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Results for “Ventricular Function, Left”

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PubMed2001

Predictors of improvement in left ventricular function after percutaneous revascularization of occluded coronary arteries: a report from the Total Occlusion Study of Canada (TOSCA).

BACKGROUND: The Total Occlusion Study of Canada (TOSCA) is a multicenter, randomized trial evaluating the effect of stenting with > =1 heparin-coated stent on long-term patency after percutaneous coronary intervention by balloon angioplasty of occluded coronary arteries. The purpose of the current study was to compare the effect of stenting and balloon angioplasty on global left ventricular ejection fraction (LVEF) and regional wall motion and to examine what clinical and angiographic factors may have an effect on left ventricular function in this setting. METHODS AND RESULTS: Analysis at the core angiographic laboratory of paired baseline and follow-up left ventricular angiograms, as well as target vessel patency, was possible in 244 of 410 cases. An improvement in LVEF was observed in the entire group (59.4% +/- 11% to 61.0% +/- 11%, P =.003). The LVEF change was +1.84 +/- 7.54 in the stent group (P =.009) and 1.28 +/- 8.16 in the percutaneous transluminal coronary angioplasty group (P =.085). There was no significant intergroup difference. Patients with duration of occlusion < or =6 weeks had an improvement in LVEF (+2.98 +/- 8.68, P =.0006), whereas those with an occlusion duration of > 6 weeks had no improvement (+0.48 +/- 7.01, P not significant). Multivariate analysis revealed baseline LVEF <60%, duration of occlusion < or =6 weeks, and Canadian Cardiology Society angina class I or II to be independent predictors of improvement in LVEF. CONCLUSIONS: The restoration of coronary patency of nonacute occluded coronary arteries is associated with a small but significant improvement in regional and global left ventricular function, especially in patients with recent occlusions and depressed left ventricular function. In spite of significant effect on long-term patency, stenting of nonacute coronary occlusions does not result in significantly better left ventricular function compared with balloon angioplasty in this setting.

Angioplasty, Balloon, Coronary↗

PubMed1990

[Left ventricular function in young type I diabetic patients. A Doppler echocardiography study].

Systolic and diastolic left ventricular function was assessed by M-mode and pulsed Doppler echocardiography in 10 young type I diabetic patients without late complications and maximal diabetes duration of 5 years and in 10 healthy persons. Fractional shortening, a measure of systolic ventricular function, was significantly lower in diabetics than in controls (33.9 +/- 2.9 vs. 37.9 +/- 4.9; p less than 0.05). Fractional shortening decreased significantly with advancing diabetes duration (R = -0.819; p less than 0.01). Indexes of diastolic ventricular function (isovolumetric relaxation period and transmitral flow velocity pattern) were not significantly different in the two groups, but 3 patients had 1 parameter (3x isovolumetric relaxation period) and another patient had 2 parameters (isovolumetric relaxation period and early diastolic peak velocity E-E') outside the normal range. Follow-up studies should define the clinical significance of these alterations of systolic and diastolic left ventricular function.

Adolescent↗

PubMed2000

Low-dose dobutamine radionuclide ventriculography for prediction of myocardial viability: quantitative analysis of regional left ventricular function.

BACKGROUND: It is important to distinguish viable myocardium from necrotic tissue in order to decide upon therapy in patients with ischemic heart disease. HYPOTHESIS: We verified the hypothesis that quantitative analysis of regional left ventricular function using low-dose dobutamine radionuclide ventriculography (RNV) can sensitively predict myocardial viability and compared its usefulness with thallium-201 (201Tl) single-photon emission computed tomography (201Tl-SPECT). METHODS: Radionuclide ventriculography at rest and during low-dose dobutamine infusion (5 micrograms/kg/min), 201Tl-SPECT, and coronary angiography were performed in 51 subjects with severe ischemia-related stenosis of coronary arteries and 3 subjects without coronary artery disease. 201Tl uptake was assessed as normal (control), low perfusion (LP), or defect. We compared the response of regional function to dobutamine with the regional 201Tl uptake. The accuracy of both methods for identifying viable myocardium was investigated in 17 patients who underwent successful coronary revascularization, with a resulting improvement in wall motion. RESULTS: The increase in regional ejection fraction (delta r-EF) in response to dobutamine was significantly greater in the control (12 +/- 6%) and LP (16 +/- 11%) regions than in the defect (5 +/- 10%) regions. The increase in one-third regional ejection fraction (delta r-1/3EF) was also significantly higher in the control (14 +/- 7%) and LP (10 +/- 8%) regions than in the defect regions (5 +/- 6%). We defined myocardial viability as a delta r-EF > 5% or a delta r-1/3EF > 2%. The sensitivity and specificity of the delta r-EF for identification of myocardial viability were 91.4 and 55.5%, respectively. The sensitivity and specificity of the delta r-1/3EF were 91.4 and 66.6%, respectively; the corresponding values for 201Tl SPECT were 74.2 and 77.8%. CONCLUSION: Low-dose dobutamine RNV with quantitative analysis of regional left ventricular function was more sensitive for identification of viable myocardium than 201Tl-SPECT.

Aged↗

PubMed1983

Left ventricular function in peripartum cardiomyopathy.

Although many cases of peripartum cardiomyopathy have been reported in the literature, detailed data from left heart catheterization and contrast ventriculography are unavailable. A patient with peripartum cardiomyopathy had catheterization performed to clarify the diagnosis. Hemodynamics at rest and with exercise, angiographic volumes, and indices of left ventricular function are presented. The data indicate no serious abnormality of global systolic left ventricular function in this patient although a segmental wall motion abnormality was noted. Volume overload or diminished diastolic compliance may explain the symptoms of heart failure in some patients with this disease.

Adult↗

PubMed2002

Ventricular reconstruction results in improved left ventricular function and amelioration of mitral insufficiency.

INTRODUCTION: Surgical restoration of the left ventricular wall (Dor procedure) has been advocated as a therapy for left ventricular dysfunction due to ischemic cardiomyopathy. This procedure involves placement of an endoventricular patch through a ventriculotomy. METHODS: We reviewed our series of patients that underwent the Dor procedure within the past 4 years and examined their pre and postoperative ventricular function and mitral valve function. Pre and postoperative ejection fraction and degree of mitral regurgitation were analyzed using the paired Student t-test. We hypothesized that this procedure would result in improved ventricular function and that it would also help improve mitral valve function. RESULTS: Thirty-four patients underwent this procedure, with one death. Of these, 30 patients underwent concomitant coronary artery bypass grafting and 8 patients had mitral intervention (seven had an Alfieri repair of the mitral valve, and one had mitral valve annuloplasty). The average preoperative ejection fraction among these patients was 26.8% (range 10-45%). The postoperative ejection fraction was significantly higher at 35.4% (range 25-52%) (P <.001). We noted an improvement in ejection fraction in 27 patients (82%). We also noted that 21 of 33 patients (64%) had improvement in the degree of mitral regurgitation based on echocardiography data (P <.001). CONCLUSIONS: We conclude that the Dor procedure results in improvement in the left ventricular function. Furthermore, we also note that this procedure ameliorates mitral regurgitation in a majority of these patients even in the absence of associated mitral valve procedures, probably due to reduction in the size of the ventricle and improved orientation of the papillary muscles.

Cardiac Surgical Procedures↗

PubMed1993

Left ventricular function assessed with echocardiography and myocardial perfusion assessed with scintigraphy under dipyridamole stress in pediatric patients after repair for anomalous origin of the left coronary artery from the pulmonary artery.

Twenty-three patients who underwent operation for anomalous origin of the left coronary artery from the pulmonary artery were reexamined with two-dimensional echocardiography and thallium 201 perfusion imaging. Follow-up studies were performed 0.6 to 16.2 years (median 2.9 years) after operation. In 22 of 23 patients, a two coronary artery system had been established by implantation of the left coronary artery into the aorta (n = 8) or by anastomosis of the left subclavian artery with the left coronary artery (n = 14). The left coronary artery had been ligated in only one patient. For stress testing, 0.8 mg dipyridamole per kilogram body weight was infused in a 10-minute period in 20 of the 23 patients. High-dose dipyridamole infusion increased mean heart rate (98.1 +/- 27.1 to 122.3 +/- 19.2 beats/min, p < 0.001) and mean left ventricular ejection fraction (54.8% +/- 11.8% to 61.3% +/- 12.5%, p < 0.05) and decreased left ventricular end-diastolic volume index (38.8 +/- 26.7 to 29.9 +/- 8.3 ml/m2, p < 0.005). At rest, left ventricular dimensions were abnormal in only one patient, in whom the anastomosis with the left coronary artery proved to be occluded, as seen with subsequent angiography. Left ventricular function seen with two-dimensional echocardiography was normal in 19 patients and was compromised in 3 (all of whom had major structural anomalies of the left ventricle, such as left ventricular aneurysm, occlusion of the anastomosis, or mitral valve prosthesis). Patients with R-wave loss as seen with preoperative electrocardiography tended to have larger left ventricular volumes at follow-up (69.2 +/- 56.5 ml/m2 versus 32.4 +/- 9.6 ml/m2, p < 0.07). Ten of 20 patients had normal thallium 201-perfusion scans. In 9 of 20 patients defects revealed by permanent thallium 201-perfusion were observed and determined to be myocardial scars. Transient perfusion defects under dipyridamole stress with redistribution at rest occurred in three children, two of whom also had permanent thallium 201 defects. None of the three patients had angina-like symptoms or S-T segment changes during dipyridamole stress. Left ventricular ejection fraction, however, decreased severely during dipyridamole infusion in the single patient with ligature of the left coronary artery. The two remaining patients had normal echocardiographic left ventricular function under stress, and the diagnosis of myocardial ischemia as seen with scintigraphy must be questioned.(ABSTRACT TRUNCATED AT 400 WORDS)

Child, Preschool↗

PubMed2000

[Recovery of left ventricular function after mitral valve replacement for chronic mitral regurgitation: optimal timing of operation according to long-term recovery].

OBJECTIVES: Surgical outcome for mitral regurgitation has significantly improved in recent years, so consideration of the optimal operative timing to achieve long-term quality of life for the patients has become more important. Preoperative indices that predict postoperative left ventricular function are very important for decision of the operative timing. To reassess the optimal operative timing for mitral regurgitation, long-term recovery of the postoperative left ventricular function was correlated with preoperative left ventricular end-systolic volume index(LVESVI). METHODS: One hundred eighty-two patients with mitral regurgitation underwent standard mitral valve replacement between January 1973 and June 1993. The patients were divided into 3 groups according to the preoperative LVESVI: Group I (LVESVI > or = 100 ml/m2) included 23 patients, Group II (60 < or = LVESVI < 100 ml/m2) 81 patients and Group III (LVESVI < 60 ml/m2) 78 patients. Two-dimensional echocardiography was performed to measure left ventricular diastolic dimension, systolic dimension, fractional shortening, end-systolic wall stress and mass index before operation(pre), and 1 month(early) and 3 years(late) after the operation. RESULTS: Left ventricular diastolic dimension in each group decreased in the early period, but Group I returned to the abnormal range in the late period. Left ventricular systolic dimension in Groups I and II was at the upper limit of the normal range in the early period and returned to the abnormal range in the late period, but Group III remained within the normal range throughout the study. Fractional shortening in all groups decreased to the abnormal range in the early period, but only Group III returned to the normal range in the late period. End-systolic wall stress in Group I tended to increase, but Group II had no change, and Group III returned to the normal range during the early and late periods. Mass index in Groups I and II remained within the abnormal range, but Group III returned to the normal range in the late period. CONCLUSIONS: Long-term recovery of the left ventricular function in Group I showed a continuous deterioration due to irreversible change of the left ventricular myocardium and Group II showed no significant change. In contrast, Group III demonstrated a significant improvement after standard mitral valve replacement. Patients with preoperative LVESVI of more than 100 ml/m2 have already lost the optimal timing for surgical treatment of mitral regurgitation.

Chronic Disease↗

PubMed1994

Obesity, pregnancy, and left ventricular functioning during the third trimester.

OBJECTIVE: Our purpose was to determine left ventricular size and function in obese pregnant patients during the third trimester. STUDY DESIGN: Eight morbidly obese pregnant patients had M-mode echocardiography. None were hypertensive or diabetic at the time of study. A group of 36 normal patients were used as controls. RESULTS: Left ventricular end-diastolic dimension, fractional shortening, and cardiac index were not significantly different between the two groups. Left atrial size, left ventricular wall thickness, interventricular septal thickness, and left ventricular mass were greater in the obese group. The radius-to-wall thickness ratio was significantly smaller in the obese group. CONCLUSIONS: (1) Left ventricular dimension and function in obese patients was similar to that of nonobese patients. (2) The left ventricle was found to be significantly hypertrophied in obese patients. Left ventricular reconfiguration appears to be important in preserving left ventricular function. Whether these changes are specific to pregnancy or secondary to maternal obesity remains to be determined.

Adult↗

PubMed1975

Ventricular arrhythmias in the late hospital phase of acute myocardial infarction. Relation to left ventricular function detected by gated cardiac blood pool scanning.

Abnormalities of left ventricular function and extent of myocardial infarction were studied in relation to prevalence of late ventricular premature contractions (VPCs) in 36 patients in the convalescent stage of acute myocardial infarction (MI). Left ventricular ejection fraction (EF) and percent akinesis (%A) were calculated from gated cardiac blood pool scans; myocardial infarct size was estimated from peak CPK values; and VPCs were detected by 24 hour ambulatory ECGs 2-4 weeks following hospitalization for acute MI. Twenty-two patients had either zero (class 0) or less than 30/hour unifocal VPCs (class I). Fourteen patients had greater than 30/hour unifocal (class II), multifocal (class III) or coupled VPCs (class IV), including ventricular tachycardia. Thirteen of 14 class II-IV patients had EF less than 40% compared with only 8 of 22 class 0-I patients. Class II-IV patients had significantly lower mean EF (30.5 +/- 2.3 SE to 49.6 +/- 4.0) P less than 0.01, higher mean %A (28.1 +/- 2.2 to 16.9 +/- 3.7) P less than 0.05, and higher mean peak CPK (1350 +/- 187 to 721 +/- 155) P less than 0.05 than class 0-I patients. These data suggest that VPCs may not be an independent risk factor for sudden cardiac death in the convalescent phase of MI.

Acute Disease↗

PubMed2004

Tissue doppler imaging predicts recovery of left ventricular function after recanalization of an occluded coronary artery.

OBJECTIVES: We tested the hypothesis that the tissue Doppler imaging (TDI)-derived positive preejection velocity (+VIC) can predict the recovery of contractile function after revascularization in patients with a recent myocardial infarction. BACKGROUND: In experimental studies, the presence and extent of TDI-derived +VIC correlated with the extent of viable myocardium. METHODS: Forty-three patients with a large myocardial infarction and an occluded left anterior descending (n = 38) or dominant right coronary (n = 5) artery were selected. The median duration of occlusion was 24 h. Longitudinal myocardial velocities were recorded at rest by pulsed-wave TDI echocardiography 6 +/- 2 h after revascularization. Functional recovery was defined as an increase in segmental chordal shortening > or =10% at three-month follow-up left ventricular angiogram as compared with baseline. RESULTS: A good quality TDI signal was obtained in 309 of 324 analyzed segments (95.4%). Severe dysfunction was present in 198 segments of which 126 (64%) showed recovery at three-month follow-up. Sampling of all dysfunctional segments lasted 11 +/- 4 min per patient. Sensitivity, specificity, and accuracy of the +VIC to predict segmental recovery were 91%, 71%, and 84%, respectively. The percentage of segments that were dysfunctional at angiography but showed a +VIC correlated with improvement of both global left ventricular ejection fraction (r = 0.60, p = 0.001) and wall motion score index (r = -0.78, p < 0.0001) at follow-up. CONCLUSIONS: Assessment of +VIC by pulsed-wave TDI is a simple and accurate method that predicts recovery of contractile function after revascularization in patients with a recent myocardial infarction.

Angioplasty, Balloon, Coronary↗

PubMed1979

The effect of propranolol on left ventricular function at rest and during exercise in patients with ischemic heart disease.

Twelve patients with ischemic heart disease were investigated by right and left heart catheterisation. All patients were studied at rest and during exercise, both before and after administration of beta-blocker propranolol, Inderal (ICI). Left ventricular function decreased after administration of propranolol, but these changes were significant only during exercise. Contractility was depressed after administration of propranolol already at rest. On the other hand, left ventricular filling pressure decreased after administration of propranolol. Our results show the poor reliability of the evaluation of the left ventricular function based solely on the left ventricular filling pressure.

Aged↗

PubMed1991

[Results of surgery in mitral valve insufficiency with impaired left ventricular function].

This cooperative study (8 French Cardiology Departments) was undertaken to determine the postoperative outcome of patients with pure, chronic, non-ischemic mitral regurgitation and poor left ventricular function (ejection fraction less than 50%). Seventy-three patients, 48 males and 25 females with a mean age of 55.5 +/- 12.1 years were included. Fifty-eight patients were in Class III or IV of the NYHA Classification. The average cardiothoracic ratio was 0.59 +/- 0.07. Forty-six patients were in atrial fibrillation. The average ejection fraction was 43 +/- 5 per cent (end systolic volume: 97.8 +/- 37.9 ml/m2; end diastolic volume: 175.2 +/- 67.6 ml/m2). Sixty-one patients underwent prosthetic mitral valve replacement and 12 had a Carpentier valvuloplasty. Two patients died after the operation and 20 died during follow-up (average 48.1 +/- 27.6 months), giving a 5 year actuarial survival rate of 69.6 per cent. In the long-term, fifteen per cent of patients were in NYHA Class III or IV. A multivariate Cox analysis showed that the only predictive factors of a poor outcome were age and female sex. These results of surgery for mitral regurgitation with moderate to severely altered left ventricular function were relatively good, but this study does not allow evaluation of the evolution of patients with mitral regurgitation and very poor left ventricular function (no patients with ejection fraction less than 25%).

Actuarial Analysis↗

PubMed1980

Effect of myocardial revascularization on the left ventricular function. Diagnosis of reversible contraction abnormalities.

Function of the left ventricle was evaluated in 28 men during the early postoperative period after myocardial revascularization by left ventricular cineangiograms. The group was characterized by patency of all aorto-coronary grafts and the absence of a new Q waves on the ECG. Improvement of the global left ventricular function occurred in a sub-group of patients with reduced ejection fraction before operation as well as in patients with segmental disturbances of left ventricular contraction. The segmental contractions improved significantly in the revascularized areas where prior to operation the function was impaired. The postoperative change was in some patients predicted before operation by administration of sublingual nitroglycerin and by means of postextrasystolic potentiation. We found the same trend of changes produced by the above stimuli and by revascularization.

Adult↗

PubMed1981

Left ventricular end-diastolic pressure in evaluating left ventricular function.

There are several factors that could affect the left ventricular end-diastolic pressure. These include heart rate, preload, afterload, pericardial or pleural pressure, diastolic properties of the ventricle, and the left ventricular inotropic state. Recognition of these factors appears important when considering the left ventricular end-diastolic pressure as an index of left ventricular function.

Blood Pressure↗

PubMed1996

Load-independent left ventricular function in a hemorrhagic shock model.

Load-independent left ventricular (LV) function has been recently shown to be reversibly depressed in septic shock. The peak systolic pressure to end systolic volume ratio (PSP/ESV) is a load independent measure of LV function. We evaluated PSP/ESV in a porcine model of hemorrhagic shock. Hemorrhagic shock was induced in five adult swine by arterial bleeding to a mean arterial pressure of 45-65 mmHg. This hypotension was maintained for 30 min, and then each animal was resuscitated to baseline mean arterial pressure using shed blood and crystalloid solution. Data (echocardiographically derived ejection fraction and oxygen transport parameters) were collected at baseline, after 30 min of hypotension and postresuscitation. Although the cardiac index, a marker for systolic function, and the mean arterial pressure, as well as oxygen delivery and consumption returned to baseline levels, the PSP/ESV ratio remained low despite adequate fluid resuscitation. This model provides a reproducible hemodynamically stable cardiac dysfunction associated with hemorrhagic shock.

Animals↗

PubMed1998

Role of positron emission tomography using fluorine-18 fluoro-2-deoxyglucose in predicting improvement in left ventricular function in patients with idiopathic dilated cardiomyopathy.

Improvement in left ventricular (LV) function in patients with idiopathic dilated cardiomyopathy (DCM) by medical treatment has been suggested. Thus, it is important to evaluate which patients will respond to medical therapy. Positron emission tomography (PET) with fluorine-18 fluoro-2-deoxyglucose (FDG) and cardiac catheterization were performed in 20 patients with DCM before the initiation of medical therapy. The regional myocardial glucose utilization rate (rMGU) was measured with FDG PET. Subjects were divided into two groups, group 1 (event-free patients, n=10) and group 2 (clinical cardiac events, n=10). Haemodynamic and PET parameters before the initiation of medication were compared between the two groups and between patients with and patients without improvement in LV function. Ejection fraction (EF) was significantly higher in group 1 (35.8%+/-9.0%) than in group 2 (24.8%+/-7.0%) and LV end-diastolic pressure (LVEDP) was significantly lower in group 1 (8.4+/-1.7 mmHg) than in group 2 (11.6+/-3.5 mmHg). Average rMGU (mg min-1 100 g-1) was similar in group 1 (11.2+/-2.5 mg min-1 100 g-1) and group 2 (11.2+/-2.9 mg min-1 100 g-1), while %CV of rMGU was significantly lower in group 1 (11.1%+/-6.3%) than in group 2 (29. 9%+/-13.9%, P<0.01). Furthermore, LV function normalized in seven patients in group 1. In these seven patients, EF (35.1%+/-10.9%), LVEDP (8.2+/-2.0 mmHg) and average rMGU (11.8+/-2.7 mg min-1 100 g-1) were comparable with those in patients without LV functional improvement (EF: 31.6%+/-9.1%; LVEDP: 10.7+/-3.3 mmHg; average rMGU: 10.8+/- 2.7 mg min-1 100 g-1). However,% CV of rMGU in patients with LV functional improvement (9.6%+/-5.6%) was significantly lower than in those without such improvement (26.3%+/-14.1%, P<0.01). %CV of rMGU <13.6% predicted prognosis with a sensitivity of 80%, a specificity of 100% and an accuracy of 90%. %CV of rMGU <13.6% also predicted improvement in LV function, with a sensitivity of 75%, a specificity of 92% and an accuracy of 85%. However, EF failed to predict improvement of LV function. In is concluded that homogeneous myocardial glucose utilization rate can predict both prognosis and improvement in LV function achieved by medical therapy in patients with DCM.

Adult↗

PubMed1983

Limitations of electrocardiographic scoring systems for estimation of left ventricular function.

Four electrocardiographic scoring systems for the assessment of left ventricular function or presence of myocardial infarction were evaluated in 231 patients with coronary artery disease. Electrocardiographic scores were compared with radionuclide ejection fraction and thallium perfusion studies. The correlation between Wagner's modified QRS score and ejection fraction was only fair (r = -0.60). Askenazi's sum of R wave voltage score correlated poorly with ejection fraction (r = 0.44), as did Gottwik's sum of voltage score from the Frank lead electrocardiogram (r = 0.44). Rautaharju's Cardiac Infarction Injury Score did not reliably predict presence of infarction in the patient group, nor did it correlate well with ejection fraction (r = -0.49). None of the correlations were significantly improved when only patients with a history of a myocardial infarction, a thallium defect compatible with a scar or a diagnostic Q wave were considered. Although Wagner's QRS score correlated best with ejection fraction, all scoring systems had limited clinical usefulness for estimating ejection fraction.

Cardiac Output↗

PubMed1981

Left ventricular function during exercise before and after bypass surgery.

Biplane left ventricular cineangiograms and pressure measurements were performed in 44 patients with coronary heart disease at rest and during submaximal or symptom-limited supine bicycle exercise before and 7 +/- 3 months after bypass surgery. Revascularization was complete in 12 (group I) and incomplete in 32 patients (group II). Preoperative left ventricular ejection fraction (EF) was within normal limits at rest and declined similarly during exercise in both groups (group I from 59 to 51%, p less than 0.01; group II from 61 to 48%, p less than 0.001). Postoperative EF at rest was nearly identical to preoperative EF in both groups (group I, 65%; group II, 58%) and remained unchanged during exercise (group I, 63%; group II, 56%). Peak systolic pressure to end-systolic volume index ratio (LVSP/ESVI in mm Hg/ml . m-2) also decreased during exercise in both groups preoperatively (group I from 3.7 to 3.2, NS; group II from 3.4 to 2.6, p less than 0.005). Postoperative LVSP/ESVI at rest was again unchanged as compared to preoperative LVSP/ESVI. During exercise, however, it increased in both groups reaching higher values in patients of group I than of group II (5.1 versus 3.7, p less than 0.05). Whereas both parameters indicate an improvement in global left ventricular function following surgery, LVSP/ESVI even suggests a more sizable recovery of function in patients with complete as compared to those with incomplete revascularization.

Adult↗