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PubMed1992

Improvement of severely reduced left ventricular function after surgical revascularization in patients with preoperative myocardial infarction.

In recent years, two pathophysiological conditions--stunned and hibernating myocardium--have been described showing how function may be depressed in myocardium that remains viable. The aims of the present study were postoperative assessment of LV function at rest and during exercise after CABG in patients with established previous myocardial infarction and impaired preoperative LV function and evaluation of preliminary experience with positron emission tomography (PET) in the preoperative identification of reversible ischaemic myocardium and its predictivity in postoperative functional improvement. We studied 23 patients with preoperative LV function under 45%. Echocardiography and complete heart catheter were performed pre- and postoperatively. PET was performed in all patients preoperatively. In 21 patients with patent grafts, CABG significantly improved systolic and diastolic function during exercise and at rest. EF improved from 34% +/- 14% to 52% +/- 11% at rest and from 31% +/- 14% to 58% +/- 13% during exercise (P less than 0.01). Time constant of diastolic relaxation was significantly reduced after revascularization. In 2 patients with pathological findings on postoperative coronarangiography, EF remained unchanged. Both global and regional contractility improved following surgery. Regional analysis indicated that improved EF at rest occurred in regions developing ischaemia during exercise before CABG and in regions showing typical mismatch in 82Rubidium-2-fluoro-2-desoxyglucose suggesting the presence of hibernating myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed2004

Assessment of left ventricular function with contrast echocardiography.

Echocardiography continues to be the primary noninvasive imaging modality for the assessment of cardiac structure and function because of significant advances in ultrasound imaging technology over the last two decades, yet quantification of the LV function has remained an elusive goal. The introduction of contrast agents has represented a major advance in clinicians' ability to visualize the endocardium and to assess LV function accurately, particularly in patients who have poor acoustic windows. Ongoing and future refinements in imaging technology used with contrast enhancement have placed automated quantification of LV function on the brink of widespread clinical use.

Contrast Media↗
PubMed2005

The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes.

BACKGROUND: The number of competitive master athletes (MA, over 40 years) has been rising. Since the incidence of coronary artery disease (CAD) is increasing in this population, cardiovascular pre-participation screening, including a maximum exercise test, is recommended. In this context the addition of contrast to echo could be useful because wall thickening and motion are better markers of myocardial function when the whole endocardial border (EB) is visible. OBJECTIVE: To evaluate the feasibility and usefulness of rest and exercise contrast echo for the assessment of LV wall motion in competitive master athletes with suboptimal acoustic windows. METHODS: Forty consecutive MA underwent echo and contrast echo both at rest and during exercise. Contrast-enhanced images were achieved at rest and at peak exercise after administration of SonoVue (BR1), using apical 4 and 2-chamber views divided into 6 myocardial segments (MS). The EB resolution for each segment was graded as: 0=not visible, 1=barely visible, 2=well-delineated. RESULTS: In the baseline at-rest echo 17/40 (45%) patients were graded as score 0, 22/40 (55%) were graded as score 1 and only 1 athlete has reached score 2. In at-rest echo contrast 28/40 (70%) athletes have reached score 1 and 12/40 (30%) score 2. Nobody was graded as score 0. At the same time in the baseline peak-exercise echo 12/40 (30%) athletes were graded as score 0, 24/40 (60%) athletes reached score 1 and 4/40 (10%) score 2, while using contrast at peak-exercise echo 28/40 (70%) were grated as score 1 and 12/40 (30%) reached score 2. The differences about the grading of the score between the two groups with and without contrasts, at rest and at peak exercise, are statistically significant (p<0.001). Considering the whole of the MS analyzed in the majority of the athletic population studied, we can see that at-rest echo, 64/480 MS (13.3%) were graded as 0, 156/480 MS (32.5%) as 1 and 260/480 MS (54.2%) were graded 2, while in the peak-exercise 96/480 MS (20%) were graded as 0, 235/480 MS (48.9%) as 1 and 209/480 MS (43.5%) were graded 2. On the other hand, using contrast, in at-rest echo, 480/480 MS (100%) were graded as 2 while in the peak-exercise echo 460/480 MS (95.9%) were graded as 2 and 20/480 MS (4.1%) as 1. The percentage of the MS graded as 2 reach almost the whole number of the analyzed MS with a percentage increment in the at-rest and peak-exercise echo of 85% and 120%, respectively. CONCLUSIONS: Our results show that the use of contrast echo improves the visibility of the EB in a way that the two groups of competitive athletes show at rest and after exercise a significant increment of the score 2 compatible with a better visibility of the EB. These results suggest that contrast echo, both at rest and during exercise, is a better method for EB analysis to understand the behaviour of the wall motion in subjects with suboptimal acoustic windows, and could be suitable for cardiovascular screening in master athletes.

Aged↗
PubMed2006

Assessment of left ventricular function by cardiac ultrasound.

Our understanding of the physical underpinnings of the assessment of cardiac function is becoming increasingly sophisticated. Recent developments in cardiac ultrasound permit exploitation of many of these newer physical concepts with current echocardiographic machines. This review will first focus on the current approach to the assessment of cardiovascular hemodynamics by cardiac ultrasound. The next focus will be the assessment of global cardiac mechanics in systole and diastole. Finally, relationships between the cardiac structure and regional myocardial function, and the way regional function can be quantified by ultrasound, will be presented. This review also discusses the clinical impact of echocardiography and its future directions and developments.

Coronary Circulation↗
PubMed2006

Effects of antihypertensive medication on left ventricular function during electroconvulsive therapy: study with transthoracic echocardiography.

STUDY OBJECTIVE: To characterize the effects of antihypertensive medications on cardiac function using transthoracic echocardiography during electroconvulsive therapy (ECT). STUDY DESIGN: Randomized, double-blind study set at a university hospital. PATIENTS: 30 American Society of Anesthesiologists (ASA) physical status I and II patients undergoing ECT. INTERVENTIONS: Patients were given thiopental sodium (two mg/kg) and succinylcholine (one mg/kg), and mask ventilation was initiated with 100% oxygen before bilateral ECT. Patients received a bolus injection of one of several different antihypertensive medications: 0.08 mg/kg alprenolol, 0.01 mg/kg nitroglycerin, 0.02 mg/kg nicardipine, or saline immediately after anesthesia induction and before electrical shock. MEASUREMENTS: Cardiac function was examined through transthoracic echocardiography before anesthesia induction, throughout the ECT procedure, and for 10 minutes after the seizure. MAIN RESULTS: Electrical shock resulted in a significant change in fractional area change when compared with the awake condition. Further fractional area change at one minute after ECT was significantly higher in patients who received nicardipine than in the other groups (means +/- SD): control group, 43% +/- 10%; nitroglycerin group, 46% +/- 8%; nicardipine group, 65% +/- 6% (P < 0.05 vs the other three groups); and alprenolol group, 51% +/- 7%. Systolic blood pressure/end-systolic area-end-diastolic area at one minute after the electrical shock was higher in the control, nitroglycerin, and alprenolol groups but not in the nicardipine group when compared with the awake condition (means +/- SD): control group, 39 +/- 8 mmHg/cm(2) (P < 0.05 vs the other three groups); nitroglycerin group, 32 +/- 9 mmHg/cm(2); nicardipine group, 29 +/- 7 mmHg/cm(2); alprenolol group, 31 +/- 6 mmHg/cm(2). CONCLUSIONS: Specific antihypertensive drugs produced different hemodynamic effects during ECT. Our data suggest that alprenolol was the most appropriate agent for minimization of changes in heart rate and transthoracic echocardiographic variables after ECT.

Adult↗
PubMed2001

Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

Adult↗
PubMed2003

Comparison of intravenous myocardial contrast echocardiography and low-dose dobutamine echocardiography for predicting left ventricular functional recovery following acute myocardial infarction.

Akinesia after acute myocardial infarction (AMI) may be reversible or irreversible. Distinguishing these 2 entities early after AMI is difficult, but clinically important. Previous studies have shown that myocardial contrast echocardiography (MCE) and low-dose dobutamine echocardiography (DE) may both be useful in this setting. However, there are few data regarding the relative and combined value of these techniques. The aim of this study was to compare the utility of real-time intravenous MCE and low-dose DE in the early prediction of functional recovery of akinetic myocardium after AMI. Thirty-seven patients were studied 3 +/- 2 days after an AMI. Each subject underwent real-time MCE using an intravenous infusion of perflutren microbubbles. Immediately after this, low-dose DE was performed. Contrast opacification and wall motion were determined by experienced observers blinded to clinical data. Repeat echocardiograms were obtained 51 +/- 19 days later and wall motion at rest was scored by an observer blinded to clinical data. Normal contrast opacification predicted functional recovery with a positive predictive value of 63%, a negative predictive value of 73%, and an accuracy of 66%. Residual contractility during low-dose DE had a positive predictive value of 82%, a negative predictive value of 72%, and a predictive accuracy of 76%. When the 2 tests were concordant (64%), they had a positive predictive value of 81%, a negative predictive value of 85%, and a predictive accuracy of 83%. Low-dose DE was superior to intravenous MCE in the prediction of functional recovery of akinetic myocardium after AMI, but the combination of both maximizes predictive accuracy.

Aged↗