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Stress-related variations in left ventricular function as assessed with gated myocardial perfusion SPECT.

BACKGROUND: There is inconsistency in reported patient characteristics associated with differences in basal and poststress left ventricular function (delta ejection fraction [DeltaEF]) assessed by gated single photon emission computed tomography (SPECT). This inconsistency may therefore hamper adequate interpretation. In this study we first determined the reproducibility of serial gated SPECT-assessed left ventricular function. Second, we determined whether left ventricular ejection fraction (LVEF) assessed directly after stress reflects basal LVEF and, if not, what patient characteristics were associated with this discrepancy in LVEF. METHODS AND RESULTS: Serial reproducibility of technetium 99m tetrofosmin gated SPECT-assessed LVEF in 22 patients showed a mean difference between two sequential measurements at rest of 0.09% EF units, with a 95% limit of agreement (2 SDs) at 5.8% EF units. In 229 patients Tc-99m tetrofosmin gated SPECT was performed after stress and at rest. Independent predictors of DeltaEF were the presence of scintigraphically proven ischemia (standardized coefficient, -1.256; P =.003) and difference in heart rate at the time of acquisition (standardized coefficient, 0.121; P =.001). CONCLUSIONS: Gated SPECT-assessed LVEF at rest is reproducible under standard clinical conditions. However, LVEF assessed after stress does not represent LVEF at rest in patients with scintigraphically proven ischemia and in patients with increased heart rate after stress compared with heart rate at rest.

Coronary Artery Disease↗
PubMed2000

Severity of residual stenosis of infarct-related lesion and left ventricular function after single-vessel anterior wall myocardial infarction: implication of ST-segment elevation in lead aVL of the admission electrocardiograms.

BACKGROUND: The relationship between the severity of chronic-phase stenosis of infarct-related lesions (IRLs) and chronic left ventricular function in anterior acute myocardial infarctions (AMI) has not been adequately investigated. HYPOTHESIS: This study investigated whether ST elevation in lead aVL of admission electrocardiogram (ECG) would be a determinant factor of the relationship between the severity of stenosis of the IRL and chronic left ventricular function after anterior wall AMI. METHODS: One month after AMI, the IRL was evaluated by coronary angiography in 98 patients with anterior AMI, and left ventricular ejection fraction (LVEF) was determined using multigated radionuclide angiocardiography. Patients were classified according to the severity of the IRL: patients with 100% occlusion (Group O), patients with 90 to 99% stenosis (Group H), and patients with < or =75% stenosis (Group L). Patients with ST elevation > or =0.1 mV in the aVL lead on their admission ECG were included in the ST-elevation group, and those with ST elevation <0.1 mV were included in the non-ST-elevation group. RESULTS: The LVEF was greater in the non-ST-elevation group than in the ST-elevation group (p<0.0001), and the LVEF in a whole group as follows: Group L LVEF>Group H LVEF>Group O LVEF (p = 0.0160). In the ST-elevation group, LVEF was higher in Group L than in the other groups (p = 0.0251). There were three independent predictors of a reduced LVEF: ST-elevation in aVL [odds ratio (OR): 3.38, p = 0.0044], IRL stenosis > or =90% (OR: 2.90, p = 0.0044), and the IRL occurring in the left anterior descending artery proximal to the first diagonal branch (OR: 6.31, p = 0.0024). CONCLUSION: Left ventricular function was preserved, regardless of the severity of residual stenosis, in patients without ST elevation in aVL if the IRL was not totally occluded. In patients with ST elevation in aVL, LVEF was lower in patients with more severe stenosis, even if the IRL was patent.

Adult↗
PubMed1995

Determinants of left ventricular function two weeks and one year after an acute myocardial infarction.

This study examines possible covariates of left ventricular function two weeks and sixteen months after an acute infarction. It was performed in a group of 312 patients randomized double blindly to recombinant tissue plasminogen activator (rt-PA) (n = 156) or placebo treatment and followed thereafter for at least one year. Two weeks after the infarction, enzymatic infarct size, infarct-related vessel, and number of diseased coronary arteries were significant determinants of the infarct-related regional wall motion (centerline method) (R2 = 0.25 to 0.60, P = 0.0001). Enzymatic infarct size, regional wall motion of both infarct-related and remote areas, reinfarction, and treatment allocation were significant independent correlates of ejection fraction (R2 = 0.76), end-diastolic volume (R2 = 0.20), and end-systolic volume (R2 = 0.69, P < 0.0001). Infarct-related coronary artery and predischarge end-systolic volume were significant independent covariates of ejection fraction at rest (R2 = 0.47) after sixteen months. Age, enzymatic infarct size, and predischarge end-diastolic volume were independent determinants of the maximal (R2 = 0.49, P < 0.0001) and peak exercise ejection fraction (R2 = 0.49, P < 0.0001).

Adult↗
PubMed2000

Correlation of predischarge electrocardiographic patterns with left ventricular function in patients with anterior wall myocardial infarction.

The aim of this prospective study was to assess the correlation between different predischarge electrocardiographic patterns and left ventricular function, evaluated by physical examination and echocardiography, in patients with first Q wave anterior acute myocardial infarction. A positive correlation was found between the electrocardiographic pattern and wall motion score assessed by echocardiography, reflecting a gradual worsening in left ventricular function among the different patterns. Patients with an isoelectric ST segment and negative T waves had a 73% decrease in the risk of clinical heart failure compared to those who continued to have ST elevation. Thus, a predischarge electrocardiogram can be used as a simple, noninvasive method for the risk stratification of patients with acute myocardial infarction.

Adult↗
PubMed1992

[Effect of crankshaft position on the results of supine bicycle ergometry testing. Hemodynamics in coronary heart disease patients with normal and impaired left ventricular function].

In 50 patients with coronary heart disease (CHD), 44 of them with a recent history of myocardial infarction, 2 tests on the bicycle-ergometer in the supine position, one with the crankshaft on the level of the examination cot and one with an elevation of the pedal axle by 30 cm were carried out within 30-minute intervals after initiating a flow directed right heart catheterization. In chronological sequence of the recruitment the patients began the ergometric tests alternately with a low or an elevated crank. The applied exercise loads of 50 and 75 watts lasted 3 minutes each. The results show clinically relevant differences between the 2 positions of the pedal axle, being in many cases statistically significant (p less than or equal to 0.01). The pressure of the pulmonary artery (PAP) was elevated at rest and under exercise load when the pedal axle was elevated. The changes of the pressure of the pulmonary artery through the exercise load are greater in patients with an impaired left ventricular function at rest with both pedal axle positions than in patients with a normal left ventricular function. We observed under increasing exercise load a diverging more pronounced elevation of PAP-curves only as a trend in the group of patients with an impaired left ventricular function. Heart rate and systolic blood pressure were on average likewise higher with the elevated crank then with the low one, however the mean variations were considerable. The oxygen saturation of the blood was somewhat less at rest and during exercise load when the pedal axle was elevated compared to the findings with the low pedal axle. The decrease of the oxygen saturation under exercise load was most pronounced in patients having already at rest an impaired left ventricular function. However, with both positions of the pedal axle the behaviour was identical.

Adult↗
PubMed1992

Significance of preinfarction angina for preservation of left ventricular function in acute myocardial infarction.

The effect of preinfarction angina on the preservation of left ventricular function was evaluated with the use of cineventriculography in 37 patients who had either total or subtotal occlusion of the proximal left anterior descending coronary artery during the convalescent period of myocardial infarction. In 15 patients who had preinfarction angina more than 1 week before the onset of acute myocardial infarction (group A), the global left ventricular ejection fraction was 54 +/- 3% (SEM) and regional wall motion in the infarct area was 10 +/- 3%. In 10 patients who had preinfarction angina occurred within 1 week before the onset of acute myocardial infarction (group B), the left ventricular ejection fraction and regional wall motion in the infarct area were 42 +/- 3% and 1 +/- 2%, respectively. In 12 patients without preinfarction angina (group C), the left ventricular ejection fraction and regional wall motion in the infarct area were 38 +/- 3% and -1 +/- 2%, respectively. In groups B and C, both the left ventricular ejection fraction and regional wall motion in the infarct area were lower than those in group A (p less than 0.05). The collateral circulation at the onset of acute myocardial infarction was better in group A compared with groups B and C (p less than 0.05). Thus the collateral circulation, promoted by repetitive anginal episodes indicative of myocardial ischemia, causes the preservation of myocardial function.

Angina Pectoris↗
PubMed1995

Maximal myocardial perfusion by videodensitometry in the assessment of the early and late results of coronary angioplasty: relationship with coronary artery measurements and left ventricular function at rest.

In the assessment of the acute results of percutaneous transluminal coronary angioplasty (PTCA), myocardial perfusion at maximal vasodilatation theoretically has fewer limitations than the coronary flow reserve measurements and quantitative coronary angiography. The purpose of this study was to compare the myocardial perfusion to the measurements of the severity of the lesion (minimal luminal diameter and percent area stenosis) and to relate it to the changes of left ventricular function after PTCA. Regional myocardial perfusion was assessed during intracoronary papaverine, using the inverse mean transit time of contrast medium (1/Tmn), before, 15 min after, 18-24 hr after, and 6 months after successful single-vessel PTCA in 14 patients with stable angina. Left ventricular angiography (before angioplasty, 18-24 hr after, and 6 months later) was analysed by area-length and centerline methods. Immediately after PTCA, 1/Tmn increased from 0.14 +/- 0.07 sec-1 to 0.21 +/- 0.09 sec-1 (P = .001). Maximal myocardial perfusion remained higher than the pre-PTCA value the day after angioplasty (1/Tmn of 0.23 +/- 0.09 sec-1), while it reduced to near pre-PTCA values at follow-up (1/Tmn of 0.16 +/- 0.05 sec-1). Before PTCA, three out of ten patients had ejection fraction of < 65%, and seven had mild-to-moderate hypokinesis. The day after PTCA the ejection fraction and the regional dysfunction improved significantly. The change in ejection fraction 18-24 hr after PTCA did not correlate with minimal luminal diameter and percent area stenosis and correlated slightly with the improvement of perfusion (r = 0.54, P = .10). At follow-up left ventricular function deteriorated in the whole group, despite the persistence of angiographic success of PTCA, possibly because of changes in the loading condition. Coronary artery stenosis measurements and 1/Tmn failed to correlate with the left ventricular function. Given the difficulties in routine application of the analysis of time-density curves, the measurement of minimal luminal diameter remains a more practical assessment of the results of the intervention. However, the improvement of myocardial perfusion may give more information than coronary artery dimensions of the early recovery of left ventricular function.

Adult↗
PubMed2003

Total right ventricular exclusion improves left ventricular function in patients with end-stage congestive right ventricular failure.

BACKGROUND: We developed a total right ventricular (RV) exclusion procedure for the treatment of isolated congestive RV failure. The objective of the present study was to elucidate the effects of a complete removal of RV volume overload (RVVO) on the surgically created single left ventricle (LV). METHODS AND RESULTS: Three adults (2 arrhythmogenic RV dysplasia, 1 Ebstein) and 5 children (all Ebstein) in NYHA class IV underwent the procedure. The RV free wall was resected from the heart, and the tricuspid orifice was closed. Pulmonary blood supply was obtained by a cavopulmonary connection in 6 patients and a systemic-pulmonary shunt in 2. The LV function was evaluated by 2-dimensional echocardiography 1 month after the surgery. All patients are alive. The paradoxical movement of the interventricular septum and geometry of the LV expressed by its eccentricity (2.1 to 1.2, P<0.01) were normalized after the operation in all 8 patients. LV end-diastolic volumes (59% to 109% of normal value, P<0.01), indexed maximal left atrial area (6.5 to 10.5 cm2/m2, P<0.01), LV ejection fraction (27% to 62%, P<0.01), and cardiac index (2.1 to 3.3 L/min/m2, P<0.05) all significantly increased. CONCLUSIONS: Removal of the RVVO by means of the total RV exclusion procedure provides effective volume loading, restores a cylindrical shape, and improves contractile function of the LV, thus leading to increased systemic output.

Adult↗
PubMed1996

Comparative hemodynamic, left ventricular functional, and antiadrenergic effects of chronic treatment with metoprolol versus carvedilol in the failing heart.

BACKGROUND: The basic pharmacology of the third-generation beta-blocking agent carvedilol differs considerably from second-generation compounds such as metoprolol. Moreover, carvedilol may produce different, ie, more favorable, clinical effects in chronic heart failure. For these reasons, we compared the effects of carvedilol and metoprolol on adrenergic activity, receptor expression, degree of clinical beta-blockade, hemodynamics, and left ventricular function in patients with mild or moderate chronic heart failure. METHODS AND RESULTS: The effects of carvedilol versus metoprolol were compared in two concurrent placebo-controlled trials with carvedilol or metoprolol that had common substudies focused on adrenergic, hemodynamic, and left ventricular functional measurements. All subjects in the substudies had chronic heart failure resulting from idiopathic dilated cardiomyopathy. Carvedilol at 50 to 100 mg/d produced reductions in exercise heart rate that were similar to metoprolol at 125 to 150 mg/d, indicating comparable degrees of beta-blockade. Compared with metoprolol, carvedilol was associated with greater improvement in New York Heart Association functional class. Although there were no significant differences in hemodynamic effects between the carvedilol and metoprolol active-treatment groups, carvedilol tended to produce relatively greater improvements in left ventricular ejection fraction, stroke volume, and stroke work compared with changes in the respective placebo groups. Carvedilol selectively lowered coronary sinus norepinephrine levels, an index of cardiac adrenergic activity, whereas metoprolol did not lower coronary sinus norepinephrine and actually increased central venous norepinephrine levels. Finally, metoprolol was associated with an increase in cardiac beta-receptor density, whereas carvedilol did not change cardiac beta-receptor expression. CONCLUSIONS: The third-generation beta-blocking agent carvedilol has substantially different effects on left ventricular function, hemodynamics, adrenergic activity, and beta-receptor expression than dose the second-generation compound metoprolol. Some or all of these differences may explain the apparent differences in clinical results between the two compounds.

Adrenergic beta-Antagonists↗
PubMed1992

[Left ventricular function in patients with chronic obstructive bronchitis].

A study of 45 patients with chronic obstructive bronchitis by the method of radionuclide ventriculography with 99mTc showed that even the early stages of the disease were characterized by an inhibition of the contractile function of the left cardiac ventricle. With progression of respiratory insufficiency, maintaining of the left cardiac ventricle stroke volume is achieved by increase of the final-diastolic and final-systolic volumes. Appearance of signs of cardiac decompensation is accompanied by a breakdown of this compensatory mechanism accompanied by a reduction of the strike volume and diminished rate of contraction of the circular fibers of the left ventricle myocardium.

Adult↗
PubMed1991

Cardiac left ventricular function before and during early thyroxine treatment in severe hypothyroidism.

In some patients with severe hypothyroidism, thyroxine replacement therapy precipitates or aggravates angina pectoris, whereas in other patients angina pectoris is ameliorated or even cured. Cardiac function in eight severely hypothyroid patients was studied by means of radionuclide ventriculography (RNV) at rest and during supine bicycle exercise before thyroxine treatment, and repeated during treatment before and after administration of 160 mg of oral verapamil. There was an exercise-induced fall in left ventricular ejection fraction (LVEF) in two patients before therapy, and in two additional subjects after 17 d on suboptimal doses of thyroxine. Verapamil attenuated the fall and induced a significant increase in LVEF during exercise (P less than 0.014). No abnormal regional cardiac wall movement (RWM) was observed. After 2 months of thyroxine treatment, LVEF increased significantly during exercise both before and after verapamil (P less than 0.012 and P less than 0.005). These findings are indicative of reversible coronary artery dysfunction. We recommend that, if feasible, thyroxine should be supplemented with verapamil during the early phase of treatment.

Adult↗
PubMed1975

[Cinegeometric analysis of left ventricular function in normals and in patients with isolated stenosis of the ramus anterior descendens (author's transl)].

The left ventricular function was evaluated by a cineangiographic method. 28 normals and 36 patients with an isolated stenosis of the anterior descending branch of the left coronary artery underwent this procedure. From single plane RAO-LV-cineangiograms following parameters were calculated: LV-volumens (EDV, ESV) according to the area-length method, ejection fraction (EF), percentage shortening of the medial perpendicular short axis (delta M, delta MPL), mean velocity of circumferential fiber shortening (VCF, VCFPL). Patients with comparable ramus anterior descendens branch findings can have normal- or abnormal pattern of LV-contraction. The critical cineangiographic parameters of left ventricular function are significantly decreased at rest in ramus anterior descendens lesions with normal systolic anterior wall motion in comparison to the normal collective. Hypokinesis, Akinesis and aneurysms deteriorate parameters of LV-function.

Angiocardiography↗
PubMed1999

Long-term preservation of left ventricular function in medically treated patients with coronary artery disease and persistent exercise-induced ischemia.

Little information is available on the long-term evolution of left ventricular function of medically treated patients with coronary artery disease and gross limitation of coronary flow reserve. The aim of this study was to assess the long-term evolution of effort tolerance and left ventricular function and their relation to the control of ischemic events in patients with coronary artery disease and prolonged inducible exercise-induced myocardial dysfunction who either declined or were ineligible for cardiac revascularization.

Aged↗
PubMed2000

Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy.

STUDY OBJECTIVES: This study sought to evaluate the pathophysiology of left and right heart failure in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were hospitalized to undergo pulmonary thromboendarterectomy (PTE). DESIGN: Thirty-nine patients (16 women and 23 men; mean +/- SD age, 55+/-12 years) with severe CTEPH were examined before and 13+/-8 days after PTE by way of transthoracic echocardiography and right heart catheterization. MEASUREMENTS AND RESULTS: Examination results confirmed in all cases that before surgery the right ventricles were enlarged and systolic function was impaired. Moderate to severe tricuspid valve regurgitation was observed. Left ventricular eccentricity indexes reflected a leftward displacement of the interventricular septum. End-diastolic left ventricular size and systolic function had decreased, and the left ventricular filling pattern showed impaired diastolic function. After surgery, mean pulmonary artery pressure was significantly lower (48+/- 10 mm Hg vs. 25+/-7 mm Hg; p<0.05). The calculated end-diastolic and end-systolic right ventricular areas had decreased: 30+/-7 cm(2) vs 21 +/-5 cm(2) (p<0.05) and 24+/-6 cm(2) vs. 14+/-4 cm(2) (p<0.05), respectively. Right ventricular fractional area change had increased (20+/-7% vs. 33+/-8%; p<0.05). Most of the patients exhibited a marked decrease in the severity of tricuspid regurgitation. Septal motion, left ventricular systolic function, and diastolic filling pattern returned to normal values (early to late diastolic left ventricular inflow ratio, 0.70+/-0.33 vs. 1.35+/-0.51; p<0.05). The mean cardiac index also improved (2.7+/-0.6 L/min/m(2) vs. 3.7+/-0.8 L/min/m(2)). CONCLUSIONS: In CTEPH, functions are impaired in the right as well as the left ventricles of the heart. Improved lung perfusion and the reduction of right ventricular pressure overload are direct results of PTE, which in turn bring a profound reduction of right ventricular size and a recovery of systolic function. Normalization of interventricular septal motion as well as improved venous return to the left atrium lead to a normalization of left ventricular diastolic and systolic function, and the cardiac index improves.

Adult↗
PubMed2000

Differential effects of right versus left stellate ganglion block on left ventricular function in humans: an echocardiographic analysis.

STUDY OBJECTIVES: To evaluate the effects of unilateral stellate ganglion blockade on left ventricular function. DESIGN: Prospective cohort of patients with chronic regional pain syndrome type I and II of the upper extremity requiring therapeutic stellate ganglion blockade. SETTING: University-affiliated hospital. PATIENTS: Fifteen adult ASA physical status I and II patients with the diagnosis of chronic regional pain syndrome type I and II of the arm were studied. Right stellate ganglion block was performed in nine subjects and a left in six. INTERVENTIONS: Stellate ganglion block was performed with 10 mL of 1% plain Xylocaine. Transthoracic echocardiograms were performed immediately prior and 30 min following the block. MEASUREMENTS: Heart rate and blood pressure were monitored at regular intervals. Global systolic function was determined by calculating ejection fraction. Regional systolic motion was evaluated on the short axis and four-chamber views using the American Society of Echocardiography criteria. Diastolic function was assessed with pulsed-wave Doppler of the left ventricular outflow tract and the mitral valve. Data collected included isovolumic relaxation time and early and atrial velocity patterns. MAIN RESULTS: A successful stellate ganglion block was achieved in all patients. Blood pressure and heart rate were not significantly different during data collection. Patients who underwent a right stellate ganglion block showed no significant differences in systolic or diastolic function. Following a left stellate ganglion block, global and regional systolic function remained unchanged. Isovolumic relaxation time was increased but did not reach statistical significance (80 +/- 13 ms to 88 +/- 9 ms; p = 0.09). Left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) were significantly increased (LVEDV from 73 +/- 9 mL to 100 +/- 9 mL, p < 0.02; LVESV from 31 +/- 4 mL to 37 +/- 4 mL, p < 0.03). CONCLUSIONS: In patients without cardiovascular disease, unilateral denervation of the left ventricle after stellate ganglion block produces no clinical deleterious effects on left ventricular function.

Adult↗
PubMed1987

[Left ventricular function of patients with chronic nonspecific lung diseases].

Echocardiographic studies of left ventricular function were carried out in 20 patients with chronic unspecific pulmonary diseases (CUPD). These patients showed no true left ventricular myocardial hypertrophy, while electrocardiographic signs of the latter might be related to the recording of potentials from the hypertrophic ventricular septum produced by positional cardiac changes due to pulmonary emphysema. In addition to septal hypertrophy, end diastolic left ventricular size was shown to be diminished. A hypothesis is proposed for the pathogenesis of left ventricular pumping disorders associated with CUPD.

Adolescent↗
PubMed1985

[Stress pulsed Doppler echocardiography in the evaluation of diastolic left ventricular function].

The effect of sublingual nifedipine on left ventricular (LV) function was assessed by analyzing LV inflow velocity patterns using pulsed Doppler echocardiography (PDE) and radioisotope (RI) angiography in 23 patients with hypertrophic cardiomyopathy (HCM), 13 with hypertensive heart disease (HHD) and 24 with ischemic heart disease (IHD). The results were as follows: LV inflow velocity pattern and M-mode echocardiography after the administration of nifedipine (Study-I). The deceleration time (DT) of the diastolic rapid filling wave was shortened after nifedipine in HCM and HHD, but not in IHD. The acceleration time (AT) of the diastolic rapid filling wave and the A/D ratio (amplitude of an atrial contraction wave/amplitude of a diastolic rapid filling wave) were not significantly changed in all groups. Peak negative Vcf was significantly improved after nifedipine in HCM, but unchanged in the other groups. Fractional shortening and peak Vcf did not change in all groups. LV inflow velocity pattern and RI angiography after nifedipine (Study-II). The mean LV rapid filling rate (V1) based on the LV volume curve by multi-gated blood pool scans increased during nifedipine in HCM and HHD, but other diastolic indices, such as the peak filling rate and 1/3 filling fraction, were unchanged. The DT-V1 relationship during nifedipine shifted toward the right and downward in HCM and HHD. In IHD, however, this relationship shifted toward the left and downward in cases with reduced LV function (V1 less than 1.0 EDC/sec), but toward the right and downward in patients whose LV function was maintained (V1 greater than or equal to 1.0 EDC/sec). Nifedipine therapy was associated with an improved LV filling in nearly all cases of HCM and HHD, and in some cases of IHD. PDE and RI angiography are useful for evaluating LV diastolic function during sublingual nifedipine in various heart diseases.

Cardiomegaly↗