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At least 649 records · Page 36Linked to original sources
PubMed2003

Assessment of left ventricular function during off-pump coronary artery bypass surgery.

Left ventricular function is commonly impaired following cardiopulmonary bypass and cardioplegic arrest. Off-pump coronary artery bypass surgery (OPCABG) offers promise of better myocardial protection, although the effect of multiple regional ischemic events on global myocardial function is unknown. Twenty-eight patients undergoing multivessel OPCABG were assessed with transesophageal echocardiography and pulmonary artery catheterization prior to and following revascularization. Both load-dependent and relatively load-independent measurements of systolic and diastolic performance were measured. Mean +/- SD age was 62+/-8.3 years, grafts performed were 3.8+/-1.6, and 28% of patients had fractional area change (FAC) <50%. Blood pressure was lower following OPCABG associated with a fall in systemic vascular resistance. There was no difference in measurements of systolic functional FAC, cardiac index, or afterload-corrected FAC. Diastolic function appeared to improve based on mitral inflow and pulmonary vein Doppler measurements, but this occurred at a significantly lower pulmonary capillary wedge pressure and end-diastolic area. No change in diastolic function was found using less load sensitive indices of diastolic function (color M-mode Doppler, tissue Doppler and instantaneous end-diastolic stiffness). Left ventricular systolic and diastolic function is preserved following multivessel OPCABG.

Catheterization, Swan-Ganz↗
PubMed1991

Impairment of left ventricular function during coronary angioplastic occlusion evaluated with a nonimaging scintillation probe.

Impairment of left ventricular function during controlled myocardial ischemia induced by coronary angioplasty has been reported from angiographic and echocardiographic studies. Ejection fraction, peak ejection, peak filling rates, and end-systolic and end-diastolic volumes were investigated before, during and after coronary occlusion on-line with a nonimaging scintillation probe. The study consisted of 18 patients (mean age 59 +/- 10 years) with coronary artery stenosis of greater than 70%. During balloon inflation of 60 seconds' duration, coronary occlusion pressure was 31.6 +/- 12 mm Hg. There was no significant change in heart rate. Delay between first and second dilatation was 109 +/- 63 seconds. Ejection fraction decreased from 53 +/- 16 to 40 +/- 12% (first dilatation, p less than 0.01) and to 39 +/- 14% (second dilatation, p less than 0.01) and recovered to 51 +/- 16% 5 minutes after the second dilatation. Peak ejection rate was significantly reduced during the first and second balloon inflations. Peak filling rate decreased from 2.5 +/- 0.8 to 2.0 +/- 0.7 end-diastolic volume.s-1 (first dilatation, p less than 0.01) and to 1.8 +/- 0.7 end-diastolic volume.s-1 (second dilatation, p less than 0.01) and remained reduced at 2.2 +/- 0.7 end-diastolic volume.s-1 (p = not significant) at 5 minutes after the second dilatation. End-systolic and end-diastolic volumes increased significantly during the first and second dilatations and returned to normal after dilatation. It is concluded that short, controlled myocardial ischemia during coronary angioplasty leads to a decrease in systolic and diastolic left ventricular function. Sequential dilatations do not further decrease function if a sufficient interval is kept.

Angioplasty, Balloon, Coronary↗
PubMed1991

Long-term treatment of ventricular tachycardia with amiodarone in presence of severe left ventricular dysfunction.

A group of 34 consecutive patients with coronary artery disease (n = 29) or dilated cardiomyopathy (n = 5) (3 women, 31 men, age 38-80 yr) who had severely impaired left ventricular function (left ventricular ejection fraction less than or equal to 40%) and high-grade ventricular ectopic activity (sustained or nonsustained ventricular tachycardia or ventricular fibrillation) were treated with amiodarone (mean dose: 206 mg/d) and followed for 1-117 (mean: 49) months. In the total group, there were seven sudden deaths, five deaths due to pump failure, one non-cardiac death, and two successful heart transplantations during follow-up. Thus the annual cardiac mortality in these carefully selected and followed patients was 8, 6%, the annual cardiac event rate was 10, 1%. The cumulative cardiac survival-rate was 62% after 5 years and 41% after 10 years. In five patients, treatment was interrupted after 10 to 43 months, three of the patients were alive at follow-up and two suffered cardiac death, resulting in an annual cardiac death rate of 12% in this subgroup of treatment. Based on the results of this retrospective analysis we conclude that in patients with low left ventricular ejection fraction and nonsustained or sustained ventricular tachycardia treated with low dose amiodarone, mortality was unexpectedly low. Thus, it may be the antiarrhythmic treatment to be considered in patients with ventricular tachycardia and severe left ventricular dysfunction.

Adult↗
PubMed2000

Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis.

OBJECTIVES: The study evaluates the clinical course and the development of systolic and diastolic left ventricular function in patients with chronic myocarditis with or without autoantibodies against cardiac myosin. BACKGROUND: Patients with myocarditis often show autoantibodies against cardiac myosin. The clinical and pathophysiologic significance of these antimyosin autoantibodies (AMAAB) is yet unknown. The results from studies comparing the clinical course and the development of left ventricular function in patients with chronic myocarditis with or without AMAAB are not yet available. METHODS: Thirty-three patients with biopsy proven chronic myocarditis underwent analysis of AMAAB, right and left heart catheterization and left ventriculography at baseline and after six months. Left ventricular volumes and ejection fraction as well as the time constant of left ventricular relaxation "tau" and the constant of myocardial stiffness "b" were determined at baseline and at follow-up. RESULTS: In 17 (52%) patients, AMAAB could be detected at baseline. After six months, AMAAB were still found in 13 (76%) initially antibody-positive patients. No initially antibody-negative (n = 16) patient developed AMAAB during follow-up. Clinical symptoms improved slightly in antibody-negative patients and remained stable in antibody-positive patients. Left ventricular ejection fraction developed significantly better in antibody-negative patients (+8.9 +/- 10.1%) compared with antibody-positive patients (-0.1 +/- 9.4%) (p < 0.012). Stroke volume (SV) and stroke volume index (SVI) also improved in antibody-negative patients (SV: +20 +/- 31 ml; SVI: +10 +/- 17 ml) compared with antibody-positive patients (SV: -14 +/- 43 ml; SVI: -8 +/- 22 ml) (SV: p < 0.015; SVI: p < 0.016). Left ventricular end-diastolic and end-systolic volumes and the time constant of left ventricular relaxation "tau" did not change significantly different in antibody-positive and antibody-negative patients. The constant of myocardial stiffness "b" improved significantly in antibody-negative patients (-6.1 +/- 10.8) compared with antibody-positive patients (+7.3 +/- 22.6) (p < 0.040). Analyzing only the persistently antibody-positive patients yielded essentially the same results. CONCLUSIONS: Antimyosin autoantibodies are associated with worse development of left ventricular systolic function and diastolic stiffness in patients with chronic myocarditis.

Adult↗
PubMed1981

Left ventricular function and the timing of surgical treatment in valvular heart disease.

The problem of when to recommend surgical treatment for valvular heart disease to avoid irreversible left ventricular damage has not been fully resolved. In aortic stenosis, left ventricular function tends to improve after aortic valve replacement even if it is markedly depressed, and operation solely to prevent irreversible left ventricular dysfunction does not seem indicated. In aortic regurgitation, left ventricular function also usually improves postoperatively if moderately depressed, but in an adult with relatively few symptoms operation should be considered when there is progressive or marked cardiomegaly with reduced systolic function. In chronic mitral regurgitation, limited studies indicate that if left ventricular size is markedly increased and the ejection fraction is even mildly reduced, left ventricular function deteriorates postoperatively; in such patients consideration of operation may be warranted even if symptoms are few. It is concluded that operative mortality and morbidity are now sufficiently low that valve replacement or repair can be considered primarily to preserve left ventricular function under certain circumstances.

Aortic Valve Insufficiency↗
PubMed1982

[Comparison of exercise capacity with resting left ventricular function evaluated by various non-invasive methods in patients with old myocardial infarction].

The purpose of this study was to investigate the relationship between exercise capacity and resting left ventricular function assessed by several non-invasive methods in patients with old myocardial infarction. Subjects were 25 male patients whose endpoint was either dyspnea or general fatigue at the symptom-limited maximal graded treadmill exercise test according to Bruce protocol. The indices obtained by non-invasive cardiac examinations included left ventricular fractional shortening (% FS), scintigraphic infarct size (% SIS) by 201Tl myocardial scintigraphy and PEP/ET (so-called Weissler's index). A significant correlation of exercise duration with % FS (r = 0.67, p less than 0.001) or with % SIS (r = -0.55, p less than 0.02) indicated that the more was impaired resting left ventricular function, the more was decreased exercise capacity. Also, a significant correlation of systolic blood pressure at the end-point in exercise test with % FS (r = 0.58, p less than 0.005) or with % SIS (r = 0.69, p less than 0.001) indicated that inadequate blood pressure response might be partially attributed to impaired left ventricular function during exercise. The response of heart rate at the Bruce protocol stage I correlated with % FS (r = -0.67, p less than 0.001) and with % SIS (r = 0.53, p less than 0.02), respectively. These findings may be interpreted as chronotropic compensatory mechanism for limited stroke volume during exercise in patients with imparied left ventricular function. Thus, it was concluded that resting left ventricular function assessed by non-invasive cardiac examinations may predict exercise capacity prior to the test to some extent. These informations can be utilized for the decision of the planning at cardiac rehabilitation and also for the guidance in daily activities. Additionally, low level exercise test with treadmill is considered to be valuable for screening cases with impaired left ventricular function in old myocardial infarction.

Adult↗
PubMedDate not supplied

Assessment of left ventricular function by ECG-gated myocardial perfusion scintigraphy with image inversion technique: comparison with equilibrium radionuclide angiography.

BACKGROUND: Inversion of gated myocardial perfusion imaging has been proposed for the evaluation of left ventricular function. This study compared the results of inversion technique of gated left anterior oblique 45 degrees images (G-LAO 45 degrees) with those provided by equilibrium radionuclide angiography in the assessment of global left ventricular function in the same patients with suspected or known coronary artery disease. METHODS AND RESULTS: A total of 107 patients (85 men and 22 women, mean age 59 +/- 9 years) with suspected or documented coronary artery disease were studied. Eighty-seven underwent a 2-day stress/rest technetium-99m sestamibi single photon emission computed tomography with acquisition of G-LAO 45 degrees images on the day of rest, and 20 underwent thallium-201 stress/redistribution single photon emission computed tomography with G-LAO 45 degrees image acquisition immediately after redistribution imaging. An excellent correlation (P < .001) with no significant differences was found between left ventricular ejection fraction values provided by inversion G-LAO 45 degree and radionuclide angiography in 87 patients studied with Tc-99m sestamibi and 20 patients studied with TI-201. The Bland-Altman analysis demonstrated the difference in absolute ejection fraction values obtained by inversion G-LAO 45 degree images and radionuclide angiography as <8%. The inversion G-LAO 45 degrees left ventricular ejection fraction distinguishes the patients with myocardial infarction (ejection fraction = 43% +/- 13%) and without myocardial infarction (ejection fraction = 60% +/- 5%) (P < .001). In patients with left ventricular ejection fraction <40%, inversion G-LAO 45 degree images provide evaluation of left ventricular function comparable with that obtained by RNA. CONCLUSIONS: Semiautomated myocardial perfusion gated inversion technique analyzed with a count-based method is useful in the evaluation of left ventricular function and provides similar results to those of radionuclide angiography.

Coronary Circulation↗
PubMed1996

Importance of infarct-related artery patency for recovery of left ventricular function and late survival after primary angioplasty for acute myocardial infarction.

OBJECTIVES: The purpose of this study was to evaluate the importance of late infarct-related artery patency for recovery of left ventricular function and late survival after primary angio-plasty for acute myocardial infarction. BACKGROUND: Infarct-related artery patency is thought to improve late survival by its effect on preservation of left ventricular function. Patency may also enhance late survival by preventing left ventricular dilation and reducing arrhythmias, independent of myocardial salvage. However, most studies have not shown patency to be an independent predictor of survival when late left ventricular function is taken into account. METHODS: We followed up 576 hospital survivors of acute myocardial infarction treated with primary angioplasty for 5.3 years. Ejection fraction and infarct-related artery patency were determined at follow-up catheterization at 6 months. Predictors of late cardiac survival were determined using Cox regression models. RESULTS: Patients with patent arteries had more improvement and a better late ejection fraction than patients with occluded arteries (56.3% vs. 47.9%, p = 0.001). In patients with acute ejection fraction < 45%, late survival was better in those with patent versus occluded arteries (89% vs. 44%, p = 0.003), but patency was not a significant predictor after improvement in ejection fraction was taken into account. In patients with a large anterior infarction, patency was a significant independent predictor of late survival. CONCLUSIONS: Infarct-related artery patency is important for recovery of left ventricular function, and in patients with acute ejection fraction < 45%, patency is important for late survival. Our data are consistent with the hypothesis that the survival benefit is due primarily to the effect of patency on recovery of left ventricular function. In patients with a large anterior infarction, patency appears to provide an additional late survival benefit independent of myocardial salvage. These observations support the need for additional clinical trials of late reperfusion in patients with a large anterior infarction.

Angioplasty, Balloon, Coronary↗
PubMed1993

Protamine and left ventricular function: a transesophageal echocardiography study.

The effect of protamine sulfate on left ventricular function was evaluated in 23 patients undergoing heart surgery requiring cardiopulmonary bypass (CPB). Ventricular function was assessed by measuring cardiac index with a thermodilution pulmonary artery catheter and fractional shortening with transesophageal echocardiography (TEE). After CPB, a heparin-neutralizing dose of protamine was infused continuously for 5 min. Hemodynamic variables were obtained and fractional shortening was measured before protamine administration (time 0), during protamine infusion (2.5 and 5 min), and after the infusion (10 and 15 min after the start of protamine). Patients with a preoperative ejection fraction > or = 50% had no statistically significant changes in either cardiac index or fractional shortening with protamine administration, when compared to time 0. However, patients with a preoperative ejection fraction < 50% had a significant decrease in fractional shortening which occurred during and immediately after protamine administration when compared to time 0 (P < 0.01), with no associated change in hemodynamics. Our results suggest that protamine may have a negative inotropic effect that is apparent in patients with impaired ventricular function.

Adult↗
PubMed1989

Errors in the determination of left ventricular functional parameters.

Gated blood-pool scans of the left ventricle are routinely employed for determination of the left ventricular ejection fraction. Recently, attempts have been made to evaluate other left ventricular functional parameters. These values include peak emptying rate (PER), time to peak emptying rate (TPER), peak filling rate (PFR), and time to peak filling rate (TPFR). In studying these parameters clinically, we identified many software errors and assumptions that impact on these values. These errors may also affect the determination of left ventricular ejection fraction (EF). We conclude that before any serious investigation of left ventricular functional parameters is undertaken, a detailed evaluation and standardization of the acquisition and edge detection algorithms must be performed.

Diagnostic Errors↗
PubMed1991

Revascularization of infarcted vs. viable myocardium. Effects on symptoms, physical performance and global/regional left ventricular function.

Symptoms, physical performance and global vs. regional left ventricular (LV) function were reviewed in 25 patients with postinfarction anterior-apical akinesia and minor dyskinesia who subsequently underwent revascularization of all graftable stenotic vessels. The observed postoperative improvement in functional NYHA capacity and physical performance was not related to significant change in any systolic or diastolic variable of global LV function. 'Nonspecific postoperative septal hypokinesia' developed in most cases. The regional ejection fraction showed slight (nonsignificant) mean increase in the infarcted apex and low anterior wall supplied by the left anterior descending artery, but marked increase in the noninfarcted lateral wall supplied by the left circumflex branch. Hearts with grafted left circumflex artery showed on average lower preoperative and postoperative ejection fraction in the lateral wall than did hearts without such grafting, but the rise in regional ejection fraction was significant only after left circumflex grafting. The clinical response to coronary artery surgery is attributed mainly to functional improvement of non-infarcted myocardium. Revascularization of viable myocardium occurs directly via bypass grafts, but collateral vessels may also contribute.

Adult↗
PubMed1993

[Left ventricular dilatation after myocardial infarct].

The aim of this prospective study was to investigate if left ventricular dilatation is confined to the early months following myocardial infarction, or if it is a progressive process over several years. One hundred patients (pts) who suffered from stable angina or had undergone myocardial infarction, could be examined twice by coronary arteriography including ventriculography in an interval of 52 +/- 14 months. The patients were retrospectively divided into three groups: 41 pts (group A) had coronary heart disease without prior myocardial infarction, in 29 pts (group B) the first examination was performed within (mean 2 +/- 1 mo.) and in 30 pts (group C) beyond 6 months after myocardial infarction (mean 32 +/- 24 mo). The three groups were comparable concerning clinical data, but more pts with former myocardial infarction had multi-vessel disease (34 of 59 vs 16 of 41 pts) and depressed left ventricular function. Left ventricular angiography was performed in RAO view 30 degrees after enddiastolic pressure (LVEDP) was registered. Left ventricular enddiastolic and endsystolic volumes (EDVI and ESVI) were calculated by use of a modified Simpson's rule equation. In group A, EDVI and LVEDP remained constant, whereas ESVI increased slightly but significantly. Pts of group B and C had significantly higher volumes, which increased significantly in both groups over a mean of 52 months. About half the pts suffered from ventricular dilatation independent of progression of underlying coronary sclerosis. Consecutively, left ventricular ejection fraction decreased and LVEDP rose significantly in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Cardiac contractility modulation with nonexcitatory electric signals improves left ventricular function in dogs with chronic heart failure.

BACKGROUND: Nonexcitatory electrical, signals termed cardiac contractility modulation (CCM) have been shown to improve contractile force of isolated papillary muscles. In this study, we examined the effects of CCM signal delivery on left ventricular function in dogs with chronic heart failure (HF). METHODS AND RESULTS: Chronic HF (ejection fraction </=35%) was produced in 7 dogs by intracoronary microembolizations. The CCM signal was delivered during the absolute refractory period using a lead implanted in the anterior coronary vein. A right ventricular and an atrial lead were implanted and used for timing of the CCM signal delivery. Hemodynamic measurements were made at baseline and at 1, 2, 3, 4, 5, and 6 hours after initiating CCM signal delivery. Ejection fraction increased from 31 +/- 1% at baseline to 41 +/- 1% at 1 hour (P <.05), 42 +/- 1% at 3 hours (P <.05), and 44 +/- 2% at 6 hours (P <.05). Similarly, stroke volume increased from 26 +/- 2 mL to 31 +/- 3 mL at 1 hour (P <.05), 33 +/- 3 mL at 3 hours (P <.05), and 34 +/- 3 mL at 6 hours (P <.05). There were no significant changes compared to baseline in ejection fraction or stroke volume in 5 HF control dogs studied for up to 4 hours. CONCLUSION: In dogs with HF, CCM signal delivery for 6 hours elicited marked improvement in LV function. This novel approach may represent a useful adjunctive therapy for the treatment of patients with HF.

Animals↗
PubMed2006

Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging. a meta-analysis and review of the current literature.

Cardiac morbidity and mortality are closely related to cardiac volumes and global left ventricular (LV) function, expressed as left ventricular ejection fraction. Accurate assessment of these parameters is required for the prediction of prognosis in individual patients as well as in entire cohorts. The current standard of reference for left ventricular function is analysis by short-axis magnetic resonance imaging. In recent years, major extensive technological improvements have been achieved in computed tomography. The most marked development has been the introduction of the multidetector CT (MDCT), which has significantly improved temporal and spatial resolutions. In order to assess the current status of MDCT for analysis of LV function, the current available literature on this subject was reviewed. The data presented in this review indicate that the global left ventricular functional parameters measured by contemporary multi-detector row systems combined with adequate reconstruction algorithms and post-processing tools show a narrow diagnostic window and are interchangeable with those obtained by MRI.

Humans↗