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PubMed2000

Head to head comparison of dobutamine-transoesophageal echocardiography and dobutamine-magnetic resonance imaging for the prediction of left ventricular functional recovery in patients with chronic coronary artery disease.

AIMS: A substantial number of patients with dysfunctional but potentially viable myocardium cannot be accurately evaluated by transthoracic echocardiography due to a poor acoustic window. This study compares the diagnostic value of alternative functional imaging techniques, such as dobutamine-transoesophageal echocardiography (dobutamine-TEE) and dobutamine magnetic resonance imaging (dobutamine-MRI) for the detection of viable myocardium and the prediction of left ventricular functional recovery in patients with chronic coronary artery disease following successful revascularization procedures. METHODS AND RESULTS: Rest and low-dose (5, 10 microg dobutamine x min(-1) x kg(-1)) multiplane dobutamine-TEE and ultrafast cine-MRI studies were performed in 103 patients. Contractile recovery of an infarct region was predicted if a dobutamine contraction reserve could be assessed visually by TEE or MRI in > or =50% of infarct-related a- or dyskinetic segments. Revascularization of the infarct-related vessel was successful in 88 patients, and 4.9 +/- 0.7 months later 52 patients still had an angiographically controlled open target vessel. These patients underwent another rest MRI study to assess left ventricular functional recovery. A dobutamine contraction reserve was observed in 27/52 (52%) patients by TEE and in 26/52 (50%) patients by MRI. Functional improvement of the infarct region was diagnosed in 28/52 (54%) patients. The positive and negative predictive accuracy of dobutamine-TEE and dobutamine-MRI for the prediction of left ventricular functional recovery was not significantly different (85% vs 92%, ns and 80% vs 85%, ns). Diagnosis of a predominantly viable infarct region by TEE and MRI predicted a significant increase in left ventricular ejection fraction (TEE: 12 +/- 8% vs 2 +/- 7% P<0.001, MRI: 13 +/- 7% vs 2 +/- 7%, P<0.001) compared to infarct regions graded as scar. CONCLUSION: A qualitative visual analysis of TEE and MRI viability studies is highly accurate for the prediction of left ventricular functional recovery in patients with dysfunctional myocardium and proved to be a clinically valuable alternative if transthoracic dobutamine-echocardiography is unsuitable. To date, TEE is cardiologists' preferred choice for the assessment of myocardial viability but MRI may become significantly more attractive with increasing local availability and experience.

Aged↗

PubMed1995

[The short- and medium-term ambulatory radionuclide study of left ventricular function (VEST) after aortocoronary bypass].

The aim of the present study was to evaluate the variation in left ventricular function at 15 and 120 days after bypass surgery. Ten male patients (mean age 59.6 +/- 7 years) with previous myocardial infarction and coronary stenosis of at least two main vessels, underwent a radionuclide ambulatory monitoring of left ventricular function (VEST) during: handgrip test, mental stress test, walking, climbing stairs. These tests were carried out 8 +/- 2 days before (T0), 15 +/- 3 days (T1) and 120 +/- 11 days after coronary bypass; heart rate (HR), ejection fraction (EF), stroke volume (SV), and cardiac output (CO) were evaluated beat by beat before and during the test until the maximal HR was reached. Handgrip and mental stress tests did not induce significant variations in cardiac indices both before and after cardiac surgery. No variation in HR was observed before and after the test. During walking, at T0, HR increased from rest to maximal effort (p < 0.01) with a significant decrease in EF (p < 0.05); at T1 HR, EF, SV and CO increased with respect to rest (p < 0.01); AT T2 HR, EF (p < 0.05) and CO (p < 0.01) increased with respect to rest. Climbing stairs, at T0, HR increased (p < 0.01) and EF decreased (p < 0.05); at T1 HR, EF, CO (p < 0.05) and SV (p < 0.01) increased with respect to rest. At T2 an increase in HR (p < 0.01) and CO (p < 0.05) was observed at maximal effort with respect to rest. The statistical analysis on the percentage variations between baseline and maximal effort (climbing stairs) showed a significant increase in SV at T2 compared to T0 (p < 0.01). In conclusion, VEST during daily normal activities 15 days and 4 months after bypass surgery showed a significant increase in cardiac function indices. The best results obtained at T1 can be explained with the transient increase in adrenergic tone at the time of early postoperative period.

Aged↗

PubMed2004

Long-term effects of bone marrow mononuclear cell transplantation on left ventricular function and remodeling in rats.

This study was performed to evaluate the long-term effect on left ventricular function and remodeling in a rat model of bone marrow cell transplantation (BMT) into acute infarcted myocardium. After myocardial infarction was induced in inbred Lewis rats by left anterior descending artery ligation, the ischemic area was directly injected with saline, peripheral blood mononuclear cells (PB-MNCs) or bone marrow mononuclear cells (BM-MNCs). Cardiac function and structure were evaluated by echocardiography before the operation, and on day 1 and 2 months post-infarct. The collagen content, the number of vessels and the vasculogenesis were examined by histology and immunohistochemistry. We found at 2 months post-infarct, BMT significantly improved cardiac systolic function and recovered diastolic function. Transplantation of BM-MNCs, but not PB-MNCs, reversed remodeling and reduced collagen density. Vessel counts showed greater angiogenesis occurred in the animals transplanted with BM-MNCs. Furthermore, a vascular endothelial cell-specific marker was detected in the transplanted bone marrow cells. Our data suggest that BM-MNC transplantation results in long-term improvement in left ventricular function-especially diastolic function- and remodeling, possibly related with the reduction of the amount of the collagen and enhancement of neovascularization.

Animals↗

PubMed1992

Echocardiographic and angiographic evaluation of left ventricular function during percutaneous transluminal aortic valvuloplasty.

Transesophageal echocardiography was used to study the effect of the balloon inflation on left ventricular function in 20 patients with critical aortic stenosis undergoing balloon valvuloplasty. Balloon inflation caused an increase of end-diastolic (15% to 34%) and end-systolic (57% to 72%) left ventricular volume. Left ventricular wall stress increased from 30 +/- 10 x 10(3) dyn/cm2 at diastole and 121 +/- 40 x 10(3) dyn/cm2 at systole to 44 +/- 11 x 10(3) dyn/cm2 and 191 +/- 55 x 10(3) dyn/cm2, respectively, when the balloon was inflated (P less than 0.05). Turbulent regurgitant jet across the mitral valve increased from 15 +/- 2% to 25 +/- 3% during balloon inflation (P less than 0.01). Continued monitoring of left ventricular function after balloon deflation demonstrated prolonged enlargement of left ventricular volumes. Our data show that balloon inflation causes an increase of left ventricular volume and impairment of contraction. Increase of left ventricular wall stress--associated with a reduction of coronary blood flow, due to lower aortic pressure--could result in ischemic myocardial injury.

Aged↗

PubMed2005

[Coronary flow reserve assessment by transthoracic color Doppler echocardiography after primary angioplasty: relationship with recovery of left ventricular function].

BACKGROUND: The aim of this study was to determine the relationship between coronary flow reserve measurement by transthoracic Doppler echocardiography in recent acute myocardial infarction treated with primary coronary angioplasty (PTCA) and recovery of left ventricular function. METHODS: Forty-one consecutive patients (3 patients excluded for not good quality of the Doppler signal) have been studied with: (1) recent first acute myocardial infarction treated with primary PTCA within 6 hours of pain onset; (2) optimal angioplasty result with stent deployment, anti-IIb/IIIa infusion and TIMI 3 flow; (3) lack of type 1 diabetes and/or hypertension; (4) good tolerance to adenosine. Transthoracic Doppler echocardiography was used to record coronary flow velocities in the distal left anterior descending and posterior descending coronary arteries at rest and after infusion of adenosine. Coronary flow reserve was measured after 11 +/- 1 days from the acute event. The wall motion score index (WMSI) was calculated at baseline, 1 month and 3 months from myocardial infarction. RESULTS: Patients of group A (n = 29 with coronary flow reserve > or = 1.6) showed a progressive and significant recovery of left ventricular function at follow-up. Patients of group B (n = 9 with coronary flow reserve < 1.6) had persistent left ventricular dysfunction at 3 months (ANOVA, p < 0.0001). WMSI was 1.64 +/- 0.26 in group A and 1.81 +/- 0.16 in group B (p = 0.09) at baseline; 1.30 +/- 0.26 in group A and 1.75 +/- 0.16 in group B (p < 0.0001) at 1 month; and 1.20 +/- 0.25 in group A and 1.73 +/- 0.17 in group B at 3 months. There was an inverse correlation between coronary flow reserve and WMSI at 1 month (r = -0.564, p < 0.0001), and at 3 months (r = -0.583, p < 0.0001). On multivariate analysis baseline WMSI and coronary flow reserve were the only predictors of 1-month WMSI recovery and of WMSI recovery at 3 months. CONCLUSIONS: Coronary flow reserve by transthoracic color Doppler echocardiography is a useful method for predicting left ventricular function recovery in patients after primary PTCA.

Adult↗

PubMed1999

Use of technetium-99m sestamibi ECG-gated single-photon emission tomography for the evaluation of left ventricular function following coronary artery bypass graft: comparison with three-dimensional magnetic resonance imaging.

In patients who had undergone cardiac surgery (coronary artery bypass graft) and whose hearts showed abnormal movement during the cardiac cycle, we studied the accuracy of functional assessment using ECG-gated single-photon emission tomography (SPET) and the automated software developed by Germano et al. by comparing the findings with magnetic resonance (MR) images acquired three-dimensionally. Sixteen patients who had undergone cardiac surgery underwent 99mTc-sestamibi gated SPET (MIBI-g-SPET) and MRI on the same day. Left ventricular end-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (LVEF) were measured using MIBI-g-SPET and the aforementioned algorithm. Regional wall thickening was assessed using a four-point scale on MIBI-g-SPET and cine MRI. There was a good correlation between MIBI-g-SPET and MRI in respect of EDV (r=0.89), ESV (r=0.93) and LVEF (r=0.89). A high degree of agreement was found between the wall thickening scores obtained by MIBI-g-SPET and MRI in total segments (kappa=0.62) and in septal segments (kappa=0.67). It is concluded that ECG-gated perfusion SPET can provide regional and global functional information, including absolute volumes, in patients following cardiac surgery.

Aged↗

PubMed2001

Pulmonary function in patients with reduced left ventricular function: influence of smoking and cardiac surgery.

STUDY OBJECTIVE: The impact of stable, chronic heart failure on baseline pulmonary function remains controversial. Confounding influences include previous coronary artery bypass or valve surgery (CABG), history of obesity, stability of disease, and smoking history. DESIGN: To control for some of the variables affecting pulmonary function in patients with chronic heart failure, we analyzed data in four patient groups, all with left ventricular (LV) dysfunction (LV ejection fraction [LVEF] < or =35%): (1) chronic heart failure, nonsmokers, no CABG (n = 78); (2) chronic heart failure, nonsmokers, CABG (n = 46); (3) chronic heart failure, smokers, no CABG (n = 40); and (4) chronic heart failure, smokers, CABG (n = 48). Comparisons were made with age- and gender-matched patients with a history of coronary disease but no LV dysfunction or smoking history (control subjects, n = 112) and to age-predicted norms. RESULTS: Relative to control subjects and percent-predicted values, all groups with chronic heart failure had reduced lung volumes (total lung capacity [TLC] and vital capacity [VC]) and expiratory flows (p < 0.05). CABG had no influence on lung volumes and expiratory flows in smokers, but resulted in a tendency toward a reduced TLC and VC in nonsmokers. Smokers with chronic heart failure had reduced expiratory flows compared to nonsmokers (p < 0.05), indicating an additive effect of smoking. Diffusion capacity of the lung for carbon monoxide (DLCO) was reduced in smokers and in subjects who underwent CABG, but not in patients with chronic heart failure alone. There was no relationship between LV size and pulmonary function in this population, although LV function (cardiac index and stroke volume) was weakly associated with lung volumes and DLCO. CONCLUSIONS: We conclude that patients with chronic heart failure have primarily restrictive lung changes with smoking causing a further reduction in expiratory flows.

Aged↗

PubMed1997

Quantification of left ventricular function with thallium-201 and technetium-99m-sestamibi myocardial gated SPECT.

UNLABELLED: Myocardial gated SPECT with 99mTc-sestamibi has been used to quantify left ventricular function. The purpose of this study was to determine if myocardial gated SPECT with 201Tl was possible and reliable to quantify left ventricular function. METHODS: One hundred and four patients referred for a myocardial perfusion study were included. Myocardial gated SPECT acquisition was performed 15 min after the intravenous injection of 111 MBq (3mCi) 201Tl and at 1 hr postinjection of 925 MBq (25 mCi) 99mTc-sestamibi. A commercially available automated myocardial gated SPECT processing software was used. Parameters evaluated were left ventricular ejection fractions (LVEF), end-diastolic volumes (EDV), end-systolic volumes (ESV) and stroke volumes (SV). RESULTS: The correlation between gated SPECT with 201Tl and gated SPECT with 99mTc-sestamibi was: r = 0.93 for LVEF, 0.92 for EDV, 0.96 for ESV and 0.68 for SV. CONCLUSION: Myocardial gated SPECT quantification of left ventricular function with 201Tl was possible and as reliable as gated SPECT with 99mTc-sestamibi. There was excellent correlation between gated SPECT with 201Tl and gated SPECT with 99mTc-sestamibi. In addition to assessment of myocardial perfusion, myocardial function and viability can be quantified in a single gated 201Tl study.

Coronary Disease↗

PubMed1990

Left ventricular function in the early postoperative stage--cardioplegic baneful effect is lost in the first 24 hours.

Early postoperative left ventricular function was investigated in 42 patients with left ventricular volume overload caused by valvular regurgitation. Preoperatively, left ventricular contractile function, stroke work and stress relations were all evaluated. Anoxic index (AnI) was considered as an index of myocardial preservation. Postoperatively, the cardiac function was estimated as the left ventricular stroke work index (SWI) after 3, 6, 24 and 48 hours of post-cardiopulmonary bypass. The release of CK-MB isoenzyme was also measured at the same time as an indication of myocardial injury. AnI and the postoperative SWI3 and SWI6 showed negative correlations in 6 hours, while preoperative SWI0 and postoperative SWI24 and SWI48 showed positive correlations after 24 hours, and SWI0 showed positive or negative correlations to the preoperative 8 parameters. It was observed that ejection fraction, end-systolic wall stress to end-systolic volume index ratio and tension volume ejection showed positive, while left ventricular end-diastolic pressure showed negative correlations to SWI48. However, none of these indexes showed any significant correlations during the first 24 hours following surgery. On the other hand, AnI and the total release of CK-MB isoenzyme showed a positive correlation. These data suggest that the cardioplegic baneful effect on cardiac function might be lost in the first 24 hours after surgery.

Female↗

PubMed1995

Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty.

Improvement in congestive heart failure and left ventricular function after dynamic cardiomyoplasty has been reported in patients with severe cardiomyopathies, but the long-term effects of this procedure remain unclear. In this investigation 31 patients undergoing cardiomyoplasty for treatment of idiopathic dilated cardiomyopathy were annually investigated with radionuclide scintigraphy, Doppler echocardiography, and right-sided heart catheterization. They were in New York Heart Association functional class III or IV before the operation. No hospital deaths occurred, but one patient with progressive heart failure required urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed up from 6 to 70 months (mean 25.6 months) and 12 patients died at late follow-up. Actuarial survivals were 86% at 1 year, 61.4% at 2 years, and 42.5% at 3 to 5 years of follow-up. Multivariate analysis of factors influencing outcome showed that long-term survival was significantly affected by preoperative functional class and pulmonary vascular resistance. Functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.7 in the surviving patients (p < 0.01). Furthermore, left ventricular ejection fraction improved from 19.8% +/- 3% to 23.9% +/- 7.2% (p < 0.01), and significant changes in stroke index, arterial pressure, pulmonary wedge pressure, and left ventricular stroke work index were also found at 6 months of follow-up. In the late postoperative period, the left ventricular ejection fraction tended to decrease and returned to preoperative levels at 5 years, whereas hemodynamic variables did not change significantly. Thus, despite the tendency of the left ventricular ejection fraction to decrease at late follow-up, the long-term course of these patients seems to be characterized by the maintenance of hemodynamic improvement. However, long-term survival after cardiomyoplasty is limited by the severity of the patient's condition before the operation.

Actuarial Analysis↗

PubMed1978

Dynamic ventriculography in patients with ischaemic heart disease. II. Influence of postextrasystolic potentiation on left ventricular function.

The effect of postextrasystolic potentiation [PESP] on left ventricular [LV] function was assessed by means of left ventricular cineangiography in 26 patients with ischaemic heart disease. Ventricular extrasystoles were induced by a catheter inserted into the LV during injection of the contrast agent. The values of parameters of segmental and global function of LV, found in potentiated and nonpotentiated sinus contractions, were compared. Segmental disturbances present at rest in 13 patients improved or disappeared after extrasystole in 8 patients. Improvements in contraction also took place in segments with normal resting contraction. Global LV function improved significantly; an improvement was observed even without an increase in the LV end-diastolic volume in the postextrasystolic beat. The advantages and limitations of the method for preoperative estimation of the effect of intended myocardial revascularization on the LV function are discussed.

Adult↗

PubMed2004

[Favorable effect of trimetazidine on clinical state and left ventricular function postinfarction period.].

AIM: To assess effect of trimetazidine on clinical course of postinfarction period and restoration of left ventricular myocardium. MATERIAL AND METHODS: 1.5-2.0 months after acute myocardial infarctions 123 patients receiving conventional therapy (aspirin, beta-blockers, angiotensin converting enzyme inhibitors, nitrates) were divided into 2 groups. Patients of group 1 (n=62) were given 60 mg/day of trimetazidine and patients of group 2 (n=61) were not. All patients were followed up for 12 months after onset of myocardial infarction. RESULTS: 12 months after myocardial infarction decreases of average heart failure and angina classes, increase of left ventricular ejection fraction, reduction of left ventricular end systolic and end diastolic volumes and left atrial dimensions occurred in group 1. Ejection fraction in this group became significantly higher while left ventricular end systolic and end diastolic volumes and left atrial dimensions significantly lower than in group 2. Index of diastolic function V(e)/V(a)ased in trimetazidine treated patients with normal and hypertrophic types of transmitral diastolic blood flow and became higher than in group 2. CONCLUSION: Trimetazidine facilitates restoration of systolic and diastolic left ventricular function after myocardial infarction.

Diastole↗

PubMed1997

[Effect of wind tunnel noise on left ventricular function of heart].

A two-dimensional color doppler ultrasonic imaging instrument was used to detect the left ventricular function in 36 wind tunnel technicians before and after their work in the wind tunnel. The results showed that under the noise between 91.5 and 101.5 dB(A) inside the wind tunnel SV, EF, Fs, MVCF, PE, SE and EAC decreased while SA, PA/PE increased. It indicates that high level wind tunnel noise has certain harmful effect on the left ventricular function of wind tunnel technicians.

Blood Pressure↗

PubMed1994

A miniature cesium iodide-photodiode detector for ambulatory monitoring of left ventricular function.

The physical characteristics of a portable nonimaging scintillation probe system for continuous ambulatory monitoring of the left ventricular function are described. The detector of the equilibrium radionuclide labeled blood pool is a single cesium iodide (CsI) crystal coupled to a silicium photodiode and interfaced to a microcomputer. The spatial properties of this small CsI crystal (1 x 1 x 1 cm3) were evaluated with various single-hole collimators. Linearity was studied in nonattenuating medium. Saturation began at 3000 cps, count loss was 10% at 4000 cps, maximal count rate was 24,000 cps. In attenuating medium, isocount curve of 5% of the maximal count rate was 100 mm deep and 160 mm wide. The most appropriate tested lead collimator to record the global ejection fraction of the left ventricle was a disc-shaped (thickness 5 mm, diameter 41 mm) single-hole (proximal aperture 8 mm, distal aperture 18 mm) collimator. Sensitivity was similar to the sensitivity of a sodium iodide nuclear probe. The detection performance appeared comparable to other available detector systems. Our results indicate that such a CsI-photodiode probe is a promising candidate for left ventricular function monitoring. The application to an ambulatory multicrystal detector system is presented and discussed.

Biophysical Phenomena↗

PubMed1987

Acute haemodynamic effects of a specific bradycardic agent in patients with coronary heart disease and impaired left ventricular function.

Alinidine is a bradycardic agent, which appears to be of potential value in the therapy of coronary heart disease. It might be useful in patients with impaired left ventricular function, where use of other bradycardic agents such as beta-blockers is limited due to their negative inotropy. To assess if alinidine has the potential to worsen haemodynamics in patients with strongly reduced left ventricular function we have examined acute haemodynamic changes after alinidine (0.5 mg kg-1 i.v.) both in a group of patients with mildly and in a group with strongly reduced left ventricular function. A significant reduction of resting heart rate and cardiac index was observed in both groups. All other haemodynamic parameters, especially left ventricular filling pressures (LVEDP, PC) and enddiastolic volume index did not show any significant change; dp/dtmax was not significantly influenced by alkinidine, when the influence of heart rate lowering was eliminated by pacing. We conclude that administration of alinidine in the dosage used does not lead to a significant deterioration even in patients with strongly impaired left ventricular function.

Anti-Arrhythmia Agents↗

PubMed2005

Hemodynamics in off-pump surgery: normal versus compromised preoperative left ventricular function.

OBJECTIVE: Off-pump coronary surgery (OPCABG), avoiding cardiopulmonary bypass and cardioplegic arrest, seems to be a better choice in patients with poor baseline cardiac function. Since cardiocirculatory collapse could be induced by heart displacement in this group of patients at high risk, a greater pathophysiologic understanding of the hemodynamic derangements occurring in such patients is needed. METHODS: Twenty-eight elective OPCABG patients were evaluated for hemodynamic changes induced by heart displacement, using arterial thermodilution to measure cardiac output and global end-diastolic volume. Hemodynamic parameters were recorded: at baseline; during proper exposure and stabilization of each vessel; and at the end of surgery. Patients were divided into two groups, according to baseline ejection fraction (EF): group A (EF>30%; N=16), group B (EF< or =30%; N=12). RESULTS: Heart displacement induced a significant drop in the cardiac and stroke index, with a lesser decrease of mean arterial pressure because of raised systemic vascular resistance. Preload, measured as global end diastolic volume, significantly decreased in group A, while it remained unchanged or increased in group B. Linear regression between the preload index and left ventricular stroke work was significant only in group A. CONCLUSIONS: Patients with poor baseline cardiac function can well tolerate OPCABG. However, the pathophysiologic modifications underlying the hemodynamic changes are different compared to those in patients with good preoperative cardiac performance.

Aged↗

PubMed1993

Serial evaluation of left ventricular function by radionuclide ventriculography at rest and during exercise after orthotopic heart transplantation.

Discrepant results have previously been reported concerning long-term left ventricular function in the human transplanted heart as assessed by radionuclide ventriculography. In this study, radionuclide ventriculograms were obtained at rest and during exercise in 19 patients < 6 months, 7-12 months, 13-24 months and > 24 months after transplantation. Ejection fraction decreased significantly from < 6 months to 13-24 months after transplantation (rest: 69.1% +/- 9.7% to 56.7% +/- 8.3%, P < 0.05; exercise: 70.4% +/- 11.3% to 59% +/- 8%, P < 0.05). Heart rate increased significantly during exercise after > 2 years (90.2 +/- 10.5 beats/min to 103.5 +/- 15 beats/min, P < 0.05) but not within 6 months after transplantation (98.5 +/- 12.8 beats/min to 99.07 +/- 15.8 beats/min). Left ventricular end-diastolic volume remained unchanged. Peak filling rate at rest decreased significantly from 4.2 +/- 0.96 edv/s < 6 months after transplantation to 3.3 +/- 0.66 edv/s (P < 0.05) 13-24 months and 3.3 +/- 0.64 edv/s (P < 0.05) > 24 months after cardiac transplantation. Exercise peak filing rate did not change significantly. It is concluded that radionuclide ventriculography demonstrates a decrease in systolic left ventricular function in the long-term course after cardiac transplantation. A significant increase in exercise peak heart rate may be due to autonomic reinnervation. Differences in the literature concerning left ventricular function may be due to different observation intervals following cardiac transplantation.

Erythrocytes↗

PubMed1992

[Changes in left ventricular function during exercise after lung resection--study with a nuclear stethoscope].

In 29 cases undergoing lung resection, effects of the surgery on left ventricular function were investigated indirectly with a Nuclear Stethoscope. Various parameters were measured following an exercise load before and after surgery. There were significant decreases in post-operative resting levels of stroke volume (SV) (p < 0.001), end-diastolic volume (EDV) (p < 0.001), ejection fraction (EF) (p < 0.05) and ejection rate (ER) (p < 0.001) and significant increase in heart rate (HR) (p < 0.001) when compared to pre-operative resting levels. Neither filling rate (FR) nor cardiac output (CO) showed significant difference. At maximum exercise load, there were significant decreases in post-operative EDV (p < 0.005), SV (p < 0.005), ER (p < 0.001) and FR (p < 0.005), but no significant differences were detected in HR and EF; consequently, there was a significant decrease in CO (p < 0.005). Ratio of the levels at maximum load to those at resting of each parameter did not show significant difference between before and after operation with regard to any parameters except CO and FR which showed significant decrease (p < 0.005 and p < 0.001, respectively). Effects of the surgery on left ventricular function were studied according to amount of lung resection. In 13 cases where more than two lobes were resected, similar significant differences to those mentioned above were found in all parameters except EF. In cases where a single lobe was resected, only ER and FR showed similar tendency to that described above. Effects of the surgery on left ventricular function were also studied according to age of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗