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PubMed1993

Importance of ischemic preconditioning and collateral circulation for left ventricular functional recovery in patients with successful intracoronary thrombolysis for acute myocardial infarction.

We studied the effects of myocardial ischemic preconditioning and preexistent collateral circulation on the preservation of left ventricular function in 30 patients who had successful intracoronary thrombolysis within 6 hours after the onset of a first acute anterior myocardial infarction. The existence of ischemic preconditioning was defined as the episode of recurrent ischemic chest pain within 4 hours before the onset of acute myocardial infarction. In 16 patients with ischemic preconditioning (group A), the left ventricular ejection fraction during the convalescence of myocardial infarction was 57% +/- 11% (mean +/- SD); regional wall motion in the infarct area was 13% +/- 9%. In 14 patients without ischemic preconditioning (group B), the left ventricular ejection fraction and regional wall motion in the infarct area were 46% +/- 9% and 5% +/- 9% (both p < 0.05 vs group A). Moreover, among group A patients, seven patients having a well-developed collateral circulation during the acute stage of myocardial infarction showed a more prominent improvement in regional wall motion in the infarct area compared with nine patients having poor or no collateral circulation (18% +/- 8% vs 9% +/- 7%, p < 0.05). These data indicate that ischemic preconditioning is effective for the preservation of left ventricular function in patients with successful intracoronary thrombolysis and that preexistent coronary collateral circulation potentiates this favorable effect of ischemic preconditioning.

Adult↗

PubMed1995

[Usefulness of 123I-MIBG and 123I-BMIPP myocardial scintigraphy for detecting coronary artery disease and for evaluating left ventricular function].

We evaluated the diagnostic value of 123I-metaiodobenzylguanidine (MIBG) and 123I-labeled beta-methyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECTs for evaluating coronary artery disease and left ventricular function, in comparison with the diagnostic value of 201Tl (Tl) SPECT. For forty-nine patients with coronary artery disease, resting MIBG and BMIPP SPECTs were performed to detect coronary artery stenosis, compared with the diagnostic value of exercise Tl. Left ventricular ejection fraction and regional wall motion were compared with the total US (TUS) and regional US (RUS) of resting MIBG and BMIPP SPECTs, and in turn, compared with resting Tl SPECT. The sensitivity of resting BMIPP SPECT for detecting coronary artery stenosis was lower, and the specificity of resting MIBG SPECT was lower than the other two methods. The accuracy of resting MIBG SPECT for evaluating coronary lesions was nearly the same as the accuracy of exercise Tl, but higher than that of BMIPP SPECT. Left ventricular ejection fraction was well correlated with TUS of resting MIBG SPECT (r = 0.80), resting BMIPP SPECT (r = 0.77), and resting Tl SPECT (r = 0.68). Regional wall motion was most correlated with RUS of resting BMIPP SPECT, compared with that of resting Tl and MIBG SPECTs. These data suggest that resting MIBG SPECT is useful for detecting coronary artery disease and that resting BMIPP SPECT is valuable in evaluating regional left ventricular function.

3-Iodobenzylguanidine↗

PubMed1991

Left ventricular function changes after cardiomyoplasty in patients with dilated cardiomyopathy.

Dynamic cardiomyoplasty has been reported in the treatment of severe myocardial failure. In this investigation significant improvement of left ventricular function with dynamic cardiomyoplasty was demonstrated in patients with dilated cardiomyopathy or Chagas' disease for more than 1 year of follow-up. Thirteen patients with advanced heart failure who were in New York Heart Association class III or IV were operated on. There were no operative deaths. Patients were followed up for a mean of 11.5 months, and two patients died during the late follow-up period. Five of nine patients observed long term are in New York Heart Association class I, three in class II, and one in class III. At 3 months of follow-up, Doppler echocardiography demonstrated that left ventricular segmental wall shortening increased from 11.4% +/- 2.3% to 16.4% +/- 3.9% (p less than 0.01), and left ventricular stroke volume from 23.9 +/- 5.7 to 34.4 +/- 10 ml (p less than 0.01). Radioisotopic left ventricular ejection fraction improved from 20.9% +/- 3.3% to 25.4% +/- 7.7% (p = 0.06), and its better increases occurred in patients with lesser left ventricular end-diastolic dimensions. Cardiac catheterization showed that left ventricular stroke work index increased from 14.6 +/- 3.8 to 23.7 +/- 6.7 gm.m/m2 (p less than 0.01), whereas pulmonary wedge pressure decreased from 24.8 +/- 3.7 to 17.2 +/- 5.8 mm Hg (p less than 0.01). At 6 and 12 months of follow-up, all the preceding values remained essentially unchanged. Thus cardiomyoplasty improves left ventricular function and may halt the steady evolution of severe cardiomyopathies.

Adolescent↗

PubMed2007

Elevated homocysteine is associated with reduced regional left ventricular function: the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: An elevated homocysteine (Hcy) level has been reported to be a risk factor for the development of congestive heart failure in individuals free of myocardial infarction. In this study, we aim to investigate the relationship between Hcy levels and regional left ventricular function in an asymptomatic population. METHOD AND RESULTS: Regional peak systolic midwall circumferential strains were calculated from 1178 tagged magnetic resonance imaging studies in participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Left ventricular regions were defined by coronary territories (left anterior descending, left circumflex, right coronary artery). For the 1178 study participants (66+/-10 years of age, 58% males), the median (interquartile range) of Hcy was 9.1 (9.0 to 9.3). After adjustment for traditional risk factors, race, height, weight, left ventricular end-diastolic mass/volume, serum creatinine, and measures of atherosclerosis, reduced regional myocardial circumferential shortening across sex-specific quartiles of plasma Hcy in the left anterior descending (P=0.038) and left circumflex (P=0.009) regions persisted, which indicated an important association of reduced function with elevated Hcy. Multiple linear regression analyses confirmed that circumferential systolic dysfunction was associated with log transformed Hcy levels in the left anterior descending (P=0.004) and left circumflex (P=0.0002) regions. In the fully adjusted model, the odds ratio for left ventricular strains below the 10th percentile with 1 SD increases in log-transformed Hcy was 1.33 (95% confidence interval, 1.04 to 1.70; P=0.022) for the left anterior descending, 1.28 (95% confidence interval, 1.00 to 1.64; P=0.046) for the left circumflex, and 1.32 (95% confidence interval, 1.03 to 1.69; P=0.025) for the right coronary artery region. CONCLUSIONS: In this asymptomatic population, an elevated Hcy level is associated with reduced regional left ventricular systolic function detected by tagged magnetic resonance imaging.

Aged↗

PubMed1997

Effects of lidoflazine on left ventricular function in patients.

OBJECTIVE: The present study evaluated the effects of the nucleoside transport inhibitor, lidoflazine, at a dose of 1 mg/kg, on left ventricular function. DESIGN: Patients were randomly assigned to receive either lidoflazine or saline in a double-blind manner. SETTING: A university hospital. PARTICIPANTS: The study was performed in 32 patients scheduled for elective coronary artery bypass surgery. INTERVENTIONS: Left ventricular pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the left ventricle were simultaneously recorded on videotape. Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relationship. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relationship. Cardiac function was assessed at baseline and after administration of either lidoflazine (group A [n = 16]) or placebo (group B [n = 16]). Data were compared using two-factor analysis of variance. MEASUREMENTS AND MAIN RESULTS: At baseline, diastolic and systolic function were comparable in both groups. Lidoflazine increased Kc from 0.079 +/- 0.015 to 0.125 +/- 0.017 mmHg/mL and decreased Ees from 2.481 +/- 0.213 to 1.217 +/- 0.211 mmHg/mL (p = 0.009 and p = 0.004, respectively). None of these changes occurred when placebo was administered. CONCLUSIONS: Administration of lidoflazine before the start of cardiopulmonary bypass impaired left ventricular systolic function but also increased diastolic stiffness.

Aged↗

PubMed1994

Lymphocyte beta-adrenergic receptors in young subjects with peripheral or central obesity: relationship with central haemodynamics and left ventricular function.

This study was designed to evaluate total (t) and surface (s) beta-adrenergic receptor (BAR) density and their relationship with central haemodynamics and left ventricular function in young subjects with central or peripheral obesity. A total of 31 obese subjects (BMI > or = 30.5 kg.m-2 for males and > or = 27.3 kg.m-2 for females) aged less than 40 years and without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) were studied. Nine had peripheral obesity and 22 central obesity according to WHR values; there were 20 lean controls (BMI < 25 kg.m-2 for males and < 24.7 kg.m-2 for females). Casual (c) and 24 h ambulatory mean blood pressures (MBP-24 h) were determined. BAR density was evaluated according to Böyum and De Blasi methods. Plasma catecholamines by high perfusion liquid chromatography and fasting immunoreactive plasma insulin (IRI) were also measured by RIA. Radionuclide angiocardiography was used to determine central haemodynamics and both systolic and diastolic left ventricular function. Total peripheral resistances (TPR) and intravascular volumes were also determined. Echocardiographic study was used to measure LVM, LVM.h-1, LVDD and IVS. Left ventricular ejection fraction (LVEF), peak filling rate (PFR), BARt and BARs were significantly lower (P < 0.05) and cardiac output, cardiac volumes, LVM, LVM. h-1 and time to PFR significantly higher (P < 0.05) in both obese groups than in lean controls. Plasma IRI was significantly (P < 0.05) higher in both obese groups whereas plasma norepinephrine was higher only in central obese.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

Effect of radiofrequency catheter ablation of ventricular tachycardia on left ventricular function in patients with prior myocardial infarction.

INTRODUCTION: Successful RF ablation of VT late after MI can involve multiple applications and long lines of RF lesions. The impact on left ventricular function is potentially important, but not well defined. Quantitative echocardiography was used to determine the effect of radiofrequency (RF) ablation on left ventricular function in patients with ventricular tachycardia (VT) after myocardial infarction (MI). METHODS AND RESULTS: In 62 patients (55 men; age 67 +/- 1.1 yr.) who underwent RF ablation for VT late after MI, left ventricular ejection fraction (LVEF) was quantified from digitized echocardiograms performed </=1 week before and <72 hours after ablation. Patients received a mean of 25.6 +/- 2.2 (range of 3-98) RF lesions. The LVEF pre- and post-ablation did not differ for the group (pre-LVEF 29.8 +/- 11.9% vs. post-LVEF 29.5 +/- 11.2%, p = 0.626), or for the 30 patients who received >25 RF lesions (Pre-LVEF 28.5 +/- 11.1% vs. Post-LVEF 28.1 +/- 10.8%, p = 0.74) or for the 7 patients who received >40 RF lesions (Pre-LVEF 29.9 +/- 12.7% vs. Post-LVEF 29.2 +/- 6.2%, p = 0.84). Although LVEF did not change for the group, LVEF increased >5% in 12/62 (19.4%) pts and decreased >/=5% in 14/62 (22.5%) pts. Patients with a decrease in EF did not differ from the remaining patients with respect to age, gender, number of RF lesions, or use of a cooled RF catheter, but did have a better initial EF (38.8 +/- 12.2% versus 27.2 +/- 10.6%, p = 0.001). CONCLUSION: Multiple RF ablation lesions confined to infarct regions do not measurably affect LV function, but a cautious approach, confining ablation lesions to areas of scar, as was attempted in this study, seems prudent.

Aged↗

PubMed1994

[Study of left ventricular function in cerebral thrombosis with pulsed Doppler echocardiography].

To evaluate the cardiac dysfunction of the cerebral infarction (cerebral thrombosis) patients in the chronic period, non-invasive studies were performed on 45 cerebral infarction patients (CI group: 25 males and 16 females, mean age 64.1 y). Forty hospitalized patient without cerebral infarction served as controls (non-CI group: 23 males and 19 females, mean age 64.8 y). The CI and non-CI group were divided into two sub-groups: patients with a past history of hypertension (HT) and without (NT). In each sub-group, the cardiac functions were compared between CI and non-CI by M-mode and Doppler echocardiography. In echocardiography, research based on the premise that the function of the left ventricle can be divided into preload (EDVi), afterload (SVR), contractility (EF, mVcf, SBP/ESV) and distensibility (E/A). On results show that there were no significant differences in preload, afterload and contractility of the left ventricle between CI and non-CI group in each HT and NT sub group. However, a significant difference was demonstrated in the diastolic function the left ventricle between the two groups in the HT (p = 0.007) and NT (p = 0.04) sub-groups. In conclusion, left ventricle diastolic function was deteriorated in cerebral infarction patients although systolic function not deteriorated. Because diastolic dysfunction may be caused by existing latent heart failure and/or silent myocardial ischemia, echocardiographic study is useful for early detection of left ventricle impairments in cerebral infarction patients.

Aged↗

PubMed1995

Prognostic value of high dose dipyridamole echocardiography in patients with chronic coronary artery disease and preserved left ventricular function.

OBJECTIVES: The prognostic value of dipyridamole echocardiography was assessed in patients with chronic coronary artery disease and preserved left ventricular function. BACKGROUND: Few data are available on the prognostic value of dipyridamole echocardiography in patients with a low risk of cardiac events. METHODS: Two hundred sixty-eight consecutive patients with stable, proven or suspected coronary artery disease and ejection fraction > or = 0.40 underwent high dose (up to 0.84 mg/kg body weight) dipyridamole echocardiography. In 204 patients definite exercise electrocardiographic (ECG) results were also available. RESULTS: During a mean (+/- SD) follow-up period of 16 +/- 8 months (range 6 to 36), 33 spontaneous events occurred: 15 "hard" events (cardiac death [n = 6], myocardial infarction [n = 9]) and 18 "soft" events (unstable angina). Events occurred more frequently in patients with positive findings on dipyridamole echocardiography (59% vs. 3%, p < 0.001; hard events 24% vs. 2%, p < 0.01). A positive response at the low dose (up to 0.56 mg/kg) identified patients with a high incidence of hard events (7 of 16 patients, sensitivity 50%, specificity 96%). In patients with an exercise ECG, a comparable sensitivity for cardiac events was found (89% vs. 93%, p = NS), but dipyridamole echocardiography was more specific (91% vs. 61%, p < 0.01). A positive response on the low work load exercise ECG (< 8 min) and a positive response to low dose dipyridamole echocardiography had similar accuracy (82% vs. 90%, p = NS). Cox analysis identified dipyridamole echocardiography as the best predictor of cardiac events (odds ratio [OR] 20.9, 95% confidence interval [CI] 10.8 to 37.9); the highest risk of hard events was found in patients with a positive response to low dose dipyridamole echocardiography (OR 25.4, 95% CI 12.2 to 54.1). CONCLUSIONS: In patients with chronic coronary artery disease and a low incidence of cardiac events, dipyridamole echocardiography was effective in prognostic stratification, and positive low work load exercise ECG results were a reliable predictor of subsequent events. Consequently, dipyridamole echocardiography should be considered a complementary tool in the presence of high work load positivity or ambiguous exercise ECG results.

Coronary Disease↗

PubMed1995

Diltiazem effects on left ventricular function preliminary results of 12 patients evaluated by calibrated apexcardiogram.

Diltiazem is a calcium channel blocker whose effects on left ventricular function (LVF) are controversial. We studied 12 patients with ischemic heart disease (IHD) before starting and 15 and 30 days after having initiated Diltiazem 60 mg t.i.d. LVF was accessed by means of the normalized indexes of the calibrated apexcardiogram: nS for systolic LVF evaluation and nA for diastolic LVF evaluation. Recent works have shown that these indexes have a good correlation with invasive parameters of LVF. We verified that nS did not change and nA decreased significantly (p < 0.05) after Diltiazem. We preliminary concluded that Diltiazem has no deleterious effect on LV systolic function and improves LV diastolic function, by decreasing nA, a parameter which correlates well with LV end diastolic pressure.

Depression, Chemical↗

PubMed1991

Impaired left-ventricular function in insulin-dependent diabetic patients with increased urinary albumin excretion.

Cardiac function was studied in 30 patients with insulin-dependent diabetes mellitus. Three groups, matched for age and diabetes duration, were defined as: group I (n = 10), normal urinary albumin excretion less than 30 mg 24 h-1; group II (n = 10), incipient diabetic nephropathy (urinary albumin excretion in the range of 30-300 mg 24 h-1); and group III (n = 10), clinical diabetic nephropathy (urinary albumin excretion greater than 300 mg 24 h-1). Ten non-diabetic subjects matched for sex and age served as controls. The left-ventricular end-diastolic volume measured by radionuclide cardiography was, at rest and during exercise, lower in group II and III compared with controls (p less than 0.05), while intermediate values were found in group I. The cardiac output was similar in the control group and group I; it was reduced, but not significantly so (p = 0.10), in group III and was significantly lower in group II (p less than 0.05). Stroke volume was also lower in group II and III than in controls (p less than 0.05), but not so in group I. These differences could not be explained by differences in metabolic control, blood pressure, blood volume status, degree of autonomic neuropathy or frequency of coronary heart disease. Our results might suggest that insulin-dependent diabetic patients with slightly but persistently elevated urinary albumin excretion have reduced diastolic compliance of the left-ventricle leading to impaired cardiac performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

Acute changes in global and regional rest left ventricular function after successful coronary angioplasty: comparative results in stable and unstable angina.

The immediate effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function were assessed by comparing 30 degrees right anterior oblique left ventricular angiograms performed immediately before and after angioplasty on 39 patients undergoing 42 successful procedures. Mean (+/- SD) lesion stenosis decreased from 88 +/- 10% to 35 +/- 11% (p less than or equal to 0.001), whereas left ventricular ejection fraction increased from 57 +/- 11% to 64 +/- 10% (p less than or equal to 0.001) for the entire group. Left ventricular functional changes were further subgrouped according to stability of angina. Eighteen procedures were performed on 17 patients with stable angina: 24 procedures were performed on 22 patients with unstable angina defined as angina at rest or on minimal activity or recently accelerated angina. There were no significant subgroup differences in mean age, gender ratio, vessel anatomy, drug therapy or extent of coronary stenosis before or after angioplasty. Global ejection fraction increased significantly for the unstable group (from 54 +/- 11% to 66 +/- 9%, p less than or equal to 0.001) but was unchanged for the stable group (from 61 +/- 9% to 61 +/- 11%, p = NS). In unstable angina, regional ejection fraction (segmental area method) increased for both jeopardized (from 37 +/- 11% to 52 +/- 9%, p less than or equal to 0.001) and nonjeopardized myocardial segments (from 43 +/- 13% to 51 +/- 13%, p less than or equal to 0.001), but improvement was significantly (p less than or equal to 0.02) greater in jeopardized segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

QT dispersion within the first 6 months after an acute myocardial infarction: relationship with systolic function, left ventricular volumes, infarct related artery status and clinical outcome.

INTRODUCTION: We analysed QT dispersion within the first 6 months postinfarction, its relationship with the main established risk stratifiers and its clinical value. METHODS AND RESULTS: In 55 patients with a first Q-wave myocardial infarction the 12-lead electrocardiogram was scanned and digitised for analysis of QT dispersion (QT maximum-QT minimum) at first day (72 [61-96] ms), first week (69 [47-90] ms), first month (67 [46-88] ms) and sixth month (47 [40-74] ms; P<0.0001 vs. first day). Cardiac catheterization was performed at first week and at sixth month; QT dispersion was not related to ejection fraction, left ventricular volumes, infarct related artery status or contractile reserve (improvement of the infarcted area with low-dose dobutamine); no relation was found between QT dispersion decrease from first week to sixth month with regional systolic function improvement. Finally, during a mean follow-up period of 35+/-22 months QT dispersion was not independently related to clinical events. CONCLUSION: QT dispersion decreases progressively during the first months after myocardial infarction. These changes should be taken into account to define cut-off values of clinical interest in this phase. This variable does not seem related to the classic prognosis predictors. In a nonselected postinfarction population it has a low clinical value.

Coronary Vessels↗

PubMed1987

Pericardial effusion and left ventricular function in patients with acute alcoholic pancreatitis.

Pericardial effusion as a complication of acute pancreatitis has been described in several isolated case reports. However, the prevalence of pericardial effusion in patients with acute pancreatitis has not been studied. Alcoholism and severe acute pancreatitis have been shown to cause left ventricular dysfunction. We studied 15 consecutive patients, hospitalized for the treatment of acute, alcohol-induced pancreatitis, and 28 control subjects by M-mode echocardiography to detect pericardial effusion and to assess left ventricular function. Seven patients (47%) with pancreatitis and three control subjects (11%) had pericardial effusion; the prevalence of pericardial effusion in patients with pancreatitis was significantly greater (Fisher's exact test) than in control subjects. There was no evidence of impairment of left ventricular function in the patients, all of whom had mild acute pancreatitis; the mean fractional systolic shortening of the left ventricle in patients was not significantly different from that of control subjects (38% +/- 8.5% vs 37% +/- 8.0%), and the mean velocity of left ventricular circumferential shortening in patients was significantly higher than in control subjects (1.58 +/- 0.34 circumferences per second vs 1.29 +/- 0.32 circumferences per second). We conclude that in patients with mild acute alcohol-induced pancreatitis, pericardial effusion occurs frequently and that left ventricular function is unimpaired.

Acute Disease↗

PubMed1982

Left ventricular function and compliance in pulmonary atresia with intact ventricular septum.

Left ventricular systolic function and compliance were assessed in 15 cases of pulmonary atresia with intact ventricular septum. The left ventricular ejection fraction measured from cineangiography was used for the evaluation of the systolic function. The end-diastolic pressure (EDP), left ventricular compliance index at end-diastole (dv/dp), and left ventricular stiffness constant K were used as compliance indices. The mean left ventricular ejection fraction was slightly diminished. The right ventricular end diastolic pressures (RVEDPs) correlated significantly (r = 0.90) with the left ventricular end diastolic pressure (LVEDP). On the basis of left ventricular compliance, two distinctive groups of patients could be identified: Group I consisted of Patients 1 to 7, all with impaired left ventricular compliance. A shunt operation was the basic palliation in this group. None of these patients survived infancy. Group II consisted of Patients 8 to 15, all with normal left ventricular compliance. Pulmonary valvotomy as well as aortopulmonary shunts were the basic palliative procedures in this group. Six of eight patients in this group are long-term survivors. No difference was found in right ventricular size, tricuspid valve size, presence of tricuspid insufficiency, presence of a patent ductus arteriosus, postoperative oxygen saturations, and atrial pressure gradients between the two groups. Evaluation of the left ventricular compliance in patients with pulmonary atresia and intact ventricular septum might be of significant prognostic valve for their early survival.

Blood Pressure↗

PubMed1989

[Left ventricular function in patients with recent onset of type I diabetes mellitus].

Left ventricular heart function was investigated by means of two dimensional (2D) echocardiography and pulsed Doppler (PD) echocardiography in 17 young consecutive patients aged 17-38 years (mean 26.6 y.) with type I diabetes mellitus of short duration (mean 5.5 y.) whose stress ECG showed no signs of ischemic heart disease and who had no other organic complications of diabetes. The series was compared with 13 healthy volunteers (mean age 25.5 y.). No differences were found between diabetics and controls in systolic function parameters (left ventricular fractional shortening, interventricular septum shortening, left ventricular posterior wall shortening, left ventricular endsystolic dimension) as established by 2D. The parameters of left ventricular diastolic filling (maximal velocity of the rapid filling period E, its maximal time and duration of the whole phase) were established by PD and computer assisted approach. These parameters were studied also during atrial systole A and the E/A ratio was determined. All findings were comparable in the group of diabetics and controls, with the only statistically significant difference (p less than 0.05) in the duration of A which was shortened in the diabetics.

Adolescent↗

PubMed2004

Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction.

BACKGROUND: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown. METHODS: We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy (in 332 patients) and no ICD therapy (in 342 patients) 6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function (left ventricular ejection fraction, 0.35 or less) and impaired cardiac autonomic function (manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome. RESULTS: During a mean (+/-SD) follow-up period of 30+/-13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group (hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group (hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group (hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02). CONCLUSIONS: Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.

Adult↗

PubMed1986

Radionuclide assessment of regional left ventricular function in acute myocardial infarction.

To determine changes in global and regional left ventricular function following acute myocardial function, 17 patients underwent radionuclide angiography at 3 and 10 days post infarction. Five patients had nontransmural myocardial infarction and 12 had transmural infarction (six anterior and six inferior). There were no previous infarctions in 16 (94%) patients. Regional ejection fractions were calculated by dividing the left ventricle into four quadrants using the geometric center of the left ventricle on the end-diastolic frame as a reference point. At 3 days post infarction, 8 of 17 (47%) patients had an abnormality of global left ventricular ejection fraction (LVEF), whereas 16 of 17 (94%) patients had abnormalities of one or more regional ejection fractions (p less than 0.01). Between 3 and 10 days, global LVEF did not change (51% to 49%, p = NS). However, there were significant changes in 23 of 68 (34%) regional LVEFs. These changes did not relate to type, ECG location, creatine kinase (CK) size of infarction, or initial global LVEF. These data suggest that regional LVEF is a sensitive technique for identifying segmental dysfunction associated with myocardial infarction. In addition, significant changes occur in regional LV function during acute myocardial infarction despite stable serial global LV performance.

Adult↗