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PubMed2004

Transient improvement of left ventricular function after peripheral blood stem cell transplantation in a patient with myelodysplastic syndrome and dilated cardiomyopathy.

A patient who had myelodysplastic syndrome (MDS) and dilated cardiomyopathy (DCM) had a transient improvement of cardiac function after peripheral blood stem cell transplantation (PBSCT). When he was admitted to hospital for PBSCT, a chest X ray showed cardiomegaly, and Tc-99m quantitative gated single photon emission computed tomography (QGS) showed increases in left ventricular (LV) volumes and a decrease in LV ejection fraction (LVEF). A coronary angiogram showed no evidence of coronary artery disease. Left ventriculography showed similar findings as QGS, and the findings from a myocardial biopsy were compatible with DCM. Three months after a successful allo-PBSCT with his brother as the donor, the cardiomegaly had been attenuated, the LV volumes decreased and LVEF increased on the QGS images. However, 10 months later, his cardiac function had deteriorated. The changes in cardiac function did not correlate with the hematological changes, such as the hemoglobin level.

Adult↗
PubMed1995

[Scintigraphic evaluation of the ischemically damaged myocardium in patients with reduced left ventricular function. From clinical aspects to the cell].

Identification of viable myocardium in patients with impaired left ventricular function, who are possible candidates for revascularization, represents an important clinical question. Modern methods of revascularization provide a therapeutic alternative to conventional pharmacological therapy even in patients with advanced ischemic heart disease. Modern diagnostic techniques make it possible to assess not only the extent of ischemia under exercise conditions, but also the presence of viable tissue in patients with severe coronary artery disease and impaired ventricular function. Currently, the most accurate methods for scintigraphic quantification of viable myocardial tissue are metabolic investigations with positron emission tomography (PET). Because of the limited availability of PET other methods like thallium-201-scintigraphy play an important clinical role. Modifications of thallium-201-scintigraphy, for example the introduction of reinjection protocols have improved the recognition of viable tissue and decreased the diagnostic difference to PET. We recommend as standard diagnostic procedure for assessment of tissue viability thallium-201-scintigraphy with reinjection. In patients with severely depressed left ventricular function and equivocal thallium-201-scintigraphy findings, PET should be considered as further diagnostic test. Low dose dobutamine-echocardiography is emerging as alternative test for evaluation of contractile reserve in dysfunctioning left ventricular segments. Its clinical role, however, remains to be determined. Besides the clinical application of these methods, newly developed radiotracers, together with PET, may provide insights into the mechanism of metabolic adaptations in patients with repeated episodes of ischemia. Furthermore, correlation of clinical data with in vitro histological and biological tissue analysis in the same patients may provide a better understanding of metabolic alterations observed in chronic ischemic heart disease.

Cell Hypoxia↗
PubMed1993

Device use patterns and clinical outcome of implantable cardioverter defibrillator patients with moderate and severe impairment of left ventricular function.

The beneficial effects of implanted cardioverter defibrillator (ICD) therapy in patients with malignant ventricular tachyarrhythmias and variable degrees of left ventricular (LV) dysfunction are debated. ICD use and patient survival were examined in 128 patients with malignant ventricular arrhythmias and moderate or severe LV dysfunction. Group I included 64 patients with moderate LV dysfunction (LV ejection fraction of > 30%) and group II, 64 patients with severe LV dysfunction (LV ejection fraction of < or = 30%). Follow-up period ranged from 1 to 78 months. The two groups were similar in age, incidence of coronary artery disease and presenting arrhythmia. The mean LV ejection fraction in group I was 44% +/- 8% and group II was 22% +/- 5% (P < 0.0001). At 4 years of follow-up, 66% of patients from group I and 62% from group II (P = NS) had ICD activation for presumed ventricular tachyarrhythmia. Survival was calculated using actuarial analysis. Arrhythmic or sudden death mortality at 4 years of follow-up was 4% in group I and 7% in group II (P = NS). Cardiac mortality was for group I, 7% (P < 0.05), 12% (P < 0.01), 15% (P < 0.01), and 15% (P < 0.01) for follow-up years 1, 2, 3, and 4, respectively. For group II, cardiac mortality was 27%, 36%, 41%, and 41% for follow-up years for 1, 2, 3, and 4, respectively. The majority of cardiac deaths in both groups was observed in the first 2 years of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1999

Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure.

OBJECTIVES: This study evaluated the effects of oral therapy with coenzyme Q on echocardiographic and hemodynamic indexes of left ventricular function and on quality of life in patients with chronic left ventricular dysfunction. BACKGROUND: Coenzyme Q is a coenzyme for oxidative phosphorylation and an antioxidant and free radical scavenger. It has been claimed to improve symptoms, quality of life, left ventricular ejection fraction and prognosis in patients with cardiac failure. METHODS: Thirty patients with ischemic or idiopathic dilated cardiomyopathy and chronic left ventricular dysfunction (ejection fraction 26 +/- 6%) were randomized to a double-blind crossover trial of oral coenzyme Q versus placebo, each for 3 months. Right heart pressures, cardiac output and echocardiographic left ventricular volumes were measured at baseline and after each treatment phase, and quality of life was assessed using the Minnesota "Living With Heart Failure" questionnaire. It was calculated that to demonstrate an increase in left ventricular ejection fraction from 25% to 30% with a standard deviation of 5% using 95% confidence intervals with a power of 80% we would require 17 patients. RESULTS: Twenty-seven completed both treatment phases. There was no significant difference in left ventricular ejection fraction, cardiac volumes or hemodynamic and quality of life indices after treatment with coenzyme Q or placebo, although plasma coenzyme Q levels increased from 903 +/- 345 nmol/l(-1) to 2,029 +/- 856 nmol/l(-1). CONCLUSIONS: In patients with left ventricular dysfunction, treatment for three months with oral coenzyme Q failed to improve resting left ventricular systolic function or quality of life despite an increase in plasma levels of coenzyme Q to more than twice basal values.

Administration, Oral↗
PubMed1996

Exercise- and hypertension-induced collagen changes are related to left ventricular function in rat hearts.

Chronic hypertension, known to affect the collagen profile of the heart, and exercise result in impaired or improved heart function, respectively. Collagen types I [alpha 1(I)2 and alpha 2(I)] and III [alpha 1(III)3] are the predominant interstitial collagens thought to influence cardiac function, and the ratio of type III to I (collagen III/I) is thought to be a significant factor in the altered relaxation observed in hypertrophy. The present study tested the hypothesis that the myocardial structure and function are different in chronically exercise-trained vs. hypertensive rat hearts. Male rats were either chronically exercised (XTr) or submitted to experimental hypertension by coarctation of the abdominal aorta (Hyp) for 10 wks. Heart rate, blood pressure, and maximal rate of fall of the left ventricular pressure (-dp/dt) were recorded during isoproterenol stimulation. Results showed that both Hyp and XTr had higher heart weight and left ventricular weight-to-body weight ratios (P < 0.05). Mean arterial pressure (MAP) was higher in Hyp and lower in XTr (P < 0.05), whereas (-dP/dt)/MAP was diminished in Hyp but enhanced in XTr. Left ventricular collagen was higher in Hyp than XTr, whereas collagen III/I was reduced in Hyp compared with XTr (P < 0.05). Scanning and transmission electron microscopy also supported an accumulation of left ventricular collagen in Hyp compared with XTr. A negative correlation was observed between collagen III/I and (-dP/dt)/ MAP (r = -0.91; P < 0.05). These results suggest an important relationship between adaptations in left ventricular collagen and the changes in diastolic function observed in both chronic hypertension and exercise cardiac stress.

Animals↗
PubMed1988

Potential protective effect of high coronary wedge pressure on left ventricular function after coronary occlusion.

To assess the potential of coronary collateral circulation to protect myocardium after occlusion of a coronary vessel, the mean coronary wedge pressure, the angiographic grade of collateral channels, and the left ventricular function were studied in 47 consecutive patients with mechanical recanalization of totally occluded coronary arteries. Coronary wedge pressure measurements were obtained 39 +/- 51 days (range, 2 hours to 361 days) after the presumed time of occlusion. The patients were divided into two groups: 31 with a coronary wedge pressure more than 30 mm Hg (group 1) and 16 with a coronary wedge pressure of or less than 30 mm Hg (group 2). Patients in group 1 had a significantly higher mean global left ventricular ejection fraction than those in group 2 (63 +/- 9% vs. 49 +/- 7%, p less than 0.001). Regional left ventricular function (artery-related area change) was also superior in group 1 compared with group 2 (47 +/- 11% vs. 36 +/- 10%, p less than 0.01). Global left ventricular function was significantly correlated to coronary wedge pressure (r = 0.51, p less than 0.001) but not to the angiographic presence of collaterals. The data suggest that a high coronary wedge pressure is associated with improved left ventricular function after coronary artery occlusion and that coronary wedge pressure more accurately reflects the physiological role of collaterals than their angiographic presence.

Angiography↗
PubMed1993

Clinical course and left ventricular function in patients with acute myocardial infarction following delayed recanalization of infarct-related artery.

The effect of delayed recanalisation of the infarct related artery on clinical course and left ventricular functions was studied in 23 patients with acute myocardial infarction (Group 2). Another 82 patients with acute myocardial infarction served as controls: 48 patients with immediate recanalisation of the infarct related artery following intracoronary thrombolytic therapy (Group 1) and 34 patients with unsuccessful thrombolysis with the artery remaining occluded on repeat angiography (Group 3). Baseline clinical characteristics and left ventricular ejection fractions in the three groups did not differ statistically. Following intracoronary thrombolysis the clinical features and left ventricular functions in the three groups, respectively were as follows: post infarction angina--45.8%, 13.1% and 11.8% (1 vs. 2 and 3, P < 0.05); reinfarction--29.2%, 8.7% and 11.8% (1 vs. 2 and 3, P < 0.05); mortality--0%, 0% and 11.8% (1 and 2 vs. 3; P < 0.05); aneurysm--16.7%, 21.7% and 52.9% (1 and 2 vs. 3, P < 0.05); heart failure--20.8%, 21.7% and 47.1% (1 and 2 vs. 3, P < 0.05). Left ventricular ejection fractions on the second and on days 10-14 were, respectively, 47.6 +/- 1.1%, 42.8 +/- 1.1% and 39.2 +/- 1.6% (1 vs. 2 and 3, P < 0.05) and --52.1 +/- 1.0%, 48.9 +/- 1.1% and 44.3 +/- 1.5% (1 and 2 vs. 3, P < 0.05). Thus following delayed recanalisation of the infarct related artery the clinical course and left ventricular function improved significantly in comparison to patients without recanalisation.

Adult↗
PubMed2002

[Clinical study on effect of Astragalus injection on left ventricular remodeling and left ventricular function in patients with acute myocardial infarction].

OBJECTIVE: To observe the effect of Astragalus injection (AI) on left ventricular remodeling and left ventricular function in patients with acute myocardial infarction (AMI). METHODS: AMI patients were randomly divided into the AI group (54 cases) treated with AI and the control group (54 cases) treated with conventional treatment. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), anterior endocardial segmental length (ASL), posterior endocardial segmental length (PSL) were assessed by echocardiogram at the 1st and the 4th week of treatment; and the cardiac systolic and diastolic functions were detected by nuclide gating cardiac blood pool imaging on the 4th week. Besides, the plasmic levels of lipid peroxide (MDA), count of endothelial cell (CEC) and superoxide dismutase (SOD) were determined before and after treatment. RESULTS: At the 4th week, changes of LVEDVI, LVESVI and ASL in the AI group were not obvious, but increased significantly in the control group, the significant difference in comparison between the two groups was shown (P < 0.05). As compared with the control group, in the AI group, the left ventricular ejection fraction, left ventricular peak ejecting rate and left ventricular peak filling rate were higher, and the left ventricular time for peak filling rate was shorter, moreover, MDA and CEC were lower and SOD was higher. The difference between groups and between before and after treatment were significant (P < 0.01 or P < 0.05). CONCLUSION: AI is one of the effective drugs in reversal of left ventricular remodeling and improving left ventricular function in patients with AMI.

Adult↗
PubMed2004

Quantitative intravenous myocardial contrast echocardiography predicts recovery of left ventricular function after revascularization in chronic coronary artery disease.

BACKGROUND: Quantitative intravenous myocardial contrast echocardiography (MCE) has been shown to measure regional myocardial blood flow velocity noninvasively. PURPOSE: To determine whether quantitative intravenous MCE could be used clinically to predict functional recovery after revascularization in patients with chronic coronary artery disease. METHODS: Twenty-eight patients with chronic stable coronary artery disease and resting regional left ventricular dysfunction were included in this study. The study permits myocardial perfusion analysis by intravenous MCE before revascularization with continuous infusion of Levovist and intermittent ultrasonic exposure. Wall motion assessment by echocardiography at rest was repeated after long-term follow-up period (7 +/- 2 months). In dysfunctional segments, we analyzed myocardial perfusion quantitatively by fitting to an exponential function, Y = A(1 - e-betat) to obtain the rate of rise (beta) of background-subtracted intensity, which represented myocardial blood flow velocity. RESULTS: Of the 101 revascularized dysfunctional segments, MCE was adequately visualized in 91 (90%) segments, and wall motion was recovered in 45 (49%) segments. The value of beta in the recovery segments was significantly higher than that in nonrecovery segments (0.80 +/- 0.50 vs 0.39 +/- 0.24, P < 0.001). The value of beta > 0.5 predicted recovery of segmental function with a sensitivity of 71%, specificity of 78%. CONCLUSION: Quantitative intravenous MCE can predict functional recovery after revascularization in patients with chronic coronary artery disease.

Aged↗
PubMed1997

Long-term follow up of patients with implantable cardioverter-defibrillators and mild, moderate, or severe impairment of left ventricular function.

OBJECTIVE: To determine whether patients with life threatening ventricular tachyarrhythmias, impaired left ventricular function, and severe heart failure will benefit from implantable cardioverter-defibrillator (ICD) treatment. DESIGN: 410 patients were followed up after ICD implant. Left ventricular function was assessed by the New York Heart Association (NYHA) functional class of heart failure: 50 patients (12%) were in NYHA I-II, 151 (37%) in NYHA II, 117 (29%) in NYHA II-III, and 92 (22%) in NYHA III. Epicardial ICD implantation was performed in 209 patients (51%) and 201 patients (49%) received non-thoracotomy ICDs. RESULTS: Perioperatively, 12 patients (3%) died, more often after epicardial ICD implant (11/209 patients, 5%) than after transvenous implant (1/201 patients, < 1%) (P < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (23%) died: nine (2%) died from sudden arrhythmia; five (1%) also died suddenly but probably not from arrhythmic causes; 55 (14%) died from cardiac causes (congestive heart failure, myocardial reinfarction); 21 (5%) died from non-cardiac causes. The three year, five year, and seven year survival was 92-96% for arrhythmic mortality in NYHA class I, II and III, compared to a three year survival of 94% and a five year and seven year survival of 84% for patients in NYHA class II-III. 338 patients (82%) received ICD shocks (21 (SD 43) shocks per patient); patients in NYHA class II (83%), class II-III (84%), and class III (90%) received ICD discharges more often than those in class I-II (64%) (P < 0.05). The mean (SD) time interval between ICD implant and the first ICD shock was shorter in NYHA class II (16 (17) months), class II-III (19 (27) months), and class III (16 (19) months) than in class 0-I (22 (24) months) (P < 0.05). CONCLUSIONS: Patients with mild, moderate, and severe left ventricular dysfunction benefit from ICD treatment and these patients survive for a considerable time after the first shock. Survival is influenced by the degree of left ventricular dysfunction; aggressive treatment of heart failure is necessary as well as ICD therapy.

Adolescent↗
PubMed1992

Effect of adenosine triphosphate on the postischemic left ventricular function of the immature myocardium.

In this study, the effect of exogenous adenosine triphosphate (ATP) on the immature myocardium was evaluated. Isolated working neonatal rabbit hearts were perfused aerobically for 15 min with Krebs-Henseleit buffer (KHB) at 37 degrees C, and then arrested with St. Thomas solution (STS) in group 1 and STS containing 500 mumol/L of ATP in group 2 at 4 degrees to 6 degrees C and maintained at 10 degrees to 14 degrees C for 60 min. Hearts were reperfused with KHB aerobically at 37 degrees C for 15 min. Each heart served as its own control before and after arrest. Systolic function was significantly depressed in group 1 compared with group 2. There was a significant decrease in the peak left ventricular (LV) systolic pressure in group 1 (preischemia mean [PIM] 54 mm Hg to postischemia mean [PoIM] 42 mm Hg, Student's t test p = 0.007) than in group 2 (PIM 66 to PoIM 62 mm Hg, p = 0.5). The LV pulse pressure decreased in group 1 (PIM 72 to PoIM 54 mm Hg, p = 0.02) but not in group 2 (PIM 84 to PoIM 86 mm Hg, p = 0.9) and the rate of rise of LV pressure (dP/dT) in group 2 improved (PIM 5718 to PoIM 6926 mm Hg, p = 0.4) compared with group 1 (PIM 7021 to PoIM 4125 mm Hg, p = 0.008). The PoIM LV flow (LVF) was greater in group 2 than group 1 (LVF group 1 = 2.7 ml/min, group 2 = 4.5 ml/min). Diastolic pressures were not significantly different in the two groups. Our findings suggest that the incorporation of ATP in STS has a significant effect in improving postischemic LV systolic function in neonatal rabbit hearts.

Adenosine Triphosphate↗
PubMed1990

Radionuclide studies of left ventricular function in normal subjects.

The effects of age and exercise on cardiac function in a normal male population have been assessed by ECG-gated radionuclide ventriculography. Fifty-nine subjects aged from 25 to 54 years were studied (mean 44 +/- 10 S.D. years). Resting left ventricular ejection fraction (LVEF) was 0.54 +/- 0.07 and this increased by 0.07 +/- 0.05 during supine submaximal exercise at 75 watts. The mean increase in cardiac output on exercise was 93 +/- 30%. Stroke volume increased on exercise by 23 +/- 13% and end-systolic volume decreased by 10 +/- 16%. There was a weak correlation (P less than 0.05) between age and change in LVEF on exercise but the increase in cardiac output on exercise was not age dependent. It is important to use an age matched control population in any study of cardiac function.

Adult↗
PubMed1987

[Hemodynamic effects of intravenously administered celiprolol in patient with coronary heart disease and depressed left ventricular function].

Hemodynamic changes after intravenous application of 10 mg celiprolol-HCl (3-[3-acetyl-4-(3-tert-butylamino-2-hydroxy-propoxy)-phenyl]-1,1-diethyl urea hydrochloride. Selectol; in the following briefly called celiprolol) were investigated over an interval of 30 min in 15 patients with angiographically determined coronary heart disease and depressed left ventricular function (ejection fraction less than 60%, left ventricular end-diastolic pressure (LVEDP) greater than 12 mmHg). One patient suffered from severe left ventricular failure with lung edema and could not be evaluated. The heart rate was not influenced, the arterial pressure was significantly reduced (p less than 0.01), similarly LVEDP (p less than 0.001), and pulmonary pressure (p less than 0.01). Cardiac output and total peripheral resistance were not changed significantly. The hemodynamic working profile of celiprolol in patients with depressed left ventricular function is that of a beta 1-receptor blocker with a strong intrinsic sympathomimetic activity (ISA = Intrinsic Sympathetic Activity) and vasodilating properties--even on preload. The intravenous application of celiprolol in patients with severely depressed left ventricular function can cause pump failure.

Adrenergic beta-Antagonists↗
PubMed1996

Left ventricular function during exercise in athletes and in sedentary men.

Aim of this study was to evaluate left ventricular function during exercise in 10 male elite runners and in 10 sedentary males. End-diastolic (EDV) and end-systolic volume (ESV), left ventricular ejection fraction (EF), early peak transmitral flow velocity (peak E), time-velocity integral of mitral inflow (m-TVI); mitral cross sectional area (m-CSA); mitral stroke volume (SV), and cardiac output (CO) were measured by echo-Doppler. We simultaneously analyzed: VO2max by spirometric method, mean arterial blood pressure (MAP) by sphygmomanometer, and heart rate (HR) by ECG. The parameters were measured under basal conditions (level 1), at 50% of maximal aerobic capacity (level 2), at peak of exercise (level 3) and during recovery. Ejection fraction in athletes increased significantly at peak of exercise through Frank-Starling mechanism. Stroke volume and cardiac output increased significantly in athletes at peak of exercise. Left ventricular diastolic function was superior in athletes versus controls: in fact, higher peak E in athletes enhanced early diastolic ventricular filling. Therefore, the athletes showed complex cardiovascular adjustments induced by training, which allowed an higher peak working power, a greater cardiac output, and VO2max when compared with an untrained control population.

Adult↗
PubMed2005

Effect of chronic right ventricular apical pacing on left ventricular function.

The determinants of change in left ventricular (LV) ejection fraction (EF) over time in patients with impaired LV function at baseline have not been clearly established. Using a nuclear database to assess changes in LV function over time, we included patients with a baseline LVEF of 25% to 40% on a gated single-photon emission computed tomographic study at rest and only if second-gated photon emission computed tomography performed approximately 18 months after the initial study showed an improvement in LVEF at rest of > or =10 points or a decrease in LVEF at rest of > or =7 points. In all, 148 patients qualified for the EF increase group and 59 patients for the EF decrease group. LVEF on average increased from 33 +/- 4% to 51 +/- 8% in the EF increase group and decreased from 35 +/- 4% to 25 +/- 5% in the EF decrease group. The strongest multivariable predictor of improvement of LVEF was beta-blocker therapy (odds ratio 3.9, p = 0.002). The strongest independent predictor of LVEF decrease was the presence of a permanent right ventricular apical pacemaker (odds ratio 6.6, p = 0.002). Thus, this study identified beta-blocker therapy as the major independent predictor for improvement in LVEF of > or =10 points, whereas a permanent pacemaker (right ventricular apical pacing) was the strongest predictor of a LVEF decrease of > or =7 points.

Adrenergic beta-Antagonists↗
PubMed1987

Effects of a new vasodilator, nicorandil, on exercise-induced impairment of left ventricular function in patients with old myocardial infarction.

Hemodynamic effects of nicorandil on exercise-induced impairment of left ventricular function were studied in nine patients with old myocardial infarction but without angina pectoris. Hemodynamic data were obtained by symptom-limited supine multistage bicycle ergometer exercise testing before and 1 h after single oral administration of 15 mg of nicorandil. Systolic and diastolic blood pressure at rest decreased significantly after nicorandil administration (p less than 0.01). A most remarkable change in the hemodynamic response to supine dynamic exercise after nicorandil was a decrease in pulmonary artery wedge pressure (both at rest and at peak exercise, p less than 0.001). An index cardiac function, obtained from the relation between pulmonary artery wedge pressure and left ventricular stroke work index, improved significantly after nicorandil. The ration of pressure-rate product to coronary sinus flow, which is an index of the ratio of myocardial oxygen consumption to myocardial oxygen supply, decreased significantly (p less than 0.05) after nicorandil administration. Reproducibility of the testings was also studied in six patients with old myocardial infarction. Invasive hemodynamic variables between two successive symptom-limited supine leg exercise testings, except pulmonary artery wedge pressure, were reproducible in patients with old myocardial infarction but without angina pectoris. Only pulmonary artery wedge pressure at rest in the second exercise testing showed a significantly lower value (p less than 0.05). It is concluded that nicorandil is a useful drug for improvement of exercise-induced impairment of left ventricular function with an increase in myocardial oxygen supply.

Adult↗
PubMed1995

Left ventricular function on exercise after surgical treatment of small aortic annuli.

To evaluate left ventricular function during exercise after aortic annular enlargement 15 patients with either aortic (group I, n = 8) or aortomitral (group II, n = 7) annuloplasty for small aortic annuli and eight patients (group III) with standard valve replacement for aortic stenosis without small aortic annuli received gated cardiac pool imagining by technetium-99m-labelled red blood cells at rest and during exercise at a mean of 23 months after operation. Left ventricular ejection fraction, preload requitable stroke work and stroke power index (preload requitable stroke work/systolic ejection period) were measured. Compared with resting values, left ventricular performance and stroke work rate on exercise after aortic annular enlargements increased significantly, as did those after standard aortic valve replacement. These results suggest that aortic annular enlargement can be indicated for surgical treatment of valvular heart diseases associated with small aortic annuli.

Adult↗