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PubMed1988

A mathematical model of left ventricular function in atrial fibrillation.

Sixty patients with atrial fibrillation (AF) have been studied with Doppler ultrasound to establish the relationship between the duration of R-R intervals and subsequent left ventricular stroke outputs, assessed as stroke distance. Using multiple regression analysis, most of the beat-to-beat variation of stroke distance could be explained in terms of the two preceding R-R intervals (Mean R = 0.82). The relative contribution of these two intervals to the variation of stroke distance was assessed in each patient. In all patients there was a positive correlation between stroke distance and the preceding R-R interval, largely due to the influence of this interval on diastolic filling or preload. In all but one patient the correlation with the second previous R-R interval was negative, the mechanism being changing contractility due to operation of the force-frequency effect. On average, 58% of the variance in stroke distance could be explained by alteration of the previous R-R interval and 10% by alteration of the second previous R-R interval. The relative contribution of the previous R-R interval (preload) falls as left ventricular function declines, and also as mean ventricular rate rises. However, there is a wide individual variation in the pattern of left ventricular function, which may be represented graphically as the haemodynamic profile.

Aged↗

PubMed1998

Effect of Poloxamer 188 on Collateral Blood Flow, Myocardial Infarct Size, and Left Ventricular Function in a Canine Model of Prolonged (3-Hour) Coronary Occlusion and Reperfusion.

Poloxamer 188 is a surfactant with hemorheological, antithrombotic, and neutrophil-inhibitory properties. This agent has been demonstrated to reduce infarct size and to improve left ventricular function in animal models of myocardial infarction and reperfusion, and recently in a randomized trial of patients receiving thrombolytic therapy for acute myocardial infarction. In addition to reducing reperfusion injury, poloxamer 188 might be beneficial by increasing collateral blood flow. The purpose of this study was to determine the effect of poloxamer 188 on collateral blood flow, myocardial infarct size, and left ventricular function in a canine model of prolonged (3 hours) coronary occlusion and reperfusion. Closed-chest dogs (n = 21) underwent a 3-hour coronary occlusion and 3 hours of reperfusion. At 1 hour of occlusion, dogs received poloxamer 188, 75 mg/kg IV bolus, followed by 150 mg/kg/h IV for the final 2 hours of coronary occlusion and throughout reperfusion, or a saline placebo. Regional myocardial blood flow was measured using colored microspheres. Myocardial infarct size and area at risk were determined by postmortem histochemical staining. Compared with controls, poloxamer 188-treated dogs showed no significant increase in collateral blood flow during the final 2 hours of a 3-hour coronary artery occlusion. In addition, poloxamer 188 treatment had no beneficial effect on infarct size or left ventricular function in this model. Increased collateral blood flow is unlikely to be a beneficial mechanism of poloxamer 188 in myocardial infarction. These data also question the benefit of this agent to reduce reperfusion injury in the setting of more prolonged (3-hour) coronary occlusion.

Journal Article↗

PubMed1990

Comparative effects of propranolol and diltiazem on systolic and diastolic left ventricular function in essential hypertension.

The effects of propranolol and diltiazem on left ventricular systolic and diastolic function in hypertensive subjects (DBP 90-114 mmHg) were examined with M-mode and 2D echocardiograms in 21 patients in a double-blind fashion prior to and after 4 months of treatment. Systolic function was assessed by measurement of fractional shortening, mean velocity of fibre shortening, peak systolic pressure/end systolic dimension ratio, and end systolic stress/end systolic dimension ratio. To assess diastolic function, maximal rate of change in left ventricular dimension (MAXD), maximal rate of change in posterior wall thinning (MAX PWT) and early diastolic (EDD) and late diastolic dimension changes (LDD) were calculated using digitised M-mode images of mid-wall diameter. Both propranolol and diltiazem reduced systolic and diastolic pressures similarly. No significant changes were observed in any of the parameters of systolic function with either drug. Similarly neither propranolol nor diltiazem altered MAXD or EDD significantly. Although changes in maximal rate of posterior wall thinning (MAX PWT) were not significant with either drug, diltiazem improved MAX PWT in 7 of 8 patients. The results of the study demonstrate that both propranolol and diltiazem reduce blood pressure without significant deleterious effects on systolic or diastolic function. Diastolic functional parameters, which were not abnormal at baseline, showed no consistent change with either propranolol or diltiazem.

Blood Pressure↗

PubMed1992

Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction.

BACKGROUND: We investigated myocardial perfusion dynamics after thrombolysis and its clinical implications. METHODS AND RESULTS: We studied 39 patients with acute anterior myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) was performed before and immediately after successful reflow with intracoronary injection of sonicated Ioxaglate. The average segmental score by two-dimensional echocardiography (graded 0, normal, to 3, akinetic/dyskinetic) and global ejection fraction (left ventricular ejection fraction, LVEF%) by left ventriculography were measured at 1 day and at 4 weeks after reflow. Hypokinesis in the infarct region was assessed by the centerline method and expressed in terms of standard deviations (regional wall motion [RWM]: SD/chord) of normal. Immediately after reflow, 30 of 39 patients (group A) showed significant contrast enhancement within the risk area. The other nine patients (23%, group B), however, showed the residual contrast defect in the risk area (myocardial no reflow). There were no significant differences in the elapsed time, angiographic collateral grade, and degree of residual stenosis between group A and group B. Before reflow, both groups exhibited similar levels of global and regional left ventricular function. Improvement in global (LVEF, average segmental score) and regional left ventricular function was greater in group A than in group B (average segmental score, 0.44 +/- 0.41 versus 0.97 +/- 0.36, p less than 0.01; LVEF, 56.4 +/- 13.4 versus 42.7 +/- 8.9, p less than 0.05; RWM, -1.87 +/- 0.85 versus -3.18 +/- 0.52, p less than 0.005). CONCLUSIONS: MCE demonstrates that angiographically successful reflow cannot be used as an indicator of successful myocardial reperfusion in AMI patients. The residual contrast defect in the risk area demonstrated immediately after reflow is a predictor of poor functional recovery of the postischemic myocardium.

Coronary Circulation↗

PubMedDate not supplied

[The assessment of left ventricular function in cardiac and extracardiac disorders in children].

The left ventricle (LV) suffers during various cardiac and extracardiac diseases. After the description of the cardiac performance during human development, the authors present the assessment of the left ventricle function in some cardiac and also extracardiac disorders of the child. There are listed the changes in myocardial structure, systolic and diastolic function in hypertrophy and dilation of the LV determined by systemic diseases that affect the pediatric patients and can lead to severe cardiac failure.

Cardiomyopathy, Hypertrophic↗

PubMed2000

Effects of long-term treatment with verapamil on left ventricular function and myocardial blood flow in patients with dilated cardiomyopathy without overt heart failure.

Myocardial blood flow (MBF) abnormalities are present in early stage dilated cardiomyopathy (DCM) and have been attributed to coronary microvascular abnormalities. The favorable effects of verapamil on coronary microcirculation might indicate its use in early stage DCM. We assessed the safety of long-term combination therapy of verapamil and enalapril and its effects on both left ventricular function and myocardial perfusion compared with enalapril alone in 18 patients with DCM (15 men, 3 women; mean age, 50+/-9 years) without overt heart failure (NYHA class I-II). At baseline and after 6 months of randomized treatment with either enalapril (10-20 mg) (nine patients, group 1) or enalapril (10-20 mg) and verapamil (120-240 mg) (nine patients, group 2), left ventricular function was assessed at rest, during handgrip, and during bicycle exercise by equilibrium radionuclide angiography. Mean MBF was measured at rest and after dipyridamole by positron emission tomography (PET) and 13N-ammonia as a flow tracer. At baseline, the two groups had reduced left ventricular ejection fraction at rest, which was further impaired during isometric exercise, but increased at peak bicycle exercise. MBF was similarly reduced in the two groups at rest and during dipyridamole. During treatment, no adverse events occurred in either group. After 6 months there was no significant difference in the main study variables either between the two groups or within each group before and after treatment. Long-term combination therapy with verapamil and enalapril is safe in patients with DCM without overt heart failure. Despite no favorable effect on myocardial perfusion, combined treatment prevented deterioration of left ventricular function, similarly to enalapril alone.

Calcium Channel Blockers↗

PubMed2006

Are stentless valves superior to modern stented valves? A prospective randomized trial.

BACKGROUND: It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. METHODS AND RESULTS: Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patients, MRI was also used to assess LVM regression, and again there was no significant difference between groups at 1 year. Hemodynamic performance of the 2 valves was similar with no difference in mean and peak systolic transvalvular gradients 1 year after surgery. In patients with reduced ventricular function (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients. CONCLUSIONS: Both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR. Comparable hemodynamics and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. In patients with ventricular impairment, stentless bioprostheses may allow for greater improvement in left ventricular function postoperatively.

Aged↗

PubMed1995

[Left ventricular function in post-endocarditis aortic insufficiency and aortic-annular ectasia].

BACKGROUND: The duration of valvular regurgitation is an important determinant of left ventricular function in the presence of severe volume overload. PURPOSE: To evaluate the effect of aortic regurgitation (aortoannullar dilatation vs. history of bacterial endocarditis) on left ventricular (LV) function. PATIENTS: Between February 1976 and January 1993 45 patients (mean; age 45 +/- 12 years) underwent diagnostic evaluation for clinical purposes. Patients were divided into three groups: group 1 consisted of 17 patients with normal LV function (controls), group 2 of 11 patients with severe aortic regurgitation due to aortoannullar dilatation (AAD) and group 3 of patients with severe aortic regurgitation and a history of bacterial endocarditis (BE). METHODS: LV function was assessed by biplane LV-angiography and simultaneous pressure recordings. The ejection fraction and peak systolic wall stress were calculated in all patients. Systolic and diastolic LV function was determined and compared within the three groups. RESULTS: Heart rate, mean aortic pressure and cardiac index were similar in the three groups. The mean aortic diameter was significantly increased in group 2 when compared to the other two groups (p < 0,001). Systolic function was significantly reduced in both groups with aortic regurgitation when compared to the control patients. The end diastolic pressure-volume relationship was shifted to the right in patients with aortic regurgitation, but only 3 patients with a history of bacterial endocarditis showed severe diastolic dysfunction. CONCLUSIONS: No hemodynamic differences were observed in patients with severe aortic regurgitation with regard to the etiology or time course of LV volume overload. However, 17% of the patients with a history of bacterial endocarditis had severe diastolic dysfunction, which is probably due to the faster development of volume overload after bacterial endocarditis.

Adult↗

PubMed1981

[The end-systolic pressure-volume relationship in the assessment of left ventricular function (author's transl)].

This investigation was undertaken to determine whether the left ventricular (LV) end-systolic pressure and end-systolic volume, as measured under clinical conditions, are linearly correlated and whether the slope of the end-systolic pressure-volume relationship (P-Ves) is a meaningful parameter in the assessment of left ventricular function. The studies were performed in twelve patients (eleven with coronary artery disease and one with congestive cardiomyopathy) during which autonomic reflex responses were minimized by propranolol (0.15 mg/kg i.v.) and atropine (1 mg i.v.). Three left ventricular angiograms (at rest, after 10 mg isosorbide dinitrate and during an infusion of 2 mg/min methoxamine) were obtained from which the three respective P-Ves data points were calculated and subjected to linear regression analysis (r greater than or equal to 0.96). The slope k of the linear P-Ves relation correlated most closely with the resting ejection fraction (EF) as an exponential function (r = 0.94). The end-systolic pressure could be interchanged with the peak systolic pressure which is more easily obtained. The theoretical end-systolic volume at end-systolic pressure = 0 (V0) was not related to the resting ejection fraction. Post-extrasystolic potentiation, resulting in an acute inotropic incrementation, shifted the P-Ves toward similar volumes and steepened its slope.

Atropine↗

PubMed1983

Radiocardiographic evaluation of left ventricular function after inhalation of C15O2.

Inhalation of C15O2 delivers a bolus of labelled water into the pulmonary veins and the left atrium; analysis of the left ventricular curve provides an easy method for the evaluation of left ventricular function. the patient was seated before six collimated probes positioned toward the lungs. An additional probe was directed toward the heart in a modified 15 to 20 degrees left anterior oblique projection. One to two mCi C15O2 was administered per study. The left ventricular curve was analysed and the ejection fraction was calculated using a new method. The background was first calculated for the cycle with the largest diastolic counts using characteristic points of the curve before and after transit of the indicator through the left ventricle. For the other cycles, the background was considered to be a constant fraction of the end-diastolic counts. The left ventricular ejection fraction was obtained for each cycle after corresponding background subtraction as the ratio of diastolic activity minus systolic activity over diastolic activity. The ejection fraction thus determined in 20 patients was highly reproducible from beat to beat and from study to study in the same patient (r = 0.97 and 0.96). It corresponded closely to the ejection fraction determined using a camera-computer system (r = 0.92). We conclude that C15O2 inhalation is an easy, rapid, reproducible and attractive method to assess left ventricular function.

Adult↗

PubMed1986

Assessment of regional left ventricular function by magnetic resonance.

The ability of magnetic resonance to determine regional left ventricular function was investigated in 18 patients--13 with coronary artery disease (nine with previous infarction), one with congestive cardiomyopathy, one with mitral stenosis, one with an atrial septal defect, and two without detectable cardiac abnormality. Coronal magnetic resonance images were acquired through the aortic valve and sagittal images were acquired in the plane of widest diameter of the left ventricle seen in the coronal image, both at end diastole and end systole. Regional wall motion assessed by magnetic resonance was compared with the results of anteroposterior and left lateral x ray ventriculograms by two independent observers. The left ventricular wall was divided into three segments in each plane and the motion of the segments was classified as normal, hypokinetic, akinetic, or dyskinetic. Muscle thickness was measured in each segment of the magnetic resonance images and was considered to be abnormal if in the systolic images it was less than 75% of that in neighbouring segments or if it failed to increase by at least 25% between diastole and systole. Wall motion assessments by the two methods agreed in 68 of 105 segments analysed, but differed by one class in 32 segments and by two classes in five segments. The differences can be explained by the conditions under which the investigations were performed and by the disparity between a tomographic section and an x ray projection. Magnetic resonance showed 25 segments to have abnormal wall thickness. Only one patient with infarction did not have an area of wall thinning and no patient without infarction had an area of thinning. It is concluded that magnetic resonance allows an accurate non-invasive assessment of left ventricular wall motion and thickness.

Adult↗

PubMed2003

[Effect of ACE gene polymorphism on left ventricular function in patients with type 2 diabetes].

The authors evaluated the influence of the ACE gene polymorphism on left ventricular function in patients with diabetes type 2. In a group of 23 patients left ventricular mass, global and regional systolic function of the left ventricle as well as diastolic function was assessed from transmitral flow using two-dimensional echocardiography. In a subgroup of patients with DD (n = 7) and ID genotype (n = 16), no significant differences were found in age (p = 0.19), duration of diabetes (p = 0.46), level of HbA1c (p = 0.10), cholesterol level (p = 0.18), quantitative proteinuria (p = 0.39), systolic and diastolic blood pressure (p = 0.25, p = 0.40). No association was found between insertion-deletion polymorphism of the ACE gene and observed echocardiographic parameters [left ventricular mass index (p = 0.43), EF (p = 0.46), wall motion index (p = 0.25), E wave (p = 0.14), A wave (p = 0.07), deceleration time of the E wave (p = 0.06), E/A (p = 0.07), flow propagation velocity (Vp) (p = 0.14) and E/Vp (p = 0.38)]. The presence of myocardial infarction, ischemic heart disease and hypertension had no association with ACE gene polymorphism (p = 0.53, p = 0.61 and p = 0.64). In conclusion, there is no association between ACE gene polymorphism and systolic and diastolic function of the left ventricle in this group of patients with diabetes type 2.

Aged↗

PubMed1987

The normal pericardium does not affect left ventricular function.

Whether the normal pericardium exerts a constraining effect on left ventricular (LV) diastolic compliance and/or systolic function is controversial. Left ventricular filling and performance were studied in 15 patients by two-dimensional transesophageal echocardiography (2D-TEE) measuring end-diastolic area (EDa), end-systolic area (ESa), ejection fraction area (EFa), and hemodynamics immediately pre- and post-pericardiotomy. To diminish the influences of other variables such as surgical stimulation, chest wall constraint, and autoregulation, measurements were performed in deeply anesthetized patients with the chest fully opened immediately before and after pericardiotomy (PC). No significant echocardiographic or hemodynamic changes were observed after PC. Although alterations in compliance cannot be excluded, no significant changes in LV diastolic filling (EDa, pulmonary capillary wedge pressure [PCWP]) or systolic performance (EFa, cardiac output [CO]) were found. Therefore, it is concluded that the normal pericardium does not exert a measurable constraining effect on LV performance.

Coronary Artery Bypass↗

PubMed2002

Evaluation of left ventricular function and mass after Medtronic Freestyle versus homograft aortic root replacement using cardiovascular magnetic resonance.

BACKGROUND AND AIM OF THE STUDY: Regression of left ventricular hypertrophy (LVH) after aortic valve replacement has traditionally been measured by echocardiography. However, cardiovascular magnetic resonance (CMR) can be used to measure left ventricular function and mass more accurately and reproducibly. This translates into fewer patients being needed to demonstrate significant changes. The study aim was to demonstrate the feasibility of using CMR to measure left ventricular mass index (LVMI) and function in patients from a prospective randomized trial, and to compare homografts with the Medtronic Freestyle root replacement. METHODS: Among 23 patients recruited, 17 had LVMI and function (end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF)) measured pre- and postoperatively using CMR (eight homograft, nine Freestyle). RESULTS: Significant regression of LVH was seen in both groups one year postoperatively (homograft LVMI 145+/-44 g/m2 preoperative versus 83+/-23 g/m2 one year postoperatively; Freestyle LVMI 140+/-28 g/m2 versus 93+/-21 g/m2, respectively). At six months there was significant regression in the xenograft group (from 140+/-28 to 106+/-22 g/m2; p <0.05) and a trend towards regression in the homograft group (from 145+/-44 to 103+/-25 g/m2; p = NS). There was also a trend towards a reduction in EDV, ESV and SV, and an increase in EF over one year in both groups. CONCLUSION: Regression of LVH was measured using CMR in patients after aortic root replacement and coronary implantation with the homograft and Medtronic Freestyle root replacement. Despite the small number of patients studied, it was possible to demonstrate the extent and pattern of regression of left ventricular mass in the two groups.

Aged↗

PubMed1986

Simultaneous measurement of left ventricular function and myocardial perfusion during a single exercise test: dual isotope imaging with gold-195 m and thallium-201.

The state of left ventricular function and myocardial perfusion are important determinants of prognosis in patients with coronary artery disease and information on both can be valuable for planning individual patient management. We have studied the feasibility of simultaneous measurement of left ventricular ejection fraction with ultra short-lived gold-195 m (half life 30.5 seconds) and myocardial perfusion with thallium-201, at rest and after exercise with a single-crystal gamma camera. The results with first-pass radionuclide angiocardiography (RNA) using gold-195 m at rest were reproducible and agreed closely with the results obtained using technetium-99 m equilibrium radionuclide angiocardiography (r = 0.93). Ejection fraction by first-pass gold-195 m RNA during semi-supine ergometric exercise decreased by greater than 5% in 13 out of 18 patients with coronary artery disease and stable angina. Simultaneous myocardial imaging with thallium-201 was abnormal in all patients. The change in regional wall motion abnormality score during exercise correlated with the change in myocardial perfusion (r = 0.71, P less than 0.01) and with the change in global left ventricular ejection fraction (r = 0.77, P less than 0.001). The widely differing energy levels and half-lives of gold-195 m and thallium-201 made it possible to separate clearly the images due to each radionuclide. This study has demonstrated the feasibility of simultaneous or sequential assessment of left ventricular function and myocardial perfusion during a single exercise test, a technique which can offer advantages in clinical evaluation of patients with coronary artery disease.

Adult↗

PubMed1993

[Correlations between arrhythmias and left ventricular function at rest and during stress in patients with postinfarct aneurysm].

The results (clinical, hemodynamic, and angiographic data) of 197 patients with left ventricular anterior wall aneurysm were evaluated at rest and during exercise (bicycle ergometer) 6 months after the acute infarction. Using the technique of digital subtraction angiography, left ventricular volumes were estimated after injection of contrast medium into the pulmonary artery and measuring of pulmonary artery pressure. In 136 patients a programmed right ventricular stimulation was performed additionally. The patients were divided into the following groups: patients with (VT+) and without (VT-) ventricular arrhythmias in history. Group VT- was subdivided in patients with positive (RV+) or negative (RV-) result of right ventricular stimulation. In group VT+ chamber volumes were greater and ejection fraction was smaller than in group VT-. At rest the results of subgroup RV+ were similar to group VT+, but during exercise similar to group RV-. These results show that left ventricular function at rest and during exercise is much more impaired in patients with spontaneous and by stimulation-induced arrhythmias than in patients without these arrhythmias. The conclusions for clinical practice of these findings are not yet clear, concerning, for example, the prophylactic use of antiarrhythmic measurements in patients without spontaneous but with induced arrhythmias. Further investigations (long-term follow-ups of these patients) will be necessary.

Arrhythmias, Cardiac↗

PubMed1998

Prognosis by measurements of left ventricular function during exercise. Duke Noninvasive Research Working Group.

UNLABELLED: This study was performed to determine whether gated equilibrium radionuclide angiogram measurements of left ventricular function during rest and exercise add independent information to clinical and catheterization data in predicting cardiac death. METHODS AND RESULTS: The study population consisted of 863 consecutive patients undergoing exercise gated equilibrium radionuclide angiography within 90 days of cardiac catheterization with data prospectively entered into the Duke Cardiovascular Database. All patients were symptomatic, medically treated, with significant coronary artery disease and had undergone follow-up for < or = 6 yr. A univariable and multivariable Cox regression analysis was utilized to evaluate the independent power in predicting 147 (17.0%) cardiac deaths. This risk-adjusted analysis revealed that only rest and exercise ejection fraction as well as maximum workload contained independent prognostic information; the nuclear variables contributed 63% of the total information within the model. A multivariable model including exercise ejection fraction and clinical history variables provided slightly more prognostic information than the combination of cardiac catheterization and clinical data. CONCLUSION: Multigated equilibrium radionuclide angiography is a key predictor of cardiac death when compared to clinical and cardiac catheterization data in patients with symptomatic, medically treated coronary artery disease. Thus, long-term outcome for patients may be determined by utilizing this noninvasive tool even when clinical and cardiac catheterization data are also available.

Cardiac Catheterization↗

PubMed2001

Early recovery of left ventricular function after stentless versus stented aortic valve replacement for pure aortic stenosis and severe cardiac dysfunction.

OBJECTIVE: The aim of this study was to evaluate early recovery of systolic function after stentless aortic valve replacement (AVR) versus stented AVR. METHODS: Fifty-four consecutive patients with pure aortic stenosis and impaired left ventricular function (LVEF < or = 35%) were studied retrospectively. Aortic regurgitation, concomitant valvular or coronary artery surgery, atrial fibrillation, and a previous AVR were exclusion criteria. Twenty-two patients (mean age, 70.0 +/- 6.5 years) received a stentless bioprosthesis and 32 (mean age, 58.9 +/- 6.2 years, P =.031 between groups) a mechanical or stented biologic valve. Patients underwent echocardiography preoperatively, at discharge, at 6 months, and at 1 year after surgery. RESULTS: At 6 months, analysis of variance demonstrated significant differences between groups in fractional shortening measured at the endocardium and midwall fractional shortening (<0.001), velocity of circumferential shortening (P <.001) ejection fraction (P =.02), left ventricular mass index (P <.001), systolic meridional wall stress, and circumferential wall stress (P <.001), One-year studies confirmed these findings. CONCLUSION: LV function showed, after a stentless AVR, an early recovery greater than in patients receiving a stented valve.

Aged↗