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PubMedDate not supplied

[Assessing the informative value of positron emission tomography with the new radiopharmaceutical Sodium 11C-butyrate versus small-dose dobutamine stress echocardiography in the diagnosis of myocardial viability in patients with coronary heart disease and left ventricular dysfunction].

Myocardial viability in patients with coronary artery disease and heart failure was assessed by echocardiography with low doses of dobutamine and positron emission tomography with Sodium 11C-butyrate. Sensitivity and specificity of those methods were compared. Positron emission tomography and Sodium 11C-butyrate had quite high sensitivity and specificity, which could be compared with positron emission tomography and fluorine-18-deoxyglucose. Echocardiography with low doses of dobutamine had high specificity and its sensitivity was lower that one of positron emission tomography and Sodium 11C-butyrate. Thus, it is necessary to use the protocol of stress dobutamine echocardiography with high doses to avoid this problem.

Adult↗
PubMedDate not supplied

[Myocardial revascularization in patients with ischemic heart disease and left ventricular dysfunction].

BACKGROUND: Operative morbidity and mortality in coronary artery bypass surgery has decreased over the last decades and coronary artery bypass surgery offers an increase in long-term survival in selected patients with lower ejection fraction. We do not know exactly the results of the surgery and evolution of our patients with chronic lower ejection fraction. OBJECTIVE: To evaluate clinical results of myocardial revascularization in patients with ischemic heart disease and chronic lower ejection fraction. MATERIAL AND METHODS: We analyzed the experience between January 2000 and December 2001 of patients with ejection fraction = 30% treated with surgical myocardial revascularization. The procedure was carried out with cardiopulmonary bypass and moderate hypothermia (30 degrees C), and myocardial protection with intermittent cold crystalloid cardioplegia. We evaluated demographic characteristics, surgical procedure carried out, length-of-stay in intensive postoperative care unit, and morbidity and mortality in perioperative period and in middle term follow-up. RESULTS: During this period, 738 patients were treated with aorto-coronary bypass surgery Thirty eight patients were patients with chronic lower ejection fraction (5.14%) and were included in this evaluation. Six patients were female (15.78%), and 32 males (84.21%). Range of duration of cardiopulmonary bypass was 65-245 min (mean, 123 min), range of aortic cross-clamping time was 30-120 min (mean, 59 min). Twelve month follow-up showed improvement in two functional classes in 15 patients (39.4%), and improvement in one functional class in 10 patients (26.3%); two patients remained in the same functional class (5.2%), and one patient decreased his/her functional class (2.6%). Mean of length-of-stay in intensive care unit was 6.5 days and in hospital, 12.5 days. Perioperative morbility was 34.2% and same-period mortality was 26%; 12 month survival was 74%. It was concluded that even with high mortality as in other series, survival and quality of life of these patients is better with than medical therapy.

Aged↗
PubMed2003

[Value of Doppler indices of diastolic left ventricular dysfunction in acute cardiac insufficiency].

OBJECTIVE: To examine the prevalence of diastolic dysfunction by Doppler study in acute cardiac failure. CONTEXT: A recent study showed that diastolic dysfunction is constant in stable cardiac failure with preserved systolic function and suggested that its measurement was not necessary for the diagnosis of diastolic cardiac failure, but the prevalence of diastolic dysfunction in acute cardiac failure is not known. METHOD: The mitral and pulmonary venous profiles, the propagation velocity Vp of colour filling flow, and the lateral velocity Ea of the mitral ring in DTI were studied at the time of treatment initiation in 28 patients in sinus rhythm and in acute cardiac failure (11 NYHA IV and 17 with pulmonary oedema), of whom 18 had an ejection fraction greater than 50%. RESULTS: Diastolic dysfunction was present in the combined study of mitral and pulmonary profiles in 95% and 100% respectively of patients in cardiac failure with preserved systolic function and altered systolic function, and Vp < 45 and/or Ea < 8 cm/s was observed in 55% and 100% respectively of these patients. At respective pathological threshold values of 1.5 and 10, the combined indices E/Vp and E/Ea were concordant with the evaluation of filling pressures in 83% of patients with preserved systolic function and 100% of the systolic cardiac failure cases. CONCLUSION: Diastolic dysfunction is almost constant in acute cardiac failure independently of the ejection fraction value. However, normal values of Ea and Vp do not exclude the diagnosis of diastolic cardiac insufficiency in the acute situation.

Acute Disease↗
PubMed2004

[Systolic and diastolic left ventricular dysfunction--independent types of cardiac failure or two sides of a single process?].

At present disturbances of systolic and diastolic myocardial function are subjected to intensive study. Most researches acknowledge possibility of development of diastolic dysfunction in the absence of systolic dysfunction. Meanwhile disturbances of systolic and diastolic myocardial functions have common pathogenetic and pathomorphological basis representing the essence of cardiac remodeling. Patients with instrumental signs of pure diastolic dysfunction and subjects with combination of disturbances of systolic and diastolic functions have similar clinical symptoms. This literature review deals with problems of relationship between systolic and diastolic dysfunction and expediency of clear delineation of these disturbances.

Diastole↗
PubMed2004

[Ischemic heart disease and left ventricular dysfunction: the role of trimetazidine].

In patients with ischemic heart disease, contractility of dysfunctional myocardium may improve through metabolic modulation. Trimetazidine is the first of a new class of cytoprotective agents with antianginal properties. There is recent evidence that trimetazidine reduces fatty acid beta-oxidation and stimulates glucose oxidation by selective inhibition of 3-ketoacyl coenzyme A thiolase. In experimentally-induced myocardial ischemia, trimetazidine increases glucose oxidation by 210%, and this effect is associated with a 37% increase of pyruvate dehydrogenase. The increased rate of glucose oxidation reduces hydrogen ions and lactate accumulation, translating into improved myocardial contractility. In a recent randomized longitudinal placebo-controlled study in humans with ischemic cardiomyopathy, trimetazidine improved the contractile response of dysfunctional myocardium at doses of 20 mg tid for 8 weeks. This effect was associated with enhanced functional capacity and a higher ischemic threshold. The lack of effects on heart rate and blood pressure offers potential advantage in conditions of bradycardia and arterial hypotension. These important benefits need to be confirmed in larger longitudinal trials.

Clinical Trials as Topic↗