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[Multiparametric analysis using radionuclide ventriculography in the assessment of left ventricular function following heart transplantation].

Left ventricular systolic and diastolic performance was evaluated by radionuclide angiography in 17 patients following cardiac transplantation and compared with normal persons. Both groups performed supine bicycle exercise during the investigation, the control group at 102 +/- 73 W and the transplanted patients at 61.2 +/- 15 W. The ejection fraction increased in the normal persons from 61 +/- 8 to 69 +/- 10% whereas in the transplanted patients it did not increase significantly. There were no relevant changes in systolic parameters during exercise in the transplant recipients. The changes in diastolic parameters were significantly smaller in transplant patients than in normals. After correction for heart rate-induced changes a significantly different time course of the systolic-diastolic sequence during the cardiac cycle became evident in the transplanted group at rest. During exercise the systolic-diastolic sequence during the cardiac cycle became similar in both groups. It is concluded that the reduced exercise capacity of patients in the late phase after cardiac transplantation is partially due to the absence of an EF increase and a limitation of diastolic reserve during exercise.

Adult

Effect of isolated right ventricular outflow obstruction on left ventricular function in infants.

Resting left ventricular (LV) function was evaluated in 29 infants with isolated right ventricular (RV) outflow obstruction. Age-corrected cardiac index was significantly inversely correlated with the degree of obstruction (r = 0.59, p = 0.0001). Right ventricular hypertension resulted in septal displacement and altered LV geometry. The magnitude of RV outflow obstruction related closely to the degree of LV distortion. Septal displacement toward the LV free wall was associated with lower values for cardiac index, indexed LV end-diastolic volume, ejection fraction, ratio of early to atrial LV diastolic inflow and with a higher RV ejection fraction. The LV end-diastolic volume index and the ratio of early to atrial LV diastolic inflow correlated with the degree of obstruction and amount of septal displacement. Four infants evaluated during the development of supravalvar pulmonary stenosis demonstrated decreasing cardiac index during development of obstruction and significant increase in cardiac index after surgical relief. These findings indicate that significant RV outflow obstruction in infants is associated with a reversible alteration in LV function related to abnormal LV geometry and impaired LV diastolic filling.

Cardiac Output

[The influence of meproscillarin on human left ventricular function (author's transl)].

Left ventricular (LV) function was assessed by echocardiography in 11 cardiac patients before and after treatment with 14-hydroxy-3beta-[(4-O-methyl-alpha-L-rhamnopyranosyl)-oxy]-14beta-bufa-4,20,22-trienolide (meproscillarin, Clift). This drug was given during 7 days in a dose of 4 X 0.25 mg/d. During a placebo period of 7 days the LV function parameters percent systolic shortening of the transverse LV diameter and mean velocity of circumferential fiber shortening did not change significantly but increased significantly (P less than 0.001) after meproscillarine. Heart rate and end-diastolic LV diameter remained unchanged throughout the study. It is concluded that peroral meproscillarin induced a true increase of LV inotropic state.

Adult

Determinants of left ventricular function one year after cardiac transplantation.

Left ventricular systolic function was assessed by radionuclide angiography in 107 consecutive transplant recipients who were alive one year after operation. Mean (SEM) ejection fraction was 62.4 (4.6) at rest and 68.8 (5.4) on exercise. The influence of donor-related factors (donor age and sex, ischaemia time), recipient-related factors (recipient age and sex, frequency of acute rejection), type of immunosuppression (cyclosporin/azathioprine or prednisolone/azathioprine), and frequency of hypertension on left ventricular function one year after operation was examined by univariate and multivariate analysis. There was a close association both at rest and on exercise between a higher ejection fraction and treatment with cyclosporin/azathioprine. There was a trend for lower donor and recipient age, shorter ischaemia time, and fewer rejection episodes to be associated with better left ventricular function, but this was not statistically significant. Left ventricular systolic function was well maintained in most patients a year after cardiac transplantation. The type of immunosuppression used had a strong influence on the left ventricular systolic function of the transplanted heart.

Adolescent

Triiodothyronine-enhanced left ventricular function after ischemic injury.

Hypothyroidism is associated with profound left ventricular dysfunction. Brain-dead organ donors and patients undergoing cardiopulmonary bypass are chemically hypothyroid with significantly reduced circulating free triiodothyronine (T3). To test the hypothesis that T3 enhances left ventricular function in a hormonally deficient environment, a total of 36 healthy New Zealand White rabbit hearts were studied using a modified Langendorff preparation with Krebs-Henseleit perfusate and intra-ventricular balloon. In 9 normal rabbit hearts a cumulative dose-response curve with logarithmically increasing doses of T3 was obtained. The vehicle solution for T3 dissolution served as control (n = 9). Left ventricular function was assessed from peak developed pressure at baseline and after T3 administration. Triiodothyronine had no effect in normal hearts on peak developed pressure or end-diastolic pressure. In 18 rabbits, the acute effect of T3 administration after ischemia was investigated. Preischemic left ventricular function was measured to serve as baseline, and hearts were subjected to 37 degrees C global ischemia. Triiodothyronine (n = 9) or vehicle (n = 9) was infused during reperfusion, and left ventricular peak developed pressure was measured at 30 and 60 minutes of reperfusion. Recovery of function (expressed as percent return of left ventricular peak developed pressure) was significantly improved within 15 minutes of reperfusion (65.0% +/- 2.1% versus 80.2% +/- 4.1%) and remained significantly improved throughout the reperfusion period (p less than 0.05 by analysis of variance). These data suggest that although T3 possesses no inotropic properties, it significantly improves postischemic left ventricular function. The rapidity of the functional improvement suggests that these effects may be due to plasma membrane-mediated mechanisms.

Animals

Noninvasive evaluation of left ventricular function in chronic severe anemia.

Left ventricular function was evaluated noninvasively in cases of chronic severe anemia (CSA) by recording systolic and diastolic time intervals (STI and DTI). These time intervals were recorded in 38 patients with CSA (hemoglobin below 7 g%), without cardiac decompensation, and in 30 control subjects. STI and DTI were measured from the simultaneous recordings of the apexcardiogram, carotid arterial pulse, electrocardiogram and phonocardiogram. The left ventricular ejection time was significantly prolonged (p less than 0.02), and associated with marked shortening of the PEP and reduction of the PEP/LVET ratio (p less than 0.001 in each case) in cases of CSA as compared to controls. Regarding the DTI, there was significant shortening of total filling time, slow filling time (p less than 0.001 in each case) and atrial systole (p less than 0.01) with no appreciable change in rapid filling time and isovolumic relaxation time. The SFT/RFT ratio and a/H ratio (the amplitude of the a-wave relative to the total height of the apexcardiogram) showed significant reductions (p less than 0.001 in each case). These changes in STI and DTI indicate enhanced left ventricular performance during diastole followed by faster and more complete relaxation during diastole in CSA.

Adult

Effects of immunosuppressive therapy in biopsy-proved myocarditis and borderline myocarditis on left ventricular function.

Twenty patients with decreased left ventricular (LV) function and endomyocardial biopsy-proved myocarditis (9 patients) or borderline myocarditis (11 patients) were studied to determine whether these 2 histologic subsets of patients with inflammatory heart disease differed in their response to a 6- to 8-week course of immunosuppressive therapy. All patients received a regimen of prednisone, 1.0 mg/kg/day, and azathioprine, 1.5 mg/kg/day, followed by repeat endomyocardial biopsy and reevaluation of LV function. LV function improved significantly in the group with borderline myocarditis, as assessed by LV stroke work--end-diastolic volume ratio (0.26 +/- 0.17 to 0.54 +/- 0.31 kg.m.ml-1, p less than 0.02), heart rate corrected velocity of circumferential shortening (0.49 +/- 0.30 to 0.80 +/- 0.29 circ.s-1, p less than 0.05), and LV ejection fraction (0.30 +/- 0.15 to 0.47 +/- 0.13, p less than 0.05). LV end-diastolic and end-systolic volume indexes also decreased significantly from 129 +/- 40 to 94 +/- 38 (p less than 0.05) and 90 +/- 37 to 49 +/- 26 ml (p less than 0.02), respectively. No significant change in these indexes of LV function or volume occurred in the myocarditis group. Whereas salutory improvements in cardiac output and filling pressures were found in both groups, objective improvement in LV function assessed by complementary indexes of contractility was greatest in the borderline myocarditis group. It is concluded that short-term immunosuppressive therapy improves LV contractile function and appears to be associated with regression of ventricular dilatation in patients with borderline myocarditis to a greater extent than patients with myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[The effects of lorcainide on the ECG pattern and left ventricular function in a patient with recurrent ventricular tachycardia].

The paper presents an adverse effect of Lorcainide on the electrocardiographic pattern and left ventricular function in a patient with recurrent ventricular tachycardia in the course of arterial hypertension and ischemic heart disease. Based upon this case report a relatively new and not well known phenomenon of drug arrhythmogenesis is presented.

Anti-Arrhythmia Agents

Assessment of left ventricular function from the electrocardiogram in left bundle branch block.

The QRS duration, maximum right precordial S amplitude, sum of amplitudes of the maximum right precordial S and T wave and T wave polarity in lead I have been analyzed in order to identify electrocardiographic predictors of left ventricular end-diastolic volume index and ejection fraction in 165 patients with complete left bundle branch block and various forms of heart disease. Multivariate analysis selected the duration, maximal amplitude of the S wave and polarity of the T wave in decreasing order of discriminatory power, which correctly identify 76.6% of the patients with a normal end-diastolic volume index less than or equal to 90 ml/m2 and a normal ejection fraction greater than or equal to 60% (n = 64) and 73.3% of those with an end-diastolic volume index greater than 90 ml/m2 or an ejection fraction less than 60% (n = 101). The comparisons of the QRS duration with the end-diastolic volume index and the ejection fraction give the best single correlations: r = 0.57 and -0.63, respectively. Multiple correlations lead to no substantial improvement of the r values: 0.06 and -0.65, respectively. A QRS duration less than 140 msec is almost always predictive of the presence of a normal end-diastolic volume index and a normal ejection fraction (sensitivity 100%, specificity 91.9%, positive predictive value 73.3%). A QRS duration greater than 170 msec is most accurate in predicting depressed left ventricular ejection fraction less than 55% (sensitivity 36.5%, specificity 98%, positive predictive value 92%). Thus, only the QRS duration provides a useful reference and guide for the evaluation of left ventricular function in the presence of left bundle branch block.

Adult

A computer-aided approach for the quantitation of regional left ventricular function using two-dimensional echocardiography.

Quantitation of regional left ventricular function is becoming increasingly important in this era of interventional cardiology. In this article we describe a computer-assisted approach for the assessment of regional left ventricular function that integrates three features. First, it measures left ventricular wall thickening and endocardial motion and curvature during an entire systolic contraction sequence. Second, it allows us to easily define endocardial and epicardial borders without actually having to manually trace the entire border. Third, it displays complex data in a simple format for easy assimilation. We believe that this approach is practical and comprehensive and can be used to quantitate regional left ventricular function with two-dimensional echocardiography.

Color

[Digital subtraction angiography and Fourier analysis of the left ventriculography: new methods of analyzing left ventricular function].

To evaluate two new methods of analyzing left ventricular function, digital subtraction left ventriculography (DSLV) and Fourier analysis of left ventriculography (FALV) were performed after conventional left ventriculography (LV) in 17 consecutive catheterized cases. Ejection fraction of FALV and LV corresponded closely with the correlation coefficient of 0.906, while segmental wall motion corresponded less with the range of correlation coefficients from 0.56 for the apical segment to 0.94 for the anterior wall. In 10 cases with asynergic segments of the left ventricle, Fourier analysis showed less hypokinesis in four (all had hypokinesis at the septal segment), the same degree in five and more in one case, suggesting the possibility of FALV to evaluate three-dimensional left ventricular function in a single projection.

Angiography, Digital Subtraction

Left ventricular function following attempted surgical repair of tetralogy of Fallot.

Left ventricular function was assessed by angiographic methods in 40 patients (ages 3-27), 1-12 years following repair of tetralogy of Fallot. Twenty of the 40 patients (group A) had a satisfactory repair with a pulmonary-systemic flow ratio (Qp/Qs) less then or equal to 1.5 and a right ventricular systolic pressure of less than or equal to 60% of the left ventricular value. The other 20 patients (group B) had a Qp/Qs greater than 1.5 and/or a right ventricular systolic pressure greater than 60% of the left ventricular value. Group A patients had a normal left ventricular end-diastolic volume (LVEDV), end-diastolic pressure (LVEDP), ejection fraction (LVEF), and mass (LVM), while the group B patients had significantly elevated LVEDV, LVEDP, LVM, and a significantly depressed LVEF. These findings indicate that patients with a satisfactory hemodynamic repair of tetralogy of Fallot have normal left ventricular function while patients with postoperative unsatisfactory hemodynamics have significantly impaired left ventricular function.

Adolescent

[Coronary surgery in patients with severely impaired left ventricular function].

Views on surgical treatment of patients with coronary disease and severely restricted left ventricular function are still controversial. In the present work the authors compare the results of direct reconstruction of the coronary arteries in 184 patients with satisfactory or medium restricted left ventricular function (SLV) with a group of 77 patients with severely restricted left ventricular function (RLV). Twenty-three clinical, angiographic, peroperative and postoperative indicators were compared. Patients with RLV had more frequently a myocardial infarction before operation, on average a more restricted functional capacity and lower ejection fraction of the left ventricle than patients with SLV. The mortality during hospitalization was 1.1% in patients with SLV and 5.2% in patients with RLV. These results confirm that reconstruction of the coronary arteries is safe also in patients with a significantly restricted left ventricular function. An essential prerequisite of successful operation is perfect peroperative protection of the heart muscle by the method of continuous local cooling.

Coronary Disease

Left ventricular function in chronic obstructive pulmonary disease.

The presence or absence of left ventricular dysfunction in chronic obstructive pulmonary disease has been debated for decades. I have reviewed the following evidence pertaining to this topic: (1) left ventricular pathologic abnormalities; (2) the methods used to determine left ventricular performance; (3) specific abnormalities of left ventricular function as revealed by systolic time intervals, left ventricular end-diastolic pressure, ejection fraction, isovolumic indices, and left ventricular function curves; and (4) pertinent experimental data. The bulk of the evidence indicates that the clinical symtoms of left-sided failure are unreliable in those with obstructive disease of the airways and that the great majority of patients have normal left ventricular function, once other causes are excluded. A small group of patients have some abnormalities in left ventricular performance, but these have not been clinically significant. The ultimate importance of such abnormalities awaits future investigation.

Animals

Left ventricular function in acute and chronic coronary artery disease.

The evaluation of left ventricular function in patients with acute myocardial infarction has shown: 1. Limitations in the use and interpretation of central venous pressure. 2. Pulmonary artery end-diastolic pressure reflects left ventricular end-diastolic pressure in the absence of pulmonary vascular or mitral valve disease. 3. Frequent elevations of left ventricular filling pressure in mild or clinically uncomplicated infarction. 4. Anterior infarctions present greater depression of left ventricular function than inferior infarctions. 5. Initial hemodynamic measurements in cardiogenic shock can predict prognosis with medical management. 6. Left ventricular function frequently improves during the early convalescent period. 7. Hemodynamic monitoring can be useful in following changes in left ventricular function and the response to therapy. The assessment of left ventricular performance in patients with chronic heart disease has shown: 1. Resting hemodynamic measurements are often normal but abnormalities can be observed in patients with disease of the left anterior descending coronary artery, diffuse coronary involvement, and after myocardial infarction. 2. Increases in end-diastolic volume or dilatation and left ventricular mass or hypertrophy can develop in severe coronary disease and after myocardial infarction. 3. The size of abnormally contracting segment after myocardial infarction is related to abnormalities in compliance, ventricular end-diastolic pressure, end-diastolic volume, and clinical manifestations of heart failure. 4. Exercise and atrial pacing can produce clinical and hemodynamic abnormalities. 5. The ejection fraction is significantly related to the slope of the ventricular function curve. 6. Angiographic abnormalities of left ventricular wall motion can be increased with atrial pacing and reduced with nitroglycerin or epinephrine.

Acute Disease

[A study of left ventricular function of workers exposed to fluorine].

The left ventricular function of 26 workers exposed to fluorine was investigated. The results demonstrated that the LVET in the higher urine fluorine group (greater than 1.5 mg/L) was significantly shorter than the control group (P less than 0.01), the PEP was much longer than the control group (P less than 0.05), and the rate of PEP/LVET compared with the control group was increased. The difference was statistically significant (P less than 0.01). In the lower urine fluorine group (less than 1.5 mg/L) the time of LVET and PEP and the rate of PEP/LVET was not significantly different from the control group. The results showed that excessive fluorine ion in the body could cause decrease of myocardial contraction. The reason may be, that the fluorine ion inhibits the activities of certain enzymes in the body, thereby producing inhibition of ATP supply and utilization.

Adult