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Results for “global functioning”

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PubMed1999

[Progressive systemic sclerosis - treatment results of extracorporeal photopheresis].

The treatment of progressive systemic sclerosis (PSS) is still unsatisfactory. We report on clinical, laboratory and immunological findings in 26 patients with PSS (6 males, 20 women) treated with extracorporeal photopheresis (ECP) for 8 cycles in a nonrandomized, uncontrolled study. ECP was performed on two consecutive days once a month. 8-methoxypsoralen concentrations in plasma and buffy coat were monitored by HPLC. We performed a standardized examination programme and determined parameters of inflammation and immune function. Global assessment revealed a partial remission in 18 patients, a stable disease in 8 patients and a slight progression in one patient. In the peripheral blood count a significant increase of CD3-positive NK cells was noted (p=0.03) although the leukocyte count decreased from 2,255 to 1,156 cells/microl. There was a non-significant decrease of elastase (102. 9 vs. 90.4 ng/ml), sulfidoleukotriens (2,255.4 vs. 1,688.9 pg/ml), ICAM-1 (301.9 vs. 276.6 ng/ml), soluble IL-2 receptor (609.0 vs. 422. 3 U/ml), and IL-10 (164.7 vs. 138.7 pg/ml). IL-6 and IL-8 did not show significant changes. The ECP treatment of patients with PSS shows immunomodulatory effects changing levels of pro-inflammatory and cytokine substances. Even after 8 cycles partial remission or stable disease is seen in patients as shown by global assessment and certain clinical symptoms. On the other hand, sufficient data on the long-term outcome are still missing.

Adult↗

PubMed2002

Patients' needs during the year after a suicide attempt. A secondary analysis of a randomised controlled intervention study.

OBJECTIVE: We first studied whether changes of needs were influenced by randomly allocated telephone interventions between 1 and 12 months after a suicide attempt in addition to treatment as usual. These were aimed at improving motivation for professional treatment. As a secondary analysis we investigated the frequency and changes of needs during this period and if changes were related to other outcome measures. METHOD: One month after a suicide attempt 216 patients were randomised to two telephone interventions or to no such interventions within 1 year. The Camberwell Assessment of Need (CAN) was used to evaluate 22 different need areas at 1 and 12 months. Other outcome measurements used were Global functioning axis V (GAF), psychological symptoms (SCL-90, GSI) and scale of suicide ideation (SSI). RESULTS: Of 178 patients who were followed up, 140 had been rated by CAN at both 1 and 12 months. Changes of needs did not differ between the randomised groups. At 1 month the patients had a mean number of 5.1 +/- 2.4 needs and 2.4 +/- 1.5 of these were considered as unmet. The most frequently reported needs concerned health aspects, basic needs and social needs. At 12 months needs concerning health aspects were significantly reduced, while basic needs and social needs were not. Changes of GAF explained 21 % and changes of GSI 4 % of the variance of the reduction of needs. CONCLUSIONS: After 12 months, needs in health aspects, basic needs and social needs were still common. A structured evaluation of the patient's needs seems to be helpful when planning treatment after a suicide attempt.

Aftercare↗

PubMed2003

Predictors of improvement in quality of life of severely mentally ill substance abusers during 18 months of co-operation between psychiatric and social services.

BACKGROUND: The aim of this study was to investigate predictors of Quality of Life in a group of severely mentally ill substance abusers. These patients took part in a multi-centre study aimed at improving co-operation between psychiatric and social services in Sweden during the years 1995 to 1998. METHODS: Two hundred and eighty-eight patients, 62.4 % men, were included in the study. The criteria to enter the study were to have a diagnosis of severe mental illness and a diagnosis of substance dependence according to the DSM-III-R criteria. Quality of Life (QoL) was measured by a global assessment, Cantril's ladder (1965). Initially and after 18 months the following measurements were also used: Addiction Severity Index (ASI), Symptom Check List 90 (SCL-90) and The Clinical Rating Scale (CRS) for Alcohol Use (AUS) and Drug Use (DUS). RESULTS: Initially those who were older and those who had an apartment of their own or who lived in sheltered living had a higher QoL than the others. Those belonging to the borderline personality disorder subgroup had a lower QoL than those belonging to other psychiatric diagnostic subgroups. At follow-up QoL had improved significantly. Improvement in QoL was related to improvements in physical health, legal and family problems, psychiatric symptoms and a reduction of alcohol and drug problems (ASI), global functioning (GAF) and psychological problems (SCL-90). A multiple stepwise regression analysis showed that improvement in QoL primarily was predicted by improvements in psychiatric symptoms. Number of months without alcohol and drugs were positively associated with improvement in QoL. As a whole, at follow-up the QoL is still not high. CONCLUSIONS: In this group of severely mentally ill substance abusers, improvement in QoL was primarily predicted by improvements in psychiatric symptoms. Further, less alcohol and drug abuse seems to augment the subjective feeling of QoL.

Adult↗

PubMed2002

Predictors of treatment discontinuity in outpatient mental health care.

BACKGROUND: Discontinuity of service utilisation among newly referred community outpatients is a common concern. However, knowledge about factors associated with service utilisation is inconsistent. METHOD: This study examined service utilisation of 323 newly referred patients in three community mental health centres (CMHCs) in Vienna, Austria over a 4-month period. Of this original cohort, 111 patients were interviewed at treatment start to identify factors associated with treatment discontinuity. RESULTS: After 4 months, one-third of the 323 newly referred patients had dropped out of CMHC treatment; one-third discontinued treatment at the CMHCs because of referrals or mutual agreement on treatment termination, and one-third was still in CMHC treatment. Multivariate analyses yielded a negative association between treatment discontinuity and the diagnosis of schizophrenia, availability of home care, living alone, and a high quality of life in the domains living situation and family/significant others. A positive association was found with unemployment, previous psychiatric admissions, low patient satisfaction with staff competence, and high self-assessment in global functioning. CONCLUSION: In treatment, differing perceptions of a patient's health status by the patient and by the psychiatrist should be addressed. Professionals should be aware that patients' difficulties in private social relations might affect both treatment alliance and service utilisation.

Adult↗

PubMed2005

Evaluation of biventricular ejection fraction with ECG-gated 16-slice CT: preliminary findings in acute pulmonary embolism in comparison with radionuclide ventriculography.

This study aimed to assess the feasibility of cardiac global function evaluation during a whole-chest multi-slice CT (MSCT) acquisition in patients referred for suspicion of pulmonary embolism (PE), and to compare the results with planar equilibrium radionuclide ventriculography (ERNA). Ten consecutive haemodynamically stable patients (six female, four male; mean age 69.7 years; heart rate 65-99 bpm) with suspicion of PE underwent an MSCT and ERNA within a 6 h period. CT acquisition was performed after contrast medium injection by using 16x1.5 mm collimation and retrospective ECG gating. Left ventricular (LVEF) and right ventricular (RVEF) ejection fractions were calculated using dedicated three-dimensional software. Relationships between measurements obtained with MSCT and ERNA were assessed using linear regression analysis and reliability of MSCT was assessed with intra-class correlation coefficient. Bland-Altman analysis was performed to calculate limits of agreement between MSCT and ERNA. MSCT was performed successfully in ten patients with a mean acquisition time of 16.5+/-2.8 s. Functional cardiac evaluation was possible on CT for all patients except for one due to poor opacification of right ventricle. Linear regression analysis showed a good correlation between MSCT and ERNA for the LVEF (R=0.91) and the RVEF (R=0.89) measurements. Intra-class correlation was superior for LVEF (0.92) than for the RVEF (0.68). Bland-Altman plots demonstrated that MSCT substantially overestimated the ERNA RVEF. Morphological CT data demonstrated PE in four of ten of patients and alternative diagnoses in five of ten patients. Our study reveals that MSCT with retrospective ECG gating may provide in one modality a morphological and a functional cardiopulmonary evaluation. Comparison with ERNA demonstrated a good correlation for both ventricular ejection fractions.

Aged↗

PubMed1999

[Blood coagulation and fibrinolysis in arteriosclerosis].

Thrombus formation at the site of atherosclerotic lesions, especially on a ruptured plaque, plays a central role in the "atherothrombosis" hypothesis. An activation of the hemostasis and a disturbed fibrinolysis are known. These alterations are especially marked in patients with acute coronary syndromes. In stable coronary artery disease, fibrinogen is elevated. Furthermore, minor alterations of the contact phase factor VII and consecutively of the thrombin system are detectable depending on the study population. Thrombin generation and activation become marked in patients with unstable angina pectoris or acute myocardial infarction. Possible reasons for this activation are an activation of the contact phase factor XII system and the release of tissue factor both from the ruptured plaque and from stimulated monocytes. The fibrinolytic system is markedly altered already in patients with stable coronary heart disease. Increased levels of tissue-type plasminogen activator and of urokinase-type plasminogen activator/receptor are measurable in atheromas. Tissue-type plasminogen activator mass concentration is systemically elevated already at early stages of atherosclerosis. Especially in patients with increased risk for acute coronary syndromes, the plasminogen activator inhibitor activity is significantly increased. Furthermore, a hypercoagulative state with increased d-dimer levels and plasmin-antiplasmin complexes can be measured. The alterations of hemostasis and especially of fibrinolysis are detectable for prolonged time period and persist much longer than the clinical symptoms of the patients. The increased plasminogen activator inhibitor activity is associated with the metabolic syndrome and constitutes an (in part genetically determined) disturbance in patients with stable or unstable coronary heart disease. However, the large intra- und interobserver as well as diurnal variability of this marker limits its use as a routine measure for risk stratification in patients. Alterations of the hemostasis and disturbances of fibrinolysis are detectable during the chronic as well as the acute phase of atherosclerosis. These changes are best documented for coronary heart disease, whereas less data are available for other manifestations of atherosclerosis. The use of newly developed molecular markers for single reaction steps of pathways instead of global functional tests and of new molecular biological methods did considerably improve the detailed knowledge on the pathomechanisms of the development of atherosclerosis, making the development of targeted therapies, e.g., against receptors possible. Future studies will investigate the quantitative impact of the various activated pathways (cause or reaction) and the effects of interventions on these pathomechanisms in patients with acute coronary syndromes. Studies will have to focus especially on the meaning of polymorphisms, early changes in the development of atherosclerosis and interactions with inflammatory processes.

Blood Coagulation Factors↗

PubMed2004

Early detection and secondary prevention of psychosis: facts and visions.

As effective and practical approaches to primary and universal prevention of psychosis are lacking, intervention efforts are targeted at the early stages of schizophrenia to prevent (by way of secondary prevention) or postpone psychosis onset, reduce severity of illness or at least ameliorate the social consequences involved. Early intervention requires early detection and early recognition (diagnosis) of persons at risk and early prediction of psychosis. Within the German Research Network on Schizophrenia (GRNS) awareness programmes are being carried out in several German cities, and these efforts are already improving utilisation of early-recognition and early-prediction services by at risk persons. The empirical basis of developing a two-step early-recognition inventory and strategies of application will be discussed. This instrument is supplemented by a set of cognitive tests, prospectively validated in the GRNS. Results from preliminary analysis of data covering a two-year period demonstrate that the inventory and the cognitive tests are readily accepted. When used for screening in non-specialist settings and at the next level, i. e. at early-recognition centres, they seem to permit identification of at-risk persons. Early intervention is being tested 1) in a randomised controlled multi-centre trial consisting of a specially developed cognitive-behavioural therapy in the early (prepsychotic) prodromal state and 2) on additional treatment with appropriate doses of amisulpride in the late prodromal (early psychotic) state. Preliminary data from Study 1 covering 16.3 months show significantly fewer transitions to psychosis and from Study 2 reduced positive and negative symptoms and improved global functioning compared with controls who had received normal clinical treatment. As a result, both the early-recognition inventory plus cognitive tests and the two therapy strategies are feasible. We hope that the favourable trend indicated by the preliminary data will be confirmed in the final analysis planned for 2005 and the objective of implementing effective and practical secondary prevention of psychosis and its consequences will be attained.

Animals↗

PubMed1999

A deviant EEG brain microstate in acute, neuroleptic-naive schizophrenics at rest.

Momentary brain electric field configurations are manifestations of momentary global functional states of the brain. Field configurations tend to persist over some time in the sub-second range ("microstates") and concentrate within few classes of configurations. Accordingly, brain field data can be reduced efficiently into sequences of re-occurring classes of brain microstates, not overlapping in time. Different configurations must have been caused by different active neural ensembles, and thus different microstates assumably implement different functions. The question arises whether the aberrant schizophrenic mentation is associated with specific changes in the repertory of microstates. Continuous sequences of brain electric field maps (multichannel EEG resting data) from 9 neuroleptic-naive, first-episode, acute schizophrenics and from 18 matched controls were analyzed. The map series were assigned to four individual microstate classes; these were tested for differences between groups. One microstate class displayed significantly different field configurations and shorter durations in patients than controls; degree of shortening correlated with severity of paranoid symptomatology. The three other microstate classes showed no group differences related to psychopathology. Schizophrenic thinking apparently is not a continuous bias in brain functions, but consists of intermittent occurrences of inappropriate brain microstates that open access to inadequate processing strategies and context information

Adult↗

PubMed2001

Amisulpride: efficacy in the management of chronic patients with predominant negative symptoms of schizophrenia.

Amisulpride is a dopamine D2/D3-selective antipsychotic drug with potent antipsychotic efficacy in acute exacerbations of schizophrenia. It also possesses substantial efficacy in chronic schizophrenic patients with enduring predominant negative symptoms. This unique property has been demonstrated in a series of short (6 weeks) and medium-/long-term (6-12 months) double-blind placebo-controlled studies. The patients in these studies were carefully selected and assessed to avoid confounding results with non-specific changes in other symptom domains. The results not only show effects on negative symptoms at the optimal dose of 100 mg/day, but also significant improvement in global functioning. The effect observed in short-term studies was maintained over longer treatment periods (6-12 months). Amisulpride was well tolerated with a safety profile similar to placebo. These results open a new therapeutic approach for negative symptoms, one of the most disabling aspects of schizophrenia.

Adolescent↗

PubMed2003

R1--systemic thrombolysis in German stroke units--the experience from the German Stroke data bank.

BACKGROUND: Systemic thrombolysis with tissue plasminogen activator (t-PA) for treatment of acute ischemic stroke was approved in Germany in 2000. Up to now, only data from single centers have been available for the study of the use of thrombolysis in a hospital-based approach outside controlled trials. We therefore sought to determine the frequency of application and complications as well as the patient outcome after t-PA treatment in clinical routine of specialized stroke centers in Germany. METHODS: Within the German Stroke Data Bank Collaboration, 6234 consecutive patients with ischemic stroke were prospectively documented in 20 stroke centers between 1998 and 1999. The patients were centrally followed via telephone interview after 3 months and 1 year to assess global functional outcome using the Modified Rankin Scale. RESULTS: 250 patients (4 %) received systemic t-PA treatment during the study period. The baseline characteristics of these patients were comparable to large clinical trials and phase IV studies. Symptomatic and asymptomatic parenchymal hemorrhage occurred in 22 patients (8.8 %) and was fatal in 3 patients. Follow-up data after 3 months were obtained in 82.4 % of all patients, of which 35 % had a favorable functional outcome (mRS </= 1), while 23.8 % were severely disabled (mRS >/= 4) and 17 % had died. CONCLUSION: The results of our study agree with the assumption that thrombolytic therapy can be performed safely and effectively in daily clinical practice. Nevertheless, the small proportion of patients receiving thrombolysis even in specialized stroke centers calls for further improvement of acute stroke management in Germany.

Cerebral Hemorrhage↗

PubMed2001

Deep brain stimulation in the treatment of severe dystonia.

A retrospective study of a consecutive series of 19 patients with medically intractable dystonia treated with uni- or bilateral deep brain stimulation (DBS) is reported. A minimal follow-up of 6 months was available, up to eleven years in one patient. The first twelve consecutive patients (4 with primary and 8 with secondary dystonia) were treated with chronic stimulation of the posterior part of the ventrolateral thalamic nucleus (VLp). In this group global functional outcome was improved in 8 patients, although dystonia movement and disability scale scores did not show significant improvement. Of the 12 patients treated first by VLp DBS, three (1 primary and 2 secondary dystonia) underwent pallidal (GPi) DBS after the VLp DBS failed to improve their symptoms. The last seven consecutive patients (5 primary and 2 secondary dystonia) were treated directly with GPi DBS. Extracranial infection prevented chronic GPi DBS in one patient. In another GPi patient, preliminary negative tests with the electrodes discouraged implantation of the stimulators, and the patient was not treated with chronic DBS. In the remaining group of eight patients including those previously treated with VLp DBS, chronic GPi DBS resulted in a significant improvement in the dystonia movement scale and disability scores. Although this is a retrospective study dealing with dystonia of heterogeneous etiology, the results strongly suggest that GPi DBS has a better outcome than VLp DBS.

Adolescent↗

PubMed1997

[Influences on the outcome of lumbar disc-surgery].

In a prospective study 30 patients suffering from a lumbar disc-prolapse and typical neurological symptoms were examined with regard to the predictors of the outcome 15 months postoperatively. Alongside the clinical examination and the raising of illness-anamnesis the Giessen pain questionnaire (Giessener Beschwerde-Bogen), the Giessen-Test, the Freiburg Personality Inventory (Freiburger Persönlichkeits-Inventar), the Mainz pain questionnaire und a pain scale were used. By means of the pain questionnaires two groups were formed. Patients without (N=15) and patients with (N=14) postoperative impairment. On the basis of selected scales of the Giessen pain questionnaire and the characteristic "psychosomatic disorder in the anamnesis" for 90% of the patients the outcome could be correctly predicted. For the estimation of the outcome by means of the estimation of global functioning level the likelihood of correct prediction was 83%. Medical and demographic parameters as well as the other results of psychological testing did not correlate with the outcome. The great importance of psychosomatic factors in a wider sense for the outcome is found to be confirmed in the literature. The significance of this result for the coping is debated with a background of the concept of "somatizing" versus "symbolizing". The conditions in therapy should lower psychological stress in order to reduce the necessity for "somatization" and facilitate "symbolization". This is specified as well for the treatment in regular surgical departments as for specialized pain-programs.

English Abstract↗

PubMed2006

The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer.

GOALS OF THE WORK: Dyspnea is a common symptom in patients with advanced cancer. The goal of this study was to investigate the relationship between dyspnea and patient satisfaction with quality of life (QoL) in advanced cancer. MATERIALS AND METHODS: A case series of 954 cancer patients treated at the Cancer Treatment Centers of America was investigated. Dyspnea was measured using the EORTC dyspnea subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between dyspnea and QLI was evaluated using multivariate analysis of variance and multiple regression analysis. RESULTS: Of 954 patients, 579 were females and 375 males with the median age at presentation of 56 years (range: 20-90 years). Of these patients, 66% did not respond to prior treatment. Most common cancers were breast (26%), colorectal (19%) and lung (16%). After controlling for the effects of age and treatment history, every ten unit increase in dyspnea was statistically significantly associated with 0.81, 0.16, 0.47, and 0.47 unit decline in QLI health/physical, social/economic, psychological/spiritual and global function score, respectively. CONCLUSIONS: We found that dyspnea is strongly correlated with patient satisfaction with QoL in advanced cancer. Future studies should evaluate the impact of integrative cancer care services on patient satisfaction with QoL.

Adult↗

PubMed2005

Relationship between bone mineral density and urine level of NTx in rheumatoid arthritis.

We analyzed the relationship between the level of type-I collagen N-telopeptide (NTx) in urine (U-NTx) and bone mineral density (BMD) in patients with rheumatoid arthritis (RA). The subjects were 62 female patients with RA who had experienced the menopause 5 years or more before the study commenced, and who had not been treated for osteoporosis. The mean age of the subjects was 61.6 years and the mean disease duration was 13.3 years. They were classified for global functional status (classes I to IV), and then grouped based on the presence or absence of corticosteroid administration. Bone mineral density (BMD) and U-NTx levels were measured. In the presence of corticosteroid administration (CS group; n = 40), the mean level of U-NTx/creatinine (Cr) was 88.8 nM and the percent young adult mean (%YAM) for BMD was 71.2%. In the no corticosteroid (nCS group; n = 22), the values were 72.1 nM and 78.2%, respectively. The U-NTx/Cr value and %YAM were not significantly different between the CS group and the nCS group. A negative correlation was observed between the U-NTx/Cr value and %YAM in both groups (P = 0.005 and P = 0.0265). No significant difference was observed for the U-NTx/Cr value or %YAM between the CS and nCS groups, in any class. In the CS group, a positive correlation was observed between the U-NTx/Cr value and the total dose of corticosteroid (P = 0.001), and a negative correlation was observed between the %YAM and the total dose of corticosteroid (P = 0.003). These results suggested that preventive medical treatment for osteoporosis is required for RA patients in class III, irrespective of whether they have had corticosteroid administration.

Activities of Daily Living↗

PubMed2002

Personality disorders in former child psychiatric patients.

The present case-control study was undertaken in order to investigate the long-term outcome with respect to personality disorder (PD) symptomatology in former child psychiatric in-patients as compared to matched controls from the general population. Altogether 359 former patients and 359 controls were invited to participate in the study. Of these, 164 (46 %) former patients and 193 (54 %) controls approved participation. From these, 137 age and sex-matched pairs with a mean age of 30.7 (SD = 6.8) years were constructed. Adult PD symptomatology was assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). There were 52 former patients (38 %) and 15 controls (10.9 %) who fulfilled criteria for at least one DSM-IV self-reported PD. There was a significantly higher prevalence for all specific self-reported PDs in former patients compared to controls. The mean number of disorders was 1.7 (SD = 2.6) in former patients and 0.3 (SD = 0.8) in controls. Moreover, former patients fulfilled more PD criteria than controls (23 vs. 11; median numbers). The former patients had significantly lower global functioning and more psychosocial problems than the controls. These problems were related to personality pathology. The results of this study indicate that child psychiatric morbidity seems to increase the risk for adult PD symptomatology. However, the results may be biased by the low participation rate.

Adolescent↗

PubMed2006

Patients' perceptions of health related quality of life in rheumatoid arthritis and chronic low back pain.

OBJECTIVES: To determine how health related quality of life (HRQL) is perceived by patients with rheumatoid arthritis (RA) and chronic low back pain (CLBP) using a textual analysis approach. PATIENTS: Two-hundred and forty-eight outpatients (85% female), mean age 58+/-13 years (40% RA and 60% CLBP). METHODS: Observational descriptive study. Sociodemographic and clinical variables were determined. A questionnaire was designed which included an open question "What does health related quality of life mean to you." which patients answered in writing. Textual data analysis was performed using a previous described method based on multivariate descriptive statistical methods. RESULTS: The two groups were homogenous with respect to gender, educational level, disease duration, comorbid conditions and global functional status. Patients with RA and CLBP used clearly differentiated terms to describe HRQL (RA: to be able (capable), house; CLBP: life, health, quality). RA patients were specific and primarily concerned with functional status and CLBP patients with health and life. The most characteristic phrase used by RA patients was: "to be able to do housework" and for CLBP: "health is the most important thing for quality of life." In the factorial representation, the two pathologies were markedly separated. CONCLUSIONS: A series of characteristic answers on HRQL may be identified in patients with RA and CLBP, showing that they have different perceptions about what HRQL is according to their pathology. The use of open questions in a group of homogenous patients with specific pathologies could result in more disease-specific responses. Textual statistical analysis of open questions may provide more information than standard methods, and may be considered as valid for the analysis of subjective issues such as quality of life.

Aged↗

PubMed2003

Surgical management of localized left ventricular aneurysm associated with acute myocarditis.

We present a case of a localized left ventricular (LV) aneurysm in a 72-year-old woman with sudden onset of severe chest pain. A left ventriculogram revealed a small saccular outpouching protruding from the apex accompanied with narrow neck connection to the ventricular cavity. Both coronary arteries and global function were normal. We preoperatively diagnosed her as having an impending rupture in the congenital LV diverticulum because no inflammatory myocardial disease was suggested by general laboratory tests. After successful surgical treatment, microscopic examination for the myocardial specimens was performed and revealed diffuse lymphocytic infiltration associated with focal necrosis of myocardium. Histological findings were consistent with those of acute lymphocytic myocarditis. Without histological confirmation, an aneurysm caused by silent myocarditis might be misdiagnosed as a diverticulum.

Aged↗

PubMed1984

The influence of bias on the subjective interpretation of cardiac angiograms.

Subjective interpretation of angiographic left ventricular regional wall motion is routinely performed with knowledge of the location and extent of coronary artery stenosis. We studied 100 patients with coronary artery disease in order to determine the accuracy of such wall motion assessment relative to a more objective standard based upon computer-assisted left ventricular (LV) ejection fraction and end-systolic fractional shortening referenced to the end-diastolic area centroid. Only 379 of 700 (54%) region-by-region comparisons of wall motion were in precise agreement. Computer-assisted wall motion analysis correlated significantly better with ejection fraction than did subjective analysis (r = 0.82 vs r = 0.61, p less than 0.002). In 56 patients, in whom major discordance was noted, subjective assessment of wall motion correlated significantly better with the presence of coronary artery stenosis (p less than 0.05), but objective assessment correlated significantly better with ejection fraction in these same patients (p less than 0.02). These data suggest that the accuracy of subjective assessment of regional wall motion, relative to global ejection fraction, can be adversely biased by knowledge of the patient's coronary anatomy. Because of the inherently reproducible nature of the algorithmic process, and in light of the better correlation with global function, computer-assisted analysis of regional wall motion might be preferable to conventional subjective assessment.

Angiography↗