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PubMed2003

Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use.

BACKGROUND: Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients. METHODS: The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate. RESULTS: The mean age of the 1,090 patients in our study was 79+/-7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705-0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655-0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations. CONCLUSION: Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure.

Age Factors↗

PubMed1988

Assessment of left ventricular function using digital angiography.

We have demonstrated that selective digital left ventricular angiography using small amounts of contrast material minimized both symptoms and hemodynamic alterations and provided good images for assessment of regional ventricular function. However, comparisons of ejection fraction (EF), end-systolic volume (ESV), and end-diastolic volume (EDV) from digital angiography, at 10 frames per second, with measurements derived from conventional angiography, showed only a fair correlation between the two methods. Using a new generation of digital equipment and an acquisition time of 30 frames per second, we studied the correlation between digital and conventional angiography in 29 patients with coronary artery disease for a wide spectrum of left ventricular functions. Ventricular volumes and EF were calculated by computer using the area-length method. The correlation coefficient (r) between both the methods was 0.93 for EF, 0.95 for ESV and 0.89 for EDV. Thus digital left ventricular angiography provides an accurate evaluation of left ventricular function and can with advantage replace conventional angiography for this purpose.

Adult↗

PubMed2001

Early prediction of 30-day mortality after Q-wave myocardial infarction by echocardiographic assessment of left ventricular function--a pilot investigation.

BACKGROUND: The GUSTO angiographic substudy demonstrated that left ventricular function measured 90 min after thrombolytic therapy was given had important prognostic implications at 30 days in patients with an acute myocardial infarction (MI). HYPOTHESIS: Thirty-day prognosis after Q-wave MI can be determined by early echocardiographic assessment of left ventricular function. METHODS: Using transthoracic echocardiography, semiquantitative ejection fraction and wall motion score index was assessed prospectively in 201 consecutive patients within 24 h following Q-wave MI. Independent experts blinded to the patient's status performed the echocardiographic assessment. All patients received standard medical care as dictated by the attending cardiologist. RESULTS: Of the 201 patients, 24 (11.9%) died within 30 days, with 70% of the deaths occurring within 10 days after the infarction. Three deaths occurred in the 120 patients with an ejection fraction > or = 45% (2.5% mortality rate). In contrast, 21 deaths occurred among the 81 patients with an ejection fraction <45% (25.9% mortality rate) p = 0.0003. Two of the three patients who died in the high ejection fraction group died as a result of intracerebral hemorrhage from thrombolytic therapy. Ejection fraction was lower in nonsurvivors (32.3+/-10.3 vs. 46.3+/-13%) than in survivors, p < 0.0002. Wall motion score index (WMSI) of < 1.4 was associated with a 2.9% 30-day mortality (two deaths in 76 patients); WMSI of > or = 1.4 was associated with a 17.6% 30-day mortality (22 deaths in 125 patients), p = 0.0007. Average WMSI was higher in the nonsurvivors (1.95+/-0.5) than in survivors (1.52+/-0.45), p = 0.00001. CONCLUSIONS: Echocardiographic assessment of left ventricular function during the first 24 h after an acute Q-wave MI can be performed in all patients regardless of stability. High-risk patients are identified early in the hospital course, with relative ease, at no risk and at an acceptable cost. An ejection fraction < 45% or WMSI > or = 1.4 identifies patients who are at a high risk of dying within 30 days. These are the patients who may benefit most from aggressive medical therapy and early angiography to assess coronary pathology.

Humans↗

PubMed1978

Left ventricular function in exercise-induced hypertrophy in dogs.

Indexes of left ventricular function and diastolic compliance were studied in 10 awake exercise-trained greyhounds with left ventricular hypertrophy. Mean left ventricular to body weight ratio and mean myocardial cell diameter were significantly greater than in normal dogs (8.73 +/- 2.7 [standard error of the mean] versus 4.63 +/- 0.24 g/kg, P less than 0.01; and 18.3 +/- 0.67 versus 12.5 +/- 0.71 mu, P less than 0.01, respectively). In awake resting animals, 7 to 50 days after implantation of a high fidelity micromanometer and sonomicrometer crystals, left ventricular contractility indexes were similar to those measured previously in normal dogs (maximal derivative of left ventricular pressure [dP/dt] 3,800 +/- 250 versus 3,810 +/- 330 mm Hg/sec, difference not significant; and mean rate of circumferential fiber shortening 1.54 +/- 0.12 versus 1.43 +/- 0.12 sec-1, difference not significant). During volume loading sufficient to produce a left ventricular end-diastolic pressure of 20 mm Hg, changes in contractility indexes were similar to those in normal dogs; however, heart rate increased significantly (74 percent, P less than 0.005) in the trained greyhounds but not in normal dogs. Left ventricular diastolic stiffness did not differ from normal (51.6 +/- 3.0 versus 45.9 +/- 5.9 mm Hg/cm, P less than 0.01). These findings suggest that left ventricular function in exercise-induced left ventricular hypertrophy is substantially normal.

Animals↗

PubMed2000

[Study on left ventricular function of chronic obstructive pulmonary diseases in stable phase by using nuclear techniques].

OBJECTIVE: To study the left ventricular function of chronic obstructive pulmonary diseases in stable phase. METHOD: The systolic and diastolic function of the left ventricles of chronic obstructive pulmonary diseases was studied by using gate cardiac blood-pool imaging. RESULTS: There are no statistical significance in left cardiac systolic and diastolic function of the patients with different degrees of chronic obstructive pulmonary diseases and control group of normal lung function on left ventricle ejection fraction(LVEF), peak ejection rate(PER), ejection fraction at one third of TES from end-diastole(1/3EF), ejection fraction rate at one third of TES from end-diastole(1/3ER), time between end-diastole and end-systole(TES), time to peak filling from diastolic to end-systole(TPE), peak filling rate(PFR), filling fraction at 1/3(TES) from end-systole(1/3FF), filling rate at 1/3 (TES) from end-systole(1/3FR). CONCLUSION: There is no significant difference in left ventricular function in patients with different degrees of chronic obstructive pulmonary diseases in the stable phase.

Adult↗

PubMed1979

Left ventricular function in rheumatic mitral stenosis. Clinical echocardiographic study.

Echocardiography was used to examine the extent and significance of impairment in left ventricular function in 20 patients with rheumatic mitral stenosis. Indices of left ventricular performance--normalised mean rate of circumferential fibre shortening (Vcf), ejection fraction, normalised posterior wall velocity, and stroke volume were reduced. The impairment in left ventricular function was related to the degree of functional disability (NYHA), right ventricular dilatation, and left atrial enlargement. Vcf was inversely related to both the internal right ventricular diameter (r=-0.767, P less than 0.001) and the degree of left atrial enlargement (r=-0.554; P less than 0.05). The normalised velocity of the interventricular septum and the maximum systolic and diastolic endocardial velocities were also reduced. These results suggest that abnormalities in contractility of left ventricular myocardium are responsible for the impaired myocardial function in patients with mitral stenosis and that such impairment is clinically significant.

Echocardiography↗

PubMed2002

Evaluation of native left ventricular function during mechanical circulatory support: theoretical basis and clinical limitations.

Left ventricular function on patients with heart disease is now evaluated by echocardiography, but these dimensional changes are erroneous in the patient supported by left ventricular assist device because of mechanical unloading for the failing heart. Left ventricular end-systolic pressure-volume relationship provides theoretically most reliable left ventricular contractility. Recently, some patients have weaned from the device because of unexpected recovery of myocardial contractility. But it is very important to evaluate the left ventricular function just before the weaning, and to predict the longevity of the recovered function to keep the good quality of life. Current clinical situation in the patients with ventricular assist device, and theoretical limitations to evaluate the recovering myocardium are discussed.

Heart Failure↗

PubMed1991

Diastolic stiffness impairs left ventricular function during hypovolemic shock in pigs.

To determine the causes of impaired left ventricular function during hypovolemic shock we measured diastolic and end-systolic pressure-volume relationships and hemodynamics. Left ventricular pressure (Millar catheter) and volume (3 ultrasonic crystal pairs) were measured in six open-chest, chloralose-morphine anesthetized, juvenile pigs. After baseline measurements, the pigs were bled and maintained at a mean aortic pressure of 50 cmH2O for 7 +/- 1 h. After resuscitation with all shed blood, left ventricular function was markedly impaired as indicated by increased end-diastolic pressure (20.3 vs. 8.7 cmH2O at baseline, P less than 0.05), decreased aortic pressure (36% of baseline, P less than 0.01), and decreased stroke volume (50% of baseline, P less than 0.01). Systolic contractility was increased (P less than 0.05), but diastolic compliance was greatly reduced due to decreased diastolic maximum (52% of baseline, P less than 0.01) and equilibrium volumes (57% of baseline, P less than 0.01). We conclude that impaired left ventricular function during hypovolemic shock is due entirely to increased diastolic stiffness. These results can theoretically be accounted for by a 20% reduction in myocardial muscle length with no change in muscle stress-strain characteristics. This may be the physiological expression of morphologically observed myocardial "zonal lesions" of hypovolemic shock.

Animals↗

PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis.

The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.

Adolescent↗

PubMed1983

Effects of propranolol on resting and postextrasystolic potentiated left ventricular function in patients with coronary artery disease.

The effect of propranolol on global and segmental left ventricular function at rest and after postextrasystolic potentiation was studied in 12 patients with chest pain. Heart rate was controlled with atrial pacing, and left ventricular cineangiograms were performed before and after 0.15 mg/kg of propranolol. During each ventriculogram a premature ventricular stimulus was introduced by means of a programmed stimulator. Propranolol decreased global left ventricular ejection fraction from 64 +/- 4.5 to 58 +/- 4.6 (p less than 0.03). Postextrasystolic potentiated global ejection fraction was not affected by propranolol (78 +/- 3.5 vs 73.6 +/- 3.4; p = NS). The area ejection fraction of the anteroapical region was decreased after propranolol (64 +/- 4.8 vs 52 +/- 6.5; p less than 0.01); however, the postextrasystolic potentiated area ejection fraction was not affected by propranolol (78 +/- 2.6 vs 71 +/- 4.6; p = NS). Frame by frame analysis of the ventriculograms demonstrated that propranolol depressed global and segmental left ventricular function by affecting the second one-third ejection fraction without influencing the first or third one-third ejection fraction. Propranolol has a small depressant effect on global and segmental left ventricular function in patients with coronary artery disease. Postextrasystolic potentiated global and segmental left ventricular function and early systolic ejection phase indices are not altered by propranolol and therefore may be useful in assessing left ventricular function in patients with coronary artery disease who are taking propranolol.

Cardiac Catheterization↗

PubMed1988

Comparison between vertical parallel hole collimator and 30 degrees rotating slant hole collimator for assessing global and regional left ventricular function by radionuclide angiography.

Left ventricular ejection fraction (LVEF) and regional wall motion abnormalities were determined in 40 patients (30 with coronary artery disease and 10 with valvular heart disease) using equilibrium radionuclide angiography. Scintigraphic acquisitions were collected in random order with 2 different collimators as follows: in anterior face (AF), left anterior oblique (25 degrees-45 degrees LAO) and 70 degrees LAO, with a vertical parallel hole collimator (VTC), and in 25 degrees-45 degrees LAO and 65 degrees-80 degrees LAO with a 30 degrees rotating slant hole collimator (RSHC), with the slant of the collimator directed towards the cardiac apex in both projections. Results were compared to contrast ventriculography (CV) performed in the 30 degrees right anterior view (3 segments: anterior, apical, inferior) and in a 60 degrees left anterior oblique view (3 segments: septal, apical and lateral). Radionuclide LVEF in both series was closely correlated with contrast ventriculographic LVEF (r = 0.89, VTC vs CV and r = 0.87, RSHC vs CV, respectively). Regional wall motion analysis was only performed among the 30 patients suffering from coronary heart disease. Eight contrast angiographic studies were normal and 22 abnormal. Global sensitivity and specificity were 100% and 63% with the VTC (3 false positives) and 91% and 87% with the 30 degrees RSHC (2 false negatives and 1 false positive, P = ns). Agreement for the localisation of the regional wall motion abnormalities between CV and radionuclide angiography was 70.6% with the VTC and 71.2% with the RSHC (P = ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗

PubMed1993

Relation of left ventricular function to habitual alcohol consumption.

Left ventricular (LV) dysfunction is a frequent finding in chronic alcoholic subjects. LV function's relation to alcohol use in the general population, where low and moderate consumption predominate, was studied in this work. A random sample of 120 people born in 1954 was invited to participate in the study, and 93 (42 men and 51 women) enrolled. Ethanol use was studied by 2-month daily recording of all alcoholic drinks; smoking and physical activity were quantified likewise, and salt intake by 7-day food records. Subsequently, subjects underwent an LV examination by M-mode echocardiography, and a transmitral flow velocity study by pulsed Doppler ultrasound. The relations of LV measurements to alcohol use were studied by multiple linear regression adjusting for sex, body size, blood pressure, heart rate, smoking, physical activity and dietary salt intake. No subject had clinical heart disease. The average daily ethanol consumption ranged from 0 to 1.2 g/kg of body weight (median 0.2). Statistically significant associations with square-root daily ethanol use were found for LV end-systolic diameter (regression coefficient [b] +/- SE 4.0 +/- 1.5 mm/square root of g/kg; p < 0.01), fractional shortening (b = -3.9 +/- 1.8%/square root of g/kg; p < 0.05), peak early transmitral velocity (b = -8.9 +/- 3.5 cm/s/square root of g/kg; p < 0.05), and peak atrial transmitral velocity (b = -4.9 +/- 1.9 cm/s/square root of g/kg; p < 0.05). No interactions with sex were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Canine left ventricular function during experimental pancreatitis.

Left ventricular contractility following induction of experimental pancreatitis (EP) was studied. Contractility was evaluated by analyzing the left ventricular end systolic pressure-diameter relationship (sigma ES). Sigma ES is independent of large changes in preload, afterload, and heart rate, but sensitive to changes in ventricular contractility. Following injection of 100,000 IU trypsin in 4% taurocholate into the pancreas to induce EP, seven of eight dogs survived 5 hr. These dogs exhibited an initial significant reduction in mean arterial pressure (MABP) which stabilized at 90% of control at 3-5 hr post-EP. Cardiac output (CO) dropped slowly after EP induction (from 3.08 +/- 0.43 to 2.22 +/- 0.22 liters/min) associated with no significant change in peripheral resistance. Stroke work and stroke volume were markedly depressed reflecting the changes in MABP and CO. No consistent changes in +dP/dt or -dP/dt were observed. The ratio of endo/epicardial blood flow was unchanged as was blood Ca2+ levels throughout the experiment. Ventricular contractility as reflected by sigma ES tended to improve (from 49.7 to 69.6 mm Hg/mm at 4 hr following EP). Therefore, it was concluded that these animals exhibited no loss of ventricular contractility during EP.

Acute Disease↗

PubMed1977

Radioisotope angiocardiographic evaluation of left ventricular function in cardiac patients.

Left ventricular volumes were determined by means of ECG-gated RI angiocardiography, which were compared with volumes derived from contrast cineangiocardiography in 25 patients with various heart disease. There was a close correlation of end-diastolic and end-systolic volumes and ejection fraction between RI and contrast angiocardiography, although stroke volume yielded rather scattered values. In 46 of 52 patients with myocardial infarction left ventricular asynergy was demonstrated with our method. Mean velocity of circumferential shortening (mVcf) was exaggerated in patients with apical asynergy. mVcf derived from direct axis measurement yielded a higher value than that from area-length method. Left ventricular volume curve was constructed to obtain normalized systolic ejection rate during initial 100--200 msec after the start of ventricular depolarization. The index was in parallel to ejection fraction in every patient except in moderately severe hypertensive patients. End-diastolic compliance was calculated from Gaasch formula by obtaining pulmonary artery wedge pressure and end-diastolic volume, which was determined by injecting 99mTc pertechnetate into pulmonary artery through Swan-Ganz catheter. This way of access to patient with acute myocard infarction was most useful to evaluate the mechanism of elevated left ventricular end-diastolic pressure.

Aged↗

PubMed2006

Comparison of 64-slice CT with gated SPECT for evaluation of left ventricular function.

UNLABELLED: Precise and reliable assessment of left ventricular (LV) function and dimensions is prognostically important in cardiac patients. As the integration of SPECT and multislice CT into hybrid scanners will promote the combined use of both techniques in the same patient, a comparison of the 2 methods is pertinent. We aimed at comparing LV dimensions, muscle mass, and function obtained by electrocardiographically gated 64-slice CT versus gated-SPECT. METHODS: Sixty patients (mean age, 64 +/- 8 y) referred for evaluation of coronary artery disease underwent 99mTc-tetrofosmin gated SPECT and 64-slice CT within 4 +/- 2 d. LV ejection fraction (LVEF), end-systolic volume (ESV), and end-diastolic volume (EDV) from CT were compared with SPECT. Additionally, LV muscle mass and quantitative regional wall motion were assessed in 20 patients with both methods. RESULTS: CT was in good agreement with SPECT for quantification of LVEF (r = 0.825), EDV (r = 0.898), and ESV (r = 0.956; all P < 0.0001). LVEF was 59% +/- 13% measured by SPECT and slightly higher but not significantly different by CT (60% +/- 12%; mean difference compared with SPECT, 1.1% +/- 1.7%; P = not significant). A systematic overestimation using CT for EDV (147 +/- 60 mL vs. 113 +/- 52 mL; mean difference, 33.5 +/- 23.1 mL) and ESV (63 +/- 55 mL vs. 53 +/- 49 mL; mean difference, 9.3 +/- 15.9 mL; P < 0.0001) was found compared with SPECT. A good correlation for muscle mass was found between the 2 methods (r = 0.868; P < 0.005). However, muscle mass calculated by SPECT was significantly lower compared with CT (127 +/- 24 g vs. 148 +/- 37 g; mean difference, 23.0 +/- 12.2 g; P < 0.001). The correlation for regional wall motion between the 2 methods was moderate (r = 0.648; P < 0.0001). CONCLUSION: LVEF and LV functional parameters as determined by 64-slice CT agree over a wide range of clinically relevant values with gated SPECT. However, interchangeable use of the 2 techniques should be avoided for LV volumes, muscle mass, and regional wall motion because of variances inherent to the different techniques.

Adult↗

PubMed1993

Long-term outcome of patients with depressed left ventricular function undergoing percutaneous transluminal coronary angioplasty. The NHLBI PTCA Registry.

BACKGROUND: Coronary revascularization with bypass has been shown to improve survival in patients with coronary artery disease and left ventricular dysfunction. In these patients, use of nonsurgical revascularization with percutaneous transluminal coronary angioplasty (PTCA) is increasing, although their long-term outcome has not been well delineated. The purpose of this investigation was to characterize the outcome of angioplasty in patients with decreased left ventricular function and contrast it with the results in patients with normal left ventricular function. METHODS AND RESULTS: In the 1985-1986 National Heart, Lung, and Blood Institute's PTCA Registry, of 1,802 patients undergoing PTCA, 244 patients (13.5%) had an ejection fraction of < or = 45% (mean, 39.6 +/- 6.8%). These patients had a higher incidence of prior infarction, a longer and worse history of manifestations of coronary disease, and more extensive coronary artery disease than patients with well-preserved function; 88% and 91%, respectively, had successful dilation of at least one lesion (nonsignificant difference). However, patients with decreased left ventricular function had a decreased frequency of successful dilation of all lesions in which PTCA was attempted (76% versus 84%, p < 0.01). There were no statistically significant differences in in-hospital complications--death occurred in 0.8% and 0.7%, nonfatal myocardial infarction occurred in 4.9% and 4.5%, and emergency surgical revascularization was performed in 4.5% and 3.2%, respectively. Patients were followed for a mean of 4.1 years; during this time, patients with decreased left ventricular function had significantly worse survival and combined event-free survival. Despite this, at 4 years, 87% of the patients with a mean ejection fraction of 39.6% remained alive, and 77% were alive and had not experienced infarction or required bypass. CONCLUSIONS: PTCA is effective in selected patients with depressed left ventricular function. Initial outcome and risk-benefit ratio are excellent. Successful dilation of at least one vessel was achieved in 88% of patients with depressed left ventricular function and in 91% of patients with more normal left ventricular function. The former group, however, had a decreased incidence of successful dilation in all lesions in which dilation was attempted (76% versus 84%, p < 0.01). There was no significant difference in in-hospital complications between the two groups. During follow-up, patients with decreased left ventricular function had worse event-free survival, although 77% were alive without infarction or bypass grafting at 4 years.

Angioplasty, Balloon, Coronary↗

PubMed1984

Effects of the presence or absence of preceding angina pectoris on left ventricular function after acute myocardial infarction.

Left ventricular (LV) function was evaluated in 31 patients, who had total occlusion of the left anterior descending coronary artery and less than 70% stenosis of the other two major coronary arteries or any branch. Fifteen of 31 patients had a history of angina pectoris before acute myocardial infarction (AMI) and 16 of 31 patients had no history of angina pectoris before AMI. The patients with angina pectoris before AMI had a significantly better ejection fraction, percentage of abnormally contracting segment, and regional wall motion than those without angina pectoris before AMI. These data suggest that the symptom of angina pectoris before AMI could be a favorable sign in preserving LV function when the patients subsequently had AMI.

Adult↗

PubMed1992

The effect of acute hypoxia on left ventricular function with special reference to diastolic function--an analysis using ultrasonic method.

In order to evaluate the effect of acute hypoxia on left ventricular (LV) contractility and diastolic function, hemodynamics and LV wall motion were investigated in anesthetized open-chest paced dogs using M-mode or pulsed Doppler echocardiography. Animals were ventilated with 10% oxygen (Hypo 1) and 6.3% oxygen (Hypo 2). LV contractility and diastolic functions were enhanced under "Hypo 1" and at an early phase of "Hypo 2". However, LV functions, both systolic and diastolic, were simultaneously reduced in the presence of hypercapnic acidosis by "Hypo 2". Peak velocities of diastolic rapid filling flow (R) and atrial contraction flow (A) were increased under "Hypo 1", but showed a biphasic change (an increase and a subsequent decrease) under "Hypo 2". The ratio of A/R, known as an index of LV diastolic function, was not altered under hypoxia alone or even under hypercapnic acidosis. Even when hypoxia seems to enhance LV contractility, LV function has already begun to be depressed with a reduction of pH. This seems, however, to be compensated for by LV dilatation and increase in preload, or preservation of left atrial performance.

Acidosis↗