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PubMed1981

Effect of valve replacement for chronic mitral insufficiency on left ventricular function during rest and exercise.

In this study we measured left ventricular function at rest and during exercise before and after operation in 18 patients who underwent mitral valve replacement (MVR) for chronic mitral insufficiency. First-transit radionuclide angiocardiography was employed a week before operation and 5 to 19 months after operation to calculate left ventricular ejection fraction, volumes, output, filling, and emptying rates. Preoperatively, left ventricular ejection fraction increased from 0.56 +/- 0.09 (mean +/- S.D.) at rest to 0.62 +/- 0.11 during exercise, and this response was not altered for the group after operation. After valve replacement, there was no consistent change in end-diastolic volume (EDV), and cardiac function was not related to an alteration in filling rates of the left ventricle. After operation, the patient group achieved a maximal ventricular filling rate during exercise comparable to that measured before operation. In addition, postoperative maximal filling rates did not correlate with prosthetic valve size. These data suggest that the hemodynamic changes elicited by MVR for chronic insufficiency are primarily related to the elimination of the regurgitant flow but no attributable to alterations of the myocardium. It is suggested that limitation in exercise performance after operation may be primarily related to the functional status of the myocardium prior to operation.

Adult↗

PubMed1991

[Changes in left ventricular function in elderly hypertension patients].

As many as 81 patients suffering from stage-II essential hypertension (EH) and 20 practically healthy persons of the same age were examined. EH patients manifested derangement of systolic function of the left ventricle, attested to by a decrease of contractility in the first third of the systole. The lowering of the velocity of active relaxation, change in the structure of the filling of the left ventricle coupled with a decrease of the role of the rapid filling phase and a rise of the contribution of the phases of slow filling and the atrial systole were noted. A decrease of the blood flow velocity at the phase of the atrial systole was also noted, which points to a decrease of the compensatory role of the left atrium in elderly patients. As compared to younger patients, compensatory hypertrophy of the left ventricle was pronounced relatively less in elderly patients. In these patients, compensatory potentialities of the hypertrophied left ventricle are preserved until the index of the left ventricular mass exceeds 170 g/m2. The further growth of that indicator is associated with a decline of the cardiac output.

Aged↗

PubMed2003

The effect of long-term aerobic exercise on maximal oxygen consumption, left ventricular function and serum lipids in elderly women.

The purpose of this study was to investigate the changes of maximal oxygen consumption, left ventricular function and serum lipids after 36 weeks of aerobic exercise in elderly women without the influence of drugs. Eight elderly women were studied by M-mode and Doppler echocardiography to assess left ventricular size, mass and function. Maximal oxygen consumption (VO(2)max) was determined for each subject by administering a treadmill exercise test. The training intensity was decided by heart rate reserve. Subjects performed exercise for 40 minutes a day, 3 days a week at 50-60% of the heart rate reserve during the 36 weeks. Exercise capacity was assessed by VO(2)max with a graded exercise test of the treadmill. Weight and % body fat decreased after training. Cardiorespiratory function improved because of the increase in VO(2)max and VO(2)max normalized for body weight after training. Systolic blood pressure significantly decreased. There are no significant difference in all left ventricular's parameters (end-diastolic dimension, end-systolic dimension, end-diastolic volume, end-systolic volume, stroke volume, cardiac output, ejection fraction, fractional shortening) after 36 weeks. Exercise training did not induce left ventricular (LV) enlargement as evidence of an absence of increase in left ventricular end-diastolic volume. The total cholesterol level and triglyceride level decreased after training. High density lipoprotein-cholesterol significantly increased and low density lipoprotein-cholesterol significantly decreased, atherogenic index (AI) significantly decreased and apolipoprotein A-I increased and apolipoprotein B decreased after training. In conclusion, although there was no significant change in left ventricular function, aerobic training showed a positive influence on body composition, maximal oxygen consumption and serum lipids.

Apolipoprotein A-I↗

PubMed1999

Effect of myocardial ischaemia on left ventricular function and adaptability to exercise training.

PURPOSE: We evaluated the possible interaction between exercise-induced myocardial ischemia and abnormalities in left ventricular function in 72 patients with coronary artery disease at entry and upon discharge from a 6-month exercise training program. METHODS: Twenty-two patients with myocardial ischemia (MIS) defined by electrocardiographic and radionuclide imaging criteria constituted our experimental group (EG). Fifty patients without MIS were assigned to the control group for exercise training (CG-ET) and 31 healthy subjects to the control group for measures of left ventricular function (CG-LV). RESULTS: Both groups EG and CG-ET showed significant and comparable increases in peak oxygen uptake (EG: 25.2 +/- 5.1 to 26.9 +/- 5.4 mL x kg(-1) x min(-1), P < 0.02; CG-ET: 25.1 +/- 0.6 to 27.4 +/- 0.7 mL x kg(-1) x min(-1), P < 0.001) after exercise training, but only CG-ET showed significant reductions in heart rate, systolic blood pressure, and rate-pressure product during submaximal exercise. A significant increase in end-diastolic volume contributed to the increase in cardiac output during exercise in patients with MIS. Heart rate or treadmill time at onset of ST segment depression failed to increase as a result of training, and stroke counts and the product of stroke counts and heart rate showed a trend toward a decrease in response to exercise, suggesting progression of disease. CONCLUSIONS: Patients with myocardial ischemia showed improvements in maximal exercise capacity but failed to elicit physiologic adaptations during submaximal exercise or to increase the threshold for ischemia after exercise training. It is possible that the main emphasis in the management of this type of patient in a cardiac rehabilitation setting should be placed more on coronary risk factor modification to slow progression of disease than on improving cardiovascular efficiency.

Adaptation, Physiological↗

PubMed2002

Effect of hypertonic saline solution on the left ventricular functions of isolated hearts from burned rats.

OBJECTIVE: To study the effect of hypertonic saline solution on the left ventricular functions of isolated hearts from burned rats. METHODS: Thirty-six Wistar rats were used and divided into 4 groups: (1) normal hearts perfused with isotonic Krebs-Henseleit solution; (2) normal hearts perfused with Krebs-Henseleit solution which contained 215 mmol/L Na+; (3) hearts of rats suffered from 25% TBSA third degree burn and perfused with isotonic Krebs-Henseleit solution; (4) hearts of the burned rats perfused with Krebs-Henseleit solution which contained 215 mmol/L Na+. The systolic and diastolic functions of the left ventricle were observed. RESULTS: During perfusion, there were very short periods of decrease in heart systolic and diastolic functions at first, but they recovered very soon and even became stronger than normal both in the normal and burned rats. The systolic and diastolic functions of the hearts increased very significantly when the perfusion solution was changed to isotonic solution from the hypertonic solutions. The effect of the hypertonic saline solution on the ventricular systolic and diastolic improvements was stronger in the hearts of the burned rats than that in the normal hearts. CONCLUSIONS: Hypertonic saline solution can directly affect myocardium and significantly improve the ventricular systolic and diastolic functions, especially in the hearts of the burned rats.

Animals↗

PubMed1992

[Diagnostic accuracy of coronary artery lesion by 99mTc-MIBI exercise myocardial scintigraphy--containing the utility of simultaneous assessment of left ventricular function].

To determine whether technetium-99m hexakis-2-methoxy isobutyl isonitrile (99mTc-MIBI) myocardial scintigraphy is a superior method in the detection of coronary artery disease, exercise and rest 99mTc-MIBI planar and SPECT scintigraphy were performed on 27 patients with coronary artery disease. When 99mTc-MIBI (555 MBq (15 mCi)) was injected, first-pass radionuclide angiography (FPRNA) was simultaneously performed by a new mobile multicrystal gamma camera (SIM-400), and LV function (LVEF) was evaluated quantitatively. Visual semiquantitative detection of coronary lesions using 99mTc-MIBI images showed superior accuracy to that obtained using 201TlCl images. 99mTc-MIBI SPECT images were particularly useful in diagnosing LCX and RCA lesions. Moreover, the simultaneous assessment of perfusion and left ventricular function by 99mTc-MIBI FPRNA proved to be useful in the diagnosis of multi-vessel disease. In summary, 99mTc-MIBI SPECT scintigraphy with simultaneous assessment of left ventricular function showed better diagnostic accuracy than 201TlCl myocardial scintigraphy.

Aged↗

PubMedDate not supplied

[Mitral valve and left ventricular function in ostium secundum type interatrial communication, studied by left ventriculography].

Clinical, hemodynamic and cineangiographic studies were performed in 11 patients with atrial septal defect (ASD) of ostium secundum type. Mitral valve prolapse was found cineangiographically in 9 cases. Systolic and diastolic left ventricular volumes were significantly increased, while left ventricular function and compliance were normal. A careful systematic exploration of mitral valve in patients with ASD ostium secundum seems to be advisable.

Adolescent↗

PubMed2005

Ascending aortic blood pressure-derived indices are not correlated with the extent of coronary artery disease in patients with impaired left ventricular function.

BACKGROUND: Ascending aortic blood pressure-derived indices were shown to be related to coronary atherosclerosis. Unfortunately, most studies published so far included patients with preserved left ventricular function. Therefore, the aim of the present study was to investigate the relation between ascending aortic blood pressure-derived indices and the extent of coronary atherosclerosis in patients with impaired left ventricular function. METHODS: The study group consisted of 375 patients (302 men and 73 women; mean age: 59.0+/-10.1 years) with angiographically confirmed coronary artery disease and ejection fraction < or =55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. RESULTS: None of the brachial or aortic blood pressure-derived indices differed between patients with one-, two- and three-vessel coronary artery disease. They were not independently related to the risk of having three-vessel coronary artery disease in none of the constructed models in logistic regression analysis. Moreover, none of the studied indices was correlated with Gensini or severity scores. We also did not find any significant correlation between blood pressure-derived indices and extent of coronary atherosclerosis in patients with ejection fraction < or =25%, 25-40% or >40%. CONCLUSION: Ascending aortic blood pressure-derived indices are not correlated with the severity of coronary atherosclerosis in patients with coronary artery disease and impaired left ventricular function.

Aorta, Thoracic↗

PubMed1999

Immediate effects of aortic valve replacement on left ventricular function and its determinants.

Replacement of the aortic valve exposes the left ventricle to myocardial ischaemia and imposes on it abrupt changes in loading conditions and geometry. We studied the immediate changes in the left ventricular function of patients undergoing aortic valve replacement by transoesophageal echocardiography. Patients with aortic regurgitation responded to surgery with a decrease in global systolic function associated with a fall in preload. Patients with aortic stenosis showed an impairment in myocardial contractility and ventricular filling, and their global systolic function did not improve despite the marked reduction in afterload. This can be a consequence of inadequate myocardial protection and intra-operative ischaemic injury of the hypertrophic myocardium. Information provided by transoesophageal echocardiography contributes to optimal and individualized management of the period immediately after aortic valve replacement.

Aortic Valve↗

PubMed1992

Survival of implantable cardioverter-defibrillator recipients: role of left ventricular function and its relationship to device use.

The quantitative benefit of ICD therapy in patients with malignant ventricular tachyarrhythmia with different degrees of left ventricular dysfunction is unclear. We evaluated patterns of ICD use and survival in 112 patients with moderate to severe left ventricular dysfunction. Group 1 included 57 patients with moderate left ventricular dysfunction (defined as left ventricular ejection fraction greater than 30%) and group 2 comprised 55 patients with severe left ventricular dysfunction (defined as ejection fraction equal to or less than 30%). The follow-up period ranged from 1 to 78 months. Age, incidence of coronary artery disease, and presenting arrhythmia in the two groups were similar. The mean left ventricular ejection fraction in group 1 was 44.6 +/- 8.2% and in group 2 was 21.6 +/- 6% (p < 0.0001). At 3 years of follow-up 65% of the patients in group 1 and 71% in group 2 (p = NS) had ICD activation for presumed ventricular tachycardia. Survival was calculated by means of actuarial analysis. Arrhythmia or sudden death mortality at 4 years of follow-up was 5% in group 1 and 9% in group 2 (NS). Cardiac mortality was higher in patients with severe left ventricular dysfunction reaching levels of statistical significance at 2 years of follow-up. At 2 years of follow-up it was 12% in group 1 and 40% in group 2 (p = 0.05), and at 4 years of follow-up it was 15% in group 1 and 43% in group 2 (p < 0.01). In both groups there was no difference in cardiac mortality in patients who did and did not have appropriate ICD shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1990

[Evaluation of the effects of coronary artery bypass grafting on left ventricular function in patients with previous myocardial infarction].

The present study was designed to assess a left ventricular function following coronary artery bypass grafting (CABG) in patients with previous myocardial infarction (MI). The subject was consisted of 10 patients with MI (MI(+) group) and 6 without it (MI(-) group). Both groups underwent complete revascularization. Stroke index (SI), ejection fraction (EF), systolic pressure/end-systolic volume index (SP/ESVI) and end-diastolic volume index (EDVI) were evaluated utilizing radionuclide angiography at rest and during exercise (Ex) before and after CABG. The influence of size of myocardial infarction on left ventricular function were also analyzed. Preoperatively during Ex, EF showed decrease, SP/ESVI no change and EDVI increase in both MI(+) and MI(-) group compared with those at rest. Postoperatively during Ex, SI, EF and EDVI showed no change and SP/ESVI increase in both MI(+) and MI(-) group compared with those at rest. Ejection fraction and SP/ESVI during Ex in MI(+) group had significant differences compared with those in both MI(-) group and control group. Ejection fraction and SP/ESVI during Ex in MI(-) showed no difference compared with those in control group. The size of MI suggested by ECG scoring system (proposed by Wagner GS et al, Circulation '82) had negative correlations with both Ex-induced increment of postoperative EF and Ex-induced increase ratio of postoperative SP/ESVI. These data indicated that complete revascularization improved EF and SP/ESVI in patients with MI, and moreover normalized those in patients without MI. But in the case of extensive MI, even complete revascularization might not recover poor functional reserve during Ex.

Adult↗

PubMed2002

Early recanalization and plasma brain natriuretic peptide as an indicator of left ventricular function after acute myocardial infarction.

BACKGROUND: Although plasma brain natriuretic peptide (BNP) levels have been widely measured in patients with acute myocardial infarction (AMI), it is still uncertain whether the early recanalization modulates the levels and whether the levels can predict chronic stage left ventricular function. This study was designed to elucidate these issues. METHODS: In 80 consecutive patients with AMI, plasma BNP levels were measured at admission and at 4 hours, 24 hours, 48 hours, and 1 month after admission. RESULTS: In 35 of the 80 patients, the infarct-related artery was patent within 6 hours from the onset of MI (6-hour patency group), and in 27 patients, the artery was still occluded after 6 hours (6-hour occlusion group). The remaining 18 patients in whom it was unclear whether recanalization of the infarct-related artery had occurred within 6 hours or not were excluded from the analyses. In the 6-hour patency group, the BNP level gradually increased and reached a maximum value at 24 hours after admission. In the 6-hour occlusion group, the level increased more, with the values at 4 hours, 24 hours, and 48 hours significantly higher than those in the 6-hour patency group (86 +/- 18 pmol/L versus 35 +/- 8 pmol/L; P <.01; 112 +/- 13 pmol/L versus 74 +/- 9 pmol/L; P <.05; 102 +/- 15 pmol/L versus 53 +/- 11 pmol/L; P <.01). Chronic stage left ventricular function was correlated with not only the BNP level at same stage but also that at 24 hours and that at 48 hours after admission. Multiple regression analysis indicated that the BNP level at 24 hours was the most powerful predictor of chronic stage left ventricular function. CONCLUSION: Plasma BNP levels can predict subsequent cardiac function. In addition, the importance of early recanalization may also be supported with BNP kinetics.

Angioplasty, Balloon, Coronary↗

PubMed1985

Coronary anatomy and left ventricular function in the first 12 hours of acute myocardial infarction: the Western Washington Randomized Intracoronary Streptokinase Trial.

The relationships among clinical variables, coronary anatomy, and left ventricular function during the early hours of acute myocardial infarction (AMI) were evaluated from data acquired in the Western Washington Intracoronary Streptokinase Trial. All patients had symptoms and electrocardiographic changes typical of AMI. All data were obtained before treatment with streptokinase. Mean time to catheterization was 4.1 hr after onset of symptoms. Coronary angiograms (n = 245) were analyzed for location of infarct-related occlusion and collateral flow to the infarct bed. Left ventricular ejection fraction and regional left ventricular function were quantitated in 227. Sixty-two percent of occlusions were in the most proximal segment of the involved coronary artery. Collateral circulation was seen in 42% overall, in 31% with left anterior descending artery (LAD) occlusion, and in 52% with right coronary artery (RCA) occlusion (p less than .005). Left ventricular ejection fraction was lowest and regional function was most abnormal in the group with proximal LAD occlusion. Hyperkinesis was present in 32%; in those with hyperkinesis, hyperkinetic segment length was longest in those with RCA or circumflex occlusion. Multivariate analysis identified proximal LAD occlusion as the factor most closely associated with left ventricular ejection fraction and with measures of left ventricular regional hypofunction. We conclude that (1) AMI is usually caused by occlusion or subtotal occlusion in the most proximal portion of the involved coronary artery, (2) collateral circulation is more frequent with RCA than with LAD occlusion, and (3) location of the infarct-related occlusion is the most important determinant of global and regional left ventricular function in the early hours of AMI.

Aged↗

PubMed1980

Effect of parathyroidectomy on left-ventricular function in haemodialysis patients.

The effect of parathyroidectomy on left-ventricular function was evaluated in chronic-haemodialysis patients with advanced hyperparathyroidism. Radionuclide angiocardiography (22 patients) and ultrasound echography (8 patients) revealed a significant increase in left-ventricular ejection fraction 1--2 weeks after parathyroidectomy. This improvement was associated with an augmented cardiac index (radionuclide method) and with an increase in mean velocity of circumferential myocardial fibre shortening (echocardiography). Circulating blood volume and erythrocyte space, as well as arterial blood-pressure, had changed little after parathyroidectomy, whereas plasma calcium, phosphate, and immunoreactive parathyroid hormone were significantly lower after surgery. Thus, correction of severe hyperparathyroidism led to a significant improvement in cardiac performance.

Adult↗

PubMed2006

[Quantification of right and left ventricular function with magnetic resonance imaging after Senning operation for complete transposition of the great arteries].

INTRODUCTION: The different non-invasive examinations do not result in unambigous results about the long-term determination of right ventricular function providing systemic circulation in children with transposition of the great arteries operated with Senning procedure. AIM: The goal of study was to determine the application of MRI for the observation of right and left ventricular morphology and function, for the recognition of the progression of the disease, and for the necessity of reoperation. METHODS: The authors have observed the morphology and function of the right and left ventricule by ECG triggered short axis MR pictures. For the analysis of MR pictures MASS 5.0 software was used. Authors have determined the end systolic and end diastolic volume, the ejection fraction, the mass, and the stroke volume of the right ventricule, the end systolic and end diastolic volume, ejection fraction, the mass, and the stroke volume of the left ventricle, and the shunt volume. The values of these data corrected to body mass have been calculated. PATIENTS: 176 Senning operations took place between 1980 and 1996. MRI exploration at 21 of the 118 analyzed patients were carried out. RESULTS: The right ventricular ejection fraction value at Senning operated patients is significantly different (49 +/- 9% vs. 70 +/- 4%) from those of healthy children (P < 0.01). Right ventricular stroke volume/m2 and right ventricular end systolic volume/m2 were significantly different compared to normal (43 +/- 10 ml/m2 vs. 48 +/- 7 ml/mn and 46 +/- 16 ml/m2 vs. 21 +/- 5 ml/m2, p < 0.05). Authors found also significant differences in left ventricular ejection fraction in Senning patients as compared to normal (60 +/- 9% vs. 70 +/- 6%, p < 0.01). CONCLUSION: MRI, which is a reliable method of objective determination of right ventricular function, became an available method in Hungary. According to the results, authors might presume that the development of right ventricular dysfunction is expected even among Senning operated children without clinical symptoms, so more frequent control is required. The pathological left ventricular parameters may be explained by ventricular interactions. Authors find MRI an important part of the complex follow-up protocol of Senning operations. MRI data extended by results of other non-invasive explorations are appropriate for the follow-up of right ventricular dysfunction.

Cardiac Surgical Procedures↗

PubMed2002

Coronary artery bypass grafting in patients with poor left ventricular function.

Coronary artery bypass grafting (CABG) in patients with poor left ventricular function remains a surgical challenge and is still controversial. The purposes of this study were to evaluate the effectiveness of CABG in such patients when performed without case selection on the basis of preoperative viability tests and to determine the predictors of postperative outcome. The preoperative, perioperative, and postoperative early and mid-term follow-up data of 273 patients with < or = 30% left ventricular ejection fraction (LVEF) who underwent isolated CABG between January 1995 and November 2000 were evaluated. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up was achieved via monthly periodical examinations in the first 6 months, and thereafter by either regular visits or phone contact. Preoperatively, 242 (88.65%) patients were in NYHA class III or IV, and the mean LVEF was 26.51 +/- 3.64%. The overall hospital mortality total was 14 (5.13%) patients. There were 44 (16.12%) late mortalities. Postoperative morbidities were observed in 74 (27.1%) patients. Two-hundred and two (93.95%) of the surviving 215 (78.75%) patients were in NYHA class I or II at 49.55 +/- 14.84 months of follow-up. Postoperative follow-up echocardiographic examinations revealed a mean LVEF of 39.66% +/- 5.43%. The improvements in functional capacity and LVEF were significant. Advanced age, diabetes, hypertension, cross-clamp time >60 min, bypass time>120 min, and severity of functional class (class III-IV of NYHA) were found to be the determinants of mortality. However, multivariate analyses revealed only older age and class III-IV of NYHA and CCS were predictors of mortality. The low mortality and morbidity rates as well as satisfactory postoperative improvements in functional capacity and LVEF measurements support the use of CABG without the need for any viability assessment in patients with left ventricular dysfunction.

Adult↗

PubMed1999

Non-invasive evaluation of left ventricular function by means of impedance cardiography.

BACKGROUND: Simple, accurate, continuous non-invasive cardiac monitoring during the peri- and postoperative periods for patients at risk of cardiac failure would be very useful. Electrical impedance cardiography (EIC) has been proposed as an accurate method for non-invasive measurement of cardiac function. However, in recent years the accuracy of EIC in stroke volume (SV) measurement has been questioned and this prevented global acceptance of the method. Beside SV, EIC is capable of measuring several other left ventricular contractility indices, which are measured directly from the impedance signal. The aim of this study was to compare these variables with the echocardiographically derived left ventricular wall motion score (WMS) as the reference method. METHODS: In a group of eight coronary artery disease patients we performed a pharmacologically (dobutamine) induced stress test. Echocardiographic and impedance cardiographic recordings were performed simultaneously during four levels of dobutamine infusion. WMS was derived from the simultaneously displayed four-stage echocardiographic image. RESULTS: Analysis of variance showed that the majority of indices changed significantly during the test. Direct correlation with the wall motion score gave very satisfactory results over all stages with the RZ time (r = 0.75, P < 0.001) and Heather index (r = -0.78, P < 0.001). Other correlations were substantially lower. CONCLUSION: The Heather index has to be preferred as indicator of the left ventricular performance. Since EIC is capable of giving continuous information of the left ventricular performance, it might be a valuable method for peri- and postoperative monitoring.

Adrenergic beta-Agonists↗

PubMed1979

[Left ventricular function in chronic obstructive pulmonary disease after decompensation (author's transl)].

13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.

Aged↗