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PubMed1983

[Evaluation of left ventricular function in patients with atrial septal defect by exercise echocardiography].

In order to evaluate left ventricular function in atrial septal defect (ASD), 12 cases with ASD, 18 postoperative cases of ASD and 27 normal controls were examined by means of exercise echocardiography using supine bicycle ergometer (50 watts and 3 min). M-mode echocardiograms and left ventricular (LV) short-axis views by two-dimensional echocardiography were subjected to the observation. M-mode echocardiographic studies: ASD group showed an increased stroke dimension (SD) during exercise mainly due to a marked increase of left ventricular end-diastolic dimension ( LVDd ) and a slight decrease of left ventricular end-systolic dimension ( LVDs ). Postoperative ASD group showed an increased SD during exercise mainly due to a marked decrease of LVDs and a slight decrease of LVDd . On the other hand, in normal control group exercise increased SD only by a significant decrease of LVDs . Right ventricular dimension was decreased during exercise in ASD group, but did not change significantly in postoperative ASD and normal control groups. During exercise in ASD group, peak velocity of circumferential fiber shortening (VCF) was increased most markedly, and negative peak VCF was decreased most strikingly. Eight of 12 patients with ASD who showed abnormal interventricular septal motion demonstrated remarkable improvement of the motion during exercise. Two-dimensional echocardiographic studies: Left ventricular short-axis views demonstrated that the shape of the left ventricular cavity changed from flattened to more circular configuration during exercise at end- and early-diastole in ASD group. The shape of the left ventricular cavity at late-systole did not change significantly during exercise in this group. In postoperative ASD group, the left ventricular short-axis view demonstrated circular configuration of the left ventricle at end-diastole both in rest and during exercise. The shape of the left ventricular cavity did not change by exercise. It was concluded that in ASD group cardiac output is increased during exercise by decreasing a left to right shunt at the atrial level and increasing left ventricular filling rate. Therefore, the left ventricular function was found to be good in ASD.

Adolescent↗

PubMed1991

Measurement of regional left ventricular function using labelled magnetic resonance imaging.

A technique for assessing regional left ventricular function using magnetic resonance imaging is described. Spatial modulation of magnetization (SPAMM) is effected immediately before images are obtained at various intervals during the cardiac cycle using a modified field echo even rephasing technique (FEER). By performing such modulation in two planes, a grid pattern of labelling can be produced across the image. On the resulting labelled short axis images of the left ventricle, the systolic increase in thickness (thickening) and decrease in length (shortening) of different regions of myocardium can then be measured. The findings in five normal volunteers are presented. Radial shortening was twice as great in the endocardium (mean 20.4%, standard deviation (SD) 5.7) than in the epicardium (mean 10.2%, SD 5.5) and appears to offer more promise as a marker of regional function than simple thickening (mean 9.8%, SD 13.6).

Adult↗

PubMed1999

The added value of simultaneous myocardial perfusion and left ventricular function.

The focus of this review is the advantages of simultaneously assessing myocardial perfusion and left ventricular function. Nuclear cardiology imaging techniques as well as the development of technetium-labeled perfusion tracers now permit combined myocardial-perfusion and left-ventricular function studies at a single testing interval. Radionuclide angiography as well as electrocardiographic-gated images of the perfused myocardium are the two well-established techniques for that purpose with a single injection of a technetium-labeled perfusion tracer. Recent data have demonstrated the impact and clinical role of these studies, when combined, in the diagnosis as well as prognosis and risk stratification of patients with suspected or known coronary artery disease. The addition of functional information to perfusion data has shown to improve the detection of multivessel disease. Most recent data have also demonstrated the ability of these combined measurements to improve the prediction of hard events. It appears that the role of each of these tests may differ, depending on the patient population, particularly in relation to gender and type of stress test performed. Finally, a third area of potential application of these combined techniques would be in the assessment of myocardial viability using pharmacologic stress tests in combination with wall-motion analysis by gated images of the perfused myocardium.

Coronary Angiography↗

PubMed1997

Effects of calcium on left ventricular function early after cardiopulmonary bypass.

OBJECTIVES: Evaluation of the effects of intravenous CaCl2 on systolic and diastolic function early after separation from cardiopulmonary bypass (CPB) DESIGN: Prospective study SETTING: University hospital PARTICIPANTS: Twenty patients scheduled for elective coronary artery surgery INTERVENTIONS: Left ventricular (LV) pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the LV were simultaneously recorded on videotape. Measurements were obtained before the start of CPB, 10 minutes after termination of CPB, after intravenous administration of CaCl2, 5 mg/kg, and 10 minutes later. MEASUREMENTS AND MAIN RESULTS: Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relation. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relation. CaCl2 increased Ees from 2.62 +/- 0.46 to 5.58 +/- 0.61 (mean +/- SD), but induced diastolic dysfunction with an increase in Kc from 0.011 +/- 0.006 to 0.019 +/- 0.007. These changes were transient and had disappeared within 10 minutes after administration of CaCl2. CONCLUSIONS: CaCl2 early after CPB transiently improved systolic function at the expense of an increase in ventricular stiffness, suggesting temporary diastolic dysfunction.

Adult↗

PubMed1990

Sustained improvement in left ventricular function after successful coronary angioplasty.

The short and long term effects of successful percutaneous transluminal coronary angioplasty on left ventricular function, at rest and on exercise were investigated in 49 patients. Thirty-four had had no previous infarction (group 1) and 15 had (group 2). Technetium-99m gated blood pool images were obtained at rest and during exercise before, six weeks after, and a mean of fifteen months after successful angioplasty. Before angioplasty the mean (SD) ejection fraction fell significantly on exercise in both groups from 58 (10)% to 53 (13)% in group 1 and from 48 (10)% to 40 (16)% in group 2. This change was paralleled by a worsening wall motion score (from 0.6 (0.4) to 1.6 (1.2) in group 1 and from 2.3 (1.9) to 3.3 (2.4) in group 2). Six weeks after the procedure there was little change in resting ejection fraction but it increased significantly on exercise (to 62 (11)% in group 1 and to 53 (13)% in group 2). There was a concomitant significant improvement in the exercise wall motion score (to 0.4 (0.6) in group 1 and to 1.8 (1.1) in group 2). This improvement in exercise ejection fraction and wall motion was maintained at later follow up with no significant deterioration in either variable and a clearly sustained improvement in ejection fraction (60 (10)% in group 1 and 51 (10)% in group 2) and wall motion score (0.2 (0.2) in group 1 and 1.3 (0.8) in group 2) compared with values before angioplasty. The initial improvement in left ventricular function on exercise after successful angioplasty was maintained for at least 9-24 months both in patients with previous myocardial infarction and in those without.

Angioplasty, Balloon, Coronary↗

PubMed1977

Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion.

To determine the sequence of changes in segmental myocardial function, regional lactate metabolism and global left ventricular function induced by mild regional ischemia, blood flow in the left anterior descending coronary artery of 10 dogs was reduced by 10 percent decrements with use of a screw clamp. At each level of flow, segmental mechanical function and regional metabolism were assessed, the former with use of a mercury-in-Silastic length gauge and the latter with transmyocardial lactate balance measurements obtained with sampling from the anterior interventricular vein. Coronary arterial flow at the onset of regional lactate production was 48 +/- 4 percent (mean +/- standard error of the mean) of the control value. The onset of segmental mechanical dysfunction coincided with the onset of lactate production. Epicardial S-T segment abnormalities over the ischemic zone usually could not be detected until coronary flow was further reduced. After the onset of regional ischemia there was a linear correlation between coronary arterial flow and regional lactate production. At the onset of mild regional ischemia, defined as the onset of regional lactate production, no significant or directionally consistent changes were noted in standard measurements of global left ventricular performance, including heart rate, mean aortic pressure, left ventricular end-diastolic pressure, cardiac output, stroke volume, stroke work and peak positive dP/dt (maximal rate of rise of pressure). However, peak negative dP/dt (maximal rate of pressure decrease) decreased from 99 +/- 2 to 89 +/- 3 percent of the control value (P less than 0.0005) coincident with the onset of ischemia. It is hypothesized that dyssynchronous wall motion in the ischemic zone during isometric relaxation accounts for this decrease in peak negative dP/dt.

Animals↗

PubMed1985

Effect of intracoronary thrombolytic therapy on global and regional left ventricular function. A three year experience with randomization.

The effect of myocardial reperfusion on regional left ventricular function has been quantitated by analysis of segmental wall motion in 185 patients enrolled in a randomized trial comparing thrombolysis with conventional treatment in patients with acute myocardial infarction. When analyzing the hemodynamic data on an "intention to treat" basis we found a significant preservation of left ventricular function after thrombolytic therapy when compared to conventional treatment. In addition, the wall motion analysis showed that a significant improvement of regional function in the "infarct zone" was observed in inferior infarction as well as in anterior infarction, although significant changes in regional function of the remote "non infarct zone" were observed at the acute as well as at the chronic stage. However, our follow-up data indicate that as yet it has not been resolved whether this method of treatment does indeed improve prognosis in patients with acute myocardial infarction. Accordingly, we maintain the view that such invasive treatment should not be generally applied until more follow-up data become available from larger randomized trials.

Aged↗

PubMedDate not supplied

Evaluation of left ventricular function during roentgen contrast ventriculography.

Changes in the left ventricular (LV) function during direct ventriculography (contrast medium injected into LV cavity) and during intravenous left ventriculography (contrast medium injected into right atrium) were assessed in 22 normal subjects. During angiography the left ventricular pressure was continuously recorded by a microtip manometer catheter. LV images and pressure curves were analysed by a computer analysis system. The forceful intraventricular injection of contrast medium during the direct ventriculogram resulted in significant changes in the LV diastolic function, and increased LV pressure and LV working parameters. Mechanical efficiency of the LV contraction decreased. Acute volume overload of the left ventricle appears to be the main limitation of this method. To overcome this limitation, we recommend the use of intravenous biventriculography with simultaneous recording of LV pressure, instead of direct ventriculography. This modification with subsequent frame to frame analysis of the study results may be used successfully in clinical research trials.

Adult↗

PubMed1981

The influence of 1 alpha-hydroxycholecalciferol on left ventricular function in end-stage renal failure.

This study was designed to assess the influence of 1 alpha-hydroxycholecalciferol on left ventricular function in end-stage renal failure. Twelve patients, all of whom were on regular haemodialysis, were investigated. M-mode echocardiography and systolic time intervals were used to derive indices of left ventricular function. Measurements were performed before and six weeks after treatment with one microgram daily of 1 alpha-hydroxycholecalciferol. Fractional fibre shortening increased from 34.6 to 37.6% (p less than 0.025) and mean velocity of fibre shortening increased from 1.21 to 1.32 circ/sec (p less than 0.01). These changes were associated with a fall in the mean plasma parathyroid hormone concentration from 1883 to 1123ng/L (p less than 0.0025) and a rise in magnesium concentration from 0.89 to 1.06 mmol/L (p less than 0.0025); plasma calcium increased from 2.59 to 2.70mmol/L but this change was not significant. Our results indicate that 1 alpha-hydroxycholecalciferol improves left ventricular function in end-stage renal failure by influencing both the turnover or secretion of parathyroid hormone and the metabolism of calcium and magnesium ions.

Adult↗

PubMed1986

[Influence of aorto-coronary bypass surgery on left ventricular function and prognosis in patients with severe left coronary artery disease].

The effects of aorto-coronary bypass surgery on left ventricular (LV) function and prognosis were studied in 21 patients with severe left coronary artery disease consisted of 8 left main trunk (LMT) stenosis and 17 left main equivalent (LME) that is the combined disease of left anterior descending (LAD) and left circumflex coronary arteries proximal to the origin of their major branches. One of 21 cases had bypass grafts occluded on the postoperative angiogram. The other 20 cases consisted of 10 cases with previous transmural myocardial infarction (PTMI) and 10 without PTMI had all bypass grafts opened including 20 grafts to LAD. In 10 cases without PTMI, all of LV function parameters markedly improved postoperatively. In the other 10 cases with PTMI, LV ejection fraction significantly increased from 0.53 +/- 0.07 preoperatively to 0.67 +/- 0.04 postoperatively (p less than 0.005). PLVSP/LVESV also increased from 1.85 +/- 0.66 to 2.89 +/- 1.16 (p less than 0.05). In both groups, LV segmental wall motion (SWM) increased in the anterior and apical segment, whereas did not in the postero-inferior segment. In the case with occluded grafts LV function was deteriorated postoperatively. Even in the cases which anterior SWM showed less than 30% (the lowest value in the normal subjects), anterior and apical SWM significantly increased postoperatively in both groups. Angina disappeared postoperatively in all cases but one with PTMI. All cases showed NYHA class III to IV preoperatively, then class I to II postoperatively. Postoperative 8 years actuarial survival rate was 91.0%.

Adult↗

PubMed1985

Effect of nitroglycerin on left ventricular function in patients with ischemic heart disease.

To evaluate the effects of nitroglycerin on left ventricular function in 27 patients with ischemic heart disease, ejection fraction (EF) was measured every 1 to 5 min by a nuclear stethoscope after sublingual administration of nitroglycerin (0.3 mg). There was a good correlation between EF determined by the nuclear stethoscope and EF by left ventriculography (r = 0.80, p less than 0.001). EF showed a rise after sublingual nitroglycerin, which was most marked at 4 to 7 min and returned to the control level in 20 to 25 min. There were no significant differences in the maximum percent increase in EF among patients with 0, 1, 2 and 3 vessel disease. The maximum percent increases in EF were 34.0 +/- 10.0% in the normal contraction group, 24.0 +/- 8.5% in the hypokinesis group (p less than 0.05 vs the normal contraction group) and 15.2 +/- 8.5% in the akinesis group (p less than 0.01 vs the normal contraction group, p less than 0.05 vs the hypokinesis group). There was a weak correlation between the maximum percent increase in EF and the changes in heart rate (r = 0.49, p less than 0.05) and there was an inverse correlation between the maximum percent increase in EF and the changes in systolic blood pressure (r = -0.65, p less than 0.01). It was shown that the improvement in EF by sublingual nitroglycerin was greatest in the normal contraction group, somewhat less in the hypokinesis group and least in the akinesis group. The nuclear stethoscope is useful in monitoring changes in left ventricular function during intervention.

Adult↗

PubMed1982

[Amyl nitrite test in the evaluation of left ventricular function: application to ischemic heart disease and Duchenne's progressive muscular dystrophy].

The effect of amyl nitrite (AN) inhalation on the left ventricular function was evaluated by mechanocardiography and echocardiography. The patient's group consisted of 110 cases with ischemic heart disease (IHD) and 25 cases of dystrophia musculorum progressiva (DMP) of Duchenne type. The former was a representative of impairment of blood supply and myocardial involvement, and the latter was of predominant myocardial disease. The control was age-matched 32 normals for IHD group and 17 cases for DMP group. Left ventricular function was mainly evaluated by systolic time intervals (STI) and the echocardiographic correlates. Fifty-five cases of IHD group were tested by coronary angiography and left ventriculography and these data were compared with the noninvasive measures. The results were as follows: I. IHD group: The ratio of ejection time (ET) to pre-ejection period (PEP), ET/PEP, did not change so much as in controls after AN inhalation, and this percent change was much smaller in cases with lesions of the left anterior descending artery (LAD) than in cases with lesions of the right coronary artery (RCA). On the other hand, mean posterior wall velocity (mPWV) and posterior wall excursion (PWE) changed greater in patients with LAD lesion than in those with RCA lesion. In cases with LAD stenosis, percent change in ET/PEP was smaller in cases with asynergy than in cases without it, disclosing more significant impairment of the left ventricle in the former. II. DMP group: In severe cases, ET/PEP was small even at rest, and percent change by AN inhalation was smaller than control in mild cases and smallest in severe cases. This seems to be useful in evaluating the severity of the diseased process. The mPWV and PWE showed impairment of left ventricular motion even at rest, but it was clearly showed in severe cases after AN inhalation. These results indicate that impairment of left ventricular function induces the poor response to AN inhalation and this, in turn, results in the lack of hyperactivity of the heart produced by this drug.

Adolescent↗

PubMed1996

Changes in calcium transient and left ventricular function during positive inotropic stimulation and myocardial ischemia in indo-1-loaded beating guinea pig heart.

To elucidate the issues such as excitation-contraction coupling and myocardial ischemia, it is necessary to measure intracellular free Ca2+ concentration and mechanical function of hearts perfused via the normal arterial circulation. For this purpose, we simultaneously measured Ca(2+)-dependent indo-1 fluorescence and left ventricular (LV) pressure on a beat-to-beat basis in Langendorff guinea-pig hearts, and investigated the changes in Ca2+ transient and LV function during inotropic stimulation and myocardial ischemia. The indo-1 fluoresence ratio and LV developed pressure increased the perfusate [Ca2+] increased from 1.6 to 3.2 mmol/L, and there was a good correlation between Ca2+ transient and LV contractility. Digoxin (10(-6) mol/L) and milrinone (10(-5) mol/L) increased LV contractility with a concomitant increase in Ca2+ transient, and the relative increase of Ca2+ transient produced by milrinone was much more than that by digoxin. The reduction of coronary perfusion pressure from 80 to 40 mm Hg decreased LV contractility with an increase in indo-1 fluorescence ratio. These results suggest that Ca2+ responsiveness of contractile apparatus declines during inotropic stimulation by milrinone and during myocardial ischemia. Thus, this experimental technique is useful to investigate the interrelation of Ca2- regulation and LV function during a variety of pharmacological and physiologic perturbations.

Animals↗

PubMed1990

[Effects of nicardipine on hemodynamic variables and on left ventricular function in hypertensive subjects].

The study aimed to assess the effects of nicardipine on the function and hemodynamic model of the left ventricle in 14 patients affected by slight to medium primary hypertension (8 male, 6 female, mean age 53 years) using M-B mode echocardiographic techniques. Results showed that the pretreatment performance of the left ventricle was excellent owing to the use of a good pre-load reserve in view of the marked parietal stress induced by high blood pressure. Following nicardipine, blood pressure fell significantly; the contractility indices remained increased, not only due to the reduction of parietal pressure and peripheral resistances, but also due to the apparently paradoxical increase in adrenergic activity induced by the drug as the result of the inhibition of the slow recurrent (L) and the stimulation of the same current due to reflex cathecolamines.

Adult↗

PubMed1992

[Myocardial infarct size and left ventricular function in diabetic patients].

We determined the relationship between myocardial infarct size (MIS) estimated by electrocardiographic measurements of infarct size (QRS score) and left ventricular function estimated by angiographically left ventricular ejection fraction (EF). MIS estimated by QRS score were the same in both DM and NDM (5.2 +/- 0.5 vs 4.3 +/- 0.4: p greater than 0.05), but EF in DM was significantly lower than in NDM (43.1 +/- 1.4 vs 51. +/- 1.1%: p less than 0.05). There was clear linear correlation between MIS and EF in NDM (r = -0.71) but not in DM. EF was much lower in DM than in NDM even at the same QRS score level. There were no differences in blood pressure, serum lipid levels, age, and the site of the myocardial infarction. The most likely explanation for this appears to be due to a previous left ventricular disease in DM.

Aged↗

PubMed1996

Effects of intracoronary carbon dioxide on left ventricular function in swine.

BACKGROUND AND HYPOTHESIS: Carbon dioxide is currently used as an arterial and venous contrast agent; however, little is known of its effects on left ventricular function. This study was undertaken to investigate those effects. METHODS: Ascending doses of 5, 10, and 20 ml of carbon dioxide were administered into the left main coronary artery of domestic swine with and without a continuous infusion of intravenous nitroglycerin (50 micrograms/min). RESULTS: Carbon dioxide had an immediate and profound depressant effect on both systolic and diastolic left ventricular function associated with ischemic electrocardiographic changes. Compared with controls (% change), ascending doses of carbon dioxide decreased systolic pressure by -35 +/- 7, -48 +/- 8, and -53 +/- 4 in the absence of nitroglycerin, and by -32 +/- 9, -50 +/- 9, and -60 +/- 9 in the presence of nitroglycerin. Peak+dP/dt decreased by -54 +/- 7, -61 +/- 11, and -64 +/- 3 in the absence of nitroglycerin, and by -36 +/- 13, -55 +/- 11, and -65 +/- 11 in the presence of nitroglycerin. Minimum -dP/dt increased by 65 +/- 8,71 +/- 8, and 77 +/- 3 in the absence of nitroglycerin, and by 63 +/- 7,71 +/- 8, and 78 +/- 7 in the presence of nitroglycerin. No significant changes in heart rate were observed; however, widespread ST-segment elevation was observed in all animals. Coronary angiography following carbon dioxide injection revealed a marked decrease in coronary flow velocity until the gas was cleared from the microcirculation. This was also documented by direct measurement of flow velocity using a Doppler catheter in an additional animal. Left ventriculography demonstrated immediate global dilation and depression of systolic function. CONCLUSIONS: In the swine model, relatively small doses of intracoronary carbon dioxide cause profound yet reversible global left ventricular dysfunction which appears to be ischemic in origin.

Animals↗

PubMed1986

Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction.

The effect of early myocardial reperfusion (within 4 hours after onset of symptoms) on regional left ventricular function in patients with acute myocardial infarction has been quantitated by analysis of segmental wall motion. Of 533 patients randomized either to conventional coronary care unit therapy or to a reperfusion strategy, in 332 high quality angiograms were obtained 2 to 8 weeks after the onset of myocardial infarction. In those assigned to thrombolytic therapy, angiographic data were also available after acute reperfusion. Analysis on an "intention to treat" basis revealed significant preservation of left ventricular function after thrombolytic therapy (ejection fraction 53%) compared with conventional treatment (ejection fraction 47%). In addition, wall motion analysis showed significant improvement of regional function in the infarct zone in both inferior and anterior infarction. In addition, significant changes occurred in regional function of the remote "noninfarct zone" in the acute as well as the chronic stage. It is concluded that improved regional and global left ventricular function can be achieved with early reperfusion and that this is the likely explanation for the reduction of early and late mortality after thrombolysis observed in this study.

Aged↗

PubMed1992

[The treatment of patients with ischemic heart disease and significant disorder of left ventricular function].

A study is presented of 71 patients with ischemic heart disease verified coronarographically and showing severe disorders of contractile function of the left ventricle. Thirty-eight patients who underwent the operation of aortocoronary shunting showed an improvement of the contractile capacity of the myocardium, and a longer survival as compared with those treated medically. Medical treatment was accompanied by more complications in the form of myocardial infarctions, cardiac insufficiency resulting often in a lethal outcome.

Coronary Artery Bypass↗