), as well as a higher rate of ejection fraction response to dobutamine (9 +/- 3% vs 2 +/- 2%, p = 0.001). The optimal cutoff values for predicting subsequent recovery of function at rest were an increment of peak velocity >1 cm/s, >5 mm of displacement, and a >5% improvement of ejection fraction with low-dose dobutamine.

Aged↗