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At least 19 recordsLinked to original sources
PubMed2000

Systolic blood pressure at end-expiration measured by the automated systolic pressure variation monitor is equivalent to systolic blood pressure during apnea.

OBJECTIVE: It is necessary to define a reference systolic arterial blood pressure (RP) to calculate delta-Up (dUp) and delta-Down (dDown) for systolic pressure variation. Most studies define the reference pressure as the average systolic blood pressure during a short period of apnea. We describe an automated systolic pressure variation monitor that measures airway pressure and defines the reference pressure as the systolic blood pressure at end-expiration. The present study compares the reference systolic blood pressure measured at end-expiration by the automated systolic pressure variation monitor and the reference systolic blood pressure measured during apnea to test whether the end-expiration value is an adequate substitute for the value during apnea. METHODS: After obtaining informed consent, 108 sets of measurements of systolic pressure variation (SPV) were made in 20 intubated, mechanically-ventilated, anesthetized patients by the automated SPV monitor and during apnea. Measurements were taken during periods of hemodynamic stability defined as three consecutive end-expiratory systolic blood pressures within four mmHg of each other. The three systolic pressures at end-expiration were averaged (RPmonitor). Immediately following these measurements, the ventilator was turned off and the systolic blood pressure was measured at 6, 8, 10 and 12 seconds of apnea. The reference pressure during apnea (RPapnea) was defined as the average of the systolic blood pressure at 8, 10 and 12 seconds of apnea. For each measurement set, RPmonitor and the systolic blood pressure at 6 seconds of apnea (SBP6) were compared to RPapnea using Bland-Altman analysis. RESULTS: Bland-Altman analysis for the difference between SBP6 and RPapnea yielded a small bias of -0.3 mmHg with standard deviation of 1.3, indicating that the systolic pressure tends to continue to increase slightly after 6 seconds of apnea. Results were similar for the difference between RPmonitor and RPapnea (-0.2 +/- 3.1 mmHg). CONCLUSIONS: dUp and dDown are calculated using the reference pressure. RPmonitor is an average of 0.2 mm Hg less than RPapnea, thus dUp calculated by the automated SPV monitor is an avenge of 0.2 mm Hg greater than dUp measured by the reference pressure during apnea and dDown is 0.2 mm Hg less. Since the bias of -0.2 mmHg is clinically insignificant, there is acceptable agreement between the reference pressure obtained during apnea and that obtained by the automated SPV monitor at end-expiration. The mean difference between RPmonitor and RPapnea is explained by the continued rise in systolic pressure during the period of apnea as demonstrated by the difference between SBP6 and RPapnea.

Anesthesia↗
PubMed1984

Left ventricular function in coronary artery disease. Evaluation of slope of end-systolic pressure-volume line (Emax) and ratio of peak systolic pressure to end-systolic volume (P/Ves).

Left ventricular function was assessed by measurement of systolic pressure-volume variables and ejection fraction in seven normal subjects (group I), five patients with coronary artery disease and normal symmetric left ventricular wall motion (group II) and eight patients with remote myocardial infarction and segmental akinesia (group III). Left ventricular volumes were obtained from right anterior oblique ventriculograms and pressures from catheter-tip micromanometer (14 patients) or fluid-filled catheters (6 patients) at two different systolic loads. P/Ves was calculated as the ratio of peak systolic pressure (P) to end-systolic volume (Ves) at rest, Emax as the slope of the end-systolic pressure volume line constructed at two systolic loads, and Vo as the volume axis intercept of this line. Emax was significantly (p less than 0.01) lower in patients with segmental akinesia (group III) (5.0 +/- 0.5) than in normal subjects (group I) (10.4 +/- 0.8) or patients with coronary artery disease and normal wall motion (group II) (9.9 +/- 0.8). In contrast, there was no significant difference in P/Ves among the three groups (6 +/- 1.0 in group I, 5 +/- 0.8 in group II, 3.7 +/- 0.5 in group III). Similarly, Ves and Vo failed to separate the three groups. Although ejection fraction was significantly (p less than 0.05) lower in group III (0.56 +/- 0.03) than in groups I and II (0.67 +/- 0.03 in both groups), there was considerable overlap of individual values in the three groups. In eight patients, measurements were repeated during isometric exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed2005

Efficacy of combination therapy for systolic blood pressure in patients with severe systolic hypertension: the Systolic Evaluation of Lotrel Efficacy and Comparative Therapies (SELECT) study.

Systolic hypertension is predominant among patients over 50 years of age, is a more important cardiovascular risk factor than diastolic blood pressure, and is more difficult to control than diastolic blood pressure. Consequently, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends combination therapy as first-line treatment for patients with stage 2 hypertension. In the Systolic Evaluation of Lotrel Efficacy and Comparative Therapies (SELECT) study, 24-hour ambulatory blood pressure monitoring was used to identify patients with systolic hypertension and to determine the impact of 8 weeks of treatment with either amlodipine besylate/benazepril HCl 5/20 mg combination therapy (n=149), amlodipine besylate 5 mg (n=146), or benazepril HCl 20 mg (n=148). Combination therapy was significantly more effective in reducing systolic blood pressure and pulse pressure than either monotherapy (p<0.0001). Significantly greater percentages of patients in the combination group compared with either monotherapy achieved blood pressure control (p<0.0001). Adverse events were low in all three treatment arms, with less peripheral edema in the combination group than in the amlodipine-treated group. The combination of amlodipine besylate/benazepril HCl given to patients with stage 2 systolic hypertension resulted in significantly greater reductions in blood pressure and pulse pressure than those seen with monotherapy and was at least as well tolerated as the separate components. This data supports the recommendation of the JNC 7 for the use of combination therapy in patients with stage 2 hypertension.

Aged↗
PubMed2004

[Differences in clinical profile and outcome in patients with decompensated heart failure and systolic dysfunction or preserved systolic function].

OBJECTIVES: To compare the clinical characteristics and short- and long-term prognosis for chronic heart failure with left ventricular systolic dysfunction or preserved systolic function. PATIENTS AND METHOD: Three-hundred twenty-eight consecutive patients with decompensated chronic heart failure were studied prospectively. Depending on ejection fraction, participants were classified as having systolic dysfunction (group 1, ejection fraction < or = 40%,) or preserved systolic function (group 2, ejection fraction >40%). RESULTS: Systolic dysfunction was detected in 192 patients (58.5%) and preserved systolic function in 41.5%. Mean age was 62.7 (12.5 years) in group 1 and 65.2 (16.2 years) in group 2 (P=.03), with a male prevalence of 73.3% and 49.3%, respectively (P<.001). Ischemic cardiomyopathy was more frequent in group 1 (44.8% vs 25%; P<.001). Physical examination and electrocardiogram findings were similar in both groups, except for a higher proportion of patients in group 1 with a heart third sound (43.2% vs 25%; P=.001) and left bundle branch block (40.6% vs 15.4%; P<.001) and abnomal Q waves (31.3% vs 20.6%; P=.04). In-hospital mortality was similar in patients with systolic dysfunction and preserved systolic function (2.9% vs 1%; P=NS). Twenty-four-month cumulative survival was 61% for patients with systolic dysfunction and 76% for patients with preserved systolic function (log rank test P=NS). In the Cox proportional hazards model, which included age, sex, functional class, hepatomegaly, peripheral hypoperfusion, BUN, sodium level, ejection fraction > 40%, and biventricular heart failure, preserved systolic function was not associated with late mortality. The variables that were independent predictors of late mortality were peripheral hypoperfusion (OR = 3.7; P<.0001), low sodium level (OR=0.9; P=.009) and male sex (OR=1.9; P=.041). CONCLUSIONS: Decompensated chronic heart failure with preserved systolic function was more frequent in women and older patients. Patients with preserved systolic function had a lower prevalence of coronary heart disease. However, these differences had no impact on the short- and long-term prognosis.

Aged↗
PubMed1999

Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.

CONTEXT: The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. OBJECTIVE: To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. DESIGN: Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. SETTING: Family practices and outpatient clinics at primary and secondary referral hospitals. PARTICIPANTS: A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. INTERVENTIONS: For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). MAIN OUTCOME MEASURES: Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. RESULTS: After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.

Aged↗
PubMed2004

Geometric changes of mitral annulus assessed by real-time 3-dimensional echocardiography: becoming enlarged and less nonplanar in the anteroposterior direction during systole in proportion to global left ventricular systolic function.

OBJECTIVE: We sought to investigate the geometric changes of the mitral annulus during systole in relation to global left ventricular (LV) systolic function using real-time 3-dimensional (3D) echocardiography. METHODS: Real-time 3D echocardiography was performed in 23 patients with global LV systolic dysfunction with ejection fraction of 37 +/- 19% and 9 control subjects with ejection fraction of 62 +/- 4%. Volumetric data were divided into 9 rotational apical planes (angle increment = 20 degrees) using 3D software. Nine rotational annular dimensions (ADs) were measured in all planes in early and late systole. Nonplanar angle (NPA) of the annulus between two vectors from two hinge points of the annulus in the anteroposterior plane to the center between two commissures in the commissure-commissure plane was measured during early and late systole. Fractional changes of NPA and AD were defined as changes in percentage during systole. RESULTS: NPA significantly increased during systole (early, 145 +/- 12 degrees; late, 160 +/- 9 degrees; P < .01). Among 9 ADs, 3 anteroposteriorly directed ADs showed the most prominent fractional increases during systole in all patients. Both fractional changes of NPA ( R 2 = 0.87, P < .01) and the anteroposterior dimension, AD 1 ( R 2 = 0.85, P < .01) showed significant positive correlation with global LV systolic function. CONCLUSIONS: Real-time 3D echocardiography demonstrated that saddle shape of the mitral annulus was getting enlarged and less nonplanar mainly in the anteroposterior direction during systole. These geometric changes were proportional to the global LV systolic function.

Adult↗
PubMed2000

[Systolic-diastolic arterial hypertension versus isolated systolic hypertension].

The presence of elevated values of both diastolic and systolic arterial blood pressure is one of the most important risk factors for coronary heart disease, stroke, and heart failure; in patients with hypertension, the pharmacological reduction of blood pressure decreases the risk of adverse cardiovascular events, though the optimal blood pressure goal is still being debated. During recent years there has been an increasing interest in isolated systolic hypertension, both as an independent risk factor for cardiovascular disease and as a clinical entity requiring treatment in its own right. The definition of what constitutes isolated systolic hypertension still remains controversial and arbitrary; the criteria generally used is a systolic blood pressure > or = 140 mmHg and a diastolic blood pressure < 90 mmHg. Not only the cut-off levels used to define isolated systolic hypertension, but also the number of occasions on which blood pressure is measured can significantly affect the prevalence of isolated systolic hypertension in the total population. The use of 24-hour ambulatory blood pressure monitoring is a relatively new method for overcoming transient elevations in blood pressure that often occur during clinic measurement; it has a good reproducibility, is subject to little "white-coat" or placebo effect, and finally provides blood pressure measurements within a subject's normal environment. Borderline isolated systolic hypertension (defined as a systolic blood pressure between 140 and 159 mmHg and a diastolic blood pressure < 90 mmHg) is probably the most common type of untreated hypertension among adults over the age of 60; in the following 20 years, about 80% of patients with borderline isolated systolic hypertension will show progression to definite hypertension with increased risk of development of cardiovascular disease. The increase in systolic and diastolic blood pressure with age is typical of Western societies, while it is not observed among some "unacculturated" populations, who tend to be lean and physically active, with a lower daily sodium intake. Maybe environmental, rather than genetic factors may contribute more to the determination of blood pressure throughout life. Pharmacological treatment of isolated systolic hypertension can lead to a significant reduction in total stroke, coronary heart disease, and cardiovascular disease. The question of which antihypertensive agents are most effective is still to be fully elucidated with specifically addressed trials.

Adult↗
PubMed1998

Systolic blood pressure, isolated systolic hypertension and risk of coronary heart disease, strokes, cardiovascular disease and all-cause mortality in the middle-aged population.

OBJECTIVE: To determine the risk of death from coronary heart disease, stroke, all cardiovascular disease and all-cause mortality associated with systolic blood pressure and in particular with isolated systolic hypertension among the middle-aged population. METHODS AND DESIGN: A prospective 15-year cohort study of two independent cross-sectional random samples of subjects participating in baseline surveys in 1972 and 1977. Each survey included a self-administered questionnaire, measurements of height, weight and blood pressure and the determination of the serum cholesterol concentration. SETTING: North Karelia and Kuopio provinces in eastern Finland. Mortality follow-up complete with the personal identification number. PARTICIPANTS: Participants were 10,333 men and 11,160 women aged 25-64 years without histories of myocardial infarction and stroke incidence at the time of the baseline survey. Isolated systolic hypertension in these analyses was defined as systolic blood pressure > or = 160 mmHg and diastolic blood pressure < 95 mmHg. Subjects with blood pressure < 160/90 mmHg were considered normotensive. RESULTS: Coronary heart disease, stroke, cardiovascular disease and all-cause mortality among men and women aged 45-64 years increased with the increasing systolic blood pressure. Among women aged 45-64 years, isolated systolic hypertension increased the relative risk of these fatal events. Among men aged 45-64 years, only coronary heart disease mortality was significantly associated with isolated systolic hypertension. CONCLUSION: Isolated systolic hypertension is an important predictor of death from coronary heart disease, stroke, cardiovascular disease and all causes for women. For men aged 45-64 years, the risk of death from coronary heart disease was associated with isolated systolic hypertension, but the risk of stroke, cardiovascular disease and all-cause mortality associated with increasing systolic blood pressure was evident already at the systolic blood pressure levels < 160 mmHg, independently of the level of diastolic blood pressure.

Age Factors↗
PubMed2003

[Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction?].

OBJECTIVES: To assess the prevalence, clinical profile and medium-term prognosis in patients with heart failure and preserved systolic ventricular function compared to those with systolic dysfunction. PATIENTS AND METHOD: 153 patients were included, 62 with preserved systolic ventricular function (left ventricular ejection fraction > or = 45%) and 91 with impaired systolic ventricular function (left ventricular ejection fraction < 45%). The mean follow-up period was 25 10 months. RESULTS: Mean age was similar (66 10 vs. 65 10; p = 0.54). There was a higher proportion of women among patients with preserved systolic function (53% vs. 28%; p < 0.01). Ischemic and idiopathic cardiomyopathy were the most common causes of heart failure in patients with systolic dysfunction, whereas valvular disease and hypertensive cardiopathy were the most common in patients with preserved systolic function. Angiotensin-converting enzyme inhibitors and beta-blockers were more often prescribed in patients with impaired systolic ventricular function (86% vs. 52%; p < 0.01 and 33% vs. 11%; p < 0.01, respectively). There were no differences between the groups in terms of mortality rate (37% vs. 29%), readmission rate for other causes (29% vs. 23%), readmission rate for heart failure (45% vs. 45%), cumulative survival (51% vs. 62%) and the likelihood of not being readmitted for heart failure (50% vs. 52%). In the multivariate analysis, left ventricular ejection fraction was not a predictor of death or readmission because of heart failure. CONCLUSIONS: In a large proportion of patients with heart failure, systolic ventricular function is preserved. Despite the clinical differences between patients with preserved and impaired systolic ventricular function, the medium-term prognosis was similar in both groups.

Aged↗
PubMed1987

The development of the entire end-systolic pressure-volume and ejection fraction-afterload relations: a new concept of systolic myocardial stiffness.

In this study we introduce a new concept of systolic myocardial stiffness that extends the Suga-Sagawa maximum ventricular elastance concept to the myocardium. End-systole is defined as the time of maximum systolic myocardial stiffness (max Eav), which we examined for its load independence and sensitivity to changes in the inotropic state and to heart rate. Seven adult mongrel dogs were instrumented with ultrasonic crystals for measurements of long and short axes and left ventricular wall thickness, and a high-fidelity micromanometer was inserted for measurement of left ventricular pressures. Preload and afterload were altered by inferior vena cava occlusion, nitroprusside, angiotensin II, atropine, propranolol, and various combinations with propranolol. End-systolic stress-strain relations (slope: max Eav) were linear in all seven dogs, implying that end-systolic myocardial stiffness is independent of end-systolic stress. Changes in max Eav (for constant preload and afterload) reflected changes in the ejection fraction; max Eav was also insensitive to propranolol and to changes in heart rate over the range from 120 to 180 beats/min. End-systolic pressure-volume relations (ESPVRs), derived analytically from these stress-strain relations, were nonlinear, and estimates of volume at zero stress (Vom) were always positive. On the other hand, ESPVRs obtained on the basis of the Suga-Sagawa maximum ventricular elastance concept, were linear, and volume at zero pressure (Vop) estimated by linear extrapolation was negative in one case. Based on the concept of systolic myocardial stiffness, the slope of the ESPVR varies with end-systolic volume and attains its maximum value (Emax) at zero end-systolic pressure. Normalization of Emax with Vom demonstrated a close relationship to max Eav. Thus both max Eav and Vom and Emax are ideal variables for assessing changes in myocardial contractility when preload and afterload are constant. Furthermore, Vom and max Eav permit development of the entire ejection fraction-afterload relationship for a given preload, thus providing a method for comparing myocardial contractile states between ventricles.

Animals↗
PubMed1989

[Is this mitral valve prolapse? A case of mitral regurgitation with early systolic murmur due to early systolic prolapse of the posterior leaflet].

This paper reports the findings of phonocardiograms, echocardiogram and Doppler echocardiograms in a case of a 50-year-old man with early mitral valve prolapse with an early systolic murmur. A characteristic early systolic crescendo murmur was recorded at the apex. By amyl nitrite inhalation, the early systolic murmur was attenuated and a late systolic murmur was evoked. On the contrary, methoxamine injection increased the intensity of the early systolic murmur. Early systolic prolapse and early systolic buckling were recorded by two-dimensional and M-mode echocardiography. The phase of mitral regurgitation detected by M-mode color Dopper echocardiography coincided well in timing with the early systolic murmur and the early systolic buckling recorded on the M-mode echocardiogram. A discussion was made on the mechanism of the early systolic mitral regurgitation due to early mitral valve prolapse.

Amyl Nitrite↗
PubMed1984

Noninvasive assessment of right ventricular systolic pressure in atrial septal defect: analysis of the end-systolic configuration of the ventricular septum by two-dimensional echocardiography.

This study was performed to determine if 2-dimensional echocardiography (2-D echo) can be used to predict right ventricular (RV) systolic pressure. Ninety-one patients with atrial septal defect were studied prospectively. Analysis of the end-systolic configuration of the ventricular septum (VS) in the short-axis 2-D echocardiogram allowed classification of patients into 4 groups: type A (67 patients)--the VS was more circular at end-systole than at end-diastole; type B (9 patients)--the VS curvature at end-systole was same as or further flattened compared with that at end-diastole; type C (9 patients)--the VS was straight at end-systole; type D (6 patients)--the VS curvature at end-systole was reversed so that it was convex toward the left ventricle. Between these types, the RV pressure was different. The RV systolic pressure ranged from 18 to 55 mm Hg (mean 34 +/- 1) in type A, 46 to 55 mm Hg (50 +/- 1) in type B, 60 to 76 mm Hg (66 +/- 2) in type C, and 72 to 118 mm Hg (93 +/- 7) in type D. The RV systolic pressure was statistically different between types except for types C and D. These data indicate that the end-systolic configuration of the VS in the short-axis 2-D echocardiogram may be useful for the semiquantitative assessment of the RV systolic pressure in patients with atrial septal defect.

Adolescent↗
PubMed1977

Effects of stroke volume and velocity of ejection on end-systolic pressure of canine left ventricle. End-systolic volume clamping.

To study the effects of contraction mode on ventricular end-systolic pressure-volume relationship, we compared the end-systolic pressure of isovolumic contraction with that of ejecting contraction at an identical end-systolic volume. The left ventricle of excised cross-circulated canine hearts was fitted with a water-filled balloon. The balloon was connected to a hydraulic pump that allowed the ventricle to contract to a preset constant end-systolic volume (19-37 ml) from a variable end-diastolic volume. At each of control, enhanced, and depressed levels of contractility, differences of end-systolic pressures of steady state isovolumic and ejecting contractions were evaluated while stroke volume and velocity of ejection were widely varied. The end-systolic pressure in the ejecting contraction tended to decrease by 5-15% from that of the isovolumic beat with increases in either stroke volume to 20-25 ml or peak velocity of ejection to about 800 ml/sec. There was no obvious difference in the results at different levels of contractility. The magnitude of the end-systolic pressure depression due to ejection was, however, relatively small as compared to 4-fold changes in end-systolic pressure due to the changes in contracility. We, therefore, conclude that the ventricular end-systolic pressure-volume relationship is affected slightly by ejection, and that this effect is much smaller than the maximal effect of changing contractility on the end-systolic pressure-volume relationship.

Animals↗
PubMed2005

Effect of age on left ventricular systolic function in humans: a study of systolic isovolumic acceleration rate.

The aim of this study was to examine the effect of age on left ventricular (LV) systolic function in normal healthy adults. Eighty consecutive subjects without cardiovascular disease underwent standard and tissue Doppler (TD) echocardiographic imaging. LV systolic function was assessed by load-dependent indices as ejection fraction (EF) and myocardial systolic velocities by TD as well as by the load-independent index, systolic isovolumic acceleration rate (IVA). None of the echocardiographic measurements of systolic function declined with age (mean IVA for the group, 286 +/- 123 cm s(-2); IVA vs. age, r = 0.21, P = 0.1). Likewise, LV end diastolic dimension, wall thickness, mass and left atrial maximum volume were not significantly related to age. On the other hand, as previously reported, echocardiographic indices of diastolic function showed a significant decline with age (P < 0.05). When the group was stratified by gender, isovolumic velocity and acceleration were higher in men than women, but the differences were not significant (P = 0.12 and 0.37, respectively). No significant relation was observed between age and measurements of LV systolic function by regression analysis in women (P > 0.1). However, in men, a positive correlation was noted between average IVA and age (r = 0.63, P = 0.007). In conclusion, age is not associated with a change in cardiac structure and LV systolic function, but is accompanied by a decline in echocardiographic indices of diastolic function. With respect to gender, age does not appear to influence LV systolic function in women, but is associated with an increase in IVA and septal systolic ejection in men.

Adult↗
PubMed1992

[Scintigraphic evaluation of the peak systolic pressure-end-systolic volume relation: comparison with invasive left ventricular contractile indexes].

We calculated the slope of peak systolic pressure-end-systolic volume relation (P/V slope) and the ratio of peak systolic pressure to end-systolic volume (P/V ratio) using radionuclide ventriculography and indirect sphygmomanometry to evaluate left ventricular contractility, and to assess the usefulness of these indexes, we compared them with mean VCF, LVEF, ESVI and ESS/ESVI using cardiac catheterization. Subjects were 12 patients who had received both radionuclide ventriculography and cardiac catheterization within a two weeks period. Left ventricular end-systolic volume and peak blood pressure were measured at 3 different points, one in the control state and the other two at two different hemodynamic states during infusion of Methoxamine. We defined P/V slope as the slope of the regression line of peak systolic pressure-end-systolic volume relation, and P/V ratio as the ratio of peak systolic pressure to left ventricular end-systolic volume at control. Left ventricular volume was measured by the non-gated-SPECT method and changes of the left ventricular volume was measured by the multigate method. P/V slope was correlated exponentially with mean VCF, LVEF and ESVI (y = 0.34.e1.9x, r = 0.86, p less than 0.001 for mean VCF; y = 0.25.e0.041x, r = 0.83, p less than 0.001 for LVEF; y = 7.8.e-0.028x, r = 0.88, p less than 0.001 for ESVI), and correlated linearly with ESS/ESVI (y = 1.6x-3.7, r = 0.88, p less than 0.001). P/V ratio was also correlated exponentially with mean VCF, LVEF and ESVI (y = 0.47.e1.4x, r = 0.86, p less than 0.001 for mean VCF; y = 0.35.e0.032x, r = 0.86, p less than 0.001 for LVEF; y = 4.8.e-0.021x, r = 0.87, p less than 0.001 for ESVI), and correlated linearly with ESS/ESVI (y = 1.2x-2.6, r = 0.83, p less than 0.001). We concluded that P/V slope and P/V ratio were useful indexes to evaluate left ventricular contractility noninvasively.

Adult↗
PubMed1984

Assessment of systolic ventricular muscle function in man: the end systolic index.

Accurate assessment of ventricular muscle contractile function in patients with heart disease is impaired by alterations in afterload, preload and wall thickness which often accompany the disease. The relationship between pressure and volume at end systole is considered to provide a contractile index which is independent of preload and which accounts for afterload. Use of the index prerequisites determinations of the left ventricular end systolic pressure, wall thickness as well as the dimensions or volumes, respectively, which may be assessed with either invasive or noninvasive methods. In patients with aortic stenosis and congestive heart failure, there was a significantly reduced slope (0.9 +/- 0.5) of the end systolic stress-volume relationship as compared with healthy subjects (5.8 +/- 1.3) or patients with aortic stenosis without congestive heart failure (3.9 +/- 1.3), while the ejection fraction showed no significant differences. In patients with mitral regurgitation with no or only minimal symptoms postoperatively, preoperatively the end systolic index (ESS/ESVI) was higher (3.3 +/- 0.4) than in patients with marked symptoms postoperatively or those who died perioperatively (2.2 +/- 0.2) and the values of both patient groups were lower than those of normals. In contrast, the values for ejection fraction among the normals and both groups of patients showed substantial overlap. In patients with aortic insufficiency and congestive heart failure, as opposed to patients with aortic insufficiency and only slight symptoms, there was a significantly compromised ejection fraction as well as diminished end systolic index (ESS/ESVI). Patients with hypertension accompanied by congestive heart failure had a significantly diminished slope of the relationship between end systolic left ventricular stress and volume while the values for hypertensive patients without congestive heart failure were within normal limits; in both groups of patients, the ejection fraction was normal. In patients with mitral stenosis, the end systolic index at 5.28 +/- 0.53 did not differ significantly from that of healthy subjects at 4.87 +/- 0.53, while the velocity of circumferential fiber shortening was diminished. Patients with large atrial septal defects and symptoms of congestive heart failure did not differ with respect to end systolic index or ejection fraction as compared with atrial septum defect patients without symptoms. In children with aortic stenosis and high pressure gradients, there was an increased ejection fraction together with a normal end systolic index.(ABSTRACT TRUNCATED AT 400 WORDS)

Anemia, Sickle Cell↗
PubMed2006

Impaired systolic torsion in dilated cardiomyopathy: reversal of apical rotation at mid-systole characterized with magnetic resonance tagging method.

Left ventricular (LV) torsion plays an important role in squeezing the blood out of the heart. To characterize the systolic torsion in LV dysfunction, we studied using magnetic resonance imaging myocardial tagging method in 26 subjects: 17 patients with dilated cardiomyopathy (DCM, LV ejection fraction [EF], 27 +/- 8%) and 9 healthy control subjects. Grid-tagged LV short-axis cine images were acquired at base, mid and apex levels. Tag-intersections were tracked during the systole, thereby determining rotation angle (positive indicated clockwise from the apex). Peak torsion was defined as the maximum difference in rotation angle between the base and apex. Time to peak torsion was expressed as % systole by dividing the time by a total systolic time. Amplitude of the rotation at peak was less in DCM than in controls at both the base (0.1 +/- 2.9 vs. 2.6 +/- 1.6 degrees , P < 0.05) and apex (-5.9 +/- 5.3 vs. -11.2 +/- 2.5 degrees , P < 0.01). Amplitude of peak torsion was then less in DCM than in controls (6.1 +/- 3.4 vs. 13.6 +/- 2.5 degrees , P < 0.001), and the timing of peak was earlier (66 +/- 22 vs. 104 +/- 16% systole, P < 0.001). The amplitude of peak torsion was correlated with LVEF (r=0.74, P < 0.001). In conclusion, amplitude of systolic torsion was impaired in proportion to LV function. Systolic torsion in LV dysfunction was characterized by the discontinuing counter-rotation of the apex to the base before end-systole.

Adult↗