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At least 19 recordsLinked to original sources
PubMed1988

Hemodynamic effects of nitrendipine on systolic ventricular function, diastolic ventricular function, and peripheral circulation in essential hypertension.

Twenty patients (aged 33-60 years) with mild to moderate essential hypertension were studied to assess systolic ventricular function, diastolic ventricular function, and peripheral hemodynamic changes induced by nitrendipine during rest and effort, comparing the acute and chronic treatment phases. We used a randomized, placebo-controlled, double-blind, crossover protocol in the acute phase and a paired, placebo group controlled study, with 20 mg single oral daily dose for a 3-week treatment period (chronic phase). The cardiac and peripheral hemodynamic parameters were quantified by noninvasive radionuclides techniques. During acute treatment, peripheral hemodynamics showed a predominantly arteriolar vasodilatory effect with a significant fall in the previously elevated forearm vascular resistance values (-38%, p less than 0.01) and an important increase in forearm blood flow (+49%, p less than 0.01) without any changes in venous capacity. Simultaneously, nitrendipine produced a significant drop in total peripheral resistance (-36%, p less than 0.01), systolic blood pressure (-13%, p less than 0.01), and diastolic blood pressured (-17%, p less than 0.01). The sudden reduction in left ventricular (LV) afterload caused a reflex increase in heart rate (HR) (+12%, p less than 0.01), cardiac index (+37%, p less than 0.01), LV ejection fraction (+17%, p less than 0.01), and peak ejection rate, with an important decrease in LV end systolic volume (-30%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Effects of glucose-insulin-potassium on baroreflex sensitivity, left ventricular function and ventricular arrhythmia in the subacute phase of myocardial infarction in rats.

Glucose-insulin-potassium (GIK) is clinically used for reducing mortality in acute myocardial infarction (MI). It is known that ventricular arrhythmia, left ventricular dysfunction and impaired baroreflex sensitivity (BRS) are the three major determinants for predicting the mortality after acute MI. The present work was designed to study the effects of GIK on BRS, ventricular arrhythmia, and left ventricular function in rats with coronary artery ligature. Sprague-Dawley rats were used and the myocardial infarction was produced by ligature of the left anterior descending artery. Five weeks after coronary artery ligation, BRS was measured in conscious state with a computerized blood pressure monitoring system and left ventricular function and electrocardiogram were determined in the anaesthetized state in the subacute phase of myocardial infarction. It was found that GIK did not affect the blood pressure and heart period in both conscious and anaesthetized rats. GIK did not enhance BRS, but reduced ventricular arrhythmia and improved left ventricular function by reducing left ventricular end diastolic pressure in anaesthetized rats with MI. It is proposed that reducing ventricular arrhythmia and improving left ventricular function contribute to the effect of GIK on reducing the mortality after MI.

Animals↗
PubMed1998

[The influence of left systolic ventricular function on right ventricular function after an acute myocardial infarct].

The aim of this study was to assess the interaction between left ventricular and right ventricular systolic function after acute myocardial infarction (AMI). The study population comprises 27 normal subjects and 71 patients assessed at predischarge (12 +/- 7 days) after AMI and divided into two subgroups, 24 with inferior AMI and 47 with non inferior AMI. The three groups were comparable for sex, age, heart rate and blood pressure. Right ventricular function was evaluated by two-dimensional assessment of tricuspid annular plane systolic excursion (TAPSE) and by Doppler analysis of right ventricular outflow tract. Left ventricular systolic function was evaluated by two-dimensional determination of ejection fraction and wall motion score index, and by Doppler analysis of left ventricular outflow tract. The overall AMI population showed reduced TAPSE, velocity-time integral (both p < 0.05) and peak velocity (p < 0.005) of right ventricular outflow tract, prolongation of Q-S2 interval and increase of pre-ejection period/acceleration time ratio (both p < 0.05) in comparison with normals. These alterations were accompanied by a decrease of left ventricular ejection fraction and increase of wall motion score index. (p < 0.0001) The changes of right ventricular indexes were confirmed in patients with inferior AMI who had also lower left ventricular ejection fraction (46 +/- 9%). Functional parameters of the right ventricle were not significantly modified in patients with non inferior AMI who had greater left ventricular ejection fraction (53 +/- 8.6%). In the overall AMI population, and in particular in inferior AMI, we found univariate relations between time-velocity integrals of left ventricular and right ventricular outflow tract and between left ventricular ejection fraction and TAPSE. Only in inferior AMI creatinkinase peak was related to time-velocity integral of right ventricular outflow tract (r = -0.59, p < 0.01). In conclusion, the magnitude of right ventricular systolic impairment developing after left ventricular AMI depends on the degree of left ventricular dysfunction, likewise by changes of hemodynamic load imposed to the right ventricle. AMI location and, only in inferior AMI, infarct extension participate in determining this dysfunction.

Analysis of Variance↗
PubMed2003

Sodium-hydrogen exchange inhibition preserves ventricular function after ventricular fibrillation in the intact swine heart.

BACKGROUND: We tested the hypothesis that sodium-hydrogen exchange inhibition attenuates ventricular dysfunction after ischemia-reperfusion injury in the intact porcine heart. METHODS: Twelve pigs (weight, 30-45 kg) were evenly divided into 2 groups. Baseline ventricular function studies were based on echocardiography, conductance, aortic flow, and left ventricular pressure. Animals were given vehicle (control) or benzamide-N-(aminoiminomethl)-4-(4-[2-furanylcarbonyl]-1-piperazinyl)-3-(methylsulfonyl)methanesulfonate (BIIB 513; 3 mg/kg administered intravenously). Ten minutes later, hearts were subjected to 75 seconds of ventricular fibrillation. After reperfusion for 40 minutes, function studies were repeated. Hearts were arrested and excised. Postmortem data included passive pressure-volume curves and myocardial water content. RESULTS: Preload recruitable stroke work was significantly decreased from baseline after ischemia and reperfusion in the control group (27.7 +/- 2.5 vs 48.0 +/- 5.6 mm Hg [+/- SEM], P =.001) but not in the BIIB 513 group (43.0 +/- 5.8 vs 45.5 +/- 4.1 mm Hg, P = not significant). In vivo diastolic and postmortem passive left ventricular compliance were reduced after ischemia and reperfusion for control animals but remained unchanged for animals receiving BIIB 513. Time required to recover baseline blood pressure after ventricular fibrillation was significantly longer for control animals (159 +/- 15 vs 88 +/- 14 seconds [+/- SEM], P =.008). Myocardial water content (78.97% +/- 0.94% vs 77.86% +/- 0.46% [+/- SEM]) and normalized left ventricular mass (137.24 +/- 6.17 vs 128.41 +/- 1.96 g [+/- SEM]) were insignificantly increased in control animals. CONCLUSIONS: Sodium-hydrogen exchange inhibition attenuates ventricular dysfunction after 75 seconds of ventricular fibrillation and 40 minutes of reperfusion. This family of agents might prove useful in patients with severe left ventricular dysfunction undergoing ventricular fibrillation for implantable cardioverter defibrillator testing.

Animals↗
PubMed2004

Right ventricular function and ventricular perfusion defects in adults with congenitally corrected transposition: correlation of echocardiography and nuclear medicine.

We undertook our study in order to evaluate right ventricular function and perfusion by conventional and contrast echocardiography in adults with congenitally corrected transposition who had not undergone cardiac surgery, comparing the echocardiographic findings with those obtained using equilibrium radionuclide ventriculography and gated single-photon emission computed tomography with Technetiumc-99 m sestamibi. We discovered severe tricuspid regurgitation in 8 patients (61%). Right ventricular ejection fraction, as calculated by nuclear medicine, had a correlation of 0.67 (p = 0.059) with area fractional shortening and 0.84 (p = 0.01) with ejection fraction calculated by the method depending on descent of the tricuspid ring. All patients with severe tricuspid regurgitation also had right ventricular dysfunction. Of these 8 patients, 7 had persistent perfusion defects, while 6 also had ischemic perfusion defects. Echo contrast had a high sensitivity, at 91%, and also specificity and positive predictive value, both at 100%, for persistent defects, and a negative predictive value of 66% compared to methods depending on nuclear medicine. The sensitivity of contrast echocardiography for detection of ischemic defects was 66%, the specificity 100%, the positive predictive value 100%, and the negative predictive value 77% compared to the methods involving nuclear medicine. The method depending on descent of the tricuspid ring had the highest correlation with equilibrium radionuclide ventriculography in evaluation of right ventricular function in patients with congenitally corrected transposition. We conclude that contrast echocardiography is extremely valuable when assessing right ventricular myocardial perfusion, having high sensitivity and specificity for detecting persistent defects, although sensitivity was less for detection of ischemic defects than that of gated single-photon emission computed tomography with Technetium-99 m Sestamibi. Persistent and ischemic perfusion defects, together with chronic volume overload from tricuspid regurgitation, are the determining factors of right ventricular dysfunction.

Adolescent↗
PubMed2003

Usefulness of frequent arrhythmias after epicardial recanalization in anterior wall acute myocardial infarction as a marker of cellular injury leading to poor recovery of left ventricular function.

Ventricular arrhythmias are associated with epicardial reperfusion but may also be a sign of cellular injury, which affects recovery of left ventricular (LV) function. To assess the correlation between reperfusion arrhythmias and the change in LV function after the acute phase in reperfused acute myocardial infarction (AMI), 62 patients with reperfused anterior wall AMI were studied. All patients underwent 24-hour Holter recording, echocardiography, and coronary angiography during the acute phase of AMI. Echocardiography was repeated at 1 to 2 months after AMI. Correlations between ventricular arrhythmias in the reperfusion phase and the change in LV wall motion score (WMS) during follow-up were studied. The number of reperfusion arrhythmias was significantly higher in patients with further deterioration of LV function; there were 5-, 14-, 131-, and 11-fold increases in isolated premature ventricular complexes (PVCs), PVCs in couplets, PVCs in bigeminy, and total PVCs, respectively, in patients with further increases in WMS after the acute phase. The incidence of repetitive, frequent, and early accelerated idioventricular rhythms (AIVRs) was correlated significantly with the change in LV function, with 129- and 105-fold increases in numbers of early AIVRs and total AIVRs, respectively, in patients with further worsening of LV function during follow-up. The incidence and the number of long-lasting nonsustained ventricular tachycardias as well as the number of rapid ventricular tachycardias and total ventricular tachycardia episodes were also correlated significantly with further deterioration. Thus, frequent arrhythmias associated with epicardial reperfusion strongly correlate with further worsening of LV function after the acute phase of AMI. This supports the hypothesis that these reperfusion arrhythmias are probably a noninvasive marker of cellular injury.

Adult↗
PubMed2001

Clinical usefulness of the combination of T-wave alternans and late potentials for identifying high-risk patients with moderately or severely impaired left ventricular function.

Ventricular tachyarrhythmia (VT) is an independent risk factor for an increased overall mortality in patients with impaired left ventricular (LV) function, but there is not an established noninvasive tool to detect such patients. The present study aimed to clarify the most useful noninvasive approach for identification of patients with moderately or severely impaired LV function complicated by VT. Sixty-seven patients in New York Heart Association (NYHA) classes I-III with an LV ejection fraction (LVEF) less than 40% and an LV end-diastolic dimension (LVDD) of at least 55 mm on echocardiography were enrolled. Impaired LV function was caused by either ischemic (n=30) or nonischemic dilated cardiomyopathy (n=37). T-wave alternans (TWA), QT dispersion (QTD), and late potentials (LP) on signal-averaged electrocardiography were sequentially determined without using antiarrhythmic drugs. VT was defined as more than 6 consecutive ventricular ectopic beats. The mean NYHA class was 1.9+/-0.7, mean LVEF was 31+/-8%, and mean LVDD was 65+/-10mm. A history of VT was present in 26 of the patients (39%). Univariate and multivariate logistic analysis showed that TWA and LP were closely related to VT, whereas NYHA> or =III, LVEF<30%, LVDD> or =70mm, and QTD> or =90ms were not. The combination of TWA and LP had the most significant value (p=0.0004, odds ratio=8.44) by univariate analysis, and only this combination had significant value in multivariate analysis (p=0.04). Therefore, the combination of TWA and LP could be a useful index for identifying those patients with impaired LV function who are at risk for VT.

Action Potentials↗
PubMed2002

Candesartan cilexetil improves left ventricular function, left ventricular hypertrophy, and endothelial function in patients with hypertensive heart disease.

Patients with hypertension often develop left ventricular (LV) hypertrophy and deterioration of the cardiac and endothelial functions. Recent clinical trials have shown the added benefits of angiotensin II receptor blockers in hypertensive patients. Twenty-nine patients with hypertensive heart disease (HHD) underwent echocardiography, radionuclide ventriculography and the measurement of endothelial function before and after administration of candesartan (8 mg/day). The subjects were divided into poorly controlled blood pressure (BP) (group P, n=6) and well controlled BP (group C, n=23). Endothelial function was evaluated from flow-dependent dilation, which was calculated as the percent change of the radial artery diameter during reactive hyperemia after upper arm occlusion, measured with a high-resolution ultrasound system. In group C, LV diastolic function and endothelial function were significantly (p<0.05) improved at 3 months after administration, LV systolic function and hypertrophy were significantly (p<0.05) improved after 6 months and these effects were maintained at 12 months. Even in group P, LV function, LV hypertrophy, endothelial function and brain natriuretic peptide were significantly (p<0.05) improved at 6 months after administration. In patients with HHD, candesartan improves LV systolic and diastolic function, LV hypertrophy and endothelial function within 6 months of administration, regardless of the control of BP.

Adult↗
PubMed1991

Assessment of ventricular function with an ambulatory left ventricular function monitor.

Changes in ventricular function caused by activities of daily living, including standing, walking, stair climbing, and mental stress, were evaluated using a radionuclide device that recorded left ventricular function on a beat-by-beat basis. The ambulatory monitor was positioned over the patient's left ventricle after a gated blood pool scan. Monitoring revealed a 10% increase of left ventricular ejection fraction from baseline to brisk walking, an 18% increase during stair climbing, and a 6% increase with mental stress. In some subjects, however, the increase in ejection fraction during mental stress exceeded that during exercise.

Activities of Daily Living↗
PubMed1997

Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function.

OBJECTIVES: In patients with severe heart failure additional therapeutic support with intravenous inotropic or vasodilator drugs is frequently used in the attempt to obtain hemodynamic control. The nature and extent to which diastolic filling, atrial function, and mitral regurgitation are modified by these drugs have not been fully explored. The aim of this study was to compare the acute adaptations of the left ventricular performance, left atrial function, and mitral regurgitation that accompanied hemodynamic improvement during intravenous dobutamine and nitroprusside infusions in patients with severe chronic heart failure. METHODS: Forty consecutive patients with severe heart failure were evaluated by simultaneous echo-Doppler and hemodynamic investigations at baseline and during nitroprusside and dobutamine administration. Mitral flow velocity variables, left atrial and ventricular volumes, left atrial reservoir, conduit and pump volumes, and mitral regurgitation jet area were compared by analysis of variance for repeated measurements. RESULTS: Nitroprusside increased cardiac output (2.1 +/- .5 vs 2.6 +/- .5 L/min/m2, p < 0.004), reduced left ventricular filling pressure (25 +/- 6 vs 14 +/- 4 mm Hg, p < 0.0001), and improved left atrial pump volume (19 +/- 3 vs 26 +/- 12 ml, p < 0.02) without variations in left atrial reservoir and conduit volume. The restoration of preload reserve and improvement of the atrial contribution to left ventricular diastolic filling were demonstrated by the Doppler mitral flow pattern, which moved from a restrictive to a normal pattern. Furthermore mitral regurgitation decreased in all patients (9 +/- 4.6 vs 4.6 +/- 3.4 cm2, p < 0.0001). Dobutamine increased cardiac output (2.1 +/- .5 vs 2.8 +/- .6 L/min/m2), but the effects on pulmonary wedge pressure and mitral regurgitation were variable and unpredictable. Left atrial reservoir and conduit volumes increased, whereas left atrial pump volume did not change (19 +/- 13 vs 22 +/- 14 ml, p = NS). Furthermore Doppler mitral flow showed a persistent restrictive pattern. CONCLUSIONS: In patients with advanced congestive heart failure both nitroprusside and dobutamine improve cardiac output, with different adaptations of left ventricular performance and left atrial function. Nitroprusside seems to restore both atrial and ventricular pump function better. Careful echo-Doppler monitoring during drug infusion provides information relevant to the clinical treatment of individual patients.

Atrial Function, Left↗
PubMed1984

Effects of acetyl-strophanthidin on left ventricular function and ventricular arrhythmias.

Digitalis drugs can suppress ventricular arrhythmias. It is uncertain whether this effect results from improved left ventricular (LV) function. We utilized radionuclide scanning techniques to evaluate changes in LV ejection fraction (EF) after an infusion of acetyl-strophanthidin in 43 patients with frequent ventricular premature beats (VPBs) (44 to 2400/hr). Acetyl-strophanthidin suppressed ventricular arrhythmia in 17 patients, but LVEF increased in only six of these patients (57% to 67%), while it was unaltered in 11 patients (28% to 30%). In 26 patients ventricular arrhythmia was not suppressed. Fifteen of these patients had an increase in LVEF (60% vs 71%), while this was unchanged in 11 patients (27% vs 29%). Thus no correlation was observed between the positive inotropic and antiarrhythmic action of acetyl-strophanthidin on ventricular arrhythmia and LVEF. We conclude that the suppression of VPBs by acetyl-strophanthidin is independent of the drug's effects on LV function. Evidence is reviewed suggesting that the antiarrhythmic effect of acetyl-strophanthidin on ventricular ectopic activity is due to its vagotonic action.

Adult↗
PubMed1998

Ventricular late potentials, interstitial fibrosis, and right ventricular function in patients with ventricular tachycardia and normal left ventricular function.

We examined 40 patients with ventricular tachycardia (VT) and no evidence of heart disease, and found a 50% prevalence of ventricular late potentials (VLPs) on the signal-averaged electrocardiogram. This finding was associated with a significantly higher content of fibrous tissue on endomyocardial biopsy and a lower right ventricular ejection fraction. Thus, VLPs are frequently found in idiopathic VT, are a marker for subclinical anatomic and functional abnormalities of the right ventricle, and may be associated with a worse outcome.

Adult↗
PubMed1985

Prediction of improvement in left ventricular function after ventricular aneurysmectomy using Fourier phase and amplitude analysis of radionuclide cardiac blood pool scans.

Postoperative improvement in left ventricular (LV) function is a common objective of LV aneurysmectomy, but is difficult to predict. The first Fourier component of time-activity curves of pre- and postoperative gated radionuclide angiographic studies was evaluated for this purpose in 20 patients who had undergone aneurysmectomy. LV aneurysms had portions that characteristically exhibited marked phase delay with varying degrees of amplitude. Total aneurysmal amplitude was obtained preoperatively by summing the amplitude component of all pixels that exhibited phase delay, suggesting paradoxical motion. LV ejection fraction (EF) before and after aneurysmectomy and the absolute postoperative increase in LVEF were calculated. Nine of 20 patients had an absolute increase of EF less than 10% despite resection of large aneurysms. A strong correlation was found between the absolute increase in EF after aneurysmectomy and the total amplitude within paradoxically moving areas (r = 0.93, p less than 0.0001). Thus, preoperative measurement of the total paradoxical amplitude predicts absolute change in EF and may be important in selecting patients for aneurysmectomy. The data also suggest that the total aneurysmal amplitude reflects the stroke volume ejected into an aneurysm in systole and that paradoxical expansion of an aneurysm contributes to LV dysfunction in some of these patients.

Adult↗
PubMed1992

[Late postoperative left ventricular function and ventricular hypertrophy after prosthetic valve replacement for aortic regurgitation].

Forty-two of 50 patients, who had undergone aortic valve replacement for acquired aortic regurgitation from Jan 1979 to Dec 1985, received late postoperative cardiac catheterization two years after operation. Their ages ranged between 10 and 69 years old (mean +/- S.D., 45.8 +/- 12.2 y.o.) and 37 men and 13 women were included. Postoperative left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and left ventricular mass (LVM) decreased significantly compared to preoperative levels, respectively (p less than 0.001). Both postoperative left ventricular end-systolic stress/end-systolic volume ratio (LVESS/ESVI) and tension volume ejection fraction (TVEF) increased significantly (p less than 0.01) compared to preoperative levels. Positive correlations were recognized between preoperative and postoperative values in LVESV, LVM, LVESS/ESVI, TVEF and LVEF. In the patients who had showed preoperative values of LVEDVI less than 180 ml/m2, LVESVI less than 90 ml/m2 and LVEF more than 0.52, their postoperative values were expected to be normal. There were also negative correlations between LVESVI and LVEF, and between LVM and contractile properties. Nineteen patients, who had recovered normal ventricular volumes at the time of postoperative cardiac catheterization, showed normal LV dimensions and % fractional shortening between five and ten years after operation. These results demonstrate the limitation of recovery in LVM and contractile properties in spite of normalization in ventricular volume and ejection performance.

Adolescent↗
PubMed1992

RETRACTED: Right ventricular function in patients with reduced left ventricular function undergoing myocardial revascularization.

Complex interrelationships exist between the right (RV) and the left ventricles (LV). Therefore, in 30 consecutive patients with reduced LV function (left ventricular ejection fraction [LVEF]) less than 40% undergoing myocardial revascularization, RV hemodynamics were studied from the beginning of anesthesia until the end of the operation. The data were compared with 30 consecutive patients with normal LVEF (greater than 70%). Ventricular function was assessed during left heart catheterization, which was carried out within 1 month of the operation. In addition to standard hemodynamic variables, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) were monitored by the thermodilution technique. The two groups did not differ preoperatively with regard to RVEF, pressure (MAP, PAP, PCWP, RAP, RVPsyst, RVEDP), cardiac index (CI), and volume variables (RVESV, RVEDV). However, when the group with preoperatively reduced LVEF was subdivided into patients with severely reduced LVEF (less than 30%; n = 14; mean value 25.1%) and patients with moderately reduced LVEF (30%-40%; n = 16; mean value 37.3%), RVEF was significantly lower in the patients with a LVEF below 30% throughout the entire investigation period. RVEDV and RVESV were significantly higher in these patients. In conjunction with the lower RVEF and normal PAP, this suggests reduced RV function. It can be concluded that a severely reduced preoperative LVEF (less than 30%) may also be associated with impaired RV function.

Analysis of Variance↗