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PubMed1987

Determinants of improved left ventricular function after thrombolytic therapy in acute myocardial infarction.

Many studies have been performed to evaluate the efficacy of thrombolytic therapy in achieving reperfusion, salvaging myocardium and enhancing survival. This review discusses the concordance between the results of these clinical studies and the observations made in experimental animals of the effect of reperfusion on the recovery of left ventricular function. The evaluation of functional recovery is affected by the timing of the measurement and the sensitivity of the method for detecting regional abnormalities. In addition, the underlying coronary anatomy also determines outcome, so that infarct location, collateral circulation and the degree of coronary obstruction merit consideration. Two factors are of paramount importance in determining the amount of myocardium salvaged, the recovery of left ventricular function and the reduction in mortality. These factors are: the time delay until reperfusion is achieved and the adequacy of the coronary reflow. The close agreement between studies measuring the effect of reperfusion on left ventricular function and studies with mortality as the end point provides indirect evidence that enhancement of survival in patients treated with thrombolytic agents is mediated by recovery of ventricular function.

Angioplasty, Balloon↗

PubMed2002

Hemodynamic and plasma atrial natriuretic peptide responses to acute digitalis therapy in patients with normal and impaired left ventricular function.

BACKGROUND: Digitalis has a long history in the treatment of heart failure but its effects on cardiac hemodynamics and neurohormonal modulation are not well characterized. AIMS: The purpose of this study was to evaluate the relationship between atrial natriuretic peptide (ANP) and the hemodynamic responses to acute digitalis administration in patients with normal and impaired left ventricular function (LVD). METHODS AND RESULTS: Thirty patients were enrolled in the study, 20 with LVD (LVEF=22+/-8%) and 10 control subjects (LVEF=77+/-10%). Hemodynamics and plasma ANP concentrations were measured supine and with leg elevation before and after digitalis. In patients with normal ventricular function, the hemodynamic stress of leg elevation in the pre-digitalis state resulted in significant (P<0.05) increases in PAWP and MPAP. Digitalis administration in the supine position produced reductions in heart rate, PAWP, MPAP and CI; SVR was increased. In LVD patients leg elevation further increased PAWP, RAP and MPAP. Digitalis in the supine position, however, reduced RAP, MPAP and PAWP and increased CI. These improved hemodynamics were preserved during the stress of leg elevation. Leg elevation following digitalis resulted in increased ANP concentrations despite decreased cardiac filling pressures. CONCLUSIONS: Acute digitalis administration results in hemodynamic improvement in LVD patients which may in part result from digitalis stimulated release of myocardial ANP under conditions of hemodynamic stress.

Adult↗

PubMed1986

Spatial and temporal variations in regional left ventricular function in isolated disease of the left anterior descending coronary artery.

The temporal and spatial pattern of left ventricular (LV) contraction and relaxation in 34 patients with isolated lesions of the left anterior descending artery (LAD) were studied from the LV cineangiogram in the right anterior oblique position using a computer interactive technique. The LV outline was divided into 100 equiangular radii from the center of the enddiastolic silhouette and the trajectory of contraction and relaxation of each radius measured and displayed. Patients were divided into different subsets. Classical anterior wall infarction caused impaired contraction of the distal two thirds of the anterior wall, the apex and the distal quarter of the inferior wall, with marked delay in contraction and relaxation of the border zones and hyperkinesis of the inferior wall. Spatial and temporal disturbances (akinesis and asynchrony) were marked in the other subsets. Left bundle branch block caused profound temporal delay particularly during relaxation.

Adult↗

PubMed1977

Left ventricular function before and following aortic valve replacement.

Twenty-four patients with aortic valve disease were studied before and 19+/-12 months following valve replacement with a well functioning prosthesis. Biplane left ventricular angiography and pressures were utilized to determine end-diastolic volume/m2 (EDV), end-systolic volume/m2 (ESV), ejection fraction (EF), left ventricular mass/m2 (LVM) and stroke work (SW). There were nine patients with aortic stenosis (AS), ten patients with combined stenosis and regurgitation (AS-AR), and five patients with aortic regurgitation (AR). Following surgery, patients with regurgitation preoperatively showed marked regression in EDV and ESV. All groups demonstrated regression in LVM. Fifteen patients with a normal EF preoperatively (65+/-11%) had no change after surgery; the nine patients with a low EF before surgery (38+/-8%) had a normal EF after surgery (60+/-16%). We conclude that left ventricular dilatation, hypertrophy, and reduced left ventricular pump function are largely reversible after successful aortic valve replacement.

Angiography↗

PubMed1985

Sensitivity of cross-sectional echocardiography in detection of impaired global and regional left ventricular function: prospective study.

In order to establish the sensitivity and specificity of cross-sectional echocardiography for detection of global and regional left ventricular function a prospective study was performed in 80 patients suspected of having coronary artery disease. Twenty four hours before heart catheterization, cross-sectional echocardiograms were recorded in the apical RAO-equivalent view and high quality echocardiograms were obtained in 71/80 patients (89%). M-mode echocardiograms of the left ventricle could be performed in 56/71 patients (79%). Based on normal values sensitivity and specificity of cross-sectional echocardiography were calculated in comparison to cineventriculography. For fractional shortening (normal value greater than 25%) sensitivity measured 46% and specificity 93%, and when the E-point septal separation was measured (normal value less than 7 mm), sensitivity increased to 73% and specificity was 84%. For detection of increased end-diastolic volume (less than 155 ml) sensitivity reached 84% and specificity 98% and for increased end-systolic (less than 70 ml) volume it was 86 and 97%, respectively. A depressed left ventricular ejection fraction (greater than 49%) was found with a sensitivity of 93% and specificity of 100%. Regional left ventricular wall motion, analyzed by an area method, revealed for anterior wall motion a sensitivity of 68% and a specificity of 94%, whereas for posterior wall motion sensitivity reached 80% and specificity 96%. Regression equation between the number of pathological segments and left ventricular ejection fraction for cineventriculography was given by Y = -4.06 X + 73.4, r = 0.93 and for cross-sectional echocardiography by Y = -3.69 X + 62.6, r = 0.85. We conclude that cross-sectional echocardiography can be used as a screening method to detect impaired left ventricular function. It is superior to M-mode echocardiography. Reduced regional function of the posterior wall can be found with high sensitivity, but depressed motion of the anterior wall may be overlooked.

Adult↗

PubMed2006

Volumetric analysis of regional left ventricular function with real-time three-dimensional echocardiography: validation by magnetic resonance and clinical utility testing.

BACKGROUND: Quantitative information on regional left ventricular volumes from real-time three-dimensional echocardiographic (RT3DE) images has significant clinical potential but needs validation. AIM: To validate these measurements against cardiac magnetic resonance (CMR) and test the feasibility of automated detection of regional wall motion (RWM) abnormalities from RT3DE data. METHODS: RT3DE (Philips) and CMR (Siemens) images were obtained from 31 patients and analysed by using prototype software to semiautomatically calculate indices of regional left ventricular function, which were compared between RT3DE and CMR (linear regression, Bland-Altman). Additionally, CMR images were reviewed by an expert, whose RWM grades were used as a reference for automated classification of segments as normal or abnormal from RT3DE and from CMR images. For each modality, normal regional ejection fraction (REF) values were obtained from 15 patients with normal wall motion. In the remaining 16 patients, REFs were compared with thresholds that were derived from patients with normal wall motion and optimised using receiver operating characteristic analysis. RESULTS: RT3DE measurements resulted in good agreement with CMR. Regional indices calculated in patients with normal wall motion varied between segments, but overall were similar between modalities. In patients with abnormal wall motion, RWM was graded as abnormal in 74% segments. CMR and RT3DE thresholds were similar (16-segment average 55 (10)% and 56 (7)%, respectively). Automated interpretation resulted in good agreement with expert interpretation, similar for CMR and RT3DE (sensitivity 0.85, 0.84; specificity 0.81, 0.78; accuracy 0.84, 0.84, respectively). CONCLUSION: Analysis of RT3DE data provides accurate quantification of regional left ventricular function and allows semiautomated detection of RWM abnormalities, which is as accurate as the same algorithm applied to CMR images.

Algorithms↗

PubMed1985

Left ventricular function during transluminal angioplasty: a haemodynamic and angiographic study.

The response of left ventricular function, was studied in a series of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). From 4 to 6 balloon inflations procedures per patient were performed with an average duration per occlusion of 51 +/- 12 sec (mean +/- SD), total occlusion time 252 +/- 140 sec. Analysis of left ventricular (LV) haemodynamics showed that the relaxation parameters peak negative rate of change in pressure and the early time constant of relaxation responded earliest to acute coronary occlusion while other parameters such as peak pressure, LV end-diastolic pressure, and peak positive rate of change of pressure responded more gradually and suggested a progressive depression in myocardial mechanics during the entire procedure. LV angiogram available in 14 patients indicate an early onset of asynchronous relaxation concurrent with the early response in peak -dP/dt and the time constant of early relaxation. All haemodynamic parameters fully recovered within minutes after the end of PTCA. The results of this study indicate no permanent dysfunction to global or regional myocardial mechanics, after PTCA with 4 to 6 coronary occlusions each lasting 40 to 60 seconds.

Angiography↗

PubMed1986

Clonidine and left ventricular function in ten patients with essential hypertension.

Left ventricular mass and function were evaluated by M-mode echocardiography in 10 patients with essential hypertension, before and after 16 weeks of treatment with clonidine. Plasma renin activity (PRA), serum and 24-h urinary Na and K were also determined. The dose range of clonidine was 0.15-0.45 mg/day. Systolic and diastolic blood pressure decreased significantly since the second week of treatment (p less than 0.0001). There was a decrease in calculated total peripheral resistance (35.3 +/- 11.08 to 30.91 +/- 6.6 RU p less than 0.01), end meridional (72.9 +/- 23.6 to 58.5 +/- 22 dynes/cm2 X 10(3), p less than 0.001) and peak systolic wall stress (453.5 +/- 140 to 378 +/- 97 dynes/cm2 X 10(3), p less than 0.01), wall tension (333 +/- 36 to 286.6 +/- 42, p less than 0.01). Left ventricular mass index decreased in six patients (83.7 +/- 20.4 to 70.7 +/- 12.4 g/m2, p less than 0.001). Decrease in left ventricular mass index was related to decrease in wall tension (r = 0.70 p less than 0.01) and septal thickness in diastole (r = 0.71, p less than 0.01). There was a decrease in "double product" (10,934 +/- 1,975 to 8,705 +/- 1,739, p less than 0.01), PRA (3.74 +/- 2.51 to 2.51 +/- 1.44 ng/ml/h p less than 0.01) with increase in 24-h urinary Na (114.9 +/- 37 to 155.3 +/- 55.8 mEq/24-h urine, p less than 0.001). Cardiac index, left ventricular ejection fraction and fractional shortening increased without significance (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

The effect of gender on left ventricular function immediately after the wingate test.

The effect of gender on left ventricular systolic function and exercise haemodynamics in healthy young subjects was studied during 30-s all-out sudden strenuous dynamic exercise. A group of 22 men [19.3 (SD 1) years] 20 women [19.1 (SD 1) years] volunteered to participate in this study. Two-dimensional direct M-mode and Doppler echocardiograph studies were performed with the subject in the sitting position. The Doppler examination of flow was located with continuous-wave, interrogating ascending aorta measurements. The subjects completed the study without showing any electrocardiograph abnormalities. An interaction effect with stroke volume (P < 0.05) was characterized by a decrease in the men and an increase of stroke volume in the women. Cardiac output rose significantly (P < 0.05) up to 14.5 (SD 6) 1.min-1) for the men and 12.1 (SD 4) 1.min-1 for the women compared to the rest values [5.8 (SD 0.4) and 4.7 (SD 0.5) 1.min-1, respectively]. Flow velocity integral and acceleration time differed significantly between the two groups at rest (P < 0.05). During exercise these differences showed an interaction effect (P < 0.05). These results would indicate that normal men and women respond to sudden strenuous exercise by reducing their left ventricular systolic function, with a significantly greater decrease in women (P < 0.05). The gender differences in the haemodynamic responses during the present study, may, as suggested by others, be attributable to differences in energy metabolism. In addition, changes in Doppler parameters of aortic flow, haemodynamics and blood pressure responses during sudden strenuous exercise differed markedly from those seen before with endurance exercise.

Adolescent↗

PubMed2002

Estimation of global left ventricular function from the velocity of longitudinal shortening.

AIMS: To determine if global ventricular function can be assessed from the long-axis contraction of the left ventricle, we compared pulsed-wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. METHODS AND RESULTS: We studied 51 patients (56 +/- 10 years, 11 women) with a radionuclide ejection fraction of 52 +/- 13% (15%-70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P < 0.001), as did the time-velocity integrals (0.57 and 0.58, respectively; P < 0.001). Correlations were higher in normal ventricles (0.62-0.69) than in patients with previous myocardial infarction (0.39-0.64). Patients with anterior myocardial infarction had the lowest correlations (0.39-0.46). The best differentiation of normal (> or = 50%) from abnormal (< 50%) ejection fraction was provided by peak systolic velocity > or = 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. CONCLUSION: Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall-motion abnormalities. However, in patients with important segmental wall-motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction.

Echocardiography, Doppler, Pulsed↗

PubMed1983

Haemodynamic effects of intravenous amrinone in patients with impaired left ventricular function.

The effects of intravenous amrinone on resting haemodynamic function were investigated in 15 patients with impaired left ventricular function. All patients received 1 X 5 mg/kg and 10 received a further 2 mg/kg. We observed dose related increases in heart rate and cardiac index, and reductions in mean arterial pressure, left ventricular end-diastolic pressure, and systemic vascular resistance. A small reduction in left ventricular end-diastolic volume and a 36% increase in ejection fraction occurred. No significant change in max dp/dt, min dp/dt, (Max dp/dt/P), max (dp/dt/P), KVmax or the ratio of left ventricular end-systolic pressure to left ventricular end-systolic volume was detected. It is concluded that the beneficial effects of intravenous amrinone on the resting haemodynamics in our patients were attributable to vasodilatation, with the drug having no demonstrable positive inotropic effect.

Adult↗

PubMed1993

Recovery of left ventricular function after acute myocardial infarction: efficacy of domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial.

BACKGROUND: The objective was to compare the effect of thrombolytic therapy given either at home or in hospital on the recovery of left ventricular function after acute myocardial infarction. METHODS: In a randomized double-blind trial, 311 patients with suspected acute myocardial infarction were given 30 units anistreplase intravenously either at home, or later, in hospital. The median time-saving made with domiciliary thrombolysis was 130 min. All patients were admitted to hospital where left ventricular stroke distance was measured daily using a simple bedside ultrasound technique, and expressed as a percentage of the age-predicted normal value. The last recorded inpatient stroke distance measurement was used to assess residual left ventricular function after recovery from myocardial infarction. RESULTS: The mean stroke distance in patients with confirmed myocardial infarction was 74% on the day of admission, rising to 83% on the last inpatient day; it did not change between discharge and 3 months after admission. For 180 patients assigned randomly to treatment within 2 h of the onset of symptoms, mean stroke distance was greater by 6.8% in those given active anistreplase at home rather than in hospital (95% confidence interval 1.0 to 12.7%, P = 0.02), but there was no significant difference in stroke distance following home or hospital thrombolysis in 111 patients assigned treatment after that time (difference -2.0%, 95% confidence interval -8.4 to 4.5%, P = 0.54). CONCLUSIONS: The efficacy of thrombolytic therapy is enhanced when administered within 2 h of the onset of symptoms.

Adult↗

PubMed1988

Left ventricular function and prognosis in patients suspected of acute myocardial infarction but without confirmed diagnosis. The risk of cardiac events related to echocardiography, systolic time intervals, and chest x-ray.

The prognosis following discharge, with cardiac events as endpoint, was related to left ventricular function in 217 patients admitted with a suspicion of acute myocardial infarction (AMI), but in whom the diagnosis was not confirmed (non-AMI patients). The investigations used were echocardiography, systolic time intervals, and chest X-ray. During follow-up (median 14 months, range 12-24 months), 18 cardiac events occurred, i.e. non-fatal AMI or cardiac death. The prognosis for non-AMI patients was only slightly better than for patients with confirmed AMI (p = 0.05). The prognosis for non-AMI patients was significantly related to a decreased left ventricular function. Measurements of relative heart volume or mitral septal separation on echocardiography gave significant information about prognosis. The percentage without cardiac events after one year was 88.0 in patients with cardiomegaly versus 96.8 in those with normal heart size (p = 0.029). We conclude that non-AMI patients with decreased left ventricular function are at increased risk of cardiac events following discharge.

Adult↗

PubMedDate not supplied

[An echocardiographic study of the left ventricular functional indices in pediatric patients on hemodialysis and in treatment with recombinant human erythropoietin (r-HuEPO)].

Recombinant human erythropoietin (r-HuEPO) is efficient in the treatment of anaemia in chronic renal failure on hemodialysis. We investigated the changes in cardiac function under r-HuEPO therapy using echocardiography. Seven patients with severe renal anaemia (Ht 19%) were treated with 50 U/kg r-HuEPO EV three times/week. Echocardiographic studies were performed in the anemic state and when hematocrit values were stable at levels (Ht 30%). Left ventricular function as showed by fractional shortening (D%) improved, the thickness of the interventricular septum and left ventricular hypertrophy were reduced. Our data indicate that the correction of renal anaemia by r-HuEPO can improve myocardial function in patients on maintenance hemodialysis.

Anemia↗

PubMed1991

Comparative effects of APSAC and rt-PA on infarct size and left ventricular function in acute myocardial infarction. A multicenter randomized study.

BACKGROUND: Recombinant tissue-type plasminogen activator (rt-PA or alteplase) and anisoylated plasminogen streptokinase activator complex (APSAC or anistreplase) have been demonstrated to limit infarct size significantly and to preserve left ventricular function when injected soon after acute myocardial infarction. However, as yet, the efficacy and safety of these two thrombolytic agents have not been directly compared in one trial; this was the aim of this study. METHODS AND RESULTS: One hundred eighty-three patients suffering from a first acute myocardial infarction were randomly allocated to either APSAC (30 units over 5 minutes) or single-chain rt-PA (100 mg over a 3-hour period) within 4 hours of the onset of symptoms. Global and regional left ventricular function were assessed from contrast angiography an average of 5.3 +/- 2.3 days after initial therapy. Radionuclide angiography and thallium-201 single-photon emission computerized tomography were performed before hospital discharge. Infarct size was assessed by single-photon emission computerized tomography and expressed in percentage of the total myocardial volume. Ninety patients received APSAC and 93 received rt-PA within a mean period of 172 +/- 52 minutes after the onset of symptoms. The two groups were similar in age, location of the acute myocardial infarction, Killip class, and time of randomization. The patency rate of the infarct-related artery was 72% in the APSAC group and 76% in the rt-PA group (NS). Initial and predischarge left ventricular ejection fraction as well as infarct size were similar in both therapeutic groups (0.50 +/- 0.14 versus 0.52 +/- 0.12 for initial and 0.48 +/- 0.10 versus 0.47 +/- 0.10 for predischarge ejection fraction, 11 +/- 7% versus 9 +/- 7% for infarct size, respectively, for APSAC- and rt-PA-treated patients). Bleeding complications requiring blood transfusion occurred in one APSAC patient and in two rt-PA patients. One patient in the rt-PA group died of a massive intracranial hemorrhage. At the end of the 3-week follow-up period, five APSAC patients (5.5%) and seven rt-PA patients (7.5%) had died. CONCLUSIONS: The early infusion of APSAC or rt-PA in acute myocardial infarction produced a similar patency rate, limitation of infarct size, and preservation of left ventricular systolic function with an equivalent rate of bleeding complications.

Anistreplase↗

PubMed1974

[Study of left ventricular function in valvular cardiopathies (mitral insufficiency and aortic insufficiency].

A study of the left ventricular function based on the haemodynamic data combined with those provided by biplane cineangiography was performed in 35 cases with left ventricular volume overload (20 cases of mitral incompetence and 15 of aortic insufficiency). The importance of the haemodynamic changes and of the adaptation mechanisms set up were described. The more intense dilatation-hypertrophy of aortic incompetence than of mitral incompetence plays an essential part. The role of Starling's mechanism is underlined. Estimation of the contractile value of the myocardium, taken into account the mechanical overload and the conditions of late-diastolic lengthening of the fibre and of impedance to left ventricular ejection was determined. An obvious myocardial failure, demonstrated in approximately one third of the cases, by determination of some contractility indices estimated in the ejection phase, Vf sigma max in particular, the only one valid in the presence of valvular regurgitation. In the other cases, the moderate decrease of myocardial contractility was masked by compensatory mechanisms.

Adolescent↗

PubMed2000

Multivessel coronary stenting versus bypass surgery in patients with multivessel coronary artery disease and normal left ventricular function: immediate and 2-year long-term follow-up.

BACKGROUND: Compared with coronary artery bypass surgery (CABG), the clinical benefits of intracoronary stenting have not been established in patients with multivessel coronary lesions. METHODS AND RESULTS: To compare the clinical outcomes of intracoronary stenting with that of CABG, we reviewed the outcomes of patients with multivessel coronary artery disease from an observational database. Two hundred consecutive patients with multivessel coronary artery disease and normal left ventricular function were evaluated. In 200 patients, multivessel stenting was performed in 100 and CABG was performed in 100. Complete revascularization was achieved in 95% in the CABG group and in 69% in the stent group (P <.05). The duration of total hospital stay and coronary care unit admission was significantly shorter in the stent group (P <.05). The long-term survival was similar between the 2 groups. There were no significant differences of cardiac events between the 2 groups except for the recurrence of angina (19% in stenting vs 8% in CABG, P =.03) and target lesion revascularization (19% vs 2%, P <.01) in the patients with stents. CONCLUSIONS: In selected patients with multivessel coronary artery disease and normal left ventricular function, intracoronary stenting may offer an effective alternative to coronary bypass surgery.

Aged↗

PubMed2003

Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial.

HYPOTHESIS: To evaluate the effects of high thoracic epidural anesthesia (TEA) on global and regional myocardial function and on perioperative coronary risk in patients undergoing coronary artery bypass grafting. DESIGN, SETTING, AND PATIENTS: Prospective and randomized clinical trial blinded for the primary outcome measure of 73 patients scheduled for coronary artery bypass grafting who had a left ventricular ejection fraction of 50% or more conducted from February 1, 2000, through August 31, 2000, at University Hospital, Münster, Germany. INTERVENTIONS: Of 73 randomized patients, 37 were control subjects (who received general anesthesia only) and 36 were in the group who received general anesthesia and high TEA. MAIN OUTCOME MEASURES: The primary outcome measure was regional left ventricular function after myocardial revascularization, assessed by transesophageal echocardiography. We further determined the plasma concentrations of cardiac troponin I and atrial and brain natriuretic peptides. Secondary outcome measures were postoperative complications recorded to 14 days and mortality recorded to 720 days. RESULTS: High TEA was effective in all patients of this group, the somatosensory block extended from T1 through T7 vertebrae. Regional left ventricular function was significantly improved (mean [SD] global wall motion index, 0.74 [0.18] vs 0.38 [0.16]; P<.05), and cardiac troponin I concentrations were reduced by 72% (mean [SD], 5.7 [1.5] vs 1.6 [0.7] ng/mL, P<.05) in patients with high TEA. Natriuretic peptide concentrations peaked during reperfusion (atrial natriuretic peptide) and 24 hours after reperfusion (brain natriuretic peptide). High TEA reduced the mean (SD) peak concentrations of atrial natriuretic peptide by 54% (211 [63] vs 98 [33] ng/mL, P =.03) and brain natriuretic peptide by 43% (189 [39] vs 108 [21] ng/mL, P =.01). One of 36 patients who received high TEA and 3 of 37 controls died. CONCLUSIONS: Reversible cardiac sympathectomy by high TEA improves regional left ventricular function and reduces postoperative ischemia after coronary artery bypass grafting. These effects of high TEA may improve the long-term outcome after myocardial revascularization.

Anesthesia, Epidural↗