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PubMedDate not supplied

[Left ventricular function in chronic obstructive lung disease (author's transl)].

Left ventricular function was studied at rest and during post-extrasystolic potentiation in 18 patients with chronic obstructive lung disease. The contractility indices used were obtained from pressures recorded in the isovolumetric period (left ventricular end-diastolic pressure, Vmax., VECmax., dP/dtmax.) and from volume variations during ejection (end-diastolic volume, ejection fraction, VCF). Left ventricular diastolic compliance was also evaluated. All patients were hypoxic (PaO2 = 58 +/- 7 torr); six of them had cor pulmonale (group B); the remaining 12 patients constituted group A. Left ventricular function of groups A and B was similar; we conclude that right cardiac failure, in cor pulmonale, is not secondary to left ventricular failure. However, left ventricular dysfunction exists; the left ventricle is hypertrophied (probably resulting from chronic hypoxia). Pump function is altered (abnormal ventricular function points are found), but left ventricular kinetics is normal or exaggerated (ejection fraction and VCF are increased). Isovolumetric phase contractility indices are diminished; however, they may increase normally during post-extrasystolic potentiation. Left ventricular compliance is abnormal due to left and right ventricular hypertrophy and to paradoxical movement of the interventricular septum which impedes diastolic expansion of the left ventricle. These changes are responsible for decreased left ventricular output. There seems to exist an impairment of left ventricular function related to both intrinsic (secondary to hypoxia, hypercapnia, left ventricular hypertrophy) and extrinsic factors (right ventricula hypertrophy deviating interventricular septum, lowering of left ventricular preload).

Adult↗

PubMed1990

Ultrastructural pathological study of left ventricular myocardium in patients with isolated rheumatic mitral stenosis with normal or abnormal left ventricular function.

An electron microscopic study of left ventricular myocardium was carried out in 15 patients who had isolated rheumatic mitral stenosis, with particular reference to the relation among ultrastructural pathological findings, the severity of mitral stenosis and left ventricular function. They were divided into 2 groups based on left ventricular performance evaluated by 2-dimensional echocardiography and angiocardiography. The severity of mitral stenosis was determined by hemodynamic data and mitral valve areas measured by 2-dimensional echocardiography. Regardless of the level of left ventricular contractile function we consistently demonstrated varying degrees of ultrastructural pathological alterations of left ventricular muscle cells, involving the myofibrils, mitochondria, nuclei and other elements of the sarcoplasm and membranes surrounding the myocardial cells in all specimens examined. The ultrastructural pathological findings did not correlate with the severity of mitral stenosis reflected in the echocardiographic and hemodynamic data. However, those patients with abnormal left ventricular function always exhibited more extensive loss of myofibrils resulting from either disproportion of the mitochondria-to-myofibril ratio or myofibrillar degeneration. The present investigation provides the morphological data at the ultrastructural level to support the widely held concept of a myocardial factor i.e., the extent of myocardial involvement by the rheumatic process as the basic pathogenetic mechanism responsible for left ventricular dysfunction in patients with isolated rheumatic mitral stenosis. Furthermore, it is suggested that pathological alterations of myocardial ultrastructure were related to the extent of myocardial involvement by the rheumatic process rather than being structural adaptations in response to the hemodynamic derangement.

Adult↗

PubMed1991

Effects of nisoldipine on systolic and diastolic function in postinfarction patients with reduced left ventricular function: a randomized, double-blind, placebo controlled study.

The long-term effects of oral nisoldipine or placebo on clinical variables, exercise test results and echo Doppler-determined systolic and diastolic functions were studied in 30 consecutive patients with reduced left ventricular function (predischarge echocardiographic wall motion score greater than or equal to 8) following myocardial infarction. Groups were comparable in clinical variables, exercise results, echo Doppler measurements and coronary anatomy. During 6 months follow-up, death, reinfarction and bypass surgery or balloon angioplasty were equally distributed. A significant increase in exercise duration and time to onset of ST-depression was found in the nisoldipine treatment group, compared to the placebo group after 3 and 6 months. Time to onset of angina was not significantly different. Echocardiographic indices of left ventricular systolic function (ejection fraction and wall motion score) were unaltered; however, the time-velocity integral of the early diastolic filling phase and the early vs late diastolic flow velocity ratio were significantly increased while the atrial time-velocity integral vs total time-velocity integral was significantly decreased in the nisoldipine treatment group after 3 and 6 months of follow-up. In conclusion, nisoldipine reduced exercise-induced ischaemia, improved exercise capacity and diastolic left ventricular function in postinfarction patients with reduced left ventricular function.

Cardiac Catheterization↗

PubMed1976

Normalized first derivative ofthe left apex cardiogram in assessment of left ventricular function.

The relation between the left displacement apex cardiogram and the left ventricular pressure during isovolumic contraction was studied in 30 patients with cardiac disease. Using the instantaneous relation between the first time derivative and the magnitude of both the left apex cardiogram and the left ventricular pressure, normalized derivatives were obtained. These noramized velocities were correlated with each other and with several indexes of left ventricular function. The normalized derivatives of the left apex cardiogram (dD/dt/D) and the left ventricular pressure (dP/dt/P) were similar in magnitude, standard deviation and variation coefficient. No such similarity was present when the first time derivatives of each tracing (dD/dt and dP/dt) were compared. A highly significant relation was found between normalized displacement velocity and normalized pressure velocity using both total (r = 0.76, P less than 0.001) and developed (r = 0.75, P less than 0.001) displacement and pressure. Significant correlations with several other indexes of left ventricular function (end-diastolic pressure, peak dP/dt, maximal velocity of the contractile elements at zero load[Vmax]) were also observed. It is concluded that the index dD/dt/D of the left apex cardiogram is an important noninvasive tool for assessing left ventricular function in man.

Adult↗

PubMed1978

Noninvasive assessment of left ventricular function in myotonic muscular dystrophy.

In order to assess left ventricular function, measurements of left ventricular internal dimension and its rate of change have been made by echocardiography in 7 patients with myotonic dystrophy and the three children of one of them, who were clinically normal but had abnormal muscle biopsies. Electrocardiograms and systolic time intervals were also recorded in all. Only one patient had signs of overt heart disease and an abnormal electrocardiogram (type B WPW). Systolic time intervals were normal in all 7 patients. Five subjects had echocardiographic abnormalities, which were of minor degree except in the patient with overt heart disease who had considerable impairment of both systolic and diastolic left ventricular function. Another patient had abnormalities of both systolic and diastolic function; systolic abnormalities occurred alone in one patient and diastolic abnormalities alone in one relative. It is concluded that patients with myotonic dystrophy and no clinical signs of heart disease may have minor abnormalities of left ventricular function as shown by echocardiography. Echocardiography is more sensitive than systolic time intervals in detecting these abnormalities; both systolic and diastolic function abnormalities, alone or together, can occur. There seems to be no relation between involvement of skeletal and cardiac muscle.

Adolescent↗

PubMed1988

Left ventricular function in double inlet left ventricle before the Fontan operation: comparison with tricuspid atresia.

Fourteen patients with double inlet left ventricle and nine patients with tricuspid atresia had biplane left ventricular angiography with simultaneous measurement of left ventricular pressure by micromanometer. Age distribution, haemodynamic function, and previous palliative operation were similar in the two groups. Left ventricular volumes were calculated frame by frame throughout the cardiac cycle by Simpson's rule. The end diastolic volume index was similar in the two groups, but the ejection fraction was significantly lower in tricuspid atresia. Left ventricular peak filling and emptying rates were also lower in tricuspid atresia, although heart rates in the two groups were similar. End diastolic shape index was significantly higher in patients with tricuspid atresia, indicating a more globular shape, and changed less during systole, suggesting differences in the mechanism of ejection between the two groups. Analysis of pressure-volume loops showed normal phase relations between pressure and volume, but systolic stroke work was reduced in tricuspid atresia and correlated with stroke volume and shape change. Left ventricular function was impaired in patients with tricuspid atresia when compared with those with double inlet left ventricle and this finding may reflect structural differences caused by the absence of one atrioventricular connection.

Adolescent↗

PubMed1991

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

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

Action Potentials↗

PubMed1989

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

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

Aged↗

PubMed1978

Left ventricular function studies in constrictive pericarditis.

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

Adolescent↗

PubMed1992

Left ventricular function and the relationship between left atrial pressure and peak early diastolic filling velocity in dog.

OBJECTIVE: The aim was to clarify the roles of left atrial pressure and ventricular function in the determination of early diastolic filling. METHODS: Various grades of ventricular dysfunction were made in 12 mongrel dogs by coronary microembolization under pentobarbitone anaesthesia. Left atrial pressure was altered by volume loading. Peak early diastolic filling velocity was measured using pulsed Doppler echocardiography. Ventricular fractional shortening was measured using M mode echocardiography. RESULTS: Peak early filling velocity increased as left atrial pressure increased. There was a direct relationship between mean left atrial pressure and the velocity before and after induction of ventricular dysfunction. The slope of the regression line between mean left atrial pressure and peak early filling velocity decreased as the grade of the dysfunction increased. There was a significant correlation between the slope of the regression line and mean left ventricular fractional shortening (r = 0.65, n = 31, p less than 0.01). CONCLUSIONS: Early diastolic filling was affected by both left atrial pressure and left ventricular function. These facts are useful in interpreting the various transmitral flow patterns observed clinically.

Animals↗

PubMed1977

[Application of non-invasive methods to assessment of left ventricular function in cardiomyopathy (author's transl)].

Left ventricular function in cardiomyopathy was studied by non-invasive methods. Various indices of left ventricular function were measured in patients with cardiomyopathy by mechanocardiography and echocardiography and were compared with indices in normal subjects and the following conclusions were obtained. 1) Patients with Congestive cardiomyopathy had high PEP/LVET, low mVcf, low EF, and low mPWV, suggesting depressed cardiac function. 2) Patients with Hypertrophic obstructive cardiomyopathy had characteristic findings, such as low DDR, high IVST/PWT, and SAM. 3) Patients with Hypertrophic non-obstructive cardiomyopathy had no characteristic changes in indices, however in some of the findings transition to Hypertrophic obstructive cardiomyopathy was suggested.

Cardiomyopathies↗

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↗

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↗

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↗

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↗

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↗