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Sample records for left ventricular impairment

  1. Increased Left Ventricular Stiffness Impairs Exercise Capacity in Patients with Heart Failure Symptoms Despite Normal Left Ventricular Ejection Fraction

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    David Sinning

    2011-01-01

    Full Text Available Aims. Several mechanisms can be involved in the development of exercise intolerance in patients with heart failure despite normal left ventricular ejection fraction (HFNEF and may include impairment of left ventricular (LV stiffness. We therefore investigated the influence of LV stiffness, determined by pressure-volume loop analysis obtained by conductance catheterization, on exercise capacity in HFNEF. Methods and Results. 27 HFNEF patients who showed LV diastolic dysfunction in pressure-volume (PV loop analysis performed symptom-limited cardiopulmonary exercise testing (CPET and were compared with 12 patients who did not show diastolic dysfunction in PV loop analysis. HFNEF patients revealed a lower peak performance (=.046, breathing reserve (=.006, and ventilation equivalent for carbon dioxide production at rest (=.002. LV stiffness correlated with peak oxygen uptake (=−0.636, <.001, peak oxygen uptake at ventilatory threshold (=−0.500, =.009, and ventilation equivalent for carbon dioxide production at ventilatory threshold (=0.529, =.005. Conclusions. CPET parameters such as peak oxygen uptake, peak oxygen uptake at ventilatory threshold, and ventilation equivalent for carbon dioxide production at ventilatory threshold correlate with LV stiffness. Increased LV stiffness impairs exercise capacity in HFNEF.

  2. Hypertensive patients with left ventricular hypertrophy have global left atrial dysfunction and impaired atrio-ventricular coupling.

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    Soullier, Camille; Niamkey, Joseph T; Ricci, Jean-Etienne; Messner-Pellenc, Patrick; Brunet, Xavier; Schuster, Iris

    2016-08-01

    The aim of this study was to comprehensively investigate left atrial (LA) reservoir, conduit, and booster pump functions, as well as their predictors in patients with primary systemic arterial hypertension (HTN) and left ventricular (LV) hypertrophy. Thirty patients with HTN and LV hypertrophy, but no history of atrial arrhythmia or heart failure, were compared with 29 normotensive controls. Speckle-tracking echocardiography of the LA wall was used to measure systolic and diastolic strains and strain rates. Early diastolic velocity of transmitral flow/early diastolic mitral annular motion velocity (E/E')/peak systolic LA strain (S-LAs) was used as an index of LA stiffness. HTN patients had higher LV mass index, impaired LV diastolic function, and higher LA volume index than controls. LA reservoir, conduit, and booster pump functions were significantly lower and LA stiffness was greater. Multiple regression analysis indicated that increased LV mass and LV filling pressures as well as reduced LV strain or E' were predictors for reduced atrial function. HTN patients showed a significant impairment of the three components of LA function. These changes were correlated with LV hypertrophy and dysfunction, and presumably related to LA fibrotic changes, underlining the importance of LA-LV coupling. The prognostic value of these new speckle-tracking echocardiography-based LA strain indices needs to be evaluated by future studies.

  3. Right ventricular dysfunction affects survival after surgical left ventricular restoration.

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    Couperus, Lotte E; Delgado, Victoria; Palmen, Meindert; van Vessem, Marieke E; Braun, Jerry; Fiocco, Marta; Tops, Laurens F; Verwey, Harriëtte F; Klautz, Robert J M; Schalij, Martin J; Beeres, Saskia L M A

    2017-04-01

    Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function. A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed. Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was -24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left

  4. A prospective study found impaired left ventricular function predicted job retirement after acute myocardial infarction

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    Nielsen, Finn E; Sørensen, Henrik T; Skagen, Knud

    2004-01-01

    reduced left ventricular systolic function had any influence on the 4-year retirement rate after acute MI. STUDY DESIGN AND SETTING: We conducted a prospective study including 242 working-active patients with MI. Left ventricular ejection fraction (LVEF) was estimated by echocardiography during hospital...... admission. Data about work outcome after 4 years were collected by telephone interviews. RESULTS: Fifty percent were retired by the end of follow-up. Moderately or severely reduced LVEF (35%) increased the risk of retirement almost twofold (risk ratio RR=1.8, 95% confidence interval CI=1.3-2.5). After...... adjusting for confounding factors, reduced LVEF was an independent predictor of retirement. Based on a stratified analysis, being female (RR=3.90, 95% CI=1.18-12.62) or having heavy physical job demands (RR=3.83, 95% CI=1.02-14.30) had a more pronounced impact on retirement for patients with LVEF 35...

  5. Prevalence of impaired left ventricular systolic function and heart failure in a middle-aged and elderly urban population segment of Copenhagen

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    Raymond, I.; Pedersen, F.; Steensgaard-Hansen, F.

    2003-01-01

    to include a minimum of 150 persons in each age decade. MAIN OUTCOME MEASURES: Prevalence of impaired systolic function and manifest heart failure. RESULTS: The prevalence of systolic dysfunction (left ventricular ejection fraction 7.6%) as among women (2...

  6. Differential anti-ischaemic effects of muscarinic receptor blockade in patients with obstructive coronary artery disease; impaired vs normal left ventricular function.

    NARCIS (Netherlands)

    A.F. van den Heuvel; D.J. van Veldhuisen (Dirk); G.L. Bartels; M. van der Ent (Martin); W.J. Remme (Willem)

    1999-01-01

    textabstractAIMS: In patients with coronary artery disease acetylcholine (a muscarinic agonist) causes vasoconstriction. The effect of atropine (a muscarinic antagonist) on coronary vasotone in patients with normal or impaired left ventricular function is unknown.

  7. Left Ventricular Assist Devices

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    Khuansiri Narajeenron

    2017-04-01

    Full Text Available Audience: The audience for this classic team-based learning (cTBL session is emergency medicine residents, faculty, and students; although this topic is applicable to internal medicine and family medicine residents. Introduction: A left ventricular assist device (LVAD is a mechanical circulatory support device that can be placed in critically-ill patients who have poor left ventricular function. After LVAD implantation, patients have improved quality of life.1 The number of LVAD patients worldwide continues to rise. Left-ventricular assist device patients may present to the emergency department (ED with severe, life-threatening conditions. It is essential that emergency physicians have a good understanding of LVADs and their complications. Objectives: Upon completion of this cTBL module, the learner will be able to: 1 Properly assess LVAD patients’ circulatory status; 2 appropriately resuscitate LVAD patients; 3 identify common LVAD complications; 4 evaluate and appropriately manage patients with LVAD malfunctions. Method: The method for this didactic session is cTBL.

  8. The association between left ventricular global longitudinal strain, renal impairment and all-cause mortality.

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    Krishnasamy, Rathika; Isbel, Nicole M; Hawley, Carmel M; Pascoe, Elaine M; Leano, Rodel; Haluska, Brian A; Stanton, Tony

    2014-06-01

    Left ventricular (LV) systolic dysfunction is an important predictor of cardiovascular death. Global longitudinal strain (GLS) is a widely available echocardiographic technique proven to be more sensitive than conventional ejection fraction (EF) in detecting subtle changes in LV function. However, the prognostic value of GLS in patients with chronic kidney disease (CKD) is unknown. We studied 447 patients from a single center who were stratified according to estimated glomerular filtration rate (eGFR). GLS was calculated using two-dimensional speckle tracking and EF was measured using Simpson's biplane. Cox proportional hazard model was used to identify independent predictors of survival and measures of discrimination and reclassification were used to assess the predictive value of GLS. Multivariable regression models were used to evaluate clinical and laboratory factors associated with GLS. The mean EF was 58 ± 11% and GLS was -16.6 ± 4.2%. eGFR correlated negatively with GLS (r = -0.14, P = 0.004). Factors that were independently associated with GLS include gender, previous myocardial infarction, eGFR and phosphate (R(2) = 0.16, P cause mortality [hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.01-1.15] following adjustment for age, diabetes mellitus, hypertension, eGFR and left ventricular mass index (LVMI). The strength of association between demographic data, eGFR, LVMI and mortality increased following addition of GLS [c-statistic 0.68 (95% CI 0.61-0.74) to 0.71 (95% CI 0.64-0.77), P = 0.04]. Addition of GLS also demonstrated a 21% net reclassification improvement in risk prediction for all-cause mortality over clinical factors. GLS is an important predictor of all-cause mortality in CKD patients. Traditional and non-traditional risk factors such as phosphate are important determinants of GLS. Strain assessment in CKD patients may provide greater cardiovascular risk stratification. © The Author 2014. Published by Oxford University Press on behalf of

  9. Surgery of secondary mitral insufficiency in patients with impaired left ventricular function

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    Weber Raluca

    2009-07-01

    Full Text Available Abstract Background Secondary mitral insufficiency (SMI is an indicator of a poor prognosis in patients with ischemic and dilated cardiomyopathies. Numerous studies corroborated that mitral valve (MV surgery improves survival and may be an alternative to heart transplantation in this group of patients. The aim of the study was to retrospectively analyze the early and mid-term clinical results after MV repair resp. replacement in patients with moderate-severe to severe SMI and left ventricular ejection fraction (LVEF below 35%. Methods We investigated 40 patients with poor LVEF (mean, 28 ± 5% and SMI who underwent MV repair (n = 26 resp. replacement (n = 14 at the University Hospital Muenster from January 1994 to December 2005. All patients were on maximized heart failure medication. 6 pts. had prior coronary artery bypass grafts (CABG. Twenty-seven patients were in New York Heart Association (NYHA class III and 13 were in class IV. Eight patients were initially considered for transplantation. During the operation, 14 pts had CABG for incidental disease and 8 had tricuspid valve repair. Follow-up included echocardiography, ECG, and physician's examination and was completed in 90% among survivors. Additionally, the late results were compared with the survival after orthotope heart transplantation (oHTX in adults with ischemic or dilated cardiomyopathies matched to the same age and time period (148 patients. Results Three operative deaths (7.5% occurred as a result of left ventricular failure in one and multiorgan failure in two patients. There were 14 late deaths, 2 to 67 months after MV procedure. Progress of heart failure was the main cause of death. 18 patients who were still alive took part on the follow-up examination. At a mean follow-up of 50 ± 34 (2–112 months the NYHA class improved significantly from 3.2 ± 0.5 to 2.2 ± 0.4 (p 0.05. Conclusion High risk mitral valve surgery in patients with cardiomyopathy and SMI offers a real mid

  10. Left ventricular hypertrophy in athletes.

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    Douglas, P S; O'Toole, M L; Katz, S E; Ginsburg, G S; Hiller, W D; Laird, R H

    1997-11-15

    Left ventricular wall thickness >1.3 cm, septal-to-posterior wall ratios > 1.5, diastolic left ventricular size >6.0 cm, and eccentric or concentric remodeling are rare in athletes. Values outside of these cutoffs in an athlete of any age probably represent a pathologic state.

  11. Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling.

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    Alter, Peter; Watz, Henrik; Kahnert, Kathrin; Pfeifer, Michael; Randerath, Winfried J; Andreas, Stefan; Waschki, Benjamin; Kleibrink, Björn E; Welte, Tobias; Bals, Robert; Schulz, Holger; Biertz, Frank; Young, David; Vogelmeier, Claus F; Jörres, Rudolf A

    2018-04-01

    Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are thought to be linked through various factors. We aimed to assess the relationship between airway obstruction, lung hyperinflation and diastolic filling in COPD. The study population was a subset of the COPD cohort COSYCONET. Echocardiographic parameters included the left atrial diameter (LA), early (E) and late (A) transmitral flow, mitral annulus velocity (e'), E wave deceleration time (E[dt]), and isovolumic relaxation time (IVRT). We quantified the effect of various predictors including forced expiratory volume in 1 s (FEV 1 ) and intrathoracic gas volume (ITGV) on the echocardiographic parameters by multiple linear regression and integrated the relationships into a path analysis model. A total of 615 COPD patients were included (mean FEV 1 52.6% predicted). In addition to influences of age, BMI and blood pressure, ITGV was positively related to e'-septal and negatively to LA, FEV 1 positively to E(dt) (p < 0.05 each). The effect of predictors was most pronounced for LA, e'-septal and E(dt), and less for E/A, IVRT and E/e'. Path analysis was used to take into account the additional relationships between the echocardiographic parameters themselves, demonstrating that their associations with the predictors were maintained and robust. Airway obstruction and lung hyperinflation were significantly associated with cardiac diastolic filling in patients with COPD, suggesting a decreased preload rather than an inherently impaired myocardial relaxation itself. This suggests that a reduction in obstruction and hyperinflation could help to improve cardiac filling. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Dabigatran for left ventricular thrombus

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    Satishkumar Kolekar

    2015-09-01

    Dabigatran is a reversible direct thrombin inhibitor and currently approved for the prevention of thromboembolic episodes in non-valvar atrial fibrillation. This case demonstrates possible thrombolytic properties of dabigatran in resolution of left ventricular thrombus.

  13. Left ventricular apical ballooning syndrome

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    Rahman, N.; Tai, J.; Soofi, A.

    2007-01-01

    The transient left ventricular apical ballooning syndrome, also known as Takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction in the absence of obstructive epicardial coronary disease. Although the syndrome has been reported in Japan since 1990, it is rare in other regions. Rapid recognition of the syndrome can modify the diagnostic and therapeutic attitude i.e. avoiding thrombolysis and performing catheterization in the acute phase. (author)

  14. Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3.

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    Zivlas, Christos; Triposkiadis, Filippos; Psarras, Stelios; Giamouzis, Gregory; Skoularigis, Ioannis; Chryssanthopoulos, Stavros; Kapelouzou, Alkistis; Ramcharitar, Steve; Barnes, Edward; Papasteriadis, Evangelos; Cokkinos, Dennis

    2017-11-01

    Backround: Left atrial (LA) enlargement plays an important role in the development of heart failure (HF) and is a robust prognostic factor. Fibrotic processes have also been advocated to evoke HF through finite signalling proteins. We examined the association of two such proteins, cystatin C (CysC) and galectin-3 (Gal-3), and other clinical, echocardiographic and biochemical parameters with LA volume index (LAVi) in patients with HF with severely impaired left ventricular ejection fraction (LVEF). Severe renal, liver, autoimmune disease and cancer were exclusion criteria. A total of 40 patients with HF (31 men, age 66.6 ± 1.7) with LVEF = 25.4 ± 0.9% were divided into two groups according to the mean LAVi (51.03 ± 2.9 ml/m 2 ) calculated by two-dimensional transthoracic echocardiography. Greater LAVi was positively associated with LV end-diastolic volume ( p = 0.017), LV end-systolic volume ( p = 0.025), mitral regurgitant volume (MRV) ( p = 0.001), right ventricular systolic pressure (RVSP) ( p < 0.001), restrictive diastolic filling pattern ( p = 0.003) and atrial fibrillation ( p = 0.005). Plasma CysC was positively correlated with LAVi ( R 2 = 0.135, p = 0.019) and log-transformed plasma Gal-3 ( R 2 = 0.109, p = 0.042) by simple linear regression analysis. Stepwise multiple linear regression analysis showed that only MRV ( t = 2.236, p = 0.032), CysC ( t = 2.467, p = 0.019) and RVSP ( t = 2.155, p = 0.038) were significant predictors of LAVi. Apart from known determinants of LAVi, circulating CysC and Gal-3 were associated with greater LA dilatation in patients with HF with reduced LVEF. Interestingly, the correlation between these two fibrotic proteins was positive.

  15. Study of the association between left ventricular diastolic impairment and cardiac autonomic neuropathy in diabetic patients using [123I] metaiodobenzylguanidine scintigraphy

    International Nuclear Information System (INIS)

    Suzuki, Rokuro; Tanaka, Shiro; Tojo, Osamu; Ishii, Tomofusa; Sato, Toshihiko; Fujii, Satoru; Tumura, Kei.

    1994-01-01

    The association between left ventricular (LV) diastolic dysfunction and myocardial MIBG accumulation was investigated. The subjects were 14 Type II diabetic patients who had no evidence of ischemic heat disease, LV hypertrophy or dilated cardiomyopathy as determined by exercise Tl-201 myocardial scintigraphy and echocardiography. In 14 diabetic patients, isovolumic relaxation time (IRT) was measured by M-mode echocardiography, and the subjects were subdivided into two groups: Group1, 8 patients with impaired left ventricular diastolic function (IRT≥80 msec), and Group 2, 6 patients with normal left ventricular diastolic function (IRT 123 I-MIBG myocardial scintigraphy was performed, and the myocardial accumulation of 123 I-MIBG was investigated. The ratio of myocardial to mediastinal MIBG uptake was significantly (p<0.01) lower in Group 1 than in Group 2. And scintigraphic defects were significantly (p<0.05) more numerous in Group 1 than in Group 2. Patients in Group 1 had a greater frequency of cardiac autonomic neuropathy evaluated by QTc interval and coefficient of variation of R-R interval, when compared with Group 2. These data suggest that, in diabetic patients with no evidence of ischemic heart disease, LV hypertrophy or dilated cardiomyopathy, impairment of left ventricular diastolic function is associated with cardiac autonomic neuropathy. (author)

  16. Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm

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    Agner, Bue Fridolin Ross; Katz, Michael G; Williams, Zachary R

    2018-01-01

    Background: Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose: To determine the reproducibility of measurements of global longitudinal strain (G...

  17. Systolic left ventricular function according to left ventricular concentricity and dilatation in hypertensive patients

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    Bang, Casper; Gerdts, Eva; Aurigemma, Gerard P

    2013-01-01

    Left ventricular hypertrophy [LVH, high left ventricular mass (LVM)] is traditionally classified as concentric or eccentric based on left ventricular relative wall thickness. We evaluated left ventricular systolic function in a new four-group LVH classification based on left ventricular dilatation...

  18. Impaired left ventricular function has a detrimental effect on image quality in multi-detector row CT coronary angiography

    International Nuclear Information System (INIS)

    Manghat, N.E.; Morgan-Hughes, G.J.; Shaw, S.R.; Marshall, A.J.; Roobottom, C.A.

    2008-01-01

    Aim: To determine whether there is a relationship between left ventricular (LV) haemodynamic parameters, circulation times, and arterial contrast opacification that might affect the image quality of computed tomography (CT) coronary angiography. Methods: Thirty-six patients were included in the study: 18 with cardiomyopathy (CM) and LV dilatation of suspected ischaemic aetiology [age 57.9 ± 13.7 years, range 30-77 years; 14 male, four female; body mass index (BMI) = 27.7 ± 4.5, range 25.5-31.8] and 18 controls (age 62.3 ± 9.4 years, range 47-89 years; 10 male, eight female; BMI 27.8 ± 6.6; range 19.2-33.6). Coronary artery image quality was assessed using a three-point visual scale; contrast medium circulation times, aortic root contrast attenuation, and LV functional parameters were studied. Results: Visually reduced contrast opacification impaired image quality more often in the CM group than the control group (27.4 versus 5.1%). A total of 55.6% CM patients had a contrast transit time ranging from 30-75 s; the number of 'unassessable' segments increased with increasing transit time conforming to a fitted quadratic model (R 2 = 0.74). The relationship between LV ejection fraction and contrast attenuation may also conform to a quadratic model (R 2 = 0.71). Conclusion: LV haemodynamics influence coronary artery opacification using cardiac CT, and users imaging this subgroup must do so with the knowledge of this potential pitfall. The results indicate the need for further studies examining CT protocols in this clinical subgroup

  19. Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial.

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    DeVore, Adam D; McNulty, Steven; Alenezi, Fawaz; Ersboll, Mads; Vader, Justin M; Oh, Jae K; Lin, Grace; Redfield, Margaret M; Lewis, Gregory; Semigran, Marc J; Anstrom, Kevin J; Hernandez, Adrian F; Velazquez, Eric J

    2017-07-01

    While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  20. Impaired right ventricular contractile function in childhood obesity and its association with right and left ventricular changes: a cine DENSE cardiac magnetic resonance study.

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    Jing, Linyuan; Pulenthiran, Arichanah; Nevius, Christopher D; Mejia-Spiegeler, Abba; Suever, Jonathan D; Wehner, Gregory J; Kirchner, H Lester; Haggerty, Christopher M; Fornwalt, Brandon K

    2017-06-28

    Pediatric obesity is a growing public health problem, which is associated with increased risk of cardiovascular disease and premature death. Left ventricular (LV) remodeling (increased myocardial mass and thickness) and contractile dysfunction (impaired longitudinal strain) have been documented in obese children, but little attention has been paid to the right ventricle (RV). We hypothesized that obese/overweight children would have evidence of RV remodeling and contractile dysfunction. One hundred and three children, ages 8-18 years, were prospectively recruited and underwent cardiovascular magnetic resonance (CMR), including both standard cine imaging and displacement encoding with stimulated echoes (DENSE) imaging, which allowed for quantification of RV geometry and function/mechanics. RV free wall longitudinal strain was quantified from the end-systolic four-chamber DENSE image. Linear regression was used to quantify correlations of RV strain with LV strain and measurements of body composition (adjusted for sex and height). Analysis of variance was used to study the relationship between RV strain and LV remodeling types (concentric remodeling, eccentric/concentric hypertrophy). The RV was sufficiently visualized with DENSE in 70 (68%) subjects, comprising 36 healthy weight (13.6 ± 2.7 years) and 34 (12.1 ± 2.9 years) obese/overweight children. Obese/overweight children had a 22% larger RV mass index (8.2 ± 0.9 vs 6.7 ± 1.1 g/m 2.7 , p right ventricles in obese/overweight children.

  1. Left ventricular diastolic performance of left ventricular hypertrophy

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    Ikezono, Tohru; Ozaki, Masaharu; Yamagishi, Takashi; Shimizu, Tatsuro; Furutani, Yuji; Kusukawa, Reizo

    1987-02-01

    To study left ventricular diastolic performance in different forms of left ventricular hypertrophy, ECG gated cardiac blood pool scan was performed in 11 patients with hypertrophic nonobstructive cardiomyopathy (HCM) and in 19 patients with hypertension (HT), and left ventricular volume curve (LVVC) was analyzed and compared with those of 13 normal subjects (N). Ejection fraction (EF) and early filling volume ratio (the ratio of volume increment of 100 msec later than the zero point in the first derivative of LVVC to the end diastolic volume) (%EFV) were computed from LVVC. Peak ejection rate (PER) and peak filling rate (PFR) were obtained from the first derivative of LVVC. Peak ejection acceleration (PEA) and peak filling acceleration (PFA) were calculated from the second derivative of LVVC. EF, PER and PEA did not show any difference between these 3 groups. PFR was lower in HT (2.6 +- 0.5) compared with those in HCM (3.0 +- 0.5) (p < 0.05) and in N (3.4 +- 0.5) (p < 0.001), but the %EFV in HCM (4.9 +- 1.8) was lower than those in HT (6.9 +- 1.9) (p < 0.01) and in N (11.4 +- 1.4) (p < 0.001). Moreover, PFA in HCM (27.9 +- 7.2) was increased than those in HT (20.2 +- 5.4) (p < 0.01) with no differences between HCM and N (29.4 +- 8.1). Significant correlation was observed between PFR and PFA (Y = 0.06X + 1.4. r = 0.856. p < 0.001). These result indicate that, in HCM, reduced increase in early left ventricular volume is compensated by a greater filling acceleration. In contrast, there is no compensation by filling acceleration in HT.

  2. Left Ventricular Pseudoaneurysm Perceived as a Left Lung Mass

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    Ugur Gocen

    2013-02-01

    Full Text Available Left ventricular pseudo-aneurysm is a rare complication of aneurysmectomy. We present a case of surgically-treated left ventricular pseudo-aneurysm which was diagnosed three years after coronary artery bypass grafting and left ventricular aneurysmectomy. The presenting symptoms, diagnostic evaluation and surgical repair are described. [Cukurova Med J 2013; 38(1.000: 123-125

  3. Prognostic significance of left ventricular diastolic dysfunction in patients with left ventricular hypertrophy and systemic hypertension (the LIFE Study)

    DEFF Research Database (Denmark)

    Wachtell, Kristian; Palmieri, Vittorio; Gerdts, Eva

    2010-01-01

    Patients with hypertension and left ventricular (LV) hypertrophy commonly have impaired diastolic filling. However, it remains unknown whether changes in LV diastolic filling variables are associated with cardiovascular morbidity and mortality. In this study, 778 patients with hypertension...

  4. Left ventricular wall stress compendium.

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    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  5. Detection of left ventricular enlargement and impaired systolic function with plasma N-terminal pro brain natriuretic peptide concentrations

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    Grønning, Bjørn Aaris; Nilsson, Jens C.; Søndergaard, Lars

    2002-01-01

    BACKGROUND: Brain- and N-terminal pro brain natriuretic peptide (NT-proBNP) have been identified as promising markers for heart failure. However, previous studies have revealed that they may hold insufficient diagnostic power for implementation into clinical practice because of a significant...... overlap in the range of plasma levels between healthy subjects and subjects with heart failure. We hypothesized that imprecision of the reference method (ie, the echocardiographic evaluation of left ventricular [LV] function) may have affected results from those earlier studies. We therefore wanted...... to investigate the diagnostic potential of NT-proBNP with magnetic resonance imaging as the reference method for the cardiac measurements. METHODS: Forty-eight patients with stable symptomatic heart failure in New York Heart Association functional classifications II to IV were examined once with blood samples...

  6. Peak oxygen uptake and left ventricular ejection fraction, but not depressive symptoms, are associated with cognitive impairment in patients with chronic heart failure

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    Steinberg G

    2011-12-01

    Full Text Available Gerrit Steinberg1,2*, Nicole Lossnitzer2*, Dieter Schellberg2, Thomas Mueller-Tasch2, Carsten Krueger3, Markus Haass4, Karl Heinz Ladwig5, Wolfgang Herzog2, Jana Juenger21University Hospital of Psychiatry, University of Bern, Bern, Switzerland; 2Department of Psychosomatic and General Internal Medicine, Medical Hospital, University of Heidelberg, Heidelberg, 3Department of Cardiology, Josefs Hospital, Heidelberg, 4Department of Cardiology, Theresien Hospital, Mannheim, 5Institute of Epidemiology, German Research Center for Environmental Health, Munich, Germany*both authors contributed equally to this paperBackground: The aim of the present study was to assess cognitive impairment in patients with chronic heart failure (CHF and its associations with depressive symptoms and somatic indicators of illness severity, which is a matter of controversy.Methods and results: Fifty-five patients with CHF (mean age 55.3 ± 7.8 years; 80% male; New York Heart Association functional class I–III underwent assessment with an expanded neuropsychological test battery (eg, memory, complex attention, mental flexibility, psychomotor speed to evaluate objective and subjective cognitive impairment. Depressive symptoms were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID and a self-report inventory (Hospital Anxiety and Depression Scale [HADS]. A comprehensive clinical dataset, including left ventricular ejection fraction, peak oxygen uptake, and a 6-minute walk test, was obtained for all patients. Neuropsychological functioning revealed impairment in 56% of patients in at least one measure of our neuropsychological test battery. However, the Mini Mental State Examination (MMSE could only detect cognitive impairment in 1.8% of all patients, 24% had HADS scores indicating depressive symptoms, and 11.1% met SCID criteria for a depressive disorder. No significant association was found

  7. Diabetes Mellitus Impairs Left Ventricular Mass Regression after Surgical or Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.

    Science.gov (United States)

    Nakamura, Teruya; Toda, Koichi; Kuratani, Toru; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Saito, Shunsuke; Yoshioka, Daisuke; Kashiyama, Noriyuki; Daimon, Takashi; Sawa, Yoshiki

    2016-01-01

    It is well-documented that persistent myocardial hypertrophy in patients with aortic stenosis is related to suboptimal postoperative outcomes after aortic valve replacement. Although diabetes is known to potentially exacerbate myocardial hypertrophy, it has yet to be examined if it affects postoperative left ventricular mass regression (LVMR). A single-centre, retrospective analysis was performed on 183 consecutive patients who underwent either surgical or transcatheter aortic valve replacement between 2010 and May 2013. Patient demographics, postoperative outcomes and echocardiographic data were obtained preoperatively and a year after surgery. There were 42 diabetic and 141 non-diabetic patients. Preoperative characteristics of diabetic patients were statistically similar to those of non-diabetic patients, except for higher prevalence of hyperlipidaemia (p regression analysis demonstrated that diabetes (standardised partial regression coefficient (SPRC)=-0.187, p=0.018), female gender (SPRC=0.245, p=0.026) and age (SPRC=0.203, p=0.018) were associated with poor postoperative LVMR. Patients with diabetes showed suboptimal postoperative LVMR, and the disease was a prognostic factor that was associated with poor LVMR. These findings suggest that diabetes may predispose the particular group of patients to worse postoperative outcomes. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  8. Left ventricular hypertrophy, geometric patterns and clinical ...

    African Journals Online (AJOL)

    Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight ...

  9. Impaired right and left ventricular function in asymptomatic children with repaired tetralogy of Fallot by two-dimensional speckle tracking echocardiography study.

    Science.gov (United States)

    Li, Yuman; Xie, Mingxing; Wang, Xinfang; Lu, Qing; Zhang, Li; Ren, Pingping

    2015-01-01

    Early detection of right ventricular (RV) and left ventricular (LV) dysfunction in patients with repaired tetralogy of Fallot (TOF) is essential because dysfunction is correlated with a poor clinical outcome. The aim of this study was to assess RV and LV function in asymptomatic children with repaired TOF by two-dimensional ultrasound speckle tracking echocardiography (STE). Fifty-six asymptomatic children with a preserved biventricular ejection fraction (EF) after repair of TOF and 35 healthy control subjects were studied. RV and LV strain and strain rate were measured by STE. RVEF and pulmonary regurgitation (PR) were assessed using cardiac magnetic resonance imaging. Compared with the control subjects, RV regional longitudinal strain and strain rate and global longitudinal strain (GLS) and strain rate (GLSR) were impaired in children with repaired TOF. Likewise, LV circumferential and radial strain and strain rate were reduced in patients with TOF. In contrast, longitudinal strain and strain rate did not differ between the groups. RV and LV GLSR were correlated with postoperative follow-up period (r1 = -0.44; r2 = -0.48). RV GLS and GLSR were associated with RVEF (r1 = 0.64; r2 = 0.60) and PR (r1 = -0.48; r2 = -0.49). LV circumferential strain rate was related to PR (r = -0.45). STE can identify abnormalities that may represent early impairment of RV and LV systolic function in postoperative TOF patients with a preserved EF. PR is associated with decreased biventricular performance in repaired patients. STE-derived strain and strain rate may be useful indices for detecting the early deterioration of biventricular performance in patients with TOF. © 2014, Wiley Periodicals, Inc.

  10. Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function.

    Science.gov (United States)

    Brand, Anna; Bathe, Marny; Oertelt-Prigione, Sabine; Seeland, Ute; Rücke, Mirjam; Regitz-Zagrosek, Vera; Stangl, Karl; Knebel, Fabian; Stangl, Verena; Dreger, Henryk

    2018-01-01

    The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD). In a cross-sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, -26.7% ± 5.6%, and -23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, -23.9% ± 5.5%, and -20.6% ± 3.8% in DD; P right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early-staged DD. © 2017 Wiley Periodicals, Inc.

  11. Electrocardiographic features suggestive of a left. ventricular ...

    African Journals Online (AJOL)

    Abstract. Electrocardiographic features suggestive of a transmural anterior myocardial infarction with resultant left ventricular aneurysm formation were found in a 22-year-old man who had sustained a ballistic missile injury to his chest.

  12. Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

    Science.gov (United States)

    Bradley, Elisa A.; Novak, Eric L.; Rasalingam, Ravi; Cedars, Ari M.; Ewald, Gregory A.; Silvestry, Scott C.; Joseph, Susan M.

    2014-01-01

    Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD. PMID:24955040

  13. Severely impaired von Willebrand factor-dependent platelet aggregation in patients with a continuous-flow left ventricular assist device (HeartMate II)

    DEFF Research Database (Denmark)

    Klovaite, Jolanta; Gustafsson, Finn; Mortensen, Svend A

    2009-01-01

    OBJECTIVES: This study investigated the influence of the mechanical blood pump HeartMate II (HMII) (Thoratec Corporation, Pleasanton, California) on blood coagulation and platelet function. BACKGROUND: HMII is an implantable left ventricular assist device used for the treatment of heart failure...

  14. Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Bridal Løgstrup, Brian; Hofsten, D. E.; Christophersen, T. B.

    2012-01-01

    . Assessment of CFR by TTE was performed in a modified apical view using color Doppler guidance. Results: The study population consisted of 183 patients (51 females) with a median age of 63 [54;70] years. Eighty-nine (49%) patients had a non-ST elevation myocardial infarction and 94 (51%) patients had a ST...... elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1...

  15. Left ventricular performance during psychological stress

    International Nuclear Information System (INIS)

    Young, D.Z.; Massachusetts General Hospital, Boston; Dimsdale, J.E.; Moore, R.H.; Barlai-Kovach, M.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Fifer, M.A.; Strauss, H.W.

    1989-01-01

    Left ventricular ejection fraction, systolic blood pressure and plasma norepinephrine were measured in six normotensive and six mildly hypertensive subjects during rest and psychological stress. Compared with rest, 8 of the 12 subjects developed significant changes in ejection fraction (increase in 6, decrease in 2); 10 of 12 subjects developed significant elevations of plasma norepinephrine; and all developed significant increases in systolic blood pressure. When the stress effects were examined for the total group, as opposed to within subjects, there were significant increases in plasma norepinephrine and systolic blood pressure but, interestingly, mean ejection fraction and stroke volume remained unchanged, implying stress led to increased left ventricular contractility. (orig.)

  16. Desmoplakin truncations and arrhythmogenic left ventricular cardiomyopathy: characterizing a phenotype.

    Science.gov (United States)

    López-Ayala, Jose María; Gómez-Milanés, Ivan; Sánchez Muñoz, Juan José; Ruiz-Espejo, Francisco; Ortíz, Martín; González-Carrillo, Josefa; López-Cuenca, David; Oliva-Sandoval, M J; Monserrat, Lorenzo; Valdés, Mariano; Gimeno, Juan R

    2014-12-01

    Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy (ARVC) is challenging in clinical practice. We lack recommendations for the risk stratification of exclusive left-sided phenotypes. The aim of this study was to investigate genotype-phenotype correlations in patients carrying a novel DSP c.1339C>T, and to review the literature on the clinical expression and the outcomes in patients with DSP truncating mutations. Genetic screening of the DSP gene was performed in 47 consecutive patients with a phenotype of either an ARVC (n = 24) or an idiopathic dilated cardiomyopathy (DCM), who presented with ventricular arrhythmias or a family history of sudden death (n = 23) (aged 40 ± 19 years, 62% males). Three unrelated probands with DCM were found to be carriers of a novel mutation (c.1339C>T). Cascade family screening led to the identification of 15 relatives who are carriers. Penetrance in c.1339C>T carriers was 83%. Sustained ventricular tachycardia was the first clinical manifestation in six patients and nine patients were diagnosed with left ventricular impairment (two had overt severe disease and seven had a mild dysfunction). Cardiac magnetic resonance revealed left ventricular involvement in nine cases and biventricular disease in three patients. Extensive fibrotic patterns in six and non-compaction phenotype in five patients were the hallmark in imaging. DSP c.1339C>T is associated with an aggressive clinical phenotype of left-dominant arrhythmogenic cardiomyopathy and left ventricular non-compaction. Truncating mutations in desmoplakin are consistently associated with aggressive phenotypes and must be considered as a risk factor of sudden death. Since ventricular tachycardia occurs even in the absence of severe systolic dysfunction, an implantable cardioverter-defibrillator should be indicated promptly. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please

  17. Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography

    International Nuclear Information System (INIS)

    Pace, L.; Salvatore, M.; Perrone-Filardi, P.; Dellegrottaglie, S.; Prastaro, M.; Crisci, T.; Ponticelli, M.P.; Piscione, F.; Chiariello, M.; Storto, G.; Della Morte, A.M.

    2000-01-01

    Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60±8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%±7%) were studied. Rest 201 Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201 Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at ≥5%. In identifying viable segments, rest 201 Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P 201 Tl SPET in group 1 than in group 2 (2.6±1.9 vs 0.6±1.2, P 201 Tl SPET and post-revascularization changes in ejection fraction (r=0.52, P 201 Tl SPET had a higher sensitivity (82% vs 53%, P=0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201 Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization. (orig.)

  18. Left ventricular mass: Myxoma or thrombus?

    Directory of Open Access Journals (Sweden)

    Monish S Raut

    2015-01-01

    Full Text Available Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart . In either case, mobile mass with embolic potential should be surgically resected.

  19. Left Ventricular Thrombus among patients undergoing Transthoracic ...

    African Journals Online (AJOL)

    Objective: Left Ventricular Thrombus (LVT) is a well recognized complication of various cardiac conditions, particularly following an acute anterior myocardial infarction and in those with systolic congestive heart failure. Transthoracic echocardiography (TTE) remains the most common imaging modality to make the diagnosis ...

  20. Left ventricular function in chronic aortic regurgitation

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Hakki, A.H.; Manno, B.; Amenta, A.; Kane, S.A.

    1983-01-01

    Left ventricular performance was determined in 42 patients with moderate or severe aortic regurgitation during upright exercise by measuring left ventricular ejection fraction and volume with radionuclide ventriculography. Classification of the patients according to exercise tolerance showed that patients with normal exercise tolerance (greater than or equal to 7.0 minutes) had a significantly higher ejection fraction at rest (probability [p] . 0.02) and during exercise (p . 0.0002), higher cardiac index at exercise (p . 0.0008) and lower exercise end-systolic volume (p . 0.01) than did patients with limited exercise tolerance. Similar significant differences were noted in younger patients compared with older patients in ejection fraction at rest and exercise (both p . 0.001) and cardiac index at rest (p . 0.03) and exercise (p . 0.0005). The end-diastolic volume decreased during exercise in 60% of the patients. The patients with a decrease in volume were significantly younger and had better exercise tolerance and a larger end-diastolic volume at rest than did patients who showed an increase in volume. The mean corrected left ventricular end-diastolic radius/wall thickness ratio was significantly greater in patients with abnormal than in those with normal exercise reserve (mean +/- standard deviation 476 +/- 146 versus 377 +/- 92 mm Hg, p less than 0.05). Thus, in patients with chronic aortic regurgitation: 1) left ventricular systolic function during exercise was related to age, exercise tolerance and corrected left ventricular end-diastolic radius/wall thickness ratio, and 2) the end-diastolic volume decreased during exercise, especially in younger patients and patients with normal exercise tolerance or a large volume at rest

  1. Left ventricular non-compaction cardiomyopathy and left ventricular assist device: a word of caution.

    Science.gov (United States)

    Kornberger, A; Stock, U A; Risteski, P; Beiras Fernandez, A

    2016-07-15

    In patients with left ventricular non-compaction (LVNC), implantation of a left ventricular assist device (LVAD) may be performed as a bridge to transplantation. In this respect, the particular characteristics of the left ventricular myocardium may represent a challenge. We report a patient with LVNC who required urgent heart transplantation for inflow cannula obstruction nine months after receiving a LVAD. LVAD parameters, echocardiography and examination of the explanted heart suggested changes of left ventricular configuration brought about by LVAD support as the most likely cause of inflow cannula obstruction. We conclude that changes experienced by non-compacted myocardium during LVAD support may give rise to inflow cannula obstruction and flow reduction. Presence of LVNC mandates tight surveillance for changes in LV configuration and LVAD flow characteristics and may justify urgent transplantation listing status.

  2. Implantation of left ventricular assist device in a patient with left ventricular non-compaction.

    Science.gov (United States)

    Balsara, Keki R; Bierhals, Andrew; Vader, Justin; Pasque, Michael K; Itoh, Aki

    2017-02-01

    Left ventricular noncompaction (LVNC) may result in systolic left ventricular (LV) failure resulting in the need for heart transplantation. LV assist devices (LVAD) have been used to bridge these patients to transplantation; however, the extensive trabeculations found in these patients predispose them to thromboembolic events and pump thrombosis. We describe a patient with LVNC in whom an aggressive surgical approach was used to debride the LV cavity of trabeculations to successfully implant an LVAD. © 2017 Wiley Periodicals, Inc.

  3. Reversal of left ventricular hypertrophy by propranolol in ...

    African Journals Online (AJOL)

    Background: Hypertension contributes significantly to the development of left ventricular hypertrophy. Left ventricular hypertrophy is associated with increased incidence of sudden cardiac death. Recognition and management of hypertension is, therefore, imperative. Objective: To establish whether propranolol can reverse ...

  4. Prevalence of left ventricular diastolic dysfunction in newly ...

    African Journals Online (AJOL)

    They were divided into hypertensives without left ventricular hypertrophy and those with left ventricular hypertrophy based on echocardiographically determined left ventricular mass index. Pulsed Doppler transmitral inflow and the pulmonary venous flow waves were used to categorise the patterns of diastolic dysfunction.

  5. Left Ventricular Geometry In Nigerians With Type II Diabetes Mellitus ...

    African Journals Online (AJOL)

    Background: Left ventricular hypertrophy is independently associated with increased incidence of cardiovascular disease, cardiovascular and all cause mortality. In a relatively healthy hypertensive adult population, type II diabetes is associated with higher left ventricular mass, concentric left ventricular geometry and lower ...

  6. Left ventricular function in hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Takahashi, Hiromi; Yamaguchi, Ryutaro; Ifuku, Masayasu

    1985-01-01

    The present study was to investigate of left ventricular (LV) function during exercise in 26 patients with hypertrophic cardiomyopathy(HCM) usingTc-99m equilibrium angiocardiography, and to elucidate the mechanism of impaired functional reserve during exercise. In patients with HCM, LV ejection fraction decreased from 65 ± 8 (mean ± SD) % at rest to 59 ± 18 % at peak exercise, in contrast to an increase among controls (from 56 ± 9 % to 64 ± 9 %). As compared with resting values, cardiac output increased to 168 ± 24 % at peak exercise in HCM, but the increase was significantly less than that in controls (215 ± 47 %). Stroke volume decreased gradually to 83 ± 16 % during exercise in HCM, while it increased to 114 ± 10 % at an exercise level of half intensity, and it decreased slightly to 106 ± 16 % at peak exercise. LV end-systolic volume decreased among controls to 78 ± 27 % at peak exercise, but remained unchanged in HCM (118 ± 58 %). An increase in peak ejection rate at peak exercise was less in HCM than in controls (143 ± 26 % vs 170 ± 42 %). No significant differences were observed between the two groups concerning changes in indices of LV diastolic function including LV end-diastolic volume, peak filling rate or 1/3 filling rate during exercise. In the analysis of LV function curves, pulmonary arterial diastolic pressure increased to a greater extent in HCM than in controls (19 ± 6 mmHg vs 11 ± 6 mmHg); whereas, an increase in the stroke work index was less in HCM (80 ± 26 g.m/m 2 /beat vs 121 ± 21 g.m/m 2 /beat) at peak exercise. Thus, the LV function curve shifted downward and to the right in patients with HCM. The above findings indicate that LV functional reserve during exercise is impaired, especially as to systolic function in patients with HCM, while deterioration of diastolic function may be partly compromised by elevated filling pressure. (J.P.N.)

  7. Left ventricular heart failure and pulmonary hypertension†

    Science.gov (United States)

    Rosenkranz, Stephan; Gibbs, J. Simon R.; Wachter, Rolf; De Marco, Teresa; Vonk-Noordegraaf, Anton; Vachiéry, Jean-Luc

    2016-01-01

    Abstract In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context. PMID:26508169

  8. Left ventricular noncompaction in a patient presenting with a left ventricular failure

    Directory of Open Access Journals (Sweden)

    Ristić-Anđelkov Anđelka

    2018-01-01

    Full Text Available Introduction. Left ventricular noncompaction (LVNC is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae and sinusoids under the endocardium. The thickness ratio between the two layers was 2.2:1. The same abnormalities were corroborated by multislice computed tomography (MSCT of the heart. Conclusion. Left ventricular noncompaction is a rare, usually hereditary cardiomyopathy, which should be considered as a possibility in patients with myocardial hypertrophy. It is very often mistaken for coronary disease owing to ECG changes and elevated cardiac specific enzymes associated with myocardial hypertrophy and heart failure.

  9. Predictors of the left ventricular dysfunction induced by ventricular arrhythmia

    Directory of Open Access Journals (Sweden)

    А. І. Vytryhovskiy

    2016-08-01

    Full Text Available The most powerful predictor of life-threatening arrhythmia risk is a combination of low heart rate variability with low ejection fraction (EF of the left ventricle. Aim. To identify predictors of left ventricle dysfunction which is induced by ventricular arrhythmia. Materials and methods. To diagnose structural changes of left ventricular functional capacity and reserves in patients with previous myocardial infarction and patients with high and very high cardiovascular risk by SCORE scale and for establishment the relationship between morphological heart changes and pathological phenomenon of heart turbulence echocardiography and study of heart rate turbulence variability were performed. 603 patients were selected for the research. All patients were divided into groups: group 1 – patients with coronary heart disease, but without associated risk factors, such as smoking, obesity, metabolic syndrome; group 2 – patients who smoke tobacco more than 2 years (very high cardiovascular risk by scale SCORE; group 3 – patients with metabolic syndrome without coronary heart disease or arterial hypertension (very high cardiovascular risk by scale SCORE. The control group consisted of 149 persons. Results. The feature of structural changes in patients with myocardial infarction and in patients with a high cardiovascular risk by SCORE with heart rate turbulence compared with cases without НRT is considerably thickening of the left interventricular septum in systole. Based on this, it can be argued that the emergence of ventricular arrhythmia and accordingly phenomenon of heart rate turbulence in patients with existing cardiovascular diseases and risk factors has both morphological and functional character. Significant difference of echocardioscopy parameters in patients with postinfarction cardiosclerosis and risk factors by the SCORE system was established by index of intraventricular septum thickness in systole, and in persons with high risk – in

  10. Patterns of left ventricular geometry in hypertensive patients in ...

    African Journals Online (AJOL)

    Systemic hypertension is associated with different left ventricular geometric adaptations, which are matched to systemic hemodynamics and ventricular load. Four geometric patterns have been described. The prevalence of these left ventricular geometric patterns in hypertension has been reported in other places but, the ...

  11. Catch 22: a case of incessant ventricular tachycardia post-left ventricular assist device resulting in right ventricular failure, left ventricular cavity obliteration and failure of endocardial ventricular tachycardia ablation.

    Science.gov (United States)

    Thosani, Amit J; Bailey, Stephen H; Raina, Amresh

    2017-06-01

    Ventricular tachycardia (VT) in the setting of left ventricular assist device (LVAD) therapy has been well described. We present a case of incessant ventricular tachycardia resulting in severe right ventricular (RV) failure and subsequent left ventricular (LV) cavity obliteration, which in turn diminished the feasibility of initial attempt at VT ablation.

  12. Mycobacterium chimaera left ventricular assist device infections.

    Science.gov (United States)

    Balsam, Leora B; Louie, Eddie; Hill, Fred; Levine, Jamie; Phillips, Michael S

    2017-06-01

    A global outbreak of invasive Mycobacterium chimaera infections after cardiac surgery has recently been linked to bioaerosols from contaminated heater-cooler units. The majority of cases have occurred after valvular surgery or aortic graft surgery and nearly half have resulted in death. To date, infections in patients with left ventricular assist devices (LVADs) have not been characterized in the literature. We report two cases of device-associated M. chimaera infection in patients with continuous-flow LVADs and describe challenges related to diagnosis and management in this population. © 2017 Wiley Periodicals, Inc.

  13. Electrocardiographic features suggestive of a left. ventricular ...

    African Journals Online (AJOL)

    1983-01-01

    Jan 1, 1983 ... sniper with an Armourlite assault rifle in Ireland. He had received a single bullet injury to the left ... His history negated any cardiovascular impairment, angina or limitation in effort tolerance. He plays ... In view of the patient's age, history and the cardiovascular findings, we would like to postulate that the ...

  14. Detection of left ventricular thrombi by computerised tomography

    International Nuclear Information System (INIS)

    Nair, C.K.; Sketch, M.H.; Mahoney, P.D.; Lynch, J.D.; Mooss, A.N.; Kenney, N.P.

    1981-01-01

    Sixteen patients suspected of having left ventricular mural thrombi were studied. All had suffered transmural myocardial infarction. Fifteen patients had a ventricular aneurysm. One had had systemic emboli. The mean length of time between the myocardial infarction and the study was 14.8 months, with a range of one month to 79 months. All patients underwent computerised tomography of the heart, M-mode echocardiography (M-mode), and two-dimensional echocardiography (2-D). Eight patients underwent left ventricular cineangiography. Five patients had surgical confirmation. Computerised tomography, two-dimensional, and M-mode echocardiography predicted left ventricular mural thrombi in 10, eight, and one of the 16 patients, respectively. Left ventricular cineangiography predicted left ventricular mural thrombi in four out of eight patients. Computerised tomography and left ventricular cineangiography correctly predicted the presence or absence of left ventricular thrombi in all five patients who underwent operation. In the same group, however, two-dimensional and M-mode echocardiography failed to predict the presence of thrombi in one and three patients, respectively. Among the 11 patients without surgical confirmation, one, in whom no left ventricular thrombi were shown by M-mode and two-dimensional echocardiography, was found to have thrombi on computerised tomography. In another, two-dimensional echocardiography was positive but this finding was not confirmed either by computerised tomography or by left ventricular angiography. (author)

  15. Videodensitometric assessment of right and left ventricular functions by digital subtraction angiography

    International Nuclear Information System (INIS)

    Ikeda, Hisao; Yoshiga, Osamu; Shibao, Keigo

    1987-01-01

    Intravenous digital subtraction (DS) ventriculography was performed in a series of 50 patients with heart diseases to determine right and left ventricular volumes and systolic indices. Right ventricular volume and right ventricular ejection fraction obtained by DS ventriculography were well correlated with those by geometric methods. In 43 patients with left ventricular ejection fraction of 55 % or greater, end-diastolic volume, stroke volume, and ejection fraction in the right ventricle did not differ from those in the left ventricle ; however, both the 1/3 ejection fraction and the peak ejection rate of the right ventricle were significantly lower than those of the left ventricle, suggesting the different modes of left and right ventricular contraction. In the other seven patients with chronic left ventricular failure, right ventricular systolic function may be preserved, even when left ventricular function is severely impaired. Digital subtraction ventriculography has proved to be a simple, useful method in the quanlitative and quantitative assessments of the right and left ventricles. (Namekawa, K.)

  16. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...... complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......V pacing. CONCLUSIONS: The acute effect of tLVp on LV systolic function and contraction pattern is significantly lower than the effect of BiV pacing and not different from intrinsic conduction in patients with LBBB and CRT....

  17. Left ventricular assist device implantation in patients after left ventricular reconstruction.

    Science.gov (United States)

    Palmen, Meindert; Braun, Jerry; Beeres, Saskia L M A; Klautz, Robert J M

    2016-12-01

    Left ventricular assist device (LVAD) implantation can be challenging in patients with a prior surgical ventricular restoration (SVR). In this case series of heart failure patients with a history of SVR, we describe the surgical technique and outcome of a customized approach for inflow cannula orientation. Seven patients with a history of SVR with end-stage chronic heart failure were accepted for long-term LVAD support. In all patients, the Dacron patch was removed through left ventriculotomy and a Hegar 22 dilator was inserted at the estimated optimal position of the LVAD inflow cannula. The left ventricle was reconstructed around the dilator from the left ventricular (LV) apex to the base. Finally, the LVAD sewing ring was sutured onto the remaining apical defect and a HeartWare® LVAD was implanted. LVAD implantation was successful in all 7 patients. Transoesophageal echocardiography ensured an adequate LVAD position and inflow and outflow cannula Doppler flow recordings. The mean intensive care unit stay was 5.8 ± 2.6 days, and the hospital stay after surgery was 32 ± 16 days. All patients follow regular visits (follow-up 20 ± 16 months) at the outpatient clinic without any remarkable event. Using the technique described, LVAD implantation in patients after SVR is feasible and safe. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Left ventricular noncompaction: Clinical-echocardiographic study

    Directory of Open Access Journals (Sweden)

    Nikolić Aleksandra

    2012-01-01

    Full Text Available Background/Aim. Left ventricular noncompaction (LVNC is a disorder in endomyocardial morphogenesis, seen either isolated (in the absence of other cardiac anomalies or in association with congenital heart disease and some neuromuscular diseases. Intrauterine arrest of the compaction of myocardial fibers is postulated to be the reason of LVNC. Recognition of this condition is extremely important due to its high mortality and morbidity that lead to progressive heart failure, ventricular arrhythmias and thromboembolic events. The aim of this study was to determine the prevalence and clinical presentation of LVNC among consecutive outpatients according to clinical and echocardiographyic findings. Methode. A total of 3,854 consecutive patients examined at the Institute for Cardiovascular Diseases within a period January 2006 - January 2007 were included in the study. All the patients underwent echocardiographic examination using the same equipment (Vivid 7, GE Medical System. Echocardiographic parameters and clinical presentation in patients with echocardiographic criteria for LVNC were analyzed. Results. Analyzing 3,854 consecutive outpatients, using two-dimensional Color Doppler echocardiography from January 2006 to January 2007, 12 patients met the criteria for LVNC. Seven of them were male. The mean age at diagnosis was 45 ± 15 years. Analyzing clinical manifestation of LVNC it was found that seven patients had signs of heart failure, six had arrhythmias with no embolic events. Conclusion. Our results suggest that the real prevalence of LVNC may be higher than expected. New studies have to be done to solve this problem.

  19. Left atrial systolic force in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Chinali, M.; Simone, G. de; Wachtell, K.

    2008-01-01

    In hypertensive patients without prevalent cardiovascular disease, enhanced left atrial systolic force is associated with left ventricular hypertrophy and increased preload. It also predicts cardiovascular events in a population with high prevalence of obesity. Relations between left atrial...... with larger left ventricular diameter and higher left ventricular mass index (both P hypertrophy was greater (84 vs. 64%; P ..., transmitral peak E velocities and peak A velocities; and lower E/A ratio (all P hypertrophy, but normal left ventricular chamber systolic function with increased...

  20. Left Ventricular Hypertrophy Evaluation in Obese Hypertensive Patients: Effect of Left Ventricular Mass Index Criteria

    Directory of Open Access Journals (Sweden)

    Eduardo Cantoni Rosa

    2002-04-01

    Full Text Available PURPOSE: To evaluate left ventricular mass (LVM index in hypertensive and normotensive obese individuals. METHODS: Using M mode echocardiography, 544 essential hypertensive and 106 normotensive patients were evaluated, and LVM was indexed for body surface area (LVM/BSA and for height² (LVM/h². The 2 indexes were then compared in both populations, in subgroups stratified according to body mass index (BMI: or = 30kg/m². RESULTS: The BSA index does not allow identification of significant differences between BMI subgroups. Indexing by height² provides significantly increased values for high BMI subgroups in normotensive and hypertensive populations. CONCLUSION: Left ventricular hypertrophy (LVH has been underestimated in the obese with the use of LVM/BSA because this index considers obesity as a physiological variable. Indexing by height² allows differences between BMI subgroups to become apparent and seems to be more appropriate for detecting LVH in obese populations.

  1. Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani

    2012-01-01

    Full Text Available Background: early diagnosis of left ventricular mass (LVM inappropriateness and left ventricular hypertrophy (LVH can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E/late diastolic peak velocity (A, deceleration time (DT, and E/early mitral annulus velocity (E′ were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P 0.05. Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025. Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

  2. Evaluation of left ventricular volumes measured by magnetic resonance imaging

    DEFF Research Database (Denmark)

    Møgelvang, J; Thomsen, C; Mehlsen, J

    1986-01-01

    Left ventricular end-diastolic and end-systolic volumes were determined in 17 patients with different levels of left ventricular function by magnetic resonance imaging (MRI). A 1.5 Tesla Magnet was used obtaining ECG triggered single and multiple slices. Calculated cardiac outputs were compared...

  3. Left Ventricular Function in Nigerians With Type 2 Diabetes Mellitus ...

    African Journals Online (AJOL)

    Background. Diabetes mellitus is an established risk factor for cardiovascular events and has been found to be independently associated with abnormal left ventricular function. We therefore decided to embark on this study to assess the left ventricular function in our diabetic patients. Method. The study design was ...

  4. Postinfarction left ventricular free wall rupture repaired successfully.

    Science.gov (United States)

    Tireli, Emin; Kalko, Yusuf; Kafali, Eylül; Basaran, Murat

    2002-09-01

    Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and a frequent cause of death. A 49-year-old man was successfully treated for a left ventricular free wall rupture that occurred on the third day after an anterior myocardial infarction. Concomitant myocardial revascularization was performed.

  5. Reversible left ventricular dysfunction - important clinical problem of contemporary cardiology

    International Nuclear Information System (INIS)

    Witkowski, A.

    1994-01-01

    An important clinical issue there is determination whether left ventricular damages are reversible or not single photon emission computed tomography and positron computed tomography techniques are shown to provide valuable data in this problem. Article describes basic syndromes connected with left ventricular dysfunction, namely: hibernating myocardium, stunned myocardium and ischemic myocardium preconditioning. (author). 18 refs

  6. Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function--a worthwhile procedure in concomitant surgical interventions?

    Science.gov (United States)

    Mellert, F; Schneider, C; Esmailzadeh, B; Balta, O; Haushofer, M; Schiller, W; Preusse, C J; Welz, A

    2012-02-01

    Cardiac resynchronization therapy (CRT) by means of multisite biventricular pacing is an effective therapeutic option for the treatment of severe heart failure. The present study estimates how many open heart-surgery patients could benefit from the implantation of permanent left ventricular (LV) pacing leads. After routine preoperative screening, epicardial electrodes were implanted in selected patients. Lead performance and outcomes were investigated. Primarily, 1059 patients were retrospectively investigated with regard to LV function, left bundle branch block and QRS duration. Afterwards, suitable patients were identified and epicardial electrodes [Medtronic 5071 (ME) or Enpath (EP)] were implanted during concomitant procedures. Mean follow-up time was 6.3 ± 5.5 months. The retrospective study showed that 24 patients (2.3%) could potentially profit from CRT. After routine preoperative screening for CRT-responders, 22 patients (1.6%) were identified who finally received epicardial leads. No complications occurred. Acute capture threshold was 0.9 ± 0.4 V (ME, n = 17) and 0.5 ± 0.2 V (EP, n = 5). While leads in 18 patients were implanted as an upgrade to an existing pacemaker or implantable cardioverter-defibrillator (ICD) technologies (Group B), 4 patients underwent prophylactic implantation with no device attached (Group A). CRT-ICDs were implanted at follow-up in 3 Group A patients (75%). In Group B patients, the QRS duration decreased (from 189 ± 35 ms to 152 ± 16 ms, p < 0.02) and their postoperative mean NYHA functional class improved significantly (2.2 ± 0.5 versus 2.8 ± 0.6). A small group of cardiac surgery patients may benefit from LV-lead implantation during concomitant procedures. A protocol for responder identification is useful. Existing devices should be upgraded to CRT systems. As CRT-ICD implantation is frequent, the additional costs and time are justified. Thieme Medical Publishers 333 Seventh Avenue

  7. Nipro extra-corporeal left ventricular assist device fitting after left ventricular reconstruction with mitral valve plasty.

    Science.gov (United States)

    Arakawa, Mamoru; Yamaguchi, Atsushi; Nishimura, Takashi; Itoh, Satoshi; Yuri, Koichi; Kyo, Shunei; Adachi, Hideo

    2015-12-01

    Both left ventricular assist device and left ventricular reconstruction are treatment choices for severe heart failure conditions. Our institution performed a left ventricular assist device installation following a left ventricular reconstruction procedure on a 42-year-old male patient who presented with dilated cardiomyopathy and low cardiac output syndrome. A mitral valve plasty was used to correct the acute mitral valve regurgitation and we performed a Nipro extra-corporeal left ventricular assist device installation on post-operative day 14. Due to the left ventricular reconstruction that the patient had in a previous operation, we needed to attach an apical cuff on posterior apex, insert the inflow cannula with a large curve, and shift the skin insertion site laterally to the left. We assessed the angle between the cardiac longitudinal axis and the inflow cannula using computed tomography. The patient did not complain of any subjective symptoms of heart failure. Although Nipro extra-corporeal left ventricular assist device installation after left ventricular reconstruction has several difficulties historically, we have experienced a successful case.

  8. Robotic-assisted excision of a left ventricular thrombus.

    Science.gov (United States)

    Lutz, Charles J; Bhamidipati, Castigliano M; Ford, Brant; Swartz, Mike; Hauser, Michael; Kyobe, Moses; Dilip, Karikehalli

    2007-09-01

    : Left ventricular thrombus is a rare entity usually associated with myocardial infarction. The daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, Calif) offers excellent visualization of the mitral subvalvular apparatus and should provide an effective means to excise a left ventricular mass. : A 34-year-old man presented to an outside institution with fever of unknown origin and ulcerative colitis. As part of this workup, he underwent a transthoracic echocardiogram and subsequently a transesophageal echocardiogram that showed a 2-cm left ventricular apical pedunculated mass. He was referred to our institution for excision of this ventricular mass. Because of the pedunculated nature of the mass, he was deemed a candidate for a robotic-assisted minimally invasive approach. : The patient underwent successful robotic-assisted excision of a left ventricular mass. Total robotic time was 15 minutes. Pathology revealed that the mass was a left ventricular thrombus. The patient experienced an uneventful recovery and was discharged home in 4 days. : Left ventricular mass excision can be safely performed with the daVinci Surgical System. The daVinci Surgical System offers excellent visualization of the entire left ventricular cavity.

  9. [Vectorcardiographic manifestations of left ventricular and biventricular enlargement].

    Science.gov (United States)

    de Micheli, A; Medrano, G A

    1979-01-01

    The basic criteria for the vectorcardiographic diagnosis of left ventricular and biventricular enlargements are discussed on the basis of the myocardial activation sequence. Left ventricular dilatation, secondary to isolated diastolic overloading, increases the manifestation of all the vectors resulting of the activation of this ventricle. These changes reflect the proximity of the left ventricular walls to the exploring electrodes. The vectors above mentioned project themselves as wide ventricular curves with counterclockwise rotation on the three planes. The T loop, of secondary type, is concordant in its orientation with the R loop. Cases with left ventricular hypertrophy, produced by a sustained systolic overloading, are also described. In the presence of global left ventricular hypertrophy without LBBB, the manifestation of all the vectors resulting from the depolarization of this ventricle (I, IIl, IIIl), is increased. This is due to a prolonged duration of the corresponding activation fronts. These vectors are projected on the different segments of the ventricular curves and they show a counterclockwise rotation on the three planes. When LBBB is also present, the first septal vector is not evident. The T loop, of secondary type, opposes the R loop on the frontal and horizontal planes. The presence of left ventricular hypertrophy of the segmentary type, generally increases the manifestation of the vector I, and sometimes, also that of the vector IIIl. When both ventricles are hypertrophied, the electromotive forces of the chamber more severely affected predominate in the vectorcardiographic records.

  10. Left Ventricular Assist Device Implantation After Intracardiac Parachute Device Removal.

    Science.gov (United States)

    Abu Saleh, Walid K; Al Jabbari, Odeaa; Bruckner, Brian A; Suarez, Erik E; Estep, Jerry D; Loebe, Matthias

    2015-08-01

    Left ventricular assist device implantation is a proven and efficient modality for the treatment of end-stage heart failure. Left ventricular assist device versatility as a bridge to heart transplantation or destination therapy has led to improved patient outcomes with a concomitant rise in its overall use. Other less invasive treatment modalities are being developed to improve heart function and morbidity and mortality for the heart failure population. Percutaneous ventricular restoration is a new investigational therapy that deploys an intracardiac parachute to wall off damaged myocardium in patients with dilated left ventricles and ischemic heart failure. Clinical trials are under way to test the efficacy of percutaneous ventricular restoration using the parachute device. This review describes our encounter with the parachute device, its explantation due to refractory heart failure, and surgical replacement with a left ventricular assist device. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Endocarditis in left ventricular assist device

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Sikachi, Rutuja R; Agrawal, Abhinav

    2016-01-01

    Summary Heart failure is one of the leading causes of death in developed nations. End stage heart failure often requires cardiac transplantation for survival. The left ventricular assist device (LVAD) has been one of the biggest evolvements in heart failure management often serving as bridge to transplant or destination therapy in advanced heart failure. Like any other medical device, LVAD is associated with complications with infections being reported in many patients. Endocarditis developing secondary to the placement of LVAD is not a frequent, serious and difficult to treat condition with high morbidity and mortality. Currently, there are few retrospective studies and case reports reporting the same. In our review, we found the most common cause of endocarditis in LVAD was due to bacteria. Both bacterial and fungal endocarditis were associated with high morbidity and mortality. In this review we will be discussing the risk factors, organisms involved, diagnostic tests, management strategies, complications, and outcomes in patients who developed endocarditis secondary to LVAD placement. PMID:27672540

  12. Genetic Testing in Pediatric Left Ventricular Noncompaction.

    Science.gov (United States)

    Miller, Erin M; Hinton, Robert B; Czosek, Richard; Lorts, Angela; Parrott, Ashley; Shikany, Amy R; Ittenbach, Richard F; Ware, Stephanie M

    2017-12-01

    Left ventricular noncompaction (LVNC) can occur in isolation or can co-occur with a cardiomyopathy phenotype or cardiovascular malformation. The yield of cardiomyopathy gene panel testing in infants, children, and adolescents with a diagnosis of LVNC is unknown. By characterizing a pediatric population with LVNC, we sought to determine the yield of cardiomyopathy gene panel testing, distinguish the yield of testing for LVNC with or without co-occurring cardiac findings, and define additional factors influencing genetic testing yield. One hundred twenty-eight individuals diagnosed with LVNC at ≤21 years of age were identified, including 59% with idiopathic pathogenesis, 32% with familial disease, and 9% with a syndromic or metabolic diagnosis. Overall, 75 individuals had either cardiomyopathy gene panel (n=65) or known variant testing (n=10). The yield of cardiomyopathy gene panel testing was 9%. The severity of LVNC by imaging criteria was not associated with positive genetic testing, co-occurring cardiac features, pathogenesis, family history, or myocardial dysfunction. Individuals with isolated LVNC were significantly less likely to have a positive genetic testing result compared with those with LVNC and co-occurring cardiomyopathy (0% versus 12%, respectively; P testing should be considered in individuals with cardiomyopathy co-occurring with LVNC. These data do not suggest an indication for cardiomyopathy gene panel testing in individuals with isolated LVNC in the absence of a family history of cardiomyopathy. © 2017 American Heart Association, Inc.

  13. Left ventricular diastolic function is associated with symptom status in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Christensen, Nicolaj L; Videbæk, Lars

    2014-01-01

    BACKGROUND: In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic...... atrial volume index, and deceleration time were still associated with the presence of symptoms. CONCLUSIONS: The present study demonstrates that symptomatic status in severe AS is associated with impaired diastolic function, LV hypertrophy, concentric remodeling, and left atrial dilatation when corrected...

  14. Heart monitoring using left ventricle impedance and ventricular electrocardiography in left ventricular assist device patients.

    Science.gov (United States)

    Her, Keun; Ahn, Chi Bum; Park, Sung Min; Choi, Seong Wook

    2015-03-21

    Patients who develop critical arrhythmia during left ventricular assist device (LVAD) perfusion have a low survival rate. For diagnosis of unexpected heart abnormalities, new heart-monitoring methods are required for patients supported by LVAD perfusion. Ventricular electrocardiography using electrodes implanted in the ventricle to detect heart contractions is unsuitable if the heart is abnormal. Left ventricular impedance (LVI) is useful for monitoring heart movement but does not show abnormal action potential in the heart muscle. To detect detailed abnormal heart conditions, we obtained ventricular electrocardiograms (v-ECGs) and LVI simultaneously in porcine models connected to LVADs. In the porcine models, electrodes were set on the heart apex and ascending aorta for real-time measurements of v-ECGs and LVI. As the carrier current frequency of the LVI was adjusted to 30 kHz, it was easily derived from the original v-ECG signal by using a high-pass filter (cutoff: 10 kHz). In addition, v-ECGs with a frequency band of 0.1 - 120 Hz were easily derived using a low-pass filter. Simultaneous v-ECG and LVI data were compared to detect heart volume changes during the Q-T period when the heart contracted. A new real-time algorithm for comparison of v-ECGs and LVI determined whether the porcine heartbeats were normal or abnormal. Several abnormal heartbeats were detected using the LVADs operating in asynchronous mode, most of which were premature ventricle contractions (PVCs). To evaluate the accuracy of the new method, the results obtained were compared to normal ECG data and cardiac output measured simultaneously using commercial devices. The new method provided more accurate detection of abnormal heart movements. This method can be used for various heart diseases, even those in which the cardiac output is heavily affected by LVAD operation.

  15. Dietary phosphorus is associated with greater left ventricular mass.

    Science.gov (United States)

    Yamamoto, Kalani T; Robinson-Cohen, Cassianne; de Oliveira, Marcia C; Kostina, Alina; Nettleton, Jennifer A; Ix, Joachim H; Nguyen, Ha; Eng, John; Lima, Joao A C; Siscovick, David S; Weiss, Noel S; Kestenbaum, Bryan

    2013-04-01

    Dietary phosphorus consumption has risen steadily in the United States. Oral phosphorus loading alters key regulatory hormones and impairs vascular endothelial function, which may lead to an increase in left ventricular mass (LVM). We investigated the association of dietary phosphorus with LVM in 4494 participants from the Multi-Ethnic Study of Atherosclerosis, a community-based study of individuals who were free of known cardiovascular disease. The intake of dietary phosphorus was estimated using a 120-item food frequency questionnaire and the LVM was measured using magnetic resonance imaging. Regression models were used to determine associations of estimated dietary phosphorus with LVM and left ventricular hypertrophy (LVH). Mean estimated dietary phosphorus intake was 1167 mg/day in men and 1017 mg/day in women. After adjustment for demographics, dietary sodium, total calories, lifestyle factors, comorbidities, and established LVH risk factors, each quintile increase in the estimated dietary phosphate intake was associated with an estimated 1.1 g greater LVM. The highest gender-specific dietary phosphorus quintile was associated with an estimated 6.1 g greater LVM compared with the lowest quintile. Higher dietary phosphorus intake was associated with greater odds of LVH among women, but not men. These associations require confirmation in other studies.

  16. Factors of Formation of Various Types of Left Ventricular Diastolic Filling in Adolescents with Myocardium Pathology

    Directory of Open Access Journals (Sweden)

    L.F. Bogmat

    2016-08-01

    Full Text Available Objective: to study the main components of the formation of impaired left ventricular diastolic filling in adolescents with myocardial pathology. Materials and methods. The study involved 110 adolescents with myocardial pathology aged 13–18 years, of which 40 — with heart rhythm disorder, 40 — with dysplastic cardiomyopathy, 30 — with primary hypertension. Morphological and functional parameters of the heart were studied using ultrasound according to standard procedure. Left ventricular diastolic function has been studied in the pulsed wave Doppler mode with transmitral flow mapping from the apical access of four-chambered heart. For an adequate assessment of left ventricular diastolic function and detection of its earliest disorders, adolescents underwent tests with isometric exercise. Based on these results, adolescents were divided in terms of the E/A ratio. In order to identify common latent factors that explain the correlation between indicators, we have used the factor analysis, namely, the principal component analysis. All statistical procedures were performed using application packages Statgraphics Centurion. Results. On the initial stages of formation of diastolic dysfunction of the left ventricular myocardium in adolescents, a significant role is played by a number of factors, which can be conditionally defined as the geometric, functional and neurohumoral factors consistently included in the pathological process. Thus, during the formation of left ventricular diastolic dysfunction type 1, the number one is neurohumoral factor, namely, the activation of the sympathoadrenal system, then peripheral vascular tone is being involved in the pathological process, and, consequently, a geometric factor — changing the sizes of the left atrium. In the formation of left ventricular diastolic dysfunction type 2, the process consistently involves the renin-angiotensin system, namely, renin, a functional factor is presented by the indices

  17. Apical left ventricular hypertrophy and mid-ventricular obstruction in fabry disease.

    Science.gov (United States)

    Cianciulli, Tomás F; Saccheri, María C; Fernández, Segundo P; Fernández, Cinthia C; Rozenfeld, Paula A; Kisinovsky, Isaac

    2015-05-01

    We report the case of a rare cardiac presentation of Fabry disease. Although concentric left ventricular hypertrophy is a major cardiac finding in Fabry disease, there is no case report of dynamic obstruction at mid-left ventricular level. We describe a 59-year-old-woman suffering from a severe form of Fabry disease, mimicking an apical hypertrophic cardiomyopathy with mid-ventricular obstruction. Differentiation of Fabry disease from hypertrophic cardiomyopathy is crucial given the therapeutic and prognostic differences. Fabry disease should always be suspected in an adult, independently of the pattern of left ventricular hypertrophy. © 2015, Wiley Periodicals, Inc.

  18. Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Shohreh Honarbakhsh, MBBS, BSc, MRCP

    2013-09-01

    Full Text Available We report a case of a 67-year old male with a recent diagnosis of left ventricular noncompaction (LVNC, initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT. This ventricular arrhythmia originated in a structurally normal right ventricle (RV and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation.

  19. Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Abderrahmane Bakkali

    2016-12-01

    Full Text Available Objective: The aim of this study was to evaluate the effect of aortic valve replacement on left ventricular function and remodeling among patients with severe aortic stenosis and severe left ventricular dysfunction. Methods: In this retrospective bicentric study extended over a 15-year period, 61 consecutive patients underwent isolated AVR for severe AS associated to reduced LV function. The mean age was 58.21 ± 12.50 years and 83.60 % were men. 70.50% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF was 32.9 ± 5.6.The mean LVEDD and LVESD were respectively 63.6 ± 9.2 and 50.2 ± 8.8 mm. The mean calculated logistic EuroScore was 12.2 ±4.5. Results: The hospital mortality was 11.5%. Morbidity was marked mainly by low output syndrome in 40.8% of cases. After a median follow-up of 38 months we have recorded 3 deaths. Almost all survivors were in class I and II of NYHA. The mean LV end-diastolic and end-systolic diameters decreased significantly at late postoperative stage. The mean LV ejection fraction increased significantly from 32.9 ± 5.6 to 38.2 ± 9.3 and to 50.3 ± 9.6 in early and late postoperative stages, respectively. Multivariate linear regression analysis found that increased early postoperative LVEF (β= 0.44, 95% CI [0.14; 0.75], p=0.006 and low mean transprosthesis gradient (β=-0.72, 95% CI [-1.42; -0.02], p= 0.04 were the independent predictors of left ventricular systolic function recovery. Conclusion: Patients with aortic valve stenosis and impaired LV systolic function benefited from AVR as regard improvement of LV function parameters and regression of the LV diameters .This improvement depends mainly on early postoperative LVEF and mean transprosthesis gradient.

  20. Normal left ventricular function does not protect against propafenone ...

    African Journals Online (AJOL)

    Normal left ventricular function does not protect against propafenone-induced incessant ventricular tachycardia. R. N. Scott Millar, J. B. Lawrenson, D.A. Milne. Abstract. Propafenone is a class Ic anti-arrhythmic agent with mild B-blocking properties which has recently become available in South Africa. We have used the ...

  1. Diastolic heart failure associated with hemangiosarcoma infiltrating left ventricular walls in a dog.

    Science.gov (United States)

    Osuga, Tatsuyuki; Nakamura, Kensuke; Morita, Tomoya; Kagawa, Yumiko; Ohta, Hiroshi; Takiguchi, Mitsuyoshi

    2017-11-01

    A 9-year-old Shetland sheepdog was diagnosed with cardiogenic pulmonary edema. Echocardiography revealed focally thickened left ventricular free wall and interventricular septum and left atrial dilation. Left ventricular systolic function was preserved. Doppler echocardiography of transmitral flow indicated restrictive left ventricular filling. Cardiac histopathology demonstrated hemangiosarcoma infiltrating the left ventricular walls.

  2. Impact of aortic prosthesis-patient mismatch on left ventricular mass regression.

    Science.gov (United States)

    Alassal, Mohamed A; Ibrahim, Bedir M; Elsadeck, Nabil

    2014-06-01

    Prostheses used for aortic valve replacement may be small in relation to body size, causing prosthesis-patient mismatch and delaying left ventricular mass regression. This study examined the effect of prosthesis-patient mismatch on regression of left ventricular mass after aortic valve replacement. We prospectively studied 96 patients undergoing aortic valve replacement between 2007 and 2012. Mean and peak gradients and indexed effective orifice area were measured by transthoracic echocardiography at 3 and 6 months postoperatively. Patient-prosthesis mismatch was defined as indexed effective orifice area ≤0.85 cm(2)·m(-2). Moderate prosthesis-patient mismatch was present in 25% of patients. There were no significant differences in demographic and operative data between patients with and without prosthesis-patient mismatch. Left ventricular dimensions, posterior wall thickness, transvalvular gradients, and left ventricular mass decreased significantly after aortic valve replacement in both groups. The interventricular septal diameter and left ventricular mass index regression, and left ventricular ejection fraction were better in patients without prosthesis-patient mismatch. There was a significant positive correlation between the postoperative indexed effective orifice area of each valve prosthesis and the rate of left ventricular mass regression. Prosthesis-patient mismatch leads to higher transprosthetic gradients and impaired left ventricular mass regression. A small-sized valve prosthesis does not necessarily result in prosthesis-patient mismatch, and may be perfectly adequate in patient with small body size. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Left Ventricular Diastolic Function in a Predialysis Patient Population ...

    African Journals Online (AJOL)

    CKD) accounting for 40%–66% of cardiovascular complications. OBJECTIVE: To determine the prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in adult Nigerians with CKD at presentation and to compare ...

  4. Body mass index, type 2 diabetes, and left ventricular function

    DEFF Research Database (Denmark)

    Musaeus, Katrine Dina; Pareek, Manan

    2018-01-01

    previous observations of body mass index as a significant predictor of incident diastolic dysfunction and increased left ventricular mass index among subjects without prevalent diabetes. We discuss potential explanations for the observed discrepancies and general difficulties associated with cardiovascular...

  5. Quantitation of global and regional left ventricular function by MRI

    NARCIS (Netherlands)

    van der Geest, RJ; Reiber, JHC; Reiber, JHC; VanDerWall, EE

    1998-01-01

    Magnetic resonance imaging (MRI) provides several imaging strategies for assessing left ventricular function. As a three-dimensional imaging technique, all measurements can be performed without relying on geometrical assumptions. Global and regional function parameters can be derived from

  6. Evaluation of left ventricular function using digital subtraction ventriculography

    International Nuclear Information System (INIS)

    Yiannikas, J.; Detrano, R.

    1986-01-01

    Digital subtraction ventriculography following injections of contrast via peripheral veins provides excellent images to assess left ventricular function. The images are essentially identical to those following DCV, but allow more uniform mixing of contrast in the left ventricular chamber. Furthermore, few, if any, cardiac arrhythmias occur, hence obviating difficulties that arise from DCV. The spatial resolution of the method is such that regional wall motion assessment of ventricular function is more accurate than that of other noninvasive imaging methods. The use of video-densitometry allows accurate assessment of left ventricular function even when the left ventricular cavity is nonsymmetrically deformed and aneurysmal. In the setting of the cardiac catheterization laboratory, digital ventriculography may provide a safer means of assessing left ventricular function when critical coronary or myocardial disease is present and allows multiple assessments of ventricular function during the same study. Although excellent correlations with standard ventriculography have been noted by all workers, significant discrepancies still exist in individual patients, particularly in the calculations of end diastolic volumes. In the authors experience and in those of most workers, the largest discrepancies existed in patients in whom suboptimal studies are included for analysis. The most frequent reason for the occasional suboptimal study as with all digital subtraction work is the misregistration that results from motion

  7. Detection and characterization of left Ventricular Thrombi by MRT compared to Transthoracic Echocardiography

    International Nuclear Information System (INIS)

    Bruder, O.; Jochims, M.; Sabin, G.V.; Waltering, K.U.; Hunhold, P.; Narin, B.; Barkhausen, J.

    2005-01-01

    Purpose: Transthoracic echocardiography is the routine diagnostic procedure in assessing patients with left ventricular thrombi, but is limited by the acoustic window and poor contrast between thrombus and adjacent myocardium. This study evaluates the role of cardiac MRI in the detection of left ventricular thrombi in patients with chronic myocardial infarction compared to standard transthoracic echocardiography. Materials and Methods: In 82 patients (55 men and 27 women, age 36 to 79 years, median 59±11 years) who suffered a myocardial infarction more than 6 months earlier, transthoracic echocardiography and MRI were performed. The MRI protocol included steady state cine imaging (true FISP: TR 3.0 ms, TE 1.5 ms, FA 65 ) in standard long and short axis orientation and contrast-enhanced imaging using a 3D IR-FLASH sequence with long inversion time (TR 4 ms; TE 1.43 ms, FA 10 , TI 300 ms) early, and a 2D IR-FLASH sequence with optimized inversion time (TR 8 ms, TE 4.3 ms, FA 20 , TI 180-280 ms) late after administration of gadolinium. Results: Transthoracic echocardiography depicted 12 thrombi. Contrast-enhanced MRI confirmed these 12 thrombi and detected 23 additional thrombi. With the exception of 2 very small apical thrombi only visible on contrast-enhanced MRI images, spherical thrombi were diagnosed by both techiques, whereas only contrast-enhanced MRI was able to visualize mural thrombi. Left ventricular thrombi were more frequently diagnosed in patients with moderate to severe impairment of the left ventricular systolic function, 32/42 (76%), or in patients with left ventricular aneurysms, 21/24 (84%). Conclusion: Contrast-enhanced MRI is mostly superior to transthoracic echocardiography in diagnosing mural left ventricular thrombi in patients who had suffered a myocardial infarction. Intracavitray thrombi are mor frequently found in patients with impaired regional and global left ventricular function. (orig.)

  8. Safety Testing of Left Ventricular Vent Valves

    OpenAIRE

    Gavin, Caroline; Coblentz, John; Acsell, Jeffrey R.; Shackelford, Anthony G.; Sistino, Joseph J.

    2015-01-01

    Vent vacuum relief valves (VRVs) are used to limit the negative pressure at the ventricular vent catheter tip as well as prevent reversal of blood flow and prevention of air embolism. The purpose of this study was to evaluate the performance of three commercially available ventricular vent valves. The negative pressure at which the vent valve opened was measured at the valve inlet using high-fidelity pressure transducers. Also, the flow rate at which air entrainment occurred due to valve open...

  9. Assessment of cardiac blood pool imaging in patients with left ventricular outflow tract stenosis

    International Nuclear Information System (INIS)

    Nakamura, Yutaka; Ono, Yasuo; Kohata, Tohru; Tsubata, Shinichi; Kamiya, Tetsuroh.

    1993-01-01

    We performed cardiac blood pool imagings with Tc-99m at rest and during supine ergometer exercise to evaluate left ventricular performance in 14 patients with left ventricular outflow tract stenosis. All catheterized patients were divided into two subgroups: 8 patients with peak systolic left ventricular to descending aortic pressure gradients of less than 50 mmHg (LPG group) and 6 patients with peak systolic gradients of more than 50 mmHg (HPG group). Control group included 10 patients without stenotic coronary lesions after Kawasaki disease. Left ventricular ejection fraction (LVEF) was obtained as systolic index; both filling fraction during the first third of diastole (1/3FF) and mean filling rate during the first third of diastole (1/3FR mean) were obtained as diastolic indices. None of the patients had abnormal findings on 201 Tl imaging. LVEF at rest in HPG group was significantly higher than those in control group, but LVEF in HPG group did not increase after exercise. It increased significantly in control group and LPG group. 1/3 FF in HPG group was significantly lower not only at rest but also during exercise. 1/3 FR mean at rest was not different significantly among the 3 groups. However, 1/3FR mean during exercise in LPG group was significantly lower; and 1/3 FR mean during exercise was significantly lower in HPG group than LPG group. The ratio of left ventricular muscular mass to left ventricular end-diastolic volume (M/V) calculated from left ventricular cineangiograms was different significantly among the 3 groups. The M/V ratio showed a correlation with LVEF and 1/3 FF both at rest and during exercise. These results would indicate that systolic function was impaired on exercise in severe left ventricular outflow tract stenosis and diastolic function was impaired on exercise in mild and severe left ventricular outflow tract stenosis. This may correlate with left ventricular hypertrophy and interaction of systolic function. (author)

  10. Assessment of cardiac blood pool imaging in patients with left ventricular outflow tract stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Yutaka (Tajimi City Hospital, Gifu (Japan)); Ono, Yasuo; Kohata, Tohru; Tsubata, Shinichi; Kamiya, Tetsuroh

    1993-09-01

    We performed cardiac blood pool imagings with Tc-99m at rest and during supine ergometer exercise to evaluate left ventricular performance in 14 patients with left ventricular outflow tract stenosis. All catheterized patients were divided into two subgroups: 8 patients with peak systolic left ventricular to descending aortic pressure gradients of less than 50 mmHg (LPG group) and 6 patients with peak systolic gradients of more than 50 mmHg (HPG group). Control group included 10 patients without stenotic coronary lesions after Kawasaki disease. Left ventricular ejection fraction (LVEF) was obtained as systolic index; both filling fraction during the first third of diastole (1/3FF) and mean filling rate during the first third of diastole (1/3FR mean) were obtained as diastolic indices. None of the patients had abnormal findings on [sup 201]Tl imaging. LVEF at rest in HPG group was significantly higher than those in control group, but LVEF in HPG group did not increase after exercise. It increased significantly in control group and LPG group. 1/3 FF in HPG group was significantly lower not only at rest but also during exercise. 1/3 FR mean at rest was not different significantly among the 3 groups. However, 1/3FR mean during exercise in LPG group was significantly lower; and 1/3 FR mean during exercise was significantly lower in HPG group than LPG group. The ratio of left ventricular muscular mass to left ventricular end-diastolic volume (M/V) calculated from left ventricular cineangiograms was different significantly among the 3 groups. The M/V ratio showed a correlation with LVEF and 1/3 FF both at rest and during exercise. These results would indicate that systolic function was impaired on exercise in severe left ventricular outflow tract stenosis and diastolic function was impaired on exercise in mild and severe left ventricular outflow tract stenosis. This may correlate with left ventricular hypertrophy and interaction of systolic function. (author).

  11. Relationship between right and left ventricular function in candidates for implantable cardioverter defibrillator with low left ventricular ejection fraction.

    Science.gov (United States)

    Jimenez-Juan, Laura; Karur, Gauri R; Connelly, Kim A; Deva, Djeven; Yan, Raymond T; Wald, Rachel M; Singh, Sheldon; Leung, General; Oikonomou, Anastasia; Dorian, Paul; Angaran, Paul; Yan, Andrew T

    2017-04-01

    Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m 2 and 81±27 mL/m 2 , respectively. Eighty-six (84%) patients had a LVEF right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF ( r =0.40, p right ventricular systolic dysfunction (Kappa=0.041). Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa.

  12. Left ventricular biomechanics in professional football players.

    Science.gov (United States)

    von Lueder, T G; Hodt, A; Gjerdalen, G F; Steine, K

    2018-01-01

    Chronic exercise induces adaptive changes of left ventricular (LV) ejection and filling capacities which may be detected by novel speckle-tracking echocardiography (STE) and tissue Doppler imaging (TDI)-based techniques. A total of 103 consecutive male elite Norwegian soccer players and 46 age-matched healthy controls underwent echocardiography at rest. STE was used to assess LV torsional mechanics and LV systolic longitudinal strain (LS). Diastolic function was evaluated by trans-mitral blood flow, mitral annular velocities by TDI, and LV inflow propagation velocity by color M-mode. Despite similar global LS, players displayed lower basal wall and higher apical wall LS values vs controls, resulting in an incremental base-to-apex gradient of LS. Color M-mode and TDI-derived data were similar in both groups. Peak systolic twist rate (TWR) was significantly lower in players (86.4±2.8 vs controls 101.9±5.2 deg/s, P<.01). Diastolic untwisting rate (UTWR) was higher in players (-124.5±4.2 vs -106.9±6.7 deg/s) and peaked earlier during the cardiac cycle (112.7±0.8 vs 117.4±2.4% of systole duration, both P<.05). Untwisting/twisting ratio (-1.48±0.05 vs -1.11±0.08; P<.001) and untwisting performance (=UTR/TW; -9.25±0.34 vs -7.38±0.40 s -1 , P<.01) were increased in players. Augmented diastolic wall strain (DWS), a novel measure of LV compliance in players, was associated with improved myocardial mechanical efficiency. The described myocardial biomechanics may underlie augmented exertional cardiac function in athletes and may have a potential role to characterize athlete's heart by itself or to distinguish it from hypertensive or hypertrophic cardiomyopathy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Assessment of stiffness of the hypertrophied left ventricle of bicyclists using left ventricular inflow Doppler velocimetry.

    Science.gov (United States)

    Fagard, R; Van den Broeke, C; Bielen, E; Vanhees, L; Amery, A

    1987-06-01

    Sixteen male bicyclists and 16 control subjects were studied to assess whether the left ventricular hypertrophy of athletes is associated with changes in diastolic left ventricular function. The cyclists had a larger left ventricular internal diameter on echocardiography (55.2 versus 47.9 mm; p less than 0.001) and a disproportionate increase in wall thickness relative to the internal diameter (0.48 versus 0.41; p less than 0.01), indicating a mixed eccentric-concentric type of hypertrophy. Left ventricular inflow Doppler velocimetry showed similar results in athletes and control subjects for peak flow velocities in the atrial contraction phase (30 versus 32 cm/s; p = NS) and in the early diastolic rapid filling phase (71 versus 67 cm/s; p = NS). The similar ratio of both velocities, that is, 0.43 in the cyclists and 0.49 in the control subjects, suggests that left ventricular distensibility is unaltered in cyclists. It is concluded that the left ventricular hypertrophy observed in cyclists is not associated with changes in ventricular stiffness, as estimated from left ventricular inflow Doppler velocimetry.

  14. Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function.

    Science.gov (United States)

    Gelsomino, Sandro; Lucà, Fabiana; Parise, Orlando; Lorusso, Roberto; Rao, Carmelo Massimiliano; Vizzardi, Enrico; Gensini, Gian Franco; Maessen, Jos G

    2013-11-01

    We explored the influence of global longitudinal strain (GLS) measured with two-dimensional speckle-tracking echocardiography on left ventricular mass regression (LVMR) in patients with pure aortic stenosis (AS) and normal left ventricular function undergoing aortic valve replacement (AVR). The study population included 83 patients with severe AS (aortic valve area regression (all P regression in patients with pure AS undergoing AVR. Our findings must be confirmed by further larger studies.

  15. Ventricular Energetics in Pediatric Left Ventricular Assist Device Patients: A Retrospective Clinical Study.

    Science.gov (United States)

    Di Molfetta, Arianna; Ferrari, Gianfranco; Iacobelli, Roberta; Filippelli, Sergio; Di Chiara, Luca; Guccione, Paolo; Amodeo, Antonio

    The aim of this study is to estimate the trend of right and left energetic parameters in left ventricular assist device (LVAD) pediatric patients. Echocardiographic data were retrospectively collected at the baseline, in the acute phase after and at the monthly follow-ups till the LVAD explantation to estimate left and right ventricular energetic parameters. A significant relationship between the left and right ventricular energetic parameter trends was found along all the study period. Left ventricular end-systolic pressure-volume relationship improved till the follow-up of 2 months and then progressively decreases. Left arteroventricular coupling decreases after the LVAD, and right arteroventricular coupling decreases at the short-term follow-up. Left ventricular external work, potential energy, and pressure-volume area decrease at the short-term follow-up and then increase progressively. Right ventricular external work, potential energy, and pressure-volume area increase after the LVAD implantation. Left (right) cardiac mechanical efficiency is improved (worsened) by the LVAD. Energetic variables show that the LVAD benefits could decrease over time. A continuous and patient tailored LVAD setting could contribute to prolong LVAD benefits. The introduction of energetic parameters could lead to a more complete evaluation of LVAD patients' outcome which is a multiparametric process.

  16. Impact of obstructive sleep apnea and snoring on left ventricular ...

    African Journals Online (AJOL)

    Background: Systemic hypertension (HTN) and obstructive sleep apnea (OSA) are individually associated with left ventricular structural and functional adaptations. However, little is known about the impact of OSA on the left ventricle in Africans with HTN. Aim: The aim of this study is to determine the association between ...

  17. Gender specific pattern of left ventricular cardiac adaptation to ...

    African Journals Online (AJOL)

    Background: Cardiac adaptation to hypertension and obesity may be related to many factors such as race, gender and haemodynamic status. Some gender specific associations with left ventricular structure and function have been described among Caucasians. Objectives: To describe the sex specific pattern of left ...

  18. Echocardiography in the diagnosis left ventricular noncompaction

    Directory of Open Access Journals (Sweden)

    Song Ze-Zhou

    2008-12-01

    Full Text Available Abstract Echocardiography is the method of choice to establish a diagnosis and determine a treatment plan for patients with noncompaction of ventricular myocardium (NVM. The 2-dimentional echocardiography, 3-dimentional echocardiography, color Doppler echocardiography and contrast-enhanced echocardiography are of critical importance for diagnosis and family screening of NVM.

  19. Right ventricular failure after implantation of a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Cordtz, Johan Joakim; Nilsson, Jens C; Hansen, Peter B

    2014-01-01

    Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients....

  20. Prediction of all-cause mortality and heart failure admissions from global left ventricular longitudinal strain in patients with acute myocardial infarction and preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2013-01-01

    This study sought to test the hypothesis that semiautomated calculation of left ventricular global longitudinal strain (GLS) can identify high-risk subjects among patients with myocardial infarctions (MIs) with left ventricular ejection fractions (LVEFs) >40%....

  1. Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure)

    NARCIS (Netherlands)

    van Veldhuisen, Dirk J.; Cohen-Solal, Alain; Boehm, Michael; Anker, Stefan D.; Babalis, Daphne; Roughton, Michael; Coats, Andrew J. S.; Poole-Wilson, Philip A.; Flather, Marcus D.

    2009-01-01

    Objectives In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular

  2. Midwall myocardial shortening in athletic left ventricular hypertrophy.

    Science.gov (United States)

    Mayet, Jamil; Ariff, Ben; Wasan, Balvinder; Chapman, Neil; Shahi, Manjit; Senior, Roxy; Foale, Rodney A; Thom, Simon A McG

    2002-12-01

    Patients with pathological left ventricular hypertrophy have depressed midwall systolic shortening in spite of normal indices of left ventricular chamber function and a reduced midwall function has been observed to be an independent predictor of cardiovascular risk. Whether midwall shortening is depressed in physiological hypertrophy is unknown. Forty-two subjects, 27 athletes and 15 age- and sex-matched normal control subjects (group 1) were studied. The athletes were divided into those with eccentric hypertrophy (group 2) and those with concentric hypertrophy (group 3). Systolic left ventricular function was assessed at the midwall and endocardium using two-dimensional echocardiography in all subjects. Left ventricular mass index was significantly greater in both athletic groups than in controls (group 1, 101+/-5.8 g/m(2), group 2, 141+/-11.1*, group 3, 155+/-5.8*; *Phypertrophy athletes compared with the other two groups (midwall fractional shortening: group 1, 21.9+/-1.1, group 2, 21.9+/-0.86, group 3, 18.4+/-0.96*%; Phypertrophy have depressed midwall fractional shortening. This suggests that the observed discrepancy between midwall and endocardial shortening in patients with left ventricular hypertrophy is likely to be a function of the geometry and not necessarily a reflection of pathology within the myocardium.

  3. CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction

    International Nuclear Information System (INIS)

    Zafar, H.M.; Litt, H.I.; Torigian, D.A.

    2008-01-01

    Aim: To determine the frequency of left ventricular myocardial fat in patients with computed tomography (CT) findings of chronic left ventricular myocardial infarction, and to review the typical CT imaging features. Materials and methods: A retrospective search of the CT and nuclear scintigraphy reports from 1998-2005 for chronic left ventricular myocardial infarction was performed. The study group comprised those cases with available CT examinations revealing findings of chronic left ventricular myocardial infarction. Assessment for the presence of various imaging characteristics of left ventricular myocardial fat was performed in all cases. Results: The frequency of left ventricular myocardial fat in 47 patients with CT evidence of chronic left ventricular myocardial infarction was 51%. Typical CT imaging features include thin linear or curvilinear fat attenuation within left ventricular myocardium, most commonly subendocardial, often associated with left ventricular wall thinning and/or calcification, predominantly in elderly men. Conclusions: Fat in the left ventricular myocardium is a common additional finding in patients with CT findings of chronic left ventricular myocardial infarction. The potential, but as yet unproven, use of this CT imaging finding is that the radiologist may be able to suggest a potential diagnosis of chronic left ventricular myocardial infarction on unenhanced, thick-section, non-gated or non-triggered chest CT imaging where identification of myocardial wall thinning may be difficult

  4. Atrial fibrillation per se was a major determinant of global left ventricular longitudinal systolic strain.

    Science.gov (United States)

    Lee, Hung-Hao; Lee, Meng-Kuang; Lee, Wen-Hsien; Hsu, Po-Chao; Chu, Chun-Yuan; Lee, Chee-Siong; Lin, Tsung-Hsien; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung; Su, Ho-Ming

    2016-06-01

    Atrial fibrillation (AF) may cause systolic abnormality via inadequate diastolic filling and tachycardia-induced cardiomyopathy. Global longitudinal strain (GLS) is a very sensitive method for detecting subtle left ventricular systolic dysfunction. Hence, this study aimed to evaluate whether AF patients had a more impaired GLS, AF was a major determinant of GLS, and determine the major correlates of GLS in AF patients.The study included 137 patients with persistent AF and left ventricular ejection fraction (LVEF) above 50% and 137 non-AF patients matched according to age, gender, and LVEF. Comprehensive echocardiography with GLS assessment was performed for all cases.Compared with non-AF patients, AF patients had a more impaired GLS, a larger left atrial volume index, higher transmitral E wave velocity (E), and early diastolic mitral velocity (Ea) (all P determinant of GLS even after adjustment for relevant clinical and echocardiographic parameters.

  5. Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Lynne K. Williams

    2015-01-01

    Full Text Available Left atrial (LA volumes are known to be increased in hypertrophic cardiomyopathy (HCM and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function.

  6. TYPES OF SURGICAL TREATMENT FOR POSTINFARCTION LEFT VENTRICULAR ANEURYSMS

    Directory of Open Access Journals (Sweden)

    A. V. Pavlov

    2015-01-01

    Full Text Available Surgical treatment of postinfarction left ventricular aneurysms in ischemic heart disease patients allows for a significant improvement of outcomes and clinical endpoints, an increase in quality of life and survival. The article deals with historical periods in surgical treatment of left ventricular aneurysms and chronologically describes the history of methods for reconstruction of the left ventricle.Despite the fact that within the last 50 years, mainly due to improvements in surgical techniques, in-hospital mortality decreased two-fold, it still remains high. The choice of technique for any kind of ventricular reparation depends on localization of the lesion that defines which sites of left ventricular asynergia should be repaired and how its form should be restored. At present, it is not possible to reliably assess benefits of any type of reparative surgery over another. Risk factors of inhospital mortality are: age, incomplete myocardial revascularization, high grade heart failure, female gender, immediate surgery, ejection fraction below 30%. To improve clinical outcomes one should strive to approximate to the physiological form of the left ventricle, to minimize negative influence of surgery on myocardial contractility.

  7. Central-Approach Surgical Repair of Coarctation of the Aorta with a Back-up Left Ventricular Assist Device for an Infant Presenting with Severe Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Tae Hoon Kim

    2015-12-01

    Full Text Available A two-month-old infant presented with coarctation of the aorta, severe left ventricular dysfunction, and moderate to severe mitral regurgitation. Through median sternotomy, the aortic arch was repaired under cardiopulmonary bypass and regional cerebral perfusion. The patient was postoperatively supported with a left ventricular assist device for five days. Left ventricular function gradually improved, eventually recovering with the concomitant regression of mitral regurgitation. Prompt surgical repair of coarctation of the aorta is indicated for patients with severe left ventricular dysfunction. A central approach for surgical repair with a back-up left ventricular assist device is a safe and effective treatment strategy for these patients.

  8. Safety Testing of Left Ventricular Vent Valves.

    Science.gov (United States)

    Gavin, Caroline; Coblentz, John; Acsell, Jeffrey R; Shackelford, Anthony G; Sistino, Joseph J

    2015-03-01

    Vent vacuum relief valves (VRVs) are used to limit the negative pressure at the ventricular vent catheter tip as well as prevent reversal of blood flow and prevention of air embolism. The purpose of this study was to evaluate the performance of three commercially available ventricular vent valves. The negative pressure at which the vent valve opened was measured at the valve inlet using high-fidelity pressure transducers. Also, the flow rate at which air entrainment occurred due to valve opening was recorded. Using a 51.5 cm column of saline, the resistance for each valve was calculated. The mean ± SD opening negative pressures were -231.3 ± 35.2 mmHg for the Quest Medical valve, -219.8 mmHg ± 17.2 for the Sorin valve, and -329.6 · 38.0 mmHg for the Terumo valve. The red Quest Medical valve opened at a lower flow (1.44 ± .03 L/min) than the dark blue Sorin valve (2.93 ± .01 L/min) and light blue LH130 Terumo valve (2.36 ± .02 L/min). The Sorin valve had the least resistance of 34.1 dyn-s/cm, followed by the Terumo LH130 valve resistance of 58.1 dyn·s/cm5, and the Quest Medical VRV-II valve with a resistance of 66.5 dyn·s/cm. We found that the valves are significantly different in the negative pressure generated. Understanding the limitations of these devices is important to reduce the occurrence of adverse events associated with venting and to select the best device for a specific clinical application.

  9. Associations of Blood Pressure Dipping Patterns With Left Ventricular Mass and Left Ventricular Hypertrophy in Blacks: The Jackson Heart Study.

    Science.gov (United States)

    Abdalla, Marwah; Caughey, Melissa C; Tanner, Rikki M; Booth, John N; Diaz, Keith M; Anstey, D Edmund; Sims, Mario; Ravenell, Joseph; Muntner, Paul; Viera, Anthony J; Shimbo, Daichi

    2017-04-05

    Abnormal diurnal blood pressure (BP), including nondipping patterns, assessed using ambulatory BP monitoring, have been associated with increased cardiovascular risk among white and Asian adults. We examined the associations of BP dipping patterns (dipping, nondipping, and reverse dipping) with cardiovascular target organ damage (left ventricular mass index and left ventricular hypertrophy), among participants from the Jackson Heart Study, an exclusively black population-based cohort. Analyses included 1015 participants who completed ambulatory BP monitoring and had echocardiography data from the baseline visit. Participants were categorized based on the nighttime to daytime systolic BP ratio into 3 patterns: dipping pattern (≤0.90), nondipping pattern (>0.90 to ≤1.00), and reverse dipping pattern (>1.00). The prevalence of dipping, nondipping, and reverse dipping patterns was 33.6%, 48.2%, and 18.2%, respectively. In a fully adjusted model, which included antihypertensive medication use and clinic and daytime systolic BP, the mean differences in left ventricular mass index between reverse dipping pattern versus dipping pattern was 8.3±2.1 g/m 2 ( P pattern versus dipping pattern was -1.0±1.6 g/m 2 ( P =0.536). Compared with participants with a dipping pattern, the prevalence ratio for having left ventricular hypertrophy was 1.65 (95% CI, 1.05-2.58) and 0.96 (95% CI, 0.63-1.97) for those with a reverse dipping pattern and nondipping pattern, respectively. In this population-based study of blacks, a reverse dipping pattern was associated with increased left ventricular mass index and a higher prevalence of left ventricular hypertrophy. Identification of a reverse dipping pattern on ambulatory BP monitoring may help identify black at increased risk for cardiovascular target organ damage. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  10. Submitral Left Ventricular Aneurysm Associated with Thrombus

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... She was given drugs for management of heart failure and ... treatment abroad. KEYWORDS: Ethiopia, heart failure, submitral aneurysm, thrombus. INTRODUCTION. Submitral left ventricle aneurysm is a rare cardiovascular disorder worldwide, but ... grade 2 pulmonary edema, and bilateral pleural effusion.

  11. Continuous monitoring of left ventricular function by VEST

    International Nuclear Information System (INIS)

    Ohtake, Tohru; Watanabe, Toshiaki; Kosaka, Noboru

    1988-01-01

    Using an ambulatory ventricular function monitor (VEST), left ventricular function (LVF) was examined in one healthy volunteer, 3 with ischemic heart disease, and one with dilated myocardiopathy (DMCP) under various conditions, such as treadmill exercise, standing, and sitting. It was also examined when two DCMP patients with associated left ventricular failure were given a nitrite (ISDM) and cardiotonic agent (E 1020). End-diastolic volume (EDV) decreased in the standing position, and increased in exercise, suggesting the involvement of venous blood pool in the legs. Ejection fraction (EF) decreased in the case of widespread ischemia during exercise. Drug tolerance test revealed decrease in EDV and end-systolic volume (ESV), no change in stroke volume (SV), and slight increase in EF on ISDM; and decrease in EDV and ESV, increase in SV, and marked increase in EF on E 1020. For EF, the VEST data were relatively well correlated with gamma camera data. (Namekawa, K.)

  12. Electronic circuit detects left ventricular ejection events in cardiovascular system

    Science.gov (United States)

    Gebben, V. D.; Webb, J. A., Jr.

    1972-01-01

    Electronic circuit processes arterial blood pressure waveform to produce discrete signals that coincide with beginning and end of left ventricular ejection. Output signals provide timing signals for computers that monitor cardiovascular systems. Circuit operates reliably for heart rates between 50 and 200 beats per minute.

  13. Left ventricular hypertrophy in renal failure review | Arodiwe ...

    African Journals Online (AJOL)

    Renal failure is becoming increasingly common in our enironment. Advances in management like availability of dialysis and transplantation is prolonging the live of patients. As a consequence complication are increasingly being encountered. Cardiovascular complication is one of the commonest; and left ventricular ...

  14. Generalised left ventricular dysfunction after traumatic right coronary ...

    African Journals Online (AJOL)

    A patient with traumatic right coronary artery to right atrial fistula, which was repaired by direct closure and aortocoronary saphenous vein bypass grafting, is described. Cardiac catheterisation and selective cine angiocardiography were performed pre- and postoperatively, and left ventricular (LV) function was studied in ...

  15. blockade therapy in patient with left ventricular systolic dysfunction ...

    African Journals Online (AJOL)

    Assessment of tolerability of β- blockade therapy in patient with left ventricular systolic dysfunction heart failure. SMI Mohammed. Abstract. Back ground: Little data exist to demonstrate the tolerability of β-blocker therapy in an unselected community heart failure population already treated with the clinical trial or higher dose ...

  16. Quantitative assessment of regional left ventricular motion using endocardial landmarks

    NARCIS (Netherlands)

    C.J. Slager (Cornelis); T.E.H. Hooghoudt (Ton); P.W.J.C. Serruys (Patrick); J.C.H. Schuurbiers (Johan); J.H.C. Reiber (Johan); G.T. Meester (Geert); P.D. Verdouw (Pieter); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractIn this study the hypothesis is tested that the motion pattern of small anatomic landmarks, recognizable at the left ventricular endocardial border in the contrast angiocardiogram, reflects the motion of the endocardial wall. To verify this, minute metal markers were inserted in the

  17. Pattern of Left Ventricular Diastolic Dysfunction and QTc ...

    African Journals Online (AJOL)

    Abnormalities of left ventricular diastolic function are known in patients with chronic heart failure but their relationship with QT interval has not been well studied, particularly in Nigeria. This study is therefore aimed at determining the relationship between pattern of diastolic dysfunction and QT interval. Ninety-six consecutive ...

  18. Normalised radionuclide measures of left ventricular diastolic function

    International Nuclear Information System (INIS)

    Lee, K.J.; Southee, A.E.; Bautovich, G.J.; Freedman, B.; McLaughlin, A.F.; Rossleigh, M.A.; Hutton, B.F.; Morris, J.G.; Royal Prince Alfred Hospital, Sydney

    1989-01-01

    Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate when normalized to end diastolic volume correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function, or if age corrected to screen for diastolic dysfunction. (orig.)

  19. Left ventricular systolic function in sickle cell anaemia: an ...

    African Journals Online (AJOL)

    Keywords: Left ventricular systolic function, sickle cell anaemia, echocardiographic evaluation, adult Nigerian patients. ..... Quadratic .505. -0.390. 12.231. 8.587 .001*. Cubic .510. -0.180. 8.264. 8.619 .001*. This relationship was further evaluated by means of scat- ter plots and subsequently by regression analysis. The.

  20. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, M.I.; Vink, Aryan; Bergmann, W.; Szatmári, V.

    2016-01-01

    Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

  1. Left ventricular cardiac myxoma and sudden death in a dog

    NARCIS (Netherlands)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-01-01

    BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

  2. Gender specific pattern of left ventricular cardiac adaptation to ...

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... Eccentric hypertrophy was defined as increased left ventricular mass with normal relative wall thickness.3,14 Study subjects were divided into four subgroups: normal subjects (not hypertensive and not overweight), obese subjects (having elevated. BMI but not hypertensive), hypertensive subjects.

  3. Impact of Obstructive Sleep Apnea and Snoring on Left Ventricular ...

    African Journals Online (AJOL)

    Impact of Obstructive Sleep Apnea and Snoring on Left Ventricular Mass and Diastolic Function in. Hypertensive Nigerians. Akintunde AA1,2, Kareem L1, Bakare A1, Audu M1. 1Department of Medicine, Division of Cardiology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso,. Nigeria, 2Goshen ...

  4. Patient-reported outcomes in left ventricular assist device therapy

    DEFF Research Database (Denmark)

    Brouwers, Corline; Denollet, Johan; de Jonge, Nicolaas

    2011-01-01

    Technological advancements of left ventricular assist devices (LVAD) have created today's potential for extending the lives of patients with end-stage heart failure. Few studies have examined the effect of LVAD therapy on patient-reported outcomes (PROs), such as health status, quality of life...

  5. Blood pressure control and left ventricular hypertrophy in ...

    African Journals Online (AJOL)

    surface area (BSA). When LVM was indexed to height, left ventricular hypertrophy was found in none of the subjects of the normotensive group, while it was found present in 43 (22.4%) and 14 (24.1%) subjects of the uncontrolled and controlled hypertensive groups, respectively. Significant difference in the prevalence of ...

  6. Left ventricular structure and function in black normotensive type 2 ...

    African Journals Online (AJOL)

    Significant myocardial injury before overt CVD in DM can be identified early using echocardiography. This study therefore aimed at evaluating left ventricular structure and function of patients with type 2 DM. Materials and Methods: One hundred and fifty adult type 2 DM patients were recruited with 150 age- and sexmatched ...

  7. Left ventricular hypertrophy among chronic kidney disease patients ...

    African Journals Online (AJOL)

    Introduction: The presence of left ventricular hypertrophy (LVH) in patients with Chronic Kidney Disease (CKD) is associated with worsening cardiovascular outcomes. There is a dearth of data on LVH in Ghanaian CKD patients. Methods: This was a cross sectional study carried out at the Komfo Anokye Teaching Hospital ...

  8. An analysis of electrocardiographic criteria for determining left ventricular hypertrophy

    Directory of Open Access Journals (Sweden)

    Gasperin Carlos Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To determine the most sensitive criterion for the detection of left ventricular hypertrophy according to echocardiographically defined left ventricular mass. METHODS: The Sokolow-Lyon voltage, Sokolow-Lyon-Rappaport, Cornell voltage duration product, White-Bock, and Romhilt-Estes point scoring criteria were compared with left ventricular mass index, corrected for body surface, obtained from the echocardiograms of 306 outpatients (176 females, 130 males, of all age groups. RESULTS: The Cornell voltage duration product criteria index had the greatest sensitivity in women (54.90%, and the Sokolow-Lyon-Rappaport index was most sensitive in men (73.53%. When applied to men at the same voltage amplitude (20mm as that in women, the Cornell index showed increased sensitivity relative to the conventional index (28mm of 67.65% (P<=0.01 and a sensitivity similar to that of the Sokolow-Lyon-Rappaport index, with higher specificity (P<=0.01. The White-Bock and Romhilt-Estes criteria were the least sensitive in men and women, despite their high specificity. The electrocardiographic criteria were more efficient when dilatation predominated over left ventricular hypertrophy. CONCLUSION: The Cornell index had greater sensitivity in women, and the Sokolow-Lyon-Rappaport index was more sensitive in men. When applied to men at the same voltage amplitude as that of women, the Cornell index had an increase in sensitivity similar to that of the Sokolow-Lyon-Rappaport index.

  9. Left ventricular function in Nigerian diabetics with or without ...

    African Journals Online (AJOL)

    Objectives: This study evaluated left ventricular function, using echocardiographic methods, in Nigerian diabetics with additional aim of assessing the effect of coexisting hypertension. Design: A descriptive cross sectional study. Setting: Hospital based study. Subjects: Ninety five subjects aged 30-60 years comprising 31 ...

  10. An unusual cause of left ventricular outflow tract obstruction

    Directory of Open Access Journals (Sweden)

    Shrenik R. Doshi

    2015-07-01

    Full Text Available Left ventricular outflow tract obstruction (LVOTO has been reported with bio-prosthetic and mechanical mitral valves (MV, though it is more common with the former. The obstruction can be dynamic or fixed. We hereby report a case of fixed LVOTO following bio-prosthetic MV replacement (MVR.

  11. Four Genetic Loci Influencing Electrocardiographic Indices of Left Ventricular Hypertrophy

    NARCIS (Netherlands)

    Shah, Sonia; Nelson, Christopher P.; Gaunt, Tom R.; van der Harst, Pim; Barnes, Timothy; Braund, Peter S.; Lawlor, Debbie A.; Casas, Juan-Pablo; Padmanabhan, Sandosh; Drenos, Fotios; Kivimaki, Mika; Talmud, Philippa J.; Humphries, Steve E.; Whittaker, John; Morris, Richard W.; Whincup, Peter H.; Dominiczak, Anna; Munroe, Patricia B.; Johnson, Toby; Goodall, Alison H.; Cambien, Francois; Diemert, Patrick; Hengstenberg, Christian; Ouwehand, Willem H.; Felix, Janine F.; Glazer, Nicole L.; Tomaszewski, Maciej; Burton, Paul R.; Tobin, Martin D.; van Veldhuisen, Dirk J.; de Boer, Rudolf A.; Navis, Gerjan; van Gilst, Wiek H.; Mayosi, Bongani M.; Thompson, John R.; Kumari, Meena; MacFarlane, Peter W.; Day, Ian N. M.; Hingorani, Aroon D.; Samani, Nilesh J.

    2011-01-01

    Background-Presence of left ventricular hypertrophy on an ECG (ECG-LVH) is widely assessed clinically and provides prognostic information in some settings. There is evidence for significant heritability of ECG-LVH. We conducted a large-scale gene-centric association analysis of 4 commonly measured

  12. Resolution of lupus-related left ventricular wall thickening and ...

    African Journals Online (AJOL)

    Cardiopulmonary involvement is one of the important manifestations of systemic lupus erythematosus (SLE) that tends to be more common in adults than children with SLE. SLE-related cardiopulmonary affection ranges from subclinical to life threatening condition. Although increased left ventricular mass and interstitial lung ...

  13. The diagnosis of left ventricular assist device thrombosis

    NARCIS (Netherlands)

    Gerds, H. Z. R.; Brugemann, J.; Rienstra, M.; Erasmus, M. E.

    The clinical course of a patient with a left ventricular assist device is described. A total of 6 weeks after device insertion, the lactate dehydrogenase (LDH) level increased to 2801 U/l despite adding low-molecular-weight heparin to acenocoumarol and aspirin. Pump thrombosis was suspected but

  14. Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration.

    Science.gov (United States)

    Erturk, Mehmet; Buturak, Ali; Pusuroglu, Hamdi; Kalkan, Ali Kemal; Gurdogan, Muhammet; Akturk, Ibrahim Faruk; Akgul, Ozgur; Aksu, Hale Unal; Uzun, Fatih; Uslu, Nevzat

    2014-01-01

    Abstract Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration. About 45 normotensive healthy volunteers (20 men, mean age 43 ± 9 years), 45 dipper (27 men, mean age 45 ± 9 years) and 45 non-dipper (25 men, 47 ± 7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time. Non-dippers indicated lower left ventricular (2.2 ± 0.4 m/s(2) versus 2.8 ± 1.0 m/s(2), p acceleration values (2.8 ± 0.8 m/s(2) versus 3.5 ± 1.0 m/s(2), p = 0.012) compared with dippers. Left ventricular mass index (p = 0.001), interventricular septal thickness (p = 0.002) and myocardial performance index (p acceleration. Left ventricular septal thickness (p = 0.002), mass index (p = 0.001) and right ventricular myocardial performance index (p acceleration. The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.

  15. Left ventricular assist device implantation via left thoracotomy: alternative to repeat sternotomy.

    Science.gov (United States)

    Pierson, Richard N; Howser, Renee; Donaldson, Terri; Merrill, Walter H; Dignan, Rebecca J; Drinkwater, Davis C; Christian, Karla G; Butler, Javed; Chomsky, Don; Wilson, John R; Clark, Rick; Davis, Stacy F

    2002-03-01

    Repeat sternotomy for left ventricular assist device insertion may result in injury to the right heart or patent coronary grafts, complicating intraoperative and postoperative management. In 4 critically ill patients, left thoracotomy was used as an alternative to repeat sternotomy. Anastomosis of the outflow conduit to the descending thoracic aorta provided satisfactory hemodynamic support.

  16. Role of left ventricular twist mechanics in cardiomyopathies, dance of the helices.

    Science.gov (United States)

    Kauer, Floris; Geleijnse, Marcel Leonard; van Dalen, Bastiaan Martijn

    2015-08-26

    Left ventricular twist is an essential part of left ventricular function. Nevertheless, knowledge is limited in "the cardiology community" as it comes to twist mechanics. Fortunately the development of speckle tracking echocardiography, allowing accurate, reproducible and rapid bedside assessment of left ventricular twist, has boosted the interest in this important mechanical aspect of left ventricular deformation. Although the fundamental physiological role of left ventricular twist is undisputable, the clinical relevance of assessment of left ventricular twist in cardiomyopathies still needs to be established. The fact remains; analysis of left ventricular twist mechanics has already provided substantial pathophysiological understanding on a comprehensive variety of cardiomyopathies. It has become clear that increased left ventricular twist in for example hypertrophic cardiomyopathy may be an early sign of subendocardial (microvascular) dysfunction. Furthermore, decreased left ventricular twist may be caused by left ventricular dilatation or an extensive myocardial scar. Finally, the detection of left ventricular rigid body rotation in noncompaction cardiomyopathy may provide an indispensible method to objectively confirm this difficult diagnosis. All this endorses the value of left ventricular twist in the field of cardiomyopathies and may further encourage the implementation of left ventricular twist parameters in the "diagnostic toolbox" for cardiomyopathies.

  17. [Echocardiographic study of left ventricular geometry in spontaneously hypertensive rats].

    Science.gov (United States)

    Escudero, Eduardo M; Pinilla, Oscar A; Carranza, Verónica B

    2009-01-01

    The purpose of this study was to analyze by echocardiogram left ventricular (LV) geometry in spontaneously hypertensive rats (SHR). Echocardiographic study, systolic blood pressure and heart rate were obtained in 114 male, 4-month old rats, 73 SHR and 41 Wistar (W). Left ventricular mass index (LVMI), relative wall thickness (RWT), stroke volume, and mid ventricular shortening were calculated with echocardiographic parameters. Normal LV was defined considering the mean plus 2 SD of LVMI and RWT in W. Patterns of abnormal LV geometry were: LV concentric remodeling, LVMI 0.71; eccentric, left ventricular hypertrophy (LVH), LVMI > 2.06 mg/g - RWT 2.06 mg/g - RWT > 0.71. Systolic blood pressure (SBP) and cardiac output (CO) were used to obtain total peripheral resistance (TPR). twelve % of SHR had normal LV geometry; 18% LV concentric remodeling; 33% concentric LVH and 37% eccentric LVH. LV concentric remodeling showed the smallest CO and highest TPR of any group. Eccentric LVH presented similar SBP as the other SHR groups and high CO with lower TPR. Our findings in SHR exhibit different patterns of LV geometry like in humans. These results strengthen the similarities between SHR and human essential hypertension.

  18. Beneficial impact of ramipril on left ventricular hypertrophy in normotensive nonalbuminuric NIDDM patients

    DEFF Research Database (Denmark)

    Nielsen, F S; Sato, A; Ali, S

    1998-01-01

    OBJECTIVE: To evaluate the effect of the ACE inhibitor ramipril as compared with placebo on left ventricular mass index (LVMI) in normotensive, nonalbuminuric NIDDM patients with left ventricular hypertrophy (LVH). Patients with NIDDM are characterized by excessive cardiovascular morbidity...

  19. Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Gerdts, Eva; Okin, Peter M; Boman, Kurt

    2012-01-01

    The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.......The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain....

  20. Large right ventricular sinusoids in an infant with aorta-left ventricular tunnel and proximal right coronary artery atresia.

    Science.gov (United States)

    Chen, Peter C; Spinner, Joseph A; Heinle, Jeffrey S

    2018-04-16

    We report a 1-month-old infant diagnosed with an aorta-left ventricular tunnel, ventricular septal defect, and right coronary atresia with right ventricular sinusoids. The patient's anatomy and physiology did not indicate right-ventricular-dependent coronary circulation, and therefore right ventricular decompression could be performed without compromising coronary perfusion during surgical correction. A detailed understanding of the coronary anatomy is critical in managing this defect when coronary anomalies are present.

  1. Left-Ventricular Energetics in Pulmonary Arterial Hypertension-Induced Right-Ventricular Hypertrophic Failure.

    Science.gov (United States)

    Han, June-Chiew; Guild, Sarah-Jane; Pham, Toan; Nisbet, Linley; Tran, Kenneth; Taberner, Andrew J; Loiselle, Denis S

    2017-01-01

    Pulmonary arterial hypertension (PAH) alters the geometries of both ventricles of the heart. While the right ventricle (RV) hypertrophies, the left ventricle (LV) atrophies. Multiple lines of clinical and experimental evidence lead us to hypothesize that the impaired stroke volume and systolic pressure of the LV are a direct consequence of the effect of pressure overload in the RV, and that atrophy in the LV plays only a minor role. In this study, we tested this hypothesis by examining the mechanoenergetic response of the atrophied LV to RV hypertrophy in rats treated with monocrotaline. Experiments were performed across multiple-scales: the whole-heart in vivo and ex vivo , and its trabeculae in vitro . Under the in vivo state where the RV was pressure-overloaded, we measured reduced systemic blood pressure and LV ventricular pressure. In contrast, under both ex vivo and in vitro conditions, where the effect of RV pressure overload was circumvented, we found that LV was capable of developing normal systolic pressure and stress. Nevertheless, LV atrophy played a minor role in that LV stroke volume remained lower, thereby contributing to lower LV mechanical work output. Concomitantly lower oxygen consumption and change of enthalpy were observed, and hence LV energy efficiency was unchanged. Our internally consistent findings between working-heart and trabecula experiments explain the rapid improvement of LV systolic function observed in patients with chronic pulmonary hypertension following surgical relief of RV pressure overload.

  2. Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease.

    Science.gov (United States)

    Gimpel, Charlotte; Jung, Bernd A; Jung, Sabine; Brado, Johannes; Schwendinger, Daniel; Burkhardt, Barbara; Pohl, Martin; Odening, Katja E; Geiger, Julia; Arnold, Raoul

    2017-02-01

    Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years-20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V E ), late diastolic (V A ) and peak systolic (V S ) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz base -10.6 ± 1.9 vs. -13.4 ± 2.0 (P children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs.

  3. Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction.

    Science.gov (United States)

    Sasaki, Norihito; Kinugawa, Toru; Yamawaki, Masahiro; Furuse, Yoshiyuki; Shimoyama, Masaki; Ogino, Kazuhide; Igawa, Osamu; Hisatome, Ichiro; Shigemasa, Chiaki

    2004-11-01

    A 44-year-old woman had tako-tsubo-like ventricular dysfunction with chest pain and ST segment elevation on the ECG. Echocardiography revealed a bicuspid aortic valve with moderate to severe aortic regurgitation. She developed mild heart failure during the clinical course, but the medication (furosemide, enalapril, and asprin) had to be stopped because of skin eruptions. Four weeks after ceasing the antiplatelet agent, she was re-admitted with acute renal infarction. Enhanced chest computed tomography revealed a filling defect in the left ventricle and echocardiography showed a high echogenic mass in the left ventricular apical wall. These findings strongly suggested that the renal infarction was caused by an embolism derived from a left ventricular thrombus that formed during the clinical course of the transient left ventricular apical ballooning. Anticoagulation therapy with urokinase and warfarin successfully lysed the thrombus. Left ventricular thrombus should be considered a complication of transient left ventricular apical ballooning, especially in patients with organic heart disease.

  4. Left ventricular diastolic filling in elder patients with systemic hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Kameoka, Masakuni (Sumitomo Hospital, Osaka (Japan))

    1990-07-01

    To study the significance of left ventricular (LV) diastolic filling in elderly patients with hypertension (HT), cardiac blood pool imagings with Tc-99m were obtained at rest in 17 normal subjects and 28 patients with systemic HT. HT patients did not show any evidence of coronary heart disease, renal insufficiency or other diseases. They showed normal LV ejection fraction (LVEF) and normal LV wall motion. From the LV volume curve and its first differentiation curve, LVEF, mean first third ejection rate (ERm) and peak ejection rate (PER) were obtained as LV systolic function indices; and LV diastolic filling rate during the first third of diastole (FRm) and peak filling rate (PFR) were obtained as LV diastolic function indices. All indices of LV systolic function were similar in all groups. In contrast, LV diastolic indices (FRm and PFR) of older groups were significantly lower than those of young HT and normal groups. LV diastolic indices in HT groups decreased significantly compared with normal groups of the same age. FRm could distinguish HT patients from normal subjects of the same age more accurately than PFR. In normal subjects, FRm correlated with age (r=-0.490) and ERm (r=-0.489). In addition to age ERm, FRm correlated with LV wall thickness measured by M-mode ecocardiography (r=-0.566) in HT patients. In the HT old group, the correlations between FRm and LV wall thickness and between FRm and ERm were more significant than those in the HT young group. The impairment of early diastolic filling of LV was more prominent in older HT patients than younger HT patients. LV diastolic abnormality was influenced more highly by the degree of LV hypertrophy in older HT patients than younger HT patients. These diastolic abnormalities may cause systolic dysfunction in older HT patients. (J.P.N.).

  5. The effects of stress on left ventricular ejection fraction

    International Nuclear Information System (INIS)

    Kiess, M.C.; Dimsdale, J.E.; Moore, R.H.; Liu, P.; Newell, J.; Barlai-Kovach, M.; Boucher, C.A.; Strauss, H.W.; Massachusetts General Hospital, Boston; Massachusetts General Hospital, Boston

    1988-01-01

    The left ventricular ejection fraction (EF) was studied in 17 healthy volunteers with a new ambulatory left ventricular function monitor. Heart rate, EF, and blood pressure measurements were made during rest, a psychiatric stress interview, cold exposure, exercise, and eating. An increase in EF was seen during emotional stress (from 0.45±0.09 to 0.51±0.13, P<0.001). This increase was comparable to that observed during exercise (0.52±0.14) and eating (0.52±0.10, P<0.001). In contrast, cold exposure caused a decrease in EF (0.43±0.13, P<0.05). These observations demonstrate the powerful hemodynamic consequences of common behaviors as well as the utility and feasability of studying such behavioral factors in ambulatory subjects. (orig.)

  6. Left ventricular cardiac myxoma and sudden death in a dog.

    Science.gov (United States)

    de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

    2016-06-22

    Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. A previously healthy 12-year-old male West Highland white terrier was found dead during its 1-week stay in a kennel. The dog was known to have a cardiac murmur. On necropsy, a pedunculated neoplasia was found attached to the interventricular aspect of the left ventricular outflow tract, resulting in almost complete obstruction of the aorta. As this was the only abnormality identified, the tumor was considered as the cause of sudden death. Histopathologic findings were compatible with a myxoma. Benign intraluminal tumors of the heart are very rare in dogs, but may have fatal consequences. Echocardiography could have revealed the cause of the cardiac murmur of this previously asymptomatic dog. Surgical removal could have been possible, as the tumor was pedunculated.

  7. Allowable variance set on left ventricular function parameter

    International Nuclear Information System (INIS)

    Zhou Li'na; Qi Zhongzhi; Zeng Yu; Ou Xiaohong; Li Lin

    2010-01-01

    Purpose: To evaluate the influence of allowable Variance settings on left ventricular function parameter of the arrhythmia patients during gated myocardial perfusion imaging. Method: 42 patients with evident arrhythmia underwent myocardial perfusion SPECT, 3 different allowable variance with 20%, 60%, 100% would be set before acquisition for every patients,and they will be acquired simultaneously. After reconstruction by Astonish, end-diastole volume(EDV) and end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) would be computed with Quantitative Gated SPECT(QGS). Using SPSS software EDV, ESV, EF values of analysis of variance. Result: there is no statistical difference between three groups. Conclusion: arrhythmia patients undergo Gated myocardial perfusion imaging, Allowable Variance settings on EDV, ESV, EF value does not have a statistical meaning. (authors)

  8. Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement.

    Science.gov (United States)

    Leidenfrost, Jeremy; Prasad, Sunil; Itoh, Akinobu; Lawrance, Christopher P; Bell, Jennifer M; Silvestry, Scott C

    2016-01-01

    Cardiogenic shock from refractory right ventricular (RV) failure during left ventricular assist device placement is associated with high morbidity and mortality. The addition of extracorporeal membrane oxygenation to RV mechanical assistance may help RV recovery and lead to improved outcomes. We retrospectively reviewed all implanted continuous-flow left ventricular assist devices from April 2009 to June 2013. RV mechanical support was utilized for RV failure defined as haemodynamic instability despite vasopressors, pulmonary vascular dilators and inotropic therapy. RV assist devices were utilized with and without in-line membrane oxygenation. During the study period, 267 continuous-flow left ventricular assist devices were implanted. RV mechanical support was utilized in 27 (10%) patients; 12 (46%) had the addition of in-line extracorporeal membrane oxygenation. The mean age of patients with a right ventricular assist device with membrane oxygenation was lower than that in patients with a right ventricular assist device alone (45.6 ± 15.9 vs 64.6 ± 6.5, P = 0.001). Support was weaned in 66% (10 of 15) of patients with right ventricular assist device (RVAD) alone vs 83% (10 of 12) of those with RVAD with membrane oxygenation (P = 0.42). The RVAD was removed after 10.4 ± 9.4 vs 5 ± 2.99 days for patients with a RVAD with membrane oxygenation (P = 0.1). Patients with RVAD with membrane oxygenation had a 30-day mortality rate of 8 vs 47% for those with RVAD alone (P = 0.04). The survival rate after discharge was 86, 63 and 54% at 3, 6 and 12 months for both groups combined. Patients with a RVAD with membrane oxygenation support for acute RV failure after continuous-flow left ventricular assist device implantation had a lower 30-day mortality than those with a RVAD alone. Patients who survive to discharge have a reasonable 1-year survival. Combining membrane oxygenation with RVAD support appears to offer a short-term survival benefit in patients with RV failure

  9. "Heart rate-dependent" electrocardiographic diagnosis of left ventricular hypertrophy.

    Science.gov (United States)

    Madias, John E

    2013-05-01

    A case is presented revealing the common phenomenon of heart rate-dependent diagnosis of electrocardiographic (ECG) diagnosis of left ventricular hypertrophy (LVH), which consists of satisfaction of LVH criteria only at faster rates whereas ECGs with a slow heart rate do not satisfy such criteria. The mechanism of the phenomenon has been attributed to the tachycardia-mediated underfilling of the left ventricle bringing the electrical "centroid" of the heart closer to the recording electrodes, which results in augmentation of the amplitude of QRS complexes, particularly in leads V2-V4. ©2012, The Author. Journal compilation ©2012 Wiley Periodicals, Inc.

  10. Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics

    International Nuclear Information System (INIS)

    Aydiner, A.; Oto, A.; Oram, E.; Oram, A.; Ugurlu, S.; Karamehmetoglu, A.; Aras, T.; Bekdik, C.F.; Gedik, O.

    1991-01-01

    Left ventricular function including regional wall motion (RWM) was evaluated by 99m Tc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart diesease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels. (orig.) [de

  11. Three-dimensional Speckle Tracking Echocardiography in Light Chain Cardiac Amyloidosis: Examination of Left and Right Ventricular Myocardial Mechanics Parameters.

    Science.gov (United States)

    Urbano-Moral, Jose Angel; Gangadharamurthy, Dakshin; Comenzo, Raymond L; Pandian, Natesa G; Patel, Ayan R

    2015-08-01

    The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n=40), and right ventricular longitudinal strain and radial displacement (n=26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r=0.95, P<.001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (-9±4 vs -16±2; P<.001, and -24±6 vs -29±4; P=.01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (-9±3 vs -17±3; P<.001, and 2.7±0.8 vs 3.8±0.3; P=.002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P=.03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I. Copyright © 2015 Sociedad Española de Cardiología. Published by

  12. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J

    2011-01-01

    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements......, r = 0.93 (p less than 0.001). LVEF determined by multigated radionuclide cardiography was, however, significantly lower than when measured by cardioangiography, the mean difference being 6 per cent (p less than 0.001). These findings suggest that radionuclide determinations of SV and LVEF...

  13. Relationship of left ventricular systolic function to persistence or development of electrocardiographic left ventricular hypertrophy in hypertensive patients

    DEFF Research Database (Denmark)

    Okin, Peter M; Wachtell, Kristian; Gerdts, Eva

    2014-01-01

    BACKGROUND: Persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria is associated with an increased risk of developing heart failure compared with regression or continued absence of LVH. We postulated that this association might be in part mediated via worse...... in ECG LVH are associated with the changing risk of developing heart failure. CLINICAL TRIALS REGISTRATION: http://clinicaltrials.gov/ct/show/NCT00338260?order=1....... substudy. Sex-specific criteria were used for abnormal MWS (

  14. Left Ventricular Non-compaction Cardiomyopathy - A Case Report

    Directory of Open Access Journals (Sweden)

    Timea Szakacs Xantus

    2015-06-01

    Full Text Available Background: Left non-compaction cardiomyopathy (LVNC or “spongy myocardium” is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and method: A 28-year-old woman was admitted with exertional dyspnoea, palpitations, non-specific chest pain and progressive fatigue on exertion. In her family history sudden cardiac-related deaths at young age are present. Cardiovascular system examination revealed tachycardia, intermittent extrabeats. The rest EKG showed sinusal tachycardia (105 bpm, negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG monitoring revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Echocardiography showed left ventricular systolic dysfunction (LVEF:30-35%, slight LV enlargement, normal right ventricle and small left ventricle (LV trabeculae in the apical area. Cardiac MRI demonstrated dilated LV and the presence of the trabeculations of LV walls suggestive for non-compaction cardiomyopathy. A combined treatment for heart failure and cardiac arrhythmias was initiated with good clinical results. Patient was scheduled for an implantable cardioverter defibrillator “life-saving”. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD “life-saving” and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for noncompaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a

  15. Effects of papillary muscles and trabeculae on left ventricular quantification: increased impact of methodological variability in patients with left ventricular hypertrophy.

    Science.gov (United States)

    Janik, Matthew; Cham, Matthew D; Ross, Michael I; Wang, Yi; Codella, Noel; Min, James K; Prince, Martin R; Manoushagian, Shant; Okin, Peter M; Devereux, Richard B; Weinsaft, Jonathan W

    2008-08-01

    Accurate quantification of left ventricular mass and ejection fraction is important for patients with left ventricular hypertrophy. Although cardiac magnetic resonance imaging has been proposed as a standard for these indices, prior studies have variably included papillary muscles and trabeculae in myocardial volume. This study investigated the contribution of papillary muscles and trabeculae to left ventricular quantification in relation to the presence and pattern of hypertrophy. Cardiac magnetic resonance quantification was performed on patients with concentric or eccentric hypertrophy and normal controls (20 per group) using two established methods that included papillary muscles and trabeculae in myocardium (method 1) or intracavitary (method 2) volumes. Among all patients, papillary muscles and trabeculae accounted for 10.5% of ventricular mass, with greater contribution with left ventricular hypertrophy than normals (12.6 vs. 6.2%, P muscles and trabeculae mass correlated with ventricular wall mass (r = 0.53) and end-diastolic volume (r = 0.52; P muscles and trabeculae inclusion in myocardium (method 1) yielded smaller differences with a standard of mass quantification from linear ventricular measurements than did method 2 (P hypertrophy: the difference in ventricular mass index was three-fold to six-fold greater in hypertrophy than normal groups (P hypertrophy (P muscles and trabeculae mass, ventricular wall mass, and smaller ventricular volume (R = 0.56, P muscles and trabeculae from myocardium. The relative impact of papillary muscles and trabeculae exclusion on calculated mass and ejection fraction is increased among patients with hypertrophy-associated left ventricular remodeling.

  16. Left Ventricular Hypertrophy: Major Risk Factor in Patients with Hypertension: Update and Practical Clinical Applications

    Directory of Open Access Journals (Sweden)

    Richard E. Katholi

    2011-01-01

    Full Text Available Left ventricular hypertrophy is a maladaptive response to chronic pressure overload and an important risk factor for atrial fibrillation, diastolic heart failure, systolic heart failure, and sudden death in patients with hypertension. Since not all patients with hypertension develop left ventricular hypertrophy, there are clinical findings that should be kept in mind that may alert the physician to the presence of left ventricular hypertrophy so a more definitive evaluation can be performed using an echocardiogram or cardiovascular magnetic resonance. Controlling arterial pressure, sodium restriction, and weight loss independently facilitate the regression of left ventricular hypertrophy. Choice of antihypertensive agents may be important when treating a patient with hypertensive left ventricular hypertrophy. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers followed by calcium channel antagonists most rapidly facilitate the regression of left ventricular hypertrophy. With the regression of left ventricular hypertrophy, diastolic function and coronary flow reserve usually improve, and cardiovascular risk decreases.

  17. A systematic review of left ventricular cardio-endoscopic surgery.

    Science.gov (United States)

    Soylu, Erdinc; Kidher, Emaddin; Ashrafian, Hutan; Stavridis, George; Harling, Leanne; Athanasiou, Thanos

    2017-05-25

    Better visualisation, accurate resection and avoidance of ventriculotomy associated with use of endoscopic devices during intracardiac surgery has led to increasing interest in their use. The possibility of combining a cardio-endoscopic technique with either minimally invasive or totally endoscopic cardiac surgery provides an incentive for its further development. Several devices have been used, however their uptake has been limited due to uncertainty around their impact on patient outcomes. A systematic review of the literature identified 34 studies, incorporating 54 subjects undergoing treatment of left ventricular tumours, thrombus or hypertrophic myocardium using a cardio-endoscopic technique. There were no mortalities (0%; 0/47). In 12 studies, the follow-up period was longer than 30 days. There were no post-operative complications apart from one case of atrial fibrillation (2.2%; 1/46). Complete resection of left ventricular lesion was achieved in all cases (100%; 50/50). These successful results demonstrate that the cardio-endoscopic technique is a useful adjunct in resection of left ventricular tumours, thrombus and hypertrophic myocardium. This approach facilitates accurate resection of pathological tissue from left ventricle whilst avoiding exposure related valvular damage and adverse effects associated with ventriculotomy. Future research should focus on designing adequately powered comparative randomised trials focusing on major cardiac and cerebrovascular morbidity outcomes in both the short and long-term. In this way, we may have a more comprehensive picture of both the safety and efficacy of this technique and determine whether such devices could be safely adopted for routine use in minimal access or robotic intra-cardiac surgery.

  18. Autosynchronized systolic unloading during left ventricular assist with a centrifugal pump.

    Science.gov (United States)

    Kono, Satoshi; Nishimura, Kazunobu; Nishina, Takeshi; Yuasa, Sadatoshi; Ueyama, Koji; Hamada, Chikuma; Akamatsu, Teruaki; Komeda, Masashi

    2003-02-01

    The purpose of this study was to investigate how the inflow cannulation site of the left ventricular assist system with a centrifugal pump would influence cardiac function on failing heart models. In 10 sheep, a left ventricular assist system was instituted by an outflow cannula in the descending aorta, two inflow cannulas in the left atrium and the left ventricle, and connecting those cannulas to a magnetically suspended centrifugal pump. A conductance catheter and a tipped micromanometer for monitoring the pressure-volume loop were also inserted into the left ventricle. Myocardial oxygen consumption was directly measured. Heart failure was induced by injection of microspheres into the left main coronary artery. The assist rate was varied from 0% to 100% at each inflow cannulation site. The pump flow with left ventricular cannulation increased during the systolic phase and decreased during the diastolic phase, whereas it was constant with left atrial cannulation. Ejection fraction with left atrial cannulation decreased as the assist rate increased, whereas that with left ventricular cannulation was maintained up to 75% assist. The external work with left atrial cannulation decreased gradually as the assist rate increased, whereas the external work with left ventricular cannulation did not decrease until the assist rate reached 75%. The myocardial oxygen consumption in both cannulations decreased proportionally as the assist rate increased; they were significantly less with left ventricular cannulation at the 100% assist rate than with left atrial cannulation. Left ventricular cannulation during left ventricular assistance maintains ejection fraction and effectively reduces oxygen consumption.

  19. Using mathematical morphology to determine left ventricular contours

    Energy Technology Data Exchange (ETDEWEB)

    Pladellorens, J. (Universitat Politecnica de Catalunya (Spain). Dept. d' Optica i Optometria); Serrat, J. (Universitat Autonoma de Barcelona (Spain). Dept. d' Informatica); Castell, A. (Hospital de la Vall d' Hebro, Barcelona (Spain). Dept. de Medicina Nuclear); Yzuel, M.J. (Universitat Autonoma de Barcelona (Spain). Dept. de Fisica)

    1993-12-01

    Mathematical morphology is used for the determination of left ventricular contours in scintigraphic images using multigated radionuclide angiography. The authors developed a completely automatic method that first restores the image with a Wiener filter, then finds the region where the left ventricle is contained, and finally segments the left ventricle contour and a background zone. The contours depend on the values of the parameters that appear in the mathematical morphology method, which are related to the height and the slope of the count distribution. Results obtained with this method are compared with the contours and the background zones outlined by experts on the basis of the number of counts, and the authors study the values of the parameters with which optimum correlation is obtained. (author).

  20. Quantitative measurement of left ventricular volume by SPECT

    International Nuclear Information System (INIS)

    Tsay, T.T.; Jaszczak, R.J.; Tsui, B.M.W.; Hawman, E.; Greer, K.L.; Coleman, R.E.

    1986-01-01

    To evaluate the accuracy of measuring left ventricular (LV) volume using SPECT images, an adjustable boundary detection algorithm was performed to optimize the estimated volume. The algorithm was based on combined first-and second-difference edge-enhancement operators weighted by a hybrid parameter α(0 < α < 1). A ventricular phantom placed inside an elliptical phantom containing two balsa wood ''lungs'' was used in the experimental measurements. Two LV volume determination methods were evaluated. In the pixel summing method, no optimal value was found. In the count summing method, the optimal value was 0.4, where the error is less than 10%. In patient studies, the estimated LV volumes determined by the count summing method with α = 0.4 agree with that determined by the cath. method

  1. Concomitant Thoracic Aortobifemoral Bypass With Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Bishawi, Muath; Shah, Asad A; McCann, Richard L; Milano, Carmelo A

    2016-11-01

    Improved quality of life for patients after left ventricular assist device (LVAD) implantation can be greatly limited by peripheral vascular disease even if heart failure symptoms are resolved by LVAD support. We present a case of concomitant thoracic aortobifemoral bypass and LVAD implantation in a patient with ischemic cardiomyopathy, severe peripheral vascular disease, and multiple previous failed revascularization attempts. In this patient, we used the LVAD outflow to provide the inflow to the femoral artery bypass graft. This graft has remained patent at a 2-year follow-up, without claudication symptoms. Performing concomitant major vascular operations safely and successfully is feasible in patients with LVADs. Quality of life after ventricular assist device placement can be limited by vascular disease, but it can be markedly improved after vascular surgical intervention. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Influence of microalbuminuria on left ventricular geometry and function in hypertensive patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Picca, Maurizio; Agozzino, Francesco; Pelosi, Giancarlo

    2003-01-01

    An increased urinary albumin excretion (UAE) is associated with an augmented risk of cardiovascular disease in diabetic patients and in non-diabetic subjects. Left ventricular hypertrophy has been demonstrated to be a powerful predictor of cardiovascular morbidity and mortality in arterial hypertension and when the ventricular geometry is concentric the relation is even stronger. This echocardiographic and Doppler study was designed to evaluate the influence of microalbuminuria on the left ventricular geometry and function in hypertensive patients with type 2 diabetes melitus. Forty-two patients (16 males, 26 females, mean age 59.6 +/- 6.7 years) with mild-to-moderate essential hypertension and type 2 diabetes mellitus were enrolled in the study. Twenty-one patients had an elevated UAE (group 1) and 21 a normal UAE (group 2). M-mode (under two-dimensional control) and Doppler echocardiography were performed after a 4-week washout period off antihypertensive therapy. The left ventricular mass index was found to be greater than the partition value of 51 g/m2.7 in both groups but was significantly higher (p diabetes mellitus, an elevated UAE is associated with an increased left ventricular mass index, a higher prevalence of a concentric left ventricular hypertrophy pattern, a depressed midwall systolic performance and a markedly impaired diastolic function...

  3. Presystolic flow in ascending aorta in a case of left ventricular diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    S.R. Mittal

    2015-03-01

    Full Text Available A 65 years old hypertensive presented with effort breathlessness. Echocardiography revealed significant concentric remodeling of left ventricle. (relative wall thickness – 0.86 with significantly impaired relaxation (E/A – 0.54 and Ea/Aa – 0.52. Doppler evaluation of flow in ascending aorta revealed a presystolic flow which coincided with P wave of ECG and A wave of mitral flow. This finding suggests increased stiffness of left ventricle resulting in significant increase in left ventricular pressure during left atrial contraction and presystolic flow in aorta. Our case shows that all cases of grade 1 diastolic dysfunction are not alike. Presystolic flow in ascending aorta suggests greater degree of diastolic dysfunction than what is apparent from conventional criteria.

  4. Serum levels of advanced glycation end products are associated with left ventricular diastolic function in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Berg, T J; Snorgaard, O; Faber, J

    1999-01-01

    Impairment of left ventricular diastolic function, possibly caused by increased collagen cross-linking of the cardiac muscle, is common in patients with type 1 diabetes even without coronary artery disease. Advanced glycation end products (AGEs) cross-link tissue collagen and are found within...

  5. Independence of intrapericardial right and left ventricular performance in septic pulmonary hypertension

    International Nuclear Information System (INIS)

    Boeck, J.C.; Eichstaedt, H.; Barker, B.C.; Lewis, F.R.; Lim, A.D.; Pollycove, M.

    1990-01-01

    To study the effect of septic pulmonary hypertension on right/left ventricular intrapericardial interactions thirteen trauma patients, seven septic and six nonseptic controls, were compared. Ventricular volumes were derived from firstpass or gated equilibrium radionuclide angiocardiography, and related to body surface area. Systemic and pulmonary pressures were measured invasively. Pulmonary arterial pressure was significantly increased in the sepsis group. Although right ventricular end-diastolic volumes were higher in sepsis, left ventricular end-diastolic volumes were not decreased. In terms of intrapericardial right/left ventricular interactions these results indicate that the right and left ventricles operate independently in septic pulmonary hypertension. (orig.) [de

  6. First Evidence of Cardiac Stem Cells From the Left Ventricular Apical Tip in Patients With Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Cameli, M; Righini, F M; Sparla, S; Tacchini, D; Dokollari, A; Sassi, C G; Di Tommaso, C; Curci, V; Censini, S; Incampo, E; Cassano, F; Droandi, G; Bernazzali, S; Focardi, M; Ietta, F; Sartiani, L; Romagnoli, R; Marotta, G; Mugelli, A; Paulesu, L; Sani, G; Tanganelli, P; Maccherini, M; Mondillo, S

    2016-03-01

    Recent studies have challenged the dogma that the adult heart is a postmitotic organ and raise the possibility of the existence of resident cardiac stem cells (CSCs). Our study aimed to explore if these CSCs are present in the "ventricular tip" obtained during left ventricular assist device (LVAD) implantation from patients with end-stage heart failure (HF) and the relationship with LV dysfunctional area extent. Four consecutive patients with ischemic cardiomyopathy and end-stage HF submitted to LVAD implantation were studied. The explanted "ventricular tip" was used as a sample of apical myocardial tissue for the pathological examination. Patients underwent clinical and echocardiographic examination, both standard transthoracic echocardiography (TTE) and speckle tracking echocardiography (STE), before LVAD implantation. All patients presented severe apical dysfunction, with apical akinesis/diskinesis and very low levels of apical longitudinal strain (-3.5 ± 2.9%). Despite this, the presence of CSCs was demonstrated in pathological myocardial samples of "ventricular tip" in all 4 of the patients. It was found to be a mean of 6 c-kit cells in 10 fields magnification 40×. Cardiac stem cells can be identified in the LV apical segment of patients who have undergone LVAD implantation despite LV apical fibrosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Left ventricular structure and remodeling in patients with COPD

    Directory of Open Access Journals (Sweden)

    Pelà G

    2016-05-01

    Full Text Available Giovanna Pelà,1 Mauro Li Calzi,1 Silvana Pinelli,1 Roberta Andreoli,1 Nicola Sverzellati,2 Giuseppina Bertorelli,1 Matteo Goldoni,1 Alfredo Chetta11Department of Clinical and Experimental Medicine, 2Department of Surgery, University Medical School, University Hospital Parma, Parma, ItalyBackground: Data on cardiac alterations such as left ventricular (LV hypertrophy, diastolic dysfunction, and lower stroke volume in patients with COPD are discordant. In this study, we investigated whether early structural and functional cardiac changes occur in patients with COPD devoid of manifest cardiovascular disease, and we assessed their associations with clinical and functional features.Methods: Forty-nine patients with COPD belonging to all Global Initiative for Chronic Obstructive Lung Disease (GOLD classes were enrolled and compared with 36 controls. All subjects underwent clinical history assessment, lung function testing, blood pressure measurement, electrocardiography, and conventional and Doppler tissue echocardiography. Patients were also subjected to computed tomography to quantify emphysema score.Results: Patients with COPD had lower LV cavity associated with a marked increase in relative wall thickness (RWT, suggesting concentric remodeling without significant changes in LV mass. RWT was significantly associated with ratio of the forced expiratory volume in 1 second to the forced vital capacity and emphysema score and was the only cardiac parameter that – after multivariate analysis – significantly correlated with COPD conditions in all individuals. Receiver operating characteristic curve analysis showed that RWT (with a cutoff point of 0.42 predicted the severity of COPD with 83% specificity and 56% sensitivity (area under the curve =0.69, 95% confidence interval =0.59–0.81. Patients with COPD showed right ventricular to be functional but no structural changes.Conclusion: Patients with COPD without evident cardiovascular disease

  8. Robotic resection of giant left ventricular myxoma causing outflow tract obstruction.

    Science.gov (United States)

    Onan, Burak; Kahraman, Zeynep; Erturk, Mehmet; Erkanli, Korhan

    2017-05-01

    We report a 38-year-old female, who presented with progressive dyspnea and fatigue. Echocardiography revealed a giant and freely mobile left ventricular myxoma causing left ventricular outflow tract (LVOT) obstruction. The patient underwent totally endoscopic robotic excision of a giant left ventricular myxoma. The tumor was completely removed through the mitral valve orifice with a left atriotomy incision. © 2017 Wiley Periodicals, Inc.

  9. Multiple left ventricular aneurysms in a young female.

    Science.gov (United States)

    Raval, Abhishek P; Shukla, Anand; Garg, Rajiv; Rana, Yashpal; Shah, Komal

    2016-02-01

    Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression

    Directory of Open Access Journals (Sweden)

    Fahad Almehmadi

    2016-01-01

    Full Text Available Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  11. Delayed Tamponade after Traumatic Wound with Left Ventricular Compression.

    Science.gov (United States)

    Almehmadi, Fahad; Chandy, Mark; Connelly, Kim A; Edwards, Jeremy

    2016-01-01

    Delayed cardiac tamponade after a penetrating chest injury is a rare complication. The clinical diagnosis of tamponade is facilitated with imaging. We present a case report of a 23-year-old male who was brought to emergency after multiple stab wounds to the chest. After resuscitation and repair of laceration of right internal mammary artery and right ventricle, he was discharged but later returned with shortness of breath. Echocardiography revealed a rare case of delayed pericardial tamponade causing left ventricular collapse. The pericardial effusion was treated with emergent pericardiocentesis and later required a thoracoscopy guided pericardial window for definitive management.

  12. Myocardial bridging with left ventricular hypertrophy presenting as Wellens pattern.

    Science.gov (United States)

    Abuarqoub, Ahmad; Naranjo, Maria; Shamoon, Fayez

    2017-10-01

    The course of epicardial coronary arteries into a muscular tunnel under a bridge of myocardium is known as myocardial bridging (MB). This could be a benign anomaly, nevertheless, it could have a great impact on the quality of life in the setting of severe anginal symptoms. The clinical presentation and diagnosis could be challenging in those patients. The treatment options start from simple medical therapy to surgical intervention in refractory cases, the role of percutaneous coronary intervention (PCI) is limited in MB. We are describing a case of severe MB presenting as Wellens pattern with underlying left ventricular hypertrophy (LVH).

  13. Impact of hypertension on left ventricular structure in patients with asymptomatic aortic valve stenosis (a SEAS substudy)

    DEFF Research Database (Denmark)

    Rieck, Ashild E; Cramariuc, Dana; Staal, Eva M

    2010-01-01

    Both hypertension and aortic valve stenosis induce left ventricular hypertrophy. However, less is known about the influence of concomitant hypertension on left ventricular structure in patients with aortic valve stenosis.......Both hypertension and aortic valve stenosis induce left ventricular hypertrophy. However, less is known about the influence of concomitant hypertension on left ventricular structure in patients with aortic valve stenosis....

  14. Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

    Directory of Open Access Journals (Sweden)

    Perez Amanda Arantes

    2003-01-01

    Full Text Available OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23 and left ventricular diastolic diameter (r=0.30. The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated.

  15. Left ventricular function improves after pulmonary valve replacement in patients with previous right ventricular outflow tract reconstruction and biventricular dysfunction.

    Science.gov (United States)

    Kane, Colin; Kogon, Brian; Pernetz, Maria; McConnell, Michael; Kirshbom, Paul; Rodby, Katherine; Book, Wendy M

    2011-01-01

    Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary valve replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of pulmonary valve replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation.Records of adult patients who had undergone pulmonary valve replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients.In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after pulmonary valve replacement, which was a statistically significant change (P < 0.01). In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10.We conclude that pulmonary valve replacement in patients with biventricular dysfunction arising from severe pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding.

  16. Left Ventricular Function Improves after Pulmonary Valve Replacement in Patients with Previous Right Ventricular Outflow Tract Reconstruction and Biventricular Dysfunction

    Science.gov (United States)

    Kane, Colin; Kogon, Brian; Pernetz, Maria; McConnell, Michael; Kirshbom, Paul; Rodby, Katherine; Book, Wendy M.

    2011-01-01

    Congenital heart defects that have a component of right ventricular outflow tract obstruction, such as tetralogy of Fallot, are frequently palliated in childhood by disruption of the pulmonary valve. Although this can provide an initial improvement in quality of life, these patients are often left with severe pulmonary valve insufficiency. Over time, this insufficiency can lead to enlargement of the right ventricle and to the deterioration of right ventricular systolic and diastolic function. Pulmonary valve replacement in these patients decreases right ventricular volume overload and improves right ventricular performance. To date, few studies have examined the effects of pulmonary valve replacement on left ventricular function in patients with biventricular dysfunction. We sought to perform such an evaluation. Records of adult patients who had undergone pulmonary valve replacement from January 2003 through November 2006 were analyzed retrospectively. We reviewed preoperative and postoperative echocardiograms and calculated left ventricular function in 38 patients. In the entire cohort, the mean left ventricular ejection fraction increased by a mean of 0.07 after pulmonary valve replacement, which was a statistically significant change (P < 0.01). In patients with preoperative ejection fractions of less than 0.50, mean ejection fractions increased by 0.10. We conclude that pulmonary valve replacement in patients with biventricular dysfunction arising from severe pulmonary insufficiency and right ventricular enlargement can improve left ventricular function. Prospective studies are needed to verify this finding. PMID:21720459

  17. Left ventricular markers of mortality and ventricular arrhythmias in heart failure patients with cardiac resynchronization therapy.

    Science.gov (United States)

    Hasselberg, Nina E; Haugaa, Kristina H; Bernard, Anne; Ribe, Margareth P; Kongsgaard, Erik; Donal, Erwan; Edvardsen, Thor

    2016-03-01

    Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure. However, prediction of the outcome remains difficult. We aimed to investigate for echocardiographic predictors of ventricular arrhythmias and fatal outcome and to explore how myocardial function is changed by biventricular pacing in heart failure. We prospectively included 170 heart failure patients (66 ± 10 years, New York Heart Association class 2.8 ± 0.5, 48% ischaemic cardiomyopathy) and recorded ventricular arrhythmias and fatal end point defined as death, heart transplantation, or left ventricular assist device implantation during 2 years. Two-dimensional echocardiography was performed before and 6 months after CRT implantation. CRT response was defined as ≥15% reduction in end-systolic volume at 6 months. Speckle-tracking technique was performed to assess longitudinal and circumferential left ventricular function, defined as global longitudinal (GLS) and circumferential strain (GCS), and to assess mechanical dyssynchrony, defined as mechanical dispersion. GLS before CRT was a predictor of fatal end point independently of CRT response [hazard ratio, HR 1.14 (1.02-1.27), P = 0.02]. Patients with GLS better than -8.3% showed event-free survival benefit (log rank, P heart failure patients with CRT, worse longitudinal function before CRT was an important predictor of fatal outcome during 2 years, independently of CRT response. Mechanical dispersion at 6 months was a strong predictor of ventricular arrhythmias. CRT response by reverse remodelling was dependent on improvement of both longitudinal and circumferential function. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  18. Changes in left ventricular function after spontaneous coronary artery dissection.

    Science.gov (United States)

    Franco, Christopher; Starovoytov, Andrew; Heydari, Milad; Mancini, G B John; Aymong, Eve; Saw, Jacqueline

    2017-03-01

    Spontaneous healing of spontaneous coronary artery dissection (SCAD) and left ventricular ejection fraction (LVEF) recovery is frequently observed clinically. However, LVEF on presentation and follow-up imaging has not been described. We hypothesize that LV dysfunction improves at follow-up after initial SCAD presentation. We included patients with nonatherosclerotic SCAD prospectively followed at Vancouver General Hospital, who had baseline assessment of LVEF and wall-motion abnormality (WMA) during their index presentation. A subset of these patients had repeat assessment of their ventricular function at follow-up. We compared the baseline LVEF and WMA with follow-up assessments and correlated to long-term cardiovascular outcomes. We included 277 SCAD patients who had baseline ventricular assessment performed. The average age was 52.4 ± 9.4 years, and 90.3% were female. All presented with myocardial infarction (24.2% STEMI, 75.8% NSTEMI). At baseline, the mean LVEF was 55.6% ± 9.1% and 72/277 (26.0%) had LVEF 50 µg/L (OR: 1.02, P = 0.005), and SCAD involvement of the LAD (OR: 2.5, P = 0.002) were independent predictors of baseline LVEF SCAD cohort, the majority of patients presented with WMA and had relatively normal LVEF. Over half had subsequent normalization of WMA and LVEF on follow-up assessment. © 2017 Wiley Periodicals, Inc.

  19. Mitral Annular Kinetics, Left Atrial and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation

    Directory of Open Access Journals (Sweden)

    Chun eSchiros

    2015-08-01

    Full Text Available Objective: The relationship of mitral annular (MA kinetics to left ventricular (LV and left atrial (LA function before and after mitral valve repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, LA and LV diastolic function post mitral valve repair. Methods: Three-dimensional analyses of mitral annular motion, LA function and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR patients at baseline and 1-year post mitral valve repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging. Results: All had normal LV ejection fraction (EF at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early-diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early-diastolic filling rate, E/A ratio and early-diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate. Conclusions— MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function and left ventricular diastolic strain rates are still impaired one year post mitral valve repair. Long term effects of these impairments should be prospectively evaluated.

  20. Contemporary Assessment of Left Ventricular Diastolic Function in Older Adults

    DEFF Research Database (Denmark)

    Shah, Amil M; Claggett, Brian; Kitzman, Dalane

    2017-01-01

    BACKGROUND: Although age-associated changes in left ventricular diastolic function are well recognized, limited data exist characterizing measures of diastolic function in older adults, including both reference ranges reflecting the older adult population and prognostically relevant values...... for incident heart failure (HF), as well as their associations with circulating biomarkers of HF risk. METHODS: Among 5801 elderly participants in the ARIC study (Atherosclerosis Risk in Communities; age range, 67-90 years; mean age, 76±5 years; 42% male; 21% black), we determined the continuous association...... of diastolic measures (tissue Doppler imaging [TDI] e', E/e', and left atrial size) with concomitant N-terminal pro-brain natriuretic peptide and subsequent HF hospitalization or death. We also determined sex-specific 10th and 90th percentile limits for these measures using quantile regression in 401...

  1. A multiparous woman with lately diagnosed multilevel left ventricular obstruction

    International Nuclear Information System (INIS)

    Rahman, M. N.; Gul, I.; Nabi, A.

    2017-01-01

    A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society (CCS) class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography (TTE) revealed moderate aortic stenosis (AS) and mid cavity left ventricular outflow (LVO) obstruction. Left heart catheterization (LHC) showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well. (author)

  2. Inhaled Milrinone After Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Haglund, Nicholas A; Burdorf, Adam; Jones, Tara; Shostrom, Valerie; Um, John; Ryan, Timothy; Shillcutt, Sasha; Fischer, Patricia; Cox, Zachary L; Raichlin, Eugenia; Anderson, Daniel R; Lowes, Brian D; Dumitru, Ioana

    2015-10-01

    Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P = .017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Symbolic representation and visual querying of left ventricular image sequences.

    Science.gov (United States)

    Baroni, M; Del Bimbo, A; Evangelist, A; Vicario, E

    1999-01-01

    In the evaluation of regional left ventricular function, relevant cardiac disorders manifest themselves not only in static features, such as shape descriptors and motion excursion in end-diastolic and end-systolic frames, but also in their temporal evolution. In common diagnostic practice, such dynamic patterns are analysed by direct inspection of frame sequences through the use of a moviola. This permits only a subjective and poorly defined evaluation of functional parameters, and definitely prevents a systematic and reproducible analysis of large sets of reports. Retrieval by contents techniques may overcome this limitation by permitting the automatic comparison of the reports in a database against queries expressing descriptive properties related to significant pathological conditions. A system is presented which is aimed at investigating the potential of this approach by supporting retrieval by contents from a database of cineangiographic or echocardiographic images. The system relies on a symbolic description of both geometrical and temporal properties of left ventricular contours. This is derived automatically by an image processing and interpretation module and associated with the report at its storage time. In the retrieval stage, queries are expressed by means of an iconic visual language which describes searched content properties over a computer screen. The system automatically interprets iconic statements and compares them against concrete descriptions in the database. This enables medical users to interact with the system to search for motion and shape abnormalities on a regional basis, in single or homogeneous groups of reports, so as to enable both prospective and retrospective diagnosis.

  4. The left ventricular response to a peripheral cold stimulus

    International Nuclear Information System (INIS)

    Changes in left ventricular function, as monitored by ECG gated radionuclide ventriculography, during immersion of the hand and wrist in ice cold water (cold pressor test) has been described as a useful screening test in the diagnosis of coronary artery disease. We have carried out cold pressor radionuclide ventriculography in 15 healthy volunteers, 13 patients with chest pain and normal coronary arteriograms and 41 patients with arteriographically proven coronary artery disease. The range of changes in left ventricular ejection fraction (LVEF) from rest during cold immersion was similar in all groups. Published criterion for the diagnosis of coronary artery disease by cold pressor radionuclide ventriculography had a sensitivity of 12% and a specificity of 93% in our study. The change in LVEF on cold pressor testing did not vary with resting LVEF level, extent of coronary disease, presence of prior infarction or administration of blocker therapy. There was no significant difference between control and coronary disease patients in the percentage change in LV and diastolic counts from rest during cold pressor testing. (Author)

  5. Predictors of global left ventricular function in metabolic syndrome.

    Science.gov (United States)

    Ivanovic, Branislava Aleksa; Tadic, Marijana Vaso; Simic, Dragan Vojislav

    2011-05-01

    The metabolic syndrome (MS) represents a cluster of cardiovascular risk factors that act synergistically. The aim of this study was to determine which parameters were independently associated with the global left ventricular (LV) function in subjects with MS estimated with the Tei index. The study included 234 subjects with MS and 96 controls adjusted by age. MS was defined by the presence of three or more of ATP- NCEP III criteria. All subjects underwent laboratory blood tests and two-dimensional, pulsed and tissue Doppler echocardiography. Appropriate tissue Doppler time intervals for the estimation of the Tei index were also assessed. The Tei index was increased in subjects with MS (0.35 ± 0.05 vs 0.49 ± 0.10, p < 0.001). Multiple regression analysis of the clinical parameters showed that systolic blood pressure (β= 0.289, p < 0.001), fasting glucose (β= 0.205, p = 0.009), LV mass index (β= 0.301, p < 0.001), E/e'(septal) (β= 0.267, p < 0.001), and e'(septal) (β= -0.176, p = 0.011) were independently associated with the global left ventricular function estimated by Tei index. MS has a significant impact on LV global function. Systolic blood pressure, fasting glucose, LV mass index, E/e'(septal), and e'(septal) were independently associated with the LV global function.

  6. Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review

    Directory of Open Access Journals (Sweden)

    Robert P. Woroniecki

    2017-05-01

    Full Text Available Adults with arterial hypertension (HTN have stroke, myocardial infarction, end-stage renal disease (ESRD, or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes “hard outcomes” observed in adults. Left ventricular hypertrophy (LVH or an anatomic and pathologic increase in left ventricular mass (LVM in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered “the gold standard” for LVM and LVH determination, pediatric data are limited to “special populations”: ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.

  7. Early results after surgical treatment of left Ventricular Aneurysm

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    Wang Xisheng

    2012-11-01

    Full Text Available Abstract Background Left ventricular aneurysm (LVA is a serious complication of myocardial infarction and reduces the chances of survival. Controversy still exists regarding the optimal surgical technique for LVA repair. We analyze the efficacy of two techniques, linear vs. endoventricular circular patch plasty, for repair of LVA and the efficacy of surgical ventricular restoration (SVR on beating heart. Methods This study included 62 patients who underwent SVR from 1086 consecutive patients were subjected to coronary artery bypass grafting (CABG between 2000 and 2009. All selected patients were divided either into group liner or patch according to the choice of the repair technique depended on factors such as localization, size and dimension of the scar. The patients also were divided either into group beating heart or cardioplegia. The pre-, intra- and postoperative relevant data of all selected patients were analyzed. Results The mortality was not significantly different between linear and patch repair groups, also the actuarial survival rates within 24 months (p= 0.529. Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups. The beating heart technique reduced postoperative peak release by 27% for Cardiac troponin I (cTnI compared with the cardioplegia group (0.46 ± 0.06 ng/mL versus 0.63 ± 0.09 ng/mL, p= 0.004, and increased the perioperative survival by 9% (97.2% versus 88.5%, but the actuarial survival rates were not significantly different between the groups from 2 to 24 months (p= 0.151. Conclusions Both techniques (linear and patch achieved good results with respect to mortality, functional status and survival. The choice of surgical technique should be adapted in each patient. The beating heart technique may to some extent relieve myocardial injury in patients undergoing SVR.

  8. Kinematic Characterization of Left Ventricular Chamber Stiffness and Relaxation

    Science.gov (United States)

    Mossahebi, Sina

    Heart failure is the most common cause of hospitalization today, and diastolic heart failure accounts for 40-50% of cases. Therefore, it is critical to identify diastolic dysfunction at a subclinical stage so that appropriate therapy can be administered before ventricular function is further, and perhaps irreversibly impaired. Basic concepts in physics such as kinematic modeling provide a unique method with which to characterize cardiovascular physiology, specifically diastolic function (DF). The advantage of an approach that is standard in physics, such as the kinematic modeling is its causal formulation that functions in contrast to correlative approaches traditionally utilized in the life sciences. Our research group has pioneered theoretical and experimental quantitative analysis of DF in humans, using both non-invasive (echocardiography, cardiac MRI) and invasive (simultaneous catheterization-echocardiography) methods. Our group developed and validated the Parametrized Diastolic Filling (PDF) formalism which is motivated by basic physiologic principles (LV is a mechanical suction pump at the mitral valve opening) that obey Newton's Laws. PDF formalism is a kinematic model of filling employing an equation of motion, the solution of which accurately predicts all E-wave contours in accordance with the rules of damped harmonic oscillatory motion. The equation's lumped parameters---ventricular stiffness, ventricular viscoelasticity/relaxation and ventricular load---are obtained by solving the 'inverse problem'. The parameters' physiologic significance and clinical utility have been repeatedly demonstrated in multiple clinical settings. In this work we apply our kinematic modeling approach to better understand how the heart works as it fills in order to advance the relationship between physiology and mathematical modeling. Through the use of this modeling, we thereby define and validate novel, causal indexes of diastolic function such as early rapid filling energy

  9. Left Ventricular Systolic Dysfunction Induced by Ventricular Ectopy: a Novel Model for PVC-induced Cardiomyopathy

    Science.gov (United States)

    Huizar, Jose F.; Kaszala, Karoly; Potfay, Jonathan; Minisi, Anthony J.; Lesnefsky, Edward J.; Abbate, Antonio; Mezzaroma, Eleonora; Chen, Qun; Kukreja, Rakesh C.; Hoke, Nicholas N.; Thacker, Leroy R.; Ellenbogen, Kenneth A.; Wood, Mark A.

    2011-01-01

    Background Premature ventricular contractions (PVCs) commonly coexist with cardiomyopathy. Recently, PVCs have been identified as possible cause of cardiomyopathy. We developed a PVC-induced cardiomyopathy animal model using a novel premature pacing algorithm to assess timeframe and reversibility of this cardiomyopathy and examine the associated histopathological abnormalities. Methods and Results Thirteen mongrel dogs were implanted with a specially programmed pacemaker capable of simulating ventricular extrasystoles. Animals were randomly assigned to either 12 weeks of bigeminal PVCs (n=7) or no PVCs (control, n=6). Continuous 24-hr Holter corroborated ventricular bigeminy in the PVC group (PVC 49.8% vs. control PVC group developed cardiomyopathy with a significant reduction in left ventricular (LV) ejection fraction (PVC 39.7±5.4% vs. control 60.7±3.8%, PPVC 33.3±3.5mm vs. control 23.7±3.6mm, PPVC group. PVC-induced cardiomyopathy was resolved within 2-4 weeks after discontinuation of PVCs. No inflammation, fibrosis, or changes in apoptosis and mitochondrial oxidative phosphorylation were observed with PVC-induced cardiomyopathy. Conclusions This novel PVC animal model demonstrates that frequent PVCs alone can induce a reversible form of cardiomyopathy in otherwise structurally normal hearts. PVC-induced CM lacks gross histopathological and mitochondrial abnormalities seen in other canine models of CM. PMID:21576277

  10. Equilibrium radionuclide technique to assess the effect of propranolol on left ventricular function in thyrotoxicosis

    Energy Technology Data Exchange (ETDEWEB)

    Critchley, M.; Gulliford, P. (Royal Liverpool Hospital (UK))

    1980-11-01

    Radionuclide imaging of the left ventricular blood pool using sup(99m)Tc pertechnetate provides a convenient non-invasive method of monitoring left ventricular function. Left ventricular function is characterised by the left ventricular volume curve which represents all phases of the cardiac cycle and is obtained by a multiple gated equilibrium method (MUGA). Volume curves were obtained over a minimum 1 1/2h period in 15 normal subjects and in 20 thyrotoxic patients. Changes in left ventricular ejection fraction (LVEF), maximum ejection fraction rate and total electromechanical time interval were recorded from volume curve data. To assess the effect of pharmacological intervention, serial measurements of LVEF were made before and after 40 mg oral propranolol. In thyrotoxic patients, LVEF decreased by 17% of the initial value and in normal subjects by less than 10% following propranolol. This method can be extended to assess the effects of physiological or pharmacological intervention on left ventricular function in other disease states.

  11. TECHNIQUES OF LEFT VENTRICULAR ANEURYSM REPAIR: CHALLENGES AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Jignesh

    2015-10-01

    Full Text Available INTRODUCTION: Left ventricular aneurysm is commonly secondary to coronary artery disease. The resulting abnormal geometry after surgical treatment is most important. Many techniques have evolved over a period to restore near normal geometry of left ventricle (LV. It is mandatory to address atherosclerotic lesions which are root ca use of ischemia and its sequel. METHOD AND MATERIALS : Four patients with myocardial infarction presented to our institute were investigated with 2 Dimensional Echocardiography and contrast enha nced computerized tomography (CECT of thorax. All patients underwent left ventricle aneurysm repair and two patients also underwent Coronary Artery Bypass Grafting (CABG. We followed all of them with CECT and clinical examination. RESULT: All patients ha d good post - operative recovery. Their Intensive Care Unit parameters were within acceptable limits. The functional class improved to New York Heart Association class II for these patients. Post - operative CECT showed significant reduction in LV dimension an d no alteration in LV geometry. CONCLUSION: The technique of Left Ventricle aneurysm repair should be determined by pre - operative evaluation and CABG must be attempted if possible

  12. Pimobendan in Chronic Right Heart Failure in a Left Ventricular Assist Device Patient

    Science.gov (United States)

    Kreibich, Maximilian; Berchtold-Herz, Michael; Beyersdorf, Friedhelm; Trummer, Georg

    2016-01-01

    We report the case of a 76-year-old patient who developed chronic right heart failure 1 year after left ventricular assist device implantation due to ischemic cardiomyopathy. Initial recompensation was achieved through dobutamin, sildenafil, and levosimendan treatment. Yet, discharge was successful only after the off-label use of the oral calcium sensitizer pimobendan. Ten months after discharge, the patient presents with no clinical signs of right heart failure and significantly improved right heart function without any impairment in quality of life. PMID:28018821

  13. Surgical treatment of post-infarct left ventricular pseudoaneurysm with on-pump beating heart technique.

    Science.gov (United States)

    Korkmaz, Kemal; Lafçi, Gökhan; Gedik, Hikmet Selçuk; Budak, Ali Baran; Yener, Ali Ümit; Ecevit, Ata Niyazi; Yalçinkaya, Adnan; Kadiroğullari, Ersin; Çağli, Kerim

    2014-01-01

    Left ventricular pseudo-aneurysms develop when cardiac rupture is contained by pericardial adhesions or scar tissue due to myocardial infarction, surgery, trauma or infection. Left ventricular pseudo-aneurysms are uncommon, difficult to diagnose and prone to cardiac rupture. Urgent surgical repair is recommended. Here we report on a case of a large left ventricular pseudo-aneurysm on the anterolateral wall due to a previous anterior myocardial infarction, and its successful repair using the on-pump beating-heart technique.

  14. Sympathetic stimulation alters left ventricular relaxation and chamber size.

    Science.gov (United States)

    Burwash, I G; Morgan, D E; Koilpillai, C J; Blackmore, G L; Johnstone, D E; Armour, J A

    1993-01-01

    Alterations in left ventricular (LV) contractility, relaxation, and chamber dimensions induced by efferent sympathetic nerve stimulation were investigated in nine anesthetized open-chest dogs in sinus rhythm. Supramaximal stimulation of acutely decentralized left stellate ganglia augmented heart rate, LV systolic pressure, and rate of LV pressure rise (maximum +dP/dt, 1,809 +/- 191 to 6,304 +/- 725 mmHg/s) and fall (maximum -dP/dt, -2,392 +/- 230 to -4,458 +/- 482 mmHg/s). It also reduced the time constant of isovolumic relaxation, tau (36.5 +/- 4.8 to 14.9 +/- 1.1 ms). Simultaneous two-dimensional echocardiography recorded reductions in end-diastolic and end-systolic LV cross-sectional chamber areas (23 and 31%, respectively), an increase in area ejection fraction (32%), and increases in end-diastolic and end-systolic wall thicknesses (14 and 13%, respectively). End-systolic and end-diastolic wall stresses were unchanged by stellate ganglion stimulation (98 +/- 12 to 95 +/- 9 dyn x 10(3)/cm2; 6.4 +/- 2.4 to 2.4 +/- 0.3 dyn x 10(3)/cm2, respectively). Atrial pacing to similar heart rates did not alter monitored indexes of contractility. Dobutamine and isoproterenol induced changes similar to those resulting from sympathetic neuronal stimulation. These data indicate that when the efferent sympathetic nervous system increases left ventricular contractility and relaxation, concomitant reductions in systolic and diastolic dimensions of that chamber occur that are associated with increasing wall thickness such that LV wall stress changes are minimized.

  15. The influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

    Directory of Open Access Journals (Sweden)

    AR Moaref1

    2008-03-01

    Full Text Available Background: Right ventricular apical (RVA pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular (LV function. Left atrial (LA enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume.Objective: The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function.Patients and Methods: The study comprised 41 consecutive patients with LV ejection fraction ≥ 45% and LV end diastolic dimension ≤ 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. Results: In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex (≥120msec, one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3±9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 (54.3±17.0 during follow-up (P<0.001.Conclusion: RVA pacing might lead to an increase in LA volume even in patients with normal LV function.

  16. Left ventricular diastolic dysfunction in chronic renal failure patients on chronic hemodialysis in Dr. Cipto-Mangunkusumo Hospital : the association with left ventricular mass

    Directory of Open Access Journals (Sweden)

    Idrus Alwi

    2006-06-01

    Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis

  17. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis

    DEFF Research Database (Denmark)

    Berning, J; Rokkedal Nielsen, J; Launbjerg, J

    1992-01-01

    Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculog......Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide...

  18. Association between left ventricular global longitudinal strain and natriuretic peptides in outpatients with chronic systolic heart failure

    DEFF Research Database (Denmark)

    Gaborit, F; Bosselmann, H; Tønder, N

    2015-01-01

    .28-8.30, P = 0.013) and linear regression (NT-proBNP: βGLS: 1.19, 95 %-CI: 0.62-1.76, P body-mass-index, atrial fibrillation, renal function) and left atrial volume index......BACKGROUND: Both impaired left ventricular (LV) global longitudinal strain (GLS) and increased plasma concentrations of natriuretic peptides(NP) are associated with a poor outcome in heart failure (HF). Increased levels of NP reflect increased wall stress of the LV. However, little is known about....... CONCLUSION: Impaired LV GLS is associated with increased plasma concentrations of NP and our data suggest that left ventricular myocardial mechanics estimated by LV GLS reflects myocardial wall stress in chronic systolic HF....

  19. Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation.

    Science.gov (United States)

    Haneya, Assad; Philipp, Alois; Puehler, Thomas; Rupprecht, Leopold; Kobuch, Reinhard; Hilker, Michael; Schmid, Christof; Hirt, Stephan W

    2012-01-01

    Acute right ventricular (RV) failure is a life-threatening condition with a poor prognosis, and sometimes the use of mechanical circulatory support is inevitable. In this article, we describe our experience using a centrifugal pump as a temporary percutaneous right ventricular assist device (RVAD) in patients with postoperative acute refractory RV failure after left ventricular assist device (LVAD) implantation. We retrospectively reviewed eight consecutive patients with acute RV failure who underwent temporary percutaneous RVAD implantation using a centrifugal pump after LVAD implantation between April 2008 and February 2011. A Dacron graft was attached to the main pulmonary artery and passed through a subxiphoid exit, where the outflow cannula was inserted. The inflow cannula was percutaneously cannulated using Seldinger's technique in the femoral vein. The chest was definitely closed. The technique allowed bedside removal, avoiding chest re-opening. The median patient age was 52 years (range: 41-58). The median duration of support was 14 days (range: 12-14). RV systolic function improved; central venous pressure and mean pulmonary artery pressure decreased significantly after RVAD support. In three patients, an oxygenator was integrated into the RVAD due to impaired pulmonary function. Six patients were successfully weaned. Five patients survived to hospital discharge. Technical problems or serious complications concerning decannulation were not observed. This report suggests that implantation of temporary percutaneous RVAD using a centrifugal pump is a safe alternative in the treatment of postoperative acute refractory RV failure. Ease of device implantation, weaning, explantation, and limited number of complications justify a liberal use.

  20. Passive and active ventricular elastances of the left ventricle

    Directory of Open Access Journals (Sweden)

    Ng Eddie YK

    2005-02-01

    Full Text Available Abstract Background Description of the heart as a pump has been dominated by models based on elastance and compliance. Here, we are presenting a somewhat new concept of time-varying passive and active elastance. The mathematical basis of time-varying elastance of the ventricle is presented. We have defined elastance in terms of the relationship between ventricular pressure and volume, as: dP = EdV + VdE, where E includes passive (Ep and active (Ea elastance. By incorporating this concept in left ventricular (LV models to simulate filling and systolic phases, we have obtained the time-varying expression for Ea and the LV-volume dependent expression for Ep. Methods and Results Using the patient's catheterization-ventriculogram data, the values of passive and active elastance are computed. Ea is expressed as: ; Epis represented as: . Ea is deemed to represent a measure of LV contractility. Hence, Peak dP/dt and ejection fraction (EF are computed from the monitored data and used as the traditional measures of LV contractility. When our computed peak active elastance (Ea,max is compared against these traditional indices by linear regression, a high degree of correlation is obtained. As regards Ep, it constitutes a volume-dependent stiffness property of the LV, and is deemed to represent resistance-to-filling. Conclusions Passive and active ventricular elastance formulae can be evaluated from a single-beat P-V data by means of a simple-to-apply LV model. The active elastance (Ea can be used to characterize the ventricle's contractile state, while passive elastance (Ep can represent a measure of resistance-to-filling.

  1. Coronary flow reserve in the remote myocardium predicts left ventricular remodeling following acute myocardial infarction.

    Science.gov (United States)

    Cheng, Rongchao; Wei, Guoqian; Yu, Longhao; Su, Zhendong; Wei, Li; Bai, Xiuping; Tian, Jiawei; Li, Xueqi

    2014-07-01

    Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI. We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration. CFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty. Microvascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

  2. The surgical anatomy of the left ventricular outflow tract in hearts with ventricular septal defect and aortic arch obstruction

    NARCIS (Netherlands)

    Shiokawa, Y.; Becker, A. E.

    1998-01-01

    Profound understanding of the left ventricular outflow tract (LVOT) anatomy is crucial to improve surgical results in patients with aortic arch obstruction, ventricular septal defect, and subaortic stenosis. We studied the morphology of the LVOT in 32 postmortem hearts with aortic arch obstruction

  3. Impact of diabetes on treatment-induced changes in left ventricular structure and function in hypertensive patients with left ventricular hypertrophy. The LIFE study

    DEFF Research Database (Denmark)

    Gerdts, E; Okin, P M; Omvik, P

    2009-01-01

    in diabetic and non-diabetic groups during treatment (33/18 vs. 28/16mmHg (ns)), diabetes was associated with higher prevalence of persistent LVH (47 vs. 39%, pdiabetes independently predicted less LV mass reduction and less improvement in stress-corrected LV midwall......BACKGROUND AND AIM: Diabetes is associated with left ventricular hypertrophy (LVH) and impaired systolic function in hypertensive patients, but less is known about its impact on LVH regression and functional improvement during antihypertensive treatment. METHODS AND RESULTS: We performed annual...... echocardiography in 730 non-diabetic and 93 diabetic patients (aged 55-80 years) with hypertension and electrocardiographic LVH during 4.8-year losartan- or atenolol-based treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Baseline mean blood pressure (BP) and LV mass did...

  4. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Hesse, Birger; Meyer, Christian; Nielsen, Flemming S

    2004-01-01

    The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary...... disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified...... with controls, maximal perfusion was reduced in patients (1.8+/-0.6 vs 2.5+/-1.0 ml min(-1) g(-1); P2.7+/-1.0 vs 3.6+/-1.3; P=0.059). During perindoprilat infusion, myocardial perfusion reserve in patients increased to 3.9+/-0.9 ( P

  5. Evaluation of left ventricular torsion in children with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Prinz, Christian; Faber, Lothar; Horstkotte, Dieter; Körperich, Hermann; Moysich, Axel; Haas, Nikolaus; Kececioglu, Deniz; Thorsten Laser, Kai

    2014-04-01

    To evaluate the role of torsion in hypertrophic cardiomyopathy in children. A total of 88 children with idiopathic hypertrophic cardiomyopathy (n = 24) and concentric hypertrophy (n = 20) were investigated with speckle-tracking echocardiography and compared with age- and gender-matched healthy controls (n = 44). In hypertrophic cardiomyopathy, we found increased torsion (2.8 ± 1.6 versus 1.9 ± 1.0°/cm [controls], p Hypertrophic cardiomyopathy patients demonstrated a negative correlation between left ventricular muscle mass and torsion (r = -0.7, p hypertrophic cardiomyopathy is characterised by predominantly enhanced systolic basal clockwise rotation. Diastolic untwisting is delayed in both groups. Torsion may be an interesting marker to guide patients with hypertrophic cardiomyopathy.

  6. Measurement of right and left ventricular ejection fraction in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Brynjolf, I.; Qvist, J.; Mygind, T.; Jordening, H.; Dorph, S.; Munck, O.

    1983-08-01

    Three techniques for measurement of right (RVEF) and two techniques for left (LVEF) ventricular ejection fraction were evaluated in five dogs. RVEF was measured with a first-pass radionuclide technique using erythrocytes labelled in vitro with Technetium-99m methylene disphosphonate (MDP) and compared with RVEF measured with a thermodilution technique. Thermodilution-determined RVEF was compared with RVEF values measured with cine angiocardiography. LVEF was measured with a radionuclide ECG-gated equilibrium technique and compared with cine angiocardiography. Measurements were performed before and during a continuous infusion of dopamine. There was an excellent correlation between RVEF measured with the first-pass and the thermodilution technique. LVEF measured with the ECG-gated equilibrium technique correlated well with cine angiocardiography.

  7. Left ventricular assist device therapy in advanced heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Rogers, Joseph G

    2017-01-01

    when deciding on LVAD implantation such as age, co-morbidity, and cardiac pathophysiology. Complications to LVAD therapy are reviewed. It is concluded that while complications with LVAD therapy are not uncommon, most are manageable, and current outcomes clearly justify use of LVADs in advanced HF....... to shortage of donor organs. Implantable left ventricular assist device (LVAD) technology has improved considerably, and the currently used continuous flow devices may last >10 years in a patient. LVADs are being used increasingly both as bridge-to-transplantation and as destination therapy. Current studies...... report 1- and 2-year survival after LVAD implantation of 80% and 70%, respectively. Outcome after LVAD implantation in stable patients is superior to that of 'crash and burn' patients or patients sliding on inotropes, favouring early referral and implantation. This review summarizes factors to consider...

  8. Left ventricular assist device hemolysis leading to dysphagia.

    Science.gov (United States)

    Wuschek, Alexander; Iqbal, Sara; Estep, Jerry; Quigley, Eamonn; Richards, David

    2015-05-14

    A 41-year-old man with a continuous-flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenase and an elevated plasma free hemoglobin consistent with intravascular hemolysis. After the hemolysis ceased, both the black urine and dysphagia resolved spontaneously. Transient esophageal dysfunction, as a manifestation of gastrointestinal dysmotility, is known to occur in the setting of hemolysis. Paroxysmal nocturnal hemoglobinuria is another recognized cause of massive hemolysis with gastrointestinal dysmotility occurring in 25%-35% of patients during a paroxysm. Intravascular hemolysis increases plasma free hemoglobin, which scavenges nitric oxide (NO), an important second messenger for smooth muscle cell relaxation. The decrease in NO can lead to esophageal spasm and resultant dysphagia. In our patient the resolution of hemolysis resulted in resolution of dysphagia.

  9. Left Ventricular Diastolic Function and Characteristics in Fetal Aortic Stenosis

    Science.gov (United States)

    Friedman, Kevin G.; Schidlow, David; Freud, Lindsay; Escobar-Diaz, Maria; Tworetzky, Wayne

    2014-01-01

    Fetal aortic valvuloplasty (FAV) has shown promise in averting progression of mid-gestation aortic stenosis (AS) to hypoplastic left heart syndrome in a subset of patients. Patients who achieve biventricular circulation after FAV frequently have left ventricular (LV) diastolic dysfunction (DD). This study evaluates DD in fetuses with AS by comparing echocardiographic indices of LV diastolic function in fetuses undergoing FAV (n=20) to controls (n=40) and evaluates for LV factors associated with DD in FAV patients. We also compared pre- and post-FAV DD variables (n=16). Median gestational age (24 weeks, range 18–29 weeks) and fetal heart rate were similar between FAV and controls. Compared to controls, FAV patients had universally abnormal LV diastolic parameters including fused mitral inflow E and A waves (p=0.008), higher E velocity(p<0.001), shorter mitral inflow time (p=0.001), lower LV lateral annulus E′ (p<0.001), septal E′ (p=0.003) and higher E/E′ (p<0.001) than controls. FAV patients had abnormal right ventricular mechanics with higher tricuspid inflow E velocity (p<0.001), and shorter tricuspid inflow time (p=0.03). Worse LV diastolic function (lower LV E′) was associated with higher endocardial fibroelastosis (EFE) grade (r=0.74, p<0.001), large LV volume (r=0.55, p=0.013) and sphericity (r=0.58, P=0.009) and with lower LV pressure by mitral regurgitation jet (r=−0.68, p<0.001). Post-FAV, fewer patients had fused mitral inflow E and A than pre-FAV (p=0.05) and septal E′ was higher (=0.04). In conclusion, fetuses with mid-gestation AS have evidence of marked DD. Worse DD is associated with larger, more spherical LV, with more extensive EFE and lower LV pressure. PMID:24819899

  10. Tissue characteristics in left ventricular hypertrophy using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Yoshida, Shigeru; Ueno, Yuji; Arita, Mikio; Nishio, Ichiro; Masuyama, Yoshiaki

    1988-01-01

    For 15 normotensive patients with asymmetric septal hypertrophy (ASH), 10 hypertensive patients with concentric hypertrophy (CH), and five normal subjects (N), we examined changes in myocardial T 1 and T 2 values related to the cardiac cycle. The usefulness of those values in differentiating diseases with left ventricular hypertrophy was evaluated. Left ventricular (LV) short-axis spin echo images and inversion recovery images were obtained at endsystolic and diastolic cardiac phases, and T 1 and T 2 images were calculated. The regional wall thickness (WT) and T 1 and T 2 values were measured in the anterior septum, anterior wall, lateral wall, posterior wall and posterior septum. Myocardial T 1 and T 2 values were significantly decreased in systole (T 1 : 185.6±37.9 msec, T 2 : 24.4±6.3 msec, mean±SD) compared to those in diastole (T 1 : 249.2±56.7 msec, T 2 : 31.7±9.4 msec). In both the ASH and CH groups, significant correlations were observed between diastolic T 1 values and WT (ASH: r = 0.80, p 2 values and WT (ASH: r = 0.58, p 1 values in the ASH group (343.4±40.5 msec) were significantly higher than those of the CH group (247.3±21.4 msec), although the mean wall thickness values were similar in both groups. The T 1 /WT and T 2 /WT were significantly lower in the CH group than those in the ASH and N groups. In conclusion, myocardial T 1 and T 2 values were related not only to the cardiac cycle, but to wall thickness and to types of hypertrophy. The T 1 and T 2 values may be useful for distinguishing hypertrophic cardiomyopathy from hypertrophy due to hypertension. (author)

  11. ASSESSMENT OF LEFT VENTRICULAR FUNCTION USING TISSUE DOPPLER IMAGING

    Directory of Open Access Journals (Sweden)

    Martin Tretjak

    2004-09-01

    Full Text Available Background. Objective evidence of cardiac dysfunction is one of the diagnostic criteria for heart failure. It is often hard to assess systolic function and assessing diastolic dysfunction is even harder because there are no generally accepted echocardiographic criteria. Tissue Doppler imaging (TDI enables analysis of the mitral annular descent velocity for detection of left ventricular diastolic dysfunction along the longitudinal axis.Methods. 30 patients with heart failure and 30 healthy participants were enrolled in the study. Pulsed wave tissue Doppler imaging velocities of septal and lateral mitral annulus borders were recorded in systole (Sm and early diastole (Em. Velocities in both groups were compared. The correlations between Sm velocity and LVEF and Em velocity and age were studied.Results. Patients with heart failure had significantly decreased Sm and Em velocities compared with healthy participants (5.3 ± 1.6 cm/s vs. 8.4 ± 1 cm/s, P < 0.001, for Sm velocity and 5 ± 1.4 cm/s vs. 8.7 ± 1.6 cm/s, P < 0.001, for Em velocity. The correlation between Sm velocity and LVEF in all participants was very good and highly significant (r = 0.91, P < 0.001. The Sm velocity ≥ 6.4 cm/s was 91% sensitive and 95% specific for LVEF ≥ 0.45. There was a good correlation between age and Em velocity (r = -0.84, P < 0.001. The Em velocity < 7 cm/s had a sensitivity of 90% and specificity of 97% for diagnosing heart failure.Conclusions. Pulsed wave tissue Doppler imaging of mitral annulus enables simple, fast and precise assessment of systolic and diastolic left ventricular function. It can replace some other more time consuming echocardiographic measurements.

  12. Intraoperative Transesophageal Echocardiography and Right Ventricular Failure After Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Silverton, Natalie A; Patel, Ravi; Zimmerman, Josh; Ma, Jianing; Stoddard, Greg; Selzman, Craig; Morrissey, Candice K

    2018-02-15

    To determine whether intraoperative measures of right ventricular (RV) function using transesophageal echocardiography are associated with subsequent RV failure after left ventricular assist device (LVAD) implantation. Retrospective, nonrandomized, observational study. Single tertiary-level, university-affiliated hospital. The study comprised 100 patients with systolic heart failure undergoing elective LVAD implantation. Transesophageal echocardiographic images before and after cardiopulmonary bypass were analyzed to quantify RV function using tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S'), fractional area change (FAC), RV global longitudinal strain, and RV free wall strain. A chart review was performed to determine which patients subsequently developed RV failure (right ventricular assist device placement or prolonged inotrope requirement ≥14 days). Nineteen patients (19%) subsequently developed RV failure. Postbypass FAC was the only measure of RV function that distinguished between the RV failure and non-RV failure groups (21.2% v 26.5%; p = 0.04). The sensitivity, specificity, and area under the curve of an abnormal RV FAC (failure after LVAD implantation were 84%, 20%, and 0.52, respectively. No other intraoperative measure of RV function was associated with subsequent RV failure. RV failure increased ventilator time, intensive care unit and hospital length of stay, and mortality. Intraoperative measures of RV function such as tricuspid annular plane systolic excursion, tricuspid annular systolic velocity, and RV strain were not associated with RV failure after LVAD implantation. Decreased postbypass FAC was significantly associated with RV failure but showed poor discrimination. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Left ventricular pressure and volume data acquisition and analysis using LabVIEW.

    Science.gov (United States)

    Cassidy, S C; Teitel, D F

    1997-03-01

    To automate analysis of left ventricular pressure-volume data, we used LabVIEW to create applications that digitize and display data recorded from conductance and manometric catheters. Applications separate data into cardiac cycles, calculate parallel conductance, and calculate indices of left ventricular function, including end-systolic elastance, preload-recruitable stroke work, stroke volume, ejection fraction, stroke work, maximum and minimum derivative of ventricular pressure, heart rate, indices of relaxation, peak filling rate, and ventricular chamber stiffness. Pressure-volume loops can be graphically displayed. These analyses are exported to a text-file. These applications have simplified and automated the process of evaluating ventricular function.

  14. A Case of Cough-induced Ventricular Tachycardia in a Patient with a Left Ventricular Assist Device.

    Science.gov (United States)

    Ruckdeschel, Emily Sue; Wolfel, Eugene; Nguyen, Duy Thai

    2016-03-01

    In this case, the patient's ventricular tachycardia (VT) was specifically induced by coughing, which has not previously been described. Decreasing the rotational speed of the left ventricular assist device (LVAD) and increasing preload by stopping the patient's nitrates and reducing diuretic dose allowed improved filling of the left ventricle (LV) and increased LV volumes. When coughing recurred, the effects on the LV cavity were less pronounced and thus VT was reduced. Although ventricular arrhythmias are common after LVAD placement, this is a unique case in which VT was caused by coughing, which is ordinarily not considered arrhythmogenic. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Left ventricular calcification following postpartum toxic shock syndrome

    Directory of Open Access Journals (Sweden)

    Stella C Pak

    2018-01-01

    Full Text Available Toxic shock syndrome (TSS is a rare but lethal clinical event that can occur during the postpartum period. Early recognition and intervention is critical to improve patient outcomes. This is a case of TSS complicated by cardiac arrest and left ventricular calcification. This is a case report of streptococcal TSS in a 29-year-old female in the postpartum period who presented with fever, abdominal distension, and a purpuric rash. Her hospital course was characterized by multiple organ failure, including respiratory distress syndrome, liver failure, renal failure, and coagulopathy. She was found to have acute compartment syndrome, which resulted in a below-the-knee amputation. She deteriorated further after experiencing cardiac arrest and the development of hypoxic-ischemic encephalopathy with hemorrhagic transformation. A computed tomography scan of the chest revealed evidence of dystrophic myocardial calcification in the left ventricle. She improved clinically but remained ventilator dependent upon discharge to an extended acute care facility. Sepsis-induced cardiomyopathy can result in myocardial calcification. As dystrophic calcification can significantly affect cardiac function, clinicians should rule out cardiac calcification in patients who have had severe septic shock.

  16. Our experience with implantation of VentrAssist left ventricular assist device

    Directory of Open Access Journals (Sweden)

    Hiriyur Shivalingappa Jayanthkumar

    2013-01-01

    Full Text Available Perioperative anaesthetic management of the VentrAssist TM left ventricular assist device (LVAD is a challenge for anaesthesiologists because patients presenting for this operation have long-standing cardiac failure and often have associated hepatic and renal impairment, which may significantly alter the pharmacokinetics of administered drugs and render the patients coagulopathic. The VentrAssist is implanted by midline sternotomy. A brief period of cardiopulmonary bypass (CPB for apical cannulation of left ventricle is needed. The centrifugal pump, which produces non-pulsatile, continuous flow, is positioned in the left sub-diaphragmatic pocket. This LVAD is preload dependent and afterload sensitive. Transoesophageal echocardiography is an essential tool to rule out contraindications and to ensure proper inflow cannula position, and following the implantation of LVAD, to ensure right ventricular (RV function. The anaesthesiologist should be prepared to manage cardiac decompensation and acute desaturation before initiation of CPB, as well as RV failure and severe coagulopathic bleeding after CPB. Three patients had undergone implantation of VentrAssist in our hospital. This pump provides flow of 5 l/min depending on preload, afterload and pump speed. All the patients were discharged after an average of 30 days. There was no perioperative mortality.

  17. New and emerging biomarkers in left ventricular systolic dysfunction--insight into dilated cardiomyopathy.

    Science.gov (United States)

    Gopal, Deepa M; Sam, Flora

    2013-08-01

    Dilated cardiomyopathy (DCM) is characterized by deteriorating cardiac performance, impaired contraction and dilation of the left ventricle (or both ventricles). Blood markers--known as "biomarkers"--allow insight into underlying pathophysiologic mechanisms and biologic pathways while predicting outcomes and guiding heart failure management and/or therapies. In this review, we provide an alternative approach to conceptualize heart failure biomarkers: the cardiomyocyte, its surrounding microenvironment, and the macroenvironment, integrating these entities which may impact cellular processes involved in the pathogenesis and/or propagation of DCM. Newer biomarkers of left ventricular systolic dysfunction can be categorized under: (a) myocyte stress and stretch, (b) myocyte apoptosis, (c) cardiac interstitium, (d) inflammation, (e) oxidative stress, (f) cardiac energetics, (g) neurohormones, and (h) renal biomarkers. Biomarkers provide insight into the pathogenesis of DCM while predicting and potentially providing prognostic information in these patients with heart failure.

  18. Pattern of left ventricular geometry in hypertension: a study of a ...

    African Journals Online (AJOL)

    Background: Hypertension is a leading cause of cardioxasular morbidity and mortality in Nigeria. The main aim of this study was to deterine the prevalence of left ventricular hypertrophy and left ventricular geometric patterns among hypertensives in Kano, Nigeria. Methods: The study was cross-sectional in design, and ...

  19. Second statement of the working group on electrocardiographic diagnosis of left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Bacharova, Ljuba; Estes, E Harvey; Bang, Lia E

    2011-01-01

    The Working Group on Electrocardiographic Diagnosis of Left Ventricular Hypertrophy, appointed by the Editor of the Journal of Electrocardiology, presents the alternative conceptual model for the ECG diagnosis of left ventricular hypertrophy (LVH). It is stressed that ECG is a record of electrical...

  20. Relaxation-systolic pressure relation. A load-independent assessment of left ventricular contractility

    NARCIS (Netherlands)

    Gillebert, T. C.; Leite-Moreira, A. F.; de Hert, S. G.

    1997-01-01

    This contribution reviews the regulation of left ventricular pressure (LVP) fall by load and relates this regulation to left ventricular contractility. Load regulation of LVP fall has to be distinguished from neurohumoral regulation, from effects induced by arterial reflected waves and from

  1. Increased left ventricular mass in normotensive type 1 diabetic patients with diabetic nephropathy

    DEFF Research Database (Denmark)

    Sato, A; Tarnow, L; Parving, H H

    1998-01-01

    OBJECTIVE: Diabetic nephropathy increases the risk of premature cardiovascular disease and sudden death, particularly in type 1 diabetic patients. One possible mechanism for this risk may be left ventricular hypertrophy. In our study, we aimed to evaluate left ventricular structure and function...

  2. The 4th Report of the Working Group on ECG diagnosis of Left Ventricular Hypertrophy

    DEFF Research Database (Denmark)

    Bacharova, Ljuba; Estes, Harvey E; Schocken, Douglas D

    2016-01-01

    The 4th Report provides a brief review of publications focused on the electrocardiographic diagnosis of left ventricular hypertrophy published during the period of 2010 to 2016 by the members of the Working Group on ECG diagnosis of Left Ventricular Hypertrophy. The Working Group recommended...

  3. Early Assistance With Left Ventricular Assist Device Limits Left Ventricular Remodeling After Acute Myocardial Infarction in a Swine Model.

    Science.gov (United States)

    Sun, Xiaotian; Li, Jun; Zhao, Weipeng; Lu, Shuyang; Guo, Changfa; Lai, Hao; Wang, Chunsheng

    2016-03-01

    Although left ventricular assist devices (LVADs) have been commonly used for patients with cardiogenic shock after acute myocardial infarction (AMI), their effects on post-AMI prognosis remain to be elucidated. In this study, we aimed to explore the effects of an LVAD on left ventricular (LV) remodeling and function at the postinfarction stage in a swine model. AMI was induced by ligation of the circumflex artery or its branches for 120 min, followed by 120 min of reperfusion. In the assist group (n = 6), LVAD was initiated at 90 min after ischemia and was maintained for support until 120 min after reperfusion, whereas the control group (n = 6) received no support. LV pressure, volume, wall stress, and stroke work were all decreased by LVAD assistance at the ischemia and reperfusion stages, and blood pressure and cardiac output were maintained. All swine were studied 1 month after the procedure, and those in the assist group showed less increased end-diastolic volumes (assist vs. 57.9 ± 6.6 vs. 79.0 ± 6.7 mL, P = 0.032) and sphericity (assist vs. 1.33 ± 0.16 vs. 1.51 ± 0.12, P = 0.01), as well as improved ejection fractions (assist vs. 59.0 ± 7.8 vs. 42.3 ± 6.0%, P = 0.002). Furthermore, despite a presence of a similar initial ischemic area, the percent of infarcted myocardium was reduced by 49.9% in the assist group (assist vs. 18.1 ± 4.8 vs. 35.3 ± 6.2%, P assistance with an LVAD in AMI limited LV remodeling, preserved postinfarction systolic function, and improved the prognosis. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  4. Derivation of indices of left ventricular contractility in the setting of continuous-flow left ventricular assist device support.

    Science.gov (United States)

    Gupta, Sunil; Muthiah, Kavitha; Woldendorp, Kei; Robson, Desiree; Jansz, Paul; Hayward, Christopher S

    2014-12-01

    It is important to accurately monitor residual cardiac function in patients under long-term continuous-flow left ventricular assist device (cfLVAD) support. Two new measures of left ventricular (LV) chamber contractility in the cfLVAD-unloaded ventricle include IQ, a regression coefficient between maximum flow acceleration and flow pulsatility at different pump speeds; and K, a logarithmic relationship between volumes moved in systole and diastole. We sought to optimize these indices. We also propose RIQ, a ratio between maximum flow acceleration and flow pulsatility at baseline pump speed, as an alternative to IQ. Eleven patients (mean age 49 ± 11 years) were studied. The K index was derived at baseline pump speed by defining systolic and diastolic onset as time points at which maximum and minimum volumes move through the pump. IQ across the full range of pump speeds was markedly different between patients. It was unreliable in three patients with underlying atrial fibrillation (coefficient of determination R(2) range: 0.38-0.74) and also when calculated without pump speed manipulation (R(2) range: 0.01-0.74). The K index was within physiological ranges, but poorly correlated to both IQ (P = 0.42) and RIQ (P = 0.92). In four patients there was excellent correspondence between RIQ and IQ, while four other patients showed a poor relationship between these indices. As RIQ does not require pump speed changes, it may be a more clinically appropriate measure. Further studies are required to determine the validity of these indices. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. The left atrium, atrial fibrillation, and the risk of stroke in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Wachtell, K.; Devereux, R.B.; Lyle, P.A.

    2008-01-01

    The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study provided extensive data on predisposing factors, consequences, and prevention of atrial fibrillation (AF) in patients with hypertension and left ventricular (LV) hypertrophy. Randomized losartan-based treatment...

  6. Endothelial and non-endothelial coronary blood flow reserve and left ventricular dysfunction in systemic hypertension

    Directory of Open Access Journals (Sweden)

    Aloísio Marchi Rocha

    2009-04-01

    Full Text Available OBJECTIVES: We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease. INTRODUCTION: Coronary blood flow reserve reduction has been proposed as a mechanism for the progression of compensated left ventricular hypertrophy to ventricular dysfunction. METHODS: Eighteen hypertensive patients with normal epicardial coronary arteries on angiography were divided into two groups according to left ventricular fractional shortening (FS. Group 1 (FS >0.25: n=8, FS=0.29 ± 0.03; Group 2 (FS <0.25: n=10, FS= 0.17 ± 0.03. RESULTS: Baseline coronary blood flow was similar in both groups (Group 1: 80.15 ± 26.41 mL/min, Group 2: 100.09 ± 21.51 mL/min, p=NS. In response to adenosine, coronary blood flow increased to 265.1 ± 100.2 mL/min in Group 1 and to 300.8 ± 113.6 mL/min (p <0.05 in Group 2. Endothelium-independent coronary blood flow reserve was similar in both groups (Group 1: 3.31 ± 0.68 and Group 2: 2.97 ± 0.80, p=NS. In response to acetylcholine, coronary blood flow increased to 156.08 ± 36.79 mL/min in Group 1 and to 177.8 ± 83.6 mL/min in Group 2 (p <0.05. Endothelium-dependent coronary blood flow reserve was similar in the two groups (Group 1: 2.08 ± 0.74 and group Group 2: 1.76 ± 0.61, p=NS. Peak acetylcholine/peak adenosine coronary blood flow response (Group 1: 0.65 ± 0.27 and Group 2: 0.60 ± 0.17 and minimal coronary vascular resistance (Group 1: 0.48 ± 0.21 mmHg/mL/min and Group 2: 0.34 ± 0.12 mmHg/mL/min were similar in both groups (p= NS. Casual diastolic blood pressure and end-systolic left ventricular stress were independently associated with FS. CONCLUSIONS: In our hypertensive patients, endothelium-dependent and endothelium-independent coronary blood flow reserve vasodilator administrations had similar effects in patients with either normal or decreased left

  7. Dynamic left ventricular outflow tract obstruction: underestimated cause of hypotension and hemodynamic instability

    Directory of Open Access Journals (Sweden)

    Dorota Sobczyk

    2014-12-01

    Full Text Available Left ventricular outflow tract obstruction, which is typically associated with hypertrophic cardiomyopathy, is the third most frequent cause of unexplained hypotension. This underestimated problem may temporarily accompany various diseases (it is found in even <1% of patients with no tangible cardiac disease and clinical situations (hypovolemia, general anesthesia. It is currently assumed that left ventricular outflow tract obstruction is a dynamic phenomenon, the occurrence of which requires the coexistence of predisposing anatomic factors and a physiological condition that induces it. The diagnosis of left ventricular outflow tract obstruction should entail immediate implementation of the therapy to eliminate the factors that can potentially intensify the obstruction. Echocardiography is the basic modality in the diagnosis and treatment of left ventricular outflow tract obstruction. This paper presents four patients in whom the immediate implementation of bedside echocardiography enabled a rapid diagnosis of left ventricular outflow tract obstruction and implementation of proper treatment.

  8. Left ventricular deformation at rest predicts exercise-induced elevation in pulmonary artery wedge pressure in patients with unexplained dyspnoea

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Santos, Mário; Rivero, Jose

    2017-01-01

    AIMS: Impaired left ventricular (LV) deformation despite preserved LV ejection fraction (LVEF) is common and predicts outcomes in heart failure with preserved LVEF. We hypothesized that impaired LV deformation at rest is a marker of impaired cardiac systolic and diastolic reserve, and aimed...... referred for evaluation of dyspnoea. All patients underwent rest echocardiography followed by right heart catheterization and cardiopulmonary exercise testing with concomitant invasive haemodynamic monitoring. The LS, CS and CS/LS ratio were measured by two-dimensional speckle-tracking echocardiography...

  9. "Left ventricular filling pressure(s)" - Ambiguous and misleading terminology, best abandoned.

    Science.gov (United States)

    Peverill, Roger E

    2015-07-15

    The use of the terms "left ventricular filling pressure" and "left ventricular filling pressures" is widespread in the cardiology literature, but the meanings ascribed to these terms have not been consistent. Left ventricular end-diastolic pressure (LVEDP) and mean left atrial pressure (LAP) cannot be used interchangeably as they will often differ in magnitude in the presence of cardiac disease and they also have different clinical significance. LVEDP is the best pressure to use when considering left ventricular function, whereas mean LAP is the most relevant pressure when considering the tendency to pulmonary congestion. The mean LAP is also the most relevant pressure for determining whether pulmonary hypertension has a left heart (post-capillary) component. If only a left ventricular pressure tracing is available then a technique to measure the mean left ventricular diastolic pressure is the best option for estimating the mean LAP. If only right heart pressures are available then the pulmonary artery end-diastolic pressure will provide a reasonable estimate of LVEDP, but only when the heart and pulmonary circulation are normal. If there is mitral valve disease, left ventricular disease or pulmonary hypertension the LVEDP cannot be estimated from right heart pressures. The problem of the ambiguity of "filling pressure (s)" is readily solved by the abandonment of this term and the use of either LVEDP or mean LAP as appropriate. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Early diagnosis of left ventricular diastolic dysfunction in diabetic patients: a possible role for natriuretic peptides

    Directory of Open Access Journals (Sweden)

    Poccia Gianfranco

    2010-12-01

    Full Text Available Abstract Background The aim of the present study was to verify whether BNP might detect pre-clinical diastolic dysfunction (LVDD in type-2 diabetic patients. Methods One-hundred and twenty-seven consecutive outpatients with type-2 diabetes mellitus were enrolled into the study. Subjects with overt heart failure or NYHA class > 1, history of coronary artery disease, severe valvulopathy or chronic atrial fibrillation were excluded from the study. All patients underwent clinical evaluation, laboratory assessment of brain natriuretic peptide (BNP and echocardiographic examination. Results No patients showed systolic impairment of left ventricular function, whereas diastolic dysfunction was detected in 53 (42% cases (all impaired relaxation. Median BNP was 27 pg/ml without any significant difference between 76 patients with normal left ventricular function and 53 with diastolic dysfunction; in 54 (43% patients showing HBA1C≥8 (uncontrolled diabetes normal function was found in 32 and diastolic dysfunction in 22, with a significant difference of BNP at multivariate analysis (OR = 1.02, 95%CI = 1.05-1.09, p = 0.003. In uncontrolled diabetic cohort, BNP was a strong predictor for LVDD (OR = 2.7, 95%CI = 1.3-5.6, p = 0.006 along with the duration of diabetes (OR = 1.6, 95%CI = 1.1-2.9, p = 0.046. BNP > 25 pg/ml was a cut-off value with high accuracy to detect a LVDD. Discussion Early screening of high-risk patients for diabetic cardiomyopathy development might be useful to better control glycemic profile in order to reduce heart disease progression or even to reverse it Conclusions BNP could be a cheap, easy and useful tool to screen those ones with preclinical ventricular diastolic dysfunction in a subset of patients particularly prone to develop cardiovascular complications, like uncontrolled diabetic patients.

  11. Assessment of left ventricular function by tissue Doppler imaging in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Osman Kuloglu

    2012-05-01

    Full Text Available Ankylosing spondylitis (ASpis a chronic, inflammatory and systemic disease affecting pericardium, myocardium and the conduction system of the heart. In this study, we aimed to analyse left ventricular systolic and diastolic functions using tissue Doppler imaging (TDI. 30 patients with ASp and 30 healthy volunteers having the similar demographic characteristics were included. Left ventricular systolic and diastolic functions were assessed by using two dimensional (2D echocardiography, M-mode, pulsed-wave (PW and tissue Doppler echocardiography. The peak systolic velocity (Sm, early diastolic myocardial peak velocity (m, late diastolic myocardial peak velocity (Am, isovolumic acceleration (IVA, myocardial precontraction time (PCTm, myocardial contraction time (CTm, myocardial relaxation time (RTm, and myocardial performance index (MPI were measured at septal and lateral mitral annulus. In conventional echocardiography, end-diastolic interventricular septum and posterior wall diameters were higher in patients with ASp than the control group. The ratio of E/A was significantly lower and deceleration time was significantly prolonged in patients with ASp, but mitral E and A velocities, isovolumic relaxation time and MPI were similar in patient and control group (P>0.05. Left ventricular lateral and septal wall tissue Doppler echocardiography showed that Em, Em/Am ratio and CTm were significantly lower, IVRTm was longer and MPI was higher in patients with ASp. No significant differences were detected between the groups for IVA, Sm, Am, PCTm, PCTm/CTm ratio (P>0.05. We have demonstrated that in patients with ASp, diastolic functions were impaired but systolic functions were preserved by using TDI.

  12. Assessment of serum asymmetric dimethylarginine levels and left ventricular diastolic function in patients with ankylosing spondylitis.

    Science.gov (United States)

    Inci, Umit; Yildiz, Abdulkadir; Batmaz, Ibrahim; Tekbas, Ebru

    2017-02-01

    To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001). Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  13. Tissue characteristics in left ventricular hypertrophy using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yoshida, Shigeru; Ueno, Yuji; Arita, Mikio; Nishio, Ichiro; Masuyama, Yoshiaki

    1988-06-01

    For 15 normotensive patients with asymmetric septal hypertrophy (ASH), 10 hypertensive patients with concentric hypertrophy (CH), and five normal subjects (N), we examined changes in myocardial T/sub 1/ and T/sub 2/ values related to the cardiac cycle. The usefulness of those values in differentiating diseases with left ventricular hypertrophy was evaluated. Left ventricular (LV) short-axis spin echo images and inversion recovery images were obtained at endsystolic and diastolic cardiac phases, and T/sub 1/ and T/sub 2/ images were calculated. The regional wall thickness (WT) and T/sub 1/ and T/sub 2/ values were measured in the anterior septum, anterior wall, lateral wall, posterior wall and posterior septum. Myocardial T/sub 1/ and T/sub 2/ values were significantly decreased in systole (T/sub 1/: 185.6+-37.9 msec, T/sub 2/: 24.4+-6.3 msec, mean+-SD) compared to those in diastole (T/sub 1/: 249.2+-56.7 msec, T/sub 2/: 31.7+-9.4 msec). In both the ASH and CH groups, significant correlations were observed between diastolic T/sub 1/ values and WT (ASH: r = 0.80, p < 0.01, CH: r = 0.45, p < 0.01), and between diastolic T/sub 2/ values and WT (ASH: r = 0.58, p < 0.01, CH: r = 0.60, p < 0.01). In the regions where diastolic WT were more than 17 mm, T/sub 1/ values in the ASH group (343.4+-40.5 msec) were significantly higher than those of the CH group (247.3+-21.4 msec), although the mean wall thickness values were similar in both groups. The T/sub 1//WT and T/sub 2//WT were significantly lower in the CH group than those in the ASH and N groups. In conclusion, myocardial T/sub 1/ and T/sub 2/ values were related not only to the cardiac cycle, but to wall thickness and to types of hypertrophy. The T/sub 1/ and T/sub 2/ values may be useful for distinguishing hypertrophic cardiomyopathy from hypertrophy due to hypertension.

  14. Determinants of left ventricular diastolic dysfunction in hypertensive patients.

    Science.gov (United States)

    Nazário Leão, R; Marques da Silva, P; Marques Pocinho, R; Alves, M; Virella, D; Palma Dos Reis, R

    2018-02-02

    The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. Older age (65 vs. 58 years, p<0.001), longer duration of hypertension (160 vs. 48 months, p<0.001), uncontrolled hypertension (59.8 vs. 15.9%, p<0.001), tobacco smoking (17.8 vs. 3.8%, p=0.016), higher systolic blood pressure (133 vs. 124mmHg, p=0.001) and slower heart rate (62 vs. 66bpm, p=0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p<0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p=0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p=0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p<0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p=0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC=0.95 (95% CI 0.91-0.98). The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Left Ventricular Assist Device Thrombosis-Amiodarone-Induced Hyperthyroidism: Causal Link?

    Science.gov (United States)

    Rajapreyar, Indranee; Acharya, Deepak; Tallaj, José; Hornbuckle, Lauren; Sharpton, Jessica; Joly, Joanna; Pamboukian, Salpy

    2018-03-05

    Ventricular arrhythmias occurs in 20-50% of patients supported with left ventricular assist devices (LVAD). Ventricular arrhythmias are well tolerated with LVAD support but long-term consequences include worsening right ventricular function. Management of ventricular arrhythmias in LVAD patients includes use of antiarrhythmic agents or ablation. Amiodarone has been used a first-line agent to treat ventricular arrhythmias post-LVAD implantation. Chronic treatment with amiodarone for arrhythmias can result in hyperthyroidism and hypothyroidism in 5-10% of patients. Hyperthyroidism is known to cause endothelial dysfunction, alterations in coagulation, and fibrinolytic pathways favoring hypercoagulable state. We describe two cases of left ventricular assist device (LVAD) thrombosis potentiated by amiodarone-induced hyperthyroidism (AIT) and discuss pathophysiological mechanisms for hypercoagulable state induced by hyperthyroidism.

  16. Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: A practical approach

    Directory of Open Access Journals (Sweden)

    Vido Diane

    2008-07-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR has excellent capabilities to assess ventricular systolic function. Current clinical scenarios warrant routine evaluation of ventricular diastolic function for complete evaluation, especially in congestive heart failure patients. To our knowledge, no systematic assessment of diastolic function over a range of lusitropy has been performed using CMR. Methods and Results Left ventricular diastolic function was assessed in 31 subjects (10 controls who underwent CMR and compared with Transthoracic echocardiogram (TTE evaluation of mitral valve (MV and pulmonary vein (PV blood flow. Blood flow in the MV and PV were successfully imaged by CMR for all cases (31/31,100% while TTE evaluated flow in all MV (31/31,100% but only 21/31 PV (68% cases. Velocities of MV flow (E and A measured by CMR correlated well with TTE (r = 0.81, p Conclusion We have shown that there is homology between CMR and TTE for the assessment of diastolic inflow over a wide range of conditions, including normal, impaired relaxation and restrictive. There is excellent agreement of quantitative velocity measurements between CMR and TTE. Diastolic blood flow assessment by CMR can be performed in a single scan, with times ranging from 20 sec to 3 min, and we show that there is good indication for applying CMR to assess diastolic conditions, either as an adjunctive test when evaluating systolic function, or even as a primary test when TTE data cannot be obtained.

  17. A Physiological Controller for Turbodynamic Ventricular Assist Devices Based on Left Ventricular Systolic Pressure.

    Science.gov (United States)

    Petrou, Anastasios; Ochsner, Gregor; Amacher, Raffael; Pergantis, Panagiotis; Rebholz, Mathias; Meboldt, Mirko; Schmid Daners, Marianne

    2016-09-01

    The current article presents a novel physiological feedback controller for turbodynamic ventricular assist devices (tVADs). This controller is based on the recording of the left ventricular (LV) pressure measured at the inlet cannula of a tVAD thus requiring only one pressure sensor. The LV systolic pressure (SP) is proposed as an indicator to determine the varying perfusion requirements. The algorithm to extract the SP from the pump inlet pressure signal used for the controller to adjust the speed of the tVAD shows robust behavior. Its performance was evaluated on a hybrid mock circulation. The experiments with changing perfusion requirements were compared with a physiological circulation and a pathological one assisted with a tVAD operated at constant speed. A sensitivity analysis of the controller parameters was conducted to identify their limits and their influence on a circulation. The performance of the proposed SP controller was evaluated for various values of LV contractility, as well as for a simulated pressure sensor drift. The response of a pathological circulation assisted by a tVAD controlled by the introduced SP controller matched the physiological circulation well, while over- and underpumping events were eliminated. The controller presented a robust performance during experiments with simulated pressure sensor drift. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  18. Evaluation of ECG criteria for left ventricular hypertrophy before and after aortic valve replacement using magnetic resonance Imaging

    NARCIS (Netherlands)

    Beyerbacht, Hugo P.; Bax, Jeroen J.; Lamb, Hildo J.; van der Laarse, Arnoud; Vliegen, Hubert W.; de Roos, Albert; Zwinderman, Aeilko H.; van der Wall, Ernst E.

    2003-01-01

    PURPOSE: Evaluation of different electrocardiographic criteria for left ventricular hypertrophy (ECG-LVH criteria) using left ventricular mass index (LVMI) determined by magnetic resonance imaging (MRI). In addition, the relation between LVMI regression after aortic valve replacement and

  19. Clinical impact of ' in-treatment' wall motion abnormalities in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Cicala, S.; Simone, G. de; Wachtell, K.

    2008-01-01

    Objectives Left ventricular systolic wall motion abnormalities have prognostic value. Whether wall motion detected by serial echocardiographic examinations predicts prognosis in hypertensive patients with left ventricular hypertrophy ( LVH) without clinically recognized atherosclerotic disease has...

  20. Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X)

    International Nuclear Information System (INIS)

    Taki, J.; Nakajima, K.; Muramori, A.; Yoshio, H.

    1994-01-01

    Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740-925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (≤ 5% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1% ± 6.7% in patients with syndrome X, 61.9% ± 6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (-3.1 ± 9.5% vs 14.7% ± 7.4%). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3% ± 8.3% vs 26.4% ± 7.3%) with the time to EF overshoot longer (114 ± 43 s vs 74 ± 43 s, P < 0.05) in patients with syndrome X. (orig./MG)

  1. The effects of candesartan on left ventricular hypertrophy and function in nonobstructive hypertrophic cardiomyopathy: a pilot, randomized study.

    Science.gov (United States)

    Penicka, Martin; Gregor, Pavel; Kerekes, Roman; Marek, Dan; Curila, Karol; Krupicka, Jiri

    2009-01-01

    Hypertrophic cardiomyopathy is caused by mutations in the genes that encode sarcomeric proteins and is primarily characterized by unexplained left ventricular hypertrophy, impaired cardiac function, reduced exercise tolerance, and a relatively high incidence of sudden cardiac death, especially in the young. The extent of left ventricular hypertrophy is one of the major determinants of disease prognosis. Angiotensin II has trophic effects on the heart and plays an important role in the development of myocardial hypertrophy. Here in a double-blind, placebo-controlled, randomized study, we show that the long-term administration of the angiotensin II type 1 receptor antagonist candesartan in patients with hypertrophic cardiomyopathy was associated with the significant regression of left ventricular hypertrophy, improvement of left ventricular function, and exercise tolerance. The magnitude of the treatment effect was dependent on specific sarcomeric protein gene mutations that had the greatest responses on the carriers of ss-myosin heavy chain and cardiac myosin binding protein C gene mutations. These data indicate that modulating the role of angiotensin II in the development of hypertrophy is specific with respect to both the affected sarcomeric protein gene and the affected codon within that gene. Thus, angiotensin II type 1 receptor blockade has the potential to attenuate myocardial hypertrophy and may, therefore, provide a new treatment option to prevent sudden cardiac death in patients with hypertrophic cardiomyopathy.

  2. Independent effects of both right and left ventricular function on plasma brain natriuretic peptide

    DEFF Research Database (Denmark)

    Vogelsang, Thomas Wiis; Jensen, Ruben J; Monrad, Astrid L

    2007-01-01

    BACKGROUND: Brain natriuretic peptide (BNP) is increased in heart failure; however, the relative contribution of the right and left ventricles is largely unknown. AIM: To investigate if right ventricular function has an independent influence on plasma BNP concentration. METHODS: Right (RVEF), left......, which is a strong prognostic marker in heart failure, independently depends on both left and right ventricular systolic function. This might, at least in part, explain why BNP holds stronger prognostic value than LVEF alone....

  3. Haemodynamic effects of dual-chamber pacing versus ventricular pacing during a walk test in patients with depressed or normal left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Adele; Salvatore, Marco; Cuocolo, Alberto [University Federico II, Department of Biomorphological and Functional Sciences, Institute of Biostructure and Bioimages of the National Council of Research, Naples (Italy); Duilio, Carlo; Santomauro, Maurizio [University Federico II, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Naples (Italy)

    2005-09-01

    Dual-chamber rate-modulated pacing provides haemodynamic benefits compared with ventricular pacing at rest, but it is unclear whether this also holds true during physical exercise in patients with heart failure. This study assessed the haemodynamic response to a walk test during dual-chamber pacing and ventricular pacing in patients with depressed or normal left ventricular (LV) function. Twelve patients with an LV ejection fraction <50% and 11 patients with an LV ejection fraction {>=}50% underwent two randomised 6-min walk tests under dual-chamber rate-modulated pacing and ventricular pacing at a fixed rate of 70 beats/min. All patients had a dual-chamber pacemaker implanted for complete heart block. LV function was monitored by a radionuclide ambulatory system. In patients with depressed LV function, the change from dual-chamber pacing to ventricular pacing induced a decrease in end-systolic volume at the peak of the walk test (P<0.05), with no difference in end-diastolic volume. As a consequence, higher increases in LV ejection fraction (P<0.0001) and stroke volume (P<0.01) were observed during ventricular pacing. No difference in cardiac output was found between the two pacing modes. In patients with normal LV function, the change from dual-chamber pacing to ventricular pacing induced a significant decrease in cardiac output (P<0.005 at rest and P<0.05 at the peak of the walk test). Compared with dual-chamber rate-modulated pacing, ventricular pacing improves cardiac function and does not affect cardiac output during physical activity in patients with depressed LV function, whereas it impairs cardiac output in those with normal function. (orig.)

  4. Haemodynamic effects of dual-chamber pacing versus ventricular pacing during a walk test in patients with depressed or normal left ventricular function

    International Nuclear Information System (INIS)

    Ferro, Adele; Salvatore, Marco; Cuocolo, Alberto; Duilio, Carlo; Santomauro, Maurizio

    2005-01-01

    Dual-chamber rate-modulated pacing provides haemodynamic benefits compared with ventricular pacing at rest, but it is unclear whether this also holds true during physical exercise in patients with heart failure. This study assessed the haemodynamic response to a walk test during dual-chamber pacing and ventricular pacing in patients with depressed or normal left ventricular (LV) function. Twelve patients with an LV ejection fraction <50% and 11 patients with an LV ejection fraction ≥50% underwent two randomised 6-min walk tests under dual-chamber rate-modulated pacing and ventricular pacing at a fixed rate of 70 beats/min. All patients had a dual-chamber pacemaker implanted for complete heart block. LV function was monitored by a radionuclide ambulatory system. In patients with depressed LV function, the change from dual-chamber pacing to ventricular pacing induced a decrease in end-systolic volume at the peak of the walk test (P<0.05), with no difference in end-diastolic volume. As a consequence, higher increases in LV ejection fraction (P<0.0001) and stroke volume (P<0.01) were observed during ventricular pacing. No difference in cardiac output was found between the two pacing modes. In patients with normal LV function, the change from dual-chamber pacing to ventricular pacing induced a significant decrease in cardiac output (P<0.005 at rest and P<0.05 at the peak of the walk test). Compared with dual-chamber rate-modulated pacing, ventricular pacing improves cardiac function and does not affect cardiac output during physical activity in patients with depressed LV function, whereas it impairs cardiac output in those with normal function. (orig.)

  5. Liberal Right Ventricular Assist Device Extracorporeal Membrane Oxygenation Support for Right Ventricular Failure after Implantable Left Ventricular Assist Device Placement.

    Science.gov (United States)

    Fischer, Quentin; Kirsch, Matthias

    2017-11-27

    Refractory right ventricular failure (RVF) after implantation of left ventricular assist device (LVAD) is a dramatic complication. The addition of right ventricular assist device (RVAD) may improve RV recovery and lead to improve outcomes. From February 2012 to September 2014, 44 patients received a HeartMate II. These patients were retrospectively compared in two groups according to early liberal implantation of an extracorporeal membrane oxygenation (ECMO) used as a RVAD established between a femoral vein and the pulmonary artery. Of the 44 patients, 22 required addition of a temporary RVAD (t-RVAD group). Patients are sicker in the t-RVAD group with significantly higher rate of preoperative extracorporeal life support (46% vs. 9%; p = 0.016) or any mechanical circulatory support (55% vs. 14%; p = 0.01), more preoperative hemofiltration (23% vs. 0%; p = 0.048), and more inotrope support by dobutamine (68.2% vs. 27.3%; p = .015). Likewise Michigan risk score was significantly higher in t-RVAD group (2.61 ± 2.2 vs. 1.0 ± 1.6 pts; p = 0.013) and INTERMACS clinical profile (2.1 ± 0.6 vs. 3.4 ± 1.3 pts; p = 0.0001). Despite severity of preimplant conditions in t-RVAD group, clinical outcomes did not differ in both groups with similar survival rate at 6 months (60.4 ± 12 vs. 71.4 ± 9.9 months; p = 0.585). Early and liberal use of temporary RVAD in patients with risk factors of RVF could improve the prognostic after LVAD implantation.

  6. Left Ventricular Mechanics in Untrained and Trained Males with Tetraplegia.

    Science.gov (United States)

    Currie, Katharine D; West, Christopher R; Stöhr, Eric J; Krassioukov, Andrei V

    2017-02-01

    Reduced left ventricular (LV) function is common in tetraplegia, yet it is unknown whether intrinsic myocardial function is attenuated. This study examined the effect of SCI and exercise-training status on LV mechanics (intrinsic function) and LV systolic/diastolic function by comparing untrained (UT) and trained (TT) individuals with tetraplegia and able-bodied (AB) individuals. Individuals with tetraplegia had a traumatic, chronic, motor-complete cervical spinal cord injury. Nine UT males (40 ± 10 years), 8 TT males (30 ± 5 years), and nine AB males (37 ± 9 years) participated in the study. LV indices were assessed using two-dimensional transthoracic echocardiography, with speckle-tracking analysis for the determination of LV mechanics. For systolic function, stroke volumes were lower in both UT (59 ± 9 mL; p tetraplegia, attenuated LV systolic function is not attributed to intrinsic dysfunction, whereas exercise-training status appears to improve both global LV diastolic function and LV mechanics.

  7. Current cardiac imaging techniques for detection of left ventricular mass

    Directory of Open Access Journals (Sweden)

    Celebi Aksuyek S

    2010-06-01

    Full Text Available Abstract Estimation of left ventricular (LV mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR and cardiovascular computed tomography (CCT are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.

  8. Medical Image of the week: left ventricular non-compaction

    Directory of Open Access Journals (Sweden)

    Khoubyari R

    2016-06-01

    Full Text Available No abstract available. Article truncated at 150 words. A 38-year-old woman with history of type 2 diabetes mellitus and hypertension presented to emergency department with worsening exertional dyspnea and orthopnea for the past 2-3 months. She also reported a 14 pound weight gain within the 2 weeks prior to presentation. She denied any prior history of cardiac or pulmonary disease. Also, there was no family history of heart disease. She denies any recent sick contacts, smoking, alcohol drinking, or substance abuse. Physical exam revealed jugular venous pressure of 10 cm H2O and significant bilateral lower extremity pitting edema. Chest x-ray showed an enlarged cardiac silhouette. Brain naturetic peptide (BNP was 2,917 pg/mL. A subsequent echocardiogram revealed a left ventricular (LV ejection fraction of 23% with severe global LV hypokinesia with moderate mitral regurgitation. Thyroid panel as well as iron panel were within normal range. Other laboratories were unremarkable. For the new onset systolic heart failure, a coronary angiography was ...

  9. Brain natriuretic peptide and left ventricular dysfunction in chagasic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Andre Talvani

    2004-10-01

    Full Text Available Global left ventricular (LV systolic dysfunction is the strongest predictor of morbidity and mortality in Chagas disease. Echocardiography is considered the gold standard for the detection of LV dysfunction, but not always available in endemic areas where chagasic cardiomyopathy is most common. Brain natriuretic peptide (BNP is a neurohormone that has been recently described as a simple and inexpensive diagnostic and prognostic marker for patients with congestive heart failure. Chagasic patients (n = 63 and non-infected healthy individuals (n = 18 were recruited prospectively and underwent complete clinical examination, echocardiography and 24-h Holter monitoring. BNP was measured from thawed plasma samples using the Triage BNP test. We observed high levels of BNP in association with depression of LV ejection fraction, with increase of LV end-diastolic diameter and with LV premature complexes. An elevated concentration of BNP, defined as a concentration of 60 pg/ml or more, had a sensitivity of 91.7%, specificity of 82.8%, positive predictive value of 52.4%, and negative predictive value of 98% for detecting LV dysfunction (LV ejection fraction < 40%.BNP measurement using a simple, relatively inexpensive and rapid test has a promising role in identifying LV dysfunction associated with chagasic cardiomyopathy. Equally important, patients with Trypanosoma cruzi infection who have low levels of BNP level in plasma have a very low likelihood of severe cardiac involvement, and echocardiography is probably not necessary.

  10. Left ventricular systolic performance is improved in elite athletes.

    Science.gov (United States)

    Caselli, Stefano; Di Pietro, Riccardo; Di Paolo, Fernando M; Pisicchio, Cataldo; di Giacinto, Barbara; Guerra, Emanuele; Culasso, Franco; Pelliccia, Antonio

    2011-07-01

    We sought to investigate the systolic time interval (STI) and efficiency of left ventricular (LV) contraction comparatively in elite athletes and healthy sedentary controls by means of three-dimensional echocardiography (3DE). Four hundred and twenty-nine elite athletes, involved in skill (n = 41), power (n = 63), mixed (n = 167), and endurance (n = 158) disciplines and 98 sedentary controls, matched for age, underwent 3DE. By off-line analysis, we measured the absolute and relative (normalized by the R-R interval) timing of LV systolic emptying (STI and STI%) and the systolic flow velocity (SFV = stroke volume/STI). Both STI and STI% were shorter in athletes, regardless of the sport discipline, compared with controls (respectively, 324 ± 36 vs. 345 ± 33 ms, P athletes showed a significant reduction (by 50.4 ms; 95% confidence interval, from 57.7 to 43.1) in STI compared with untrained subjects. Finally, higher SFV were identified in skill (256 ± 60 mL/s; P athletes compared with controls (204 ± 50 mL/s). Elite athletes show a significant shortening of the systolic time duration in comparison with sedentary controls, in association with a significant increase in LV emptying velocity. This pattern characterizes the physiological LV adaptation of the athletes and may potentially be useful in differential diagnosis of the 'athlete heart'.

  11. MR image analysis: Longitudinal cardiac motion influences left ventricular measurements

    International Nuclear Information System (INIS)

    Berkovic, Patrick; Hemmink, Maarten; Parizel, Paul M.; Vrints, Christiaan J.; Paelinck, Bernard P.

    2010-01-01

    Background: Software for the analysis of left ventricular (LV) volumes and mass using border detection in short-axis images only, is hampered by through-plane cardiac motion. Therefore we aimed to evaluate software that involves longitudinal cardiac motion. Methods: Twenty-three consecutive patients underwent 1.5-Tesla cine magnetic resonance (MR) imaging of the entire heart in the long-axis and short-axis orientation with breath-hold steady-state free precession imaging. Offline analysis was performed using software that uses short-axis images (Medis MASS) and software that includes two-chamber and four-chamber images to involve longitudinal LV expansion and shortening (CAAS-MRV). Intraobserver and interobserver reproducibility was assessed by using Bland-Altman analysis. Results: Compared with MASS software, CAAS-MRV resulted in significantly smaller end-diastolic (156 ± 48 ml versus 167 ± 52 ml, p = 0.001) and end-systolic LV volumes (79 ± 48 ml versus 94 ± 52 ml, p < 0.001). In addition, CAAS-MRV resulted in higher LV ejection fraction (52 ± 14% versus 46 ± 13%, p < 0.001) and calculated LV mass (154 ± 52 g versus 142 ± 52 g, p = 0.004). Intraobserver and interobserver limits of agreement were similar for both methods. Conclusion: MR analysis of LV volumes and mass involving long-axis LV motion is a highly reproducible method, resulting in smaller LV volumes, higher ejection fraction and calculated LV mass.

  12. Incremental first pass technique to measure left ventricular ejection fraction

    International Nuclear Information System (INIS)

    Kocak, R.; Gulliford, P.; Hoggard, C.; Critchley, M.

    1980-01-01

    An incremental first pass technique was devised to assess the acute effects of any drug on left ventricular ejection fraction (LVEF) with or without a physiological stress. In particular, the effects of the vasodilater isosorbide dinitrate on LVEF before and after exercise were studied in 11 patients who had suffered cardiac failure. This was achieved by recording the passage of sup(99m)Tc pertechnetate through the heart at each stage of the study using a gamma camera computer system. Consistent values for four consecutive first pass values without exercise or drug in normal subjects illustrated the reproducibility of the technique. There was no significant difference between LVEF values obtained at rest and exercise before or after oral isosorbide dinitrate with the exception of one patient with gross mitral regurgitation. The advantages of the incremental first pass technique are that the patient need not be in sinus rhythm, the effects of physiological intervention may be studied and tests may also be repeated at various intervals during long term follow-up of patients. A disadvantage of the method is the limitation in the number of sequential measurements which can be carried out due to the amount of radioactivity injected. (U.K.)

  13. Detection of left ventricular thrombi by echotomography and computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kanemitsu, H.; Hirata, S.; Inagaki, T.; Ishikawa, K. (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1981-09-01

    Left ventricular (LV) thrombi are rarely recognized during life, though they are not infrequent at the post-mortem examination of patients succumbed to valvular disease, acute myocardial infarction, and cardiomyopathy. We presented five cases in which LV thrombi were detected by cross-sectional echocardiography (CSE) and confirmed by computed tomography. The main purpose of this study was to compare the echocardiographic findings of the LV thrombi with the manifestations of the LV thrombi on the computed tomograms, with a hope to augment the clinical utility of CSE in the detection of LV thrombi. CSE was recorded from the apical and four-chamber views in addition to the conventional approach. A computed tomographic whole-body scanner which utilized a continuously rotating gantry and pulsed anode with X-ray radiation collimated to form a thin fan-shaped beam was used. A complete section scan was performed in 3 seconds. Sustained enhancement was obtained with a rapid intravenous infusion of 30% meglumine iothalanate. Most of the LV thrombi showed an abnormal echo with irregular borders and/or a mobile mass echo at the apex by CSE. Computed tomographic findings suggestive of LV thrombi appeared as a defect, which was apparently different in quality from the surrounding myocardium or valvular apparatus. These findings were quite consistent with those of CSE with respect to the number and the location of the LV thrombi.

  14. Quantitation of left ventricular asynchrony on radionuclide angiography phase images

    International Nuclear Information System (INIS)

    Alfano, B.; Betocchi, S.; Pace, L.; Perrone-Filardi, P.; Chiariello, M.; Salvatore, M.; Naples Univ.

    1990-01-01

    Quantitation of left ventricular (LV) asynchrony is relevant in clinical cardiology, as well as in evaluating LV mechanical properties. Radionuclide angiography (RA) phase images are extensively used, and asynchrony is usually assessed by computing the standard deviation of phase angle distribution (SD). However, SD is dependent on count statistics and does not take into account the spatial distribution of asynchrony. In this study a new index to evaluate asynchrony on phase images is presented (differential uniformity parameter, DUP). DUP is based on the frequency analysis of phase images. Diagnostic accuracy and reproducibility of either SD or DUP were tested. Reproducibility was evaluated in 15 patients studied by RA twice within a few minutes. DUP showed a better reproducibility than SD. Diagnostic accuracy was estimated in 84 patients, divided into four subgroups on the basis of coronary arteriography and contrast ventriculogrpahy findings: (a) 25 control subjects, (b) 16 patients with coronary artery disease (CAD) and normal LV wall motion, (c) 23 patients with CAD and LV hypokinesia and (d) 20 patients with CAD and LV dyskinesia. Relative diagnostic ability was assessed by comparing the areas under receiver-operating characteristic curves. DUP's area was larger than SD's when group D was tested against all the other groups (DUP's area=87%±5%, SD's area=76%±7%; P<0.01). Thus, our study indicates that DUP is more reproducible and more accurate than SD in identifying patients with CAD and LV dyskinesia. (orig.)

  15. Left Ventricular Assist Device: Care On Inpatient Rehabilitation Facility.

    Science.gov (United States)

    Forrest, George; Radu, Gabriel; Rifenburg, Kathleen; Shields, Evelyn; Clift, Sarah

    2015-01-01

    Investigate the outcomes of patients admitted to an inpatient rehabilitation facility (IRF) after placement of a left ventricular assist device (LVAD). Retrospective review of records. Authors reviewed records of patients admitted to the IRF after cardiac surgery or admission to the hospital with either acute myocardial infarction, congestive heart failure, or placement of an LVAD. The study reports improvement in function, length of stay (LOS), and location of discharge. The patients in the LVAD group made as much progress in terms of improvement in function as the other groups. None of the patients in the LVAD group required transfer back to medical or surgical units. All were discharged to home. Length of stay (LOS) of the LVAD group was not significantly longer than that of the other cardiac patients. Patients who have had placement of an LVAD can be safely cared for in an IRF. This paper provides information about the indications for LVAD, the nursing care of patients with an LVAD, and the outcomes of care in an IRF. © 2014 Association of Rehabilitation Nurses.

  16. Androgenic anabolic steroids also impair right ventricular function.

    Science.gov (United States)

    Kasikcioglu, Erdem; Oflaz, Huseyin; Umman, Berrin; Bugra, Zehra

    2009-05-01

    Chronic anabolic steroid use suppresses left ventricular functions. However, there is no information regarding the chronic effects of anabolic steroids on right ventricular function which also plays a key role in global cardiac function. The main objective of the present study was to investigate the effects of androgenic anabolic steroids usage among athletes on remodeling the right part of the heart. Androgenic-anabolic steroids-using bodybuilders had smaller diastolic velocities of both ventricles than drug-free bodybuilders and sedentary counterparts. This study shows that androgenic anabolic steroids-using bodybuilders exhibited depressed diastolic functions of both ventricles.

  17. Associations of childhood and adult obesity with left ventricular structure and function.

    Science.gov (United States)

    Yang, H; Huynh, Q L; Venn, A J; Dwyer, T; Marwick, T H

    2017-04-01

    Overweight and obesity are associated with left ventricular (LV) dysfunction. We sought whether echocardiographic evidence of abnormal adult cardiac structure and function was related to childhood or adult adiposity. This study included 159 healthy individuals aged 7-15 years and followed until age 36-45 years. Anthropometric measurements were performed both at baseline and follow-up. Cardiac structure (indexed left atrial volume (LAVi), left ventricular mass (LVMi)) and LV function (global longitudinal strain (GLS), mitral e') were assessed using standard echocardiography at follow-up. Conventional cutoffs were used to define abnormal LAVi, LVMi, GLS and mitral annular e'. Childhood body mass index (BMI) was correlated with LVMi (r=0.25, P=0.002), and child waist circumference was correlated with LVMi (r=0.18, P=0.03) and LAVi (r=0.20, P=0.01), but neither were correlated with GLS. One s.d. (by age and sex) increase in childhood BMI was associated with LV hypertrophy (relative risk: 2.04 (95% confidence interval (CI): 1.09, 3.78)) and LA enlargement (relative risk: 1.81 (95% CI: 1.02, 3.21)) independent of adult BMI, but the association was not observed with impaired GLS or mitral e'. Cardiac functional measures were more impaired in those who had normal BMI as child, but had high BMI in adulthood (Pobese as a child and remained so in adulthood (P>0.33). Childhood adiposity is independently associated with structural cardiac disturbances (LVMi and LAVi). However, functional alterations (GLS and mitral e') were more frequently associated with adult overweight or obesity, independent of childhood adiposity.

  18. [Experience of left ventricular assist device "Incor" as "bridge to recovery" implantation in patients with end stage congestive heart failure].

    Science.gov (United States)

    Khubulava, G G; Ivchenko, E V; Paĭvin, A A; Kravchuk, V N; Iurchenko, D L; Ivashchenko, A I; Didenko, M V; Luk'ianov, N G; Peleshok, A S; Tsygan, N V; Liubimov, A I; Naumov, A B; Shorokhov, K H; Sukharev, A E; Kniazev, E A; Porembskaia, I A

    2011-11-01

    Left ventricular assist device "Incor" ("Berlinhear", Germany) implantation experience in patient with ischemic cardiomiopathy and severe congestive heart failure is presented. Left ventricular assist device implantation was followed by coronary artery bypass grafting simultaneously. Total assist time was 211 days. Complications developed during assisting time are shown. After Left ventricular assist device explantation three chamber pacemaker was implanted as cardiac resynchronization therapy. Left ventricular end diastolic size decreased (from 78 to 70 mm), ejection fraction increased (from 19 to 35%) during assist time.

  19. Mitral Annular Kinetics, Left Atrial, and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation.

    Science.gov (United States)

    Schiros, Chun G; Ahmed, Mustafa I; McGiffin, David C; Zhang, Xiaoxia; Lloyd, Steven G; Aban, Inmaculada; Denney, Thomas S; Dell'Italia, Louis J; Gupta, Himanshu

    2015-01-01

    The relationship of mitral annular (MA) kinetics to left ventricular (LV) and left atrial (LA) function before and after mitral valve (MV) repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, and LA and LV diastolic function post MV repair. Three-dimensional analyses of mitral annular motion, LA function, and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR) patients at baseline and 1-year post MV repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging. All had normal LV ejection fraction (EF) at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early diastolic filling rate, E/A ratio, and early diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate. MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function, and LV diastolic strain rates are still impaired 1 year post MV repair. Long-term effects of these impairments should be prospectively evaluated.

  20. Improved left ventricular function after growth hormone replacement in patients with hypopituitarism: assessment with radionuclide angiography

    International Nuclear Information System (INIS)

    Cuocolo, A.; Nicolai, E.; Colao, A.; Longobardi, S.; Cardei, S.; Fazio, S.; Merola, B.; Lombardi, G.; Sacca, L.; Salvatore, M.

    1996-01-01

    Prolonged growth hormone deficiency (GHD) leads to marked cardiac dysfunction; however, whether reversal of this abnormality may be achieved after specific replacement therapy has not yet been completely clarified. Fourteen patients with childhood-onset GHD (nine men and five women, mean age 27±4 years) and 12 normal control subjects underwent equilibrium radionuclide angiography under control conditions at rest. Patients with GHD were also studied 6 months after recombinant human (rh) GH treatment (0.05 IU/kg per day). Normal control subjects and patients with GHD did not differ with respect to age, gender and heart rate. In contrast, left ventricular ejection fraction (53%±9% vs 66%±6%, P 2 , P 2 , P 2 , P 2 , P <0.01) was observed in GHD patients. In conclusion, prolonged lack of GH leads to impaired left ventricular function at rest. Reversal of this abnormality may be observed after 6 months of specific replacement therapy in patients with childhood-onset GHD. (orig.). With 4 figs., 1 tab

  1. Evaluation of Subclinical Left Ventricular Systolic Dysfunction in Chronic Asymptomatic Alcoholics by Speckle Tracking Echocardiography

    Directory of Open Access Journals (Sweden)

    Murathan Kucuk

    2017-01-01

    Full Text Available By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r=0.27, p=0.083. Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

  2. Dietary phosphorus is associated with a significant increase in left ventricular mass

    Science.gov (United States)

    Yamamoto, Kalani T.; Robinson-Cohen, Cassianne; de Oliveira, Marcia C.; Kostina, Alina; Nettleton, Jennifer A.; Ix, Joachim H.; Nguyen, Ha; Eng, John; Lima, Joao A.C.; Siscovick, David; Weiss, Noel S.; Kestenbaum, Bryan

    2012-01-01

    Dietary phosphorus consumption has risen steadily in the United States. Oral phosphorus loading alters key regulatory hormones and impairs vascular endothelial function which may lead to an increase in left ventricular mass (LVM). We investigated the association of dietary phosphorus with LVM in 4,494 participants from the Multi-Ethnic Study of Atherosclerosis, a community-based study of individuals free of known cardiovascular disease. The intake of dietary phosphorus was estimated using a 120-item food frequency questionnaire and the LVM was measured using magnetic resonance imaging. Regression models were used to determine associations of estimated dietary phosphorus with LVM and left ventricular hypertrophy (LVH). Mean estimated dietary phosphorus intake was 1,167 mg/day in men and 1,017 mg/day in women. After adjustment for demographics, dietary sodium, total calories, lifestyle factors, comorbidities, and established LVH risk factors, each quintile increase in the estimated dietary phosphate intake was associated with an estimated 1.1 gram greater LVM. The highest gender-specific dietary phosphorus quintile was associated with an estimated 6.1 gram greater LVM compared to the lowest quintile. Higher dietary phosphorus intake was associated with greater odds of LVH among women, but not men. These associations require confirmation in other studies. PMID:23283134

  3. Left ventricular dysfunction after mitral valve repair--the fallacy of "normal" preoperative myocardial function.

    Science.gov (United States)

    Quintana, Eduard; Suri, Rakesh M; Thalji, Nassir M; Daly, Richard C; Dearani, Joseph A; Burkhart, Harold M; Li, Zhuo; Enriquez-Sarano, Maurice; Schaff, Hartzell V

    2014-12-01

    A proportion of patients experience a decrease in left ventricular (LV) ejection fraction (EF) after mitral valve repair; however, predictors and long-term consequences remain unclear. A study of 1705 patients with severe, degenerative mitral valve regurgitation and normal preoperative EF (>60%) undergoing mitral valve repair from 1993 to 2012 was performed. Multivariate logistic regression and Cox proportional hazards models were used to determine the predictors of early postoperative LV dysfunction (EF 60%) in only one third of patients with postrepair EF 49 mm Hg and left ventricular end-systolic diameter >36 mm were independently associated with a 4.4- and 6.5-fold increased risk of developing a postoperative EF < 40% (P < .001, for both). De novo postoperative LV dysfunction is not uncommon in patients with "normal" preoperative EF undergoing mitral valve repair. LV dysfunction can persist, impairing recovery of LV size, function, and survival. The consideration of mitral repair before the onset of excessive LV dilation or pulmonary hypertension, even in those with preserved EF, seems warranted. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  4. Calculation of cardiac pressures using left ventricular ejection fraction (LVEF) derived from radionuclide angiography

    International Nuclear Information System (INIS)

    Hommer, E.

    1981-01-01

    An attempt has been made to develop formulas to determine cardiac pressures in an undisturbed flow in patients without valvular or shunt diseases. These are based entirely on the results of left ventricular ejection fraction rates, permitting pressure analysis of several compartments at the same tine. According to BORER et al. they also enable determination of left ventricular 'Functional Reserve' after bycycle exercise as well as left ventricular 'Relaxation Reserve'. They support the views of NYHA in determining the grades of cardiac insufficiency proving the system- and low-pressure participation. A single formula for pulmonary flow can determine the pulmonary arterial pressure. The left ventricular enddiastolic pressure can also be exclusively calculated by values of left ventricular functions, thus both formulas may be used in disorders of the mitral valves. The possibility to calculate pressures of all the compartments of the heart from left ventricular ejection rate shows, that in undisturbed flow global heart function depends on left ventricular function. Therefore the mutual dependence of these formulas presents an intercompartimental pressure regulation of the heart through pulmonary flow and pulmonary vascular pressure, which leaves an aspect of autonomous cardiac regulation open to discussion. (orig.) [de

  5. Influence of age on left ventricular performance during exercise in normal Japanese subject

    International Nuclear Information System (INIS)

    Konishi, Tokuji; Koyama, Takao; Aoki, Toshikazu; Makino, Katsutoshi; Yamamuro, Masashi; Nakai, Kyudayu; Nakamura, Masayuki; Nakano, Takeshi.

    1990-01-01

    To assess the effects of age on left ventricular performance, multistage supine ergometer exercise radionuclide ventriculography (RNV) was performed in 92 normal subjects. The subjects ranged in age from 24 to 86 years and were free of cardiopulmonary disease and diabetes. Age-related changes in exercise duration, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), cardiac output (CO) left ventricular ejection fraction (LVEF), left ventricular dv/dt, systolic and diastolic time indexes of dv/dt, and peak systolic pressure/left ventricular end-systolic volume (PSP/LVESV) were analyzed at rest and during the peak exercise stage. Age-related decrease in LVEDV and peak diastolic dv/dt were significant at rest. The time indexes of ECG R to peak systolic dv/dt and time of end-systole to peak diastolic dv/dt also were prolonged with age. Both maximum heart rate and exercise duration were shown to decline with age. No age-related difference was observed in LVESV, LVEF or PSP/LVESV either at rest or during exercise. However, the change of LVEF and LVESV during exercise was less in subjects aged 60 or more. These results indicate decreased left ventricular function during exercise in elderly subjects. (author)

  6. Diagnostic accuracy of computer-assisted electrocardiography in the diagnosis of left ventricular hypertrophy in left bundle branch block.

    Science.gov (United States)

    Rodríguez-Padial, Luis; Rodríguez-Picón, Blanca; Jerez-Valero, Miguel; Casares-Medrano, Julio; Akerström, Finn O; Calderon, Alberto; Barrios, Vivencio; Sarría-Santamera, Antonio; González-Juanatey, José R; Coca, Antonio; Andrés, Josep; Ruiz-Baena, Jessica

    2012-01-01

    Left ventricular hypertrophy has important prognostic implications. Although electrocardiography is the technique most often recommended in the diagnosis of hypertrophy, its diagnostic accuracy is hampered in the presence of a left bundle branch block. In 1875 consecutive patients (56±16 years) undergoing studies to rule out heart disease and/or hypertension, 2-dimensional echocardiography and electrocardiography were performed simultaneously in an outpatient clinic. Digitized electrocardiograms were interpreted using an online computer-assisted platform (ELECTROPRES). Sensitivity, specificity, likelihood ratios, and predictive values of standard electrocardiographic criteria and of some diagnostic algorithms for left ventricular hypertrophy were determined and compared with the findings in patients with neither left bundle branch block nor myocardial infarction. Left bundle branch block was present in 233 (12%) patients. Left ventricular hypertrophy was detected more frequently in patients with left bundle branch block (60% vs 31%). In patients with left bundle branch block, sensitivities were low but similar to those observed in patients without it, and ranged from 6.4% to 70.9%, whereas specificities were high, ranging from 57.6% to 100%. Positive likelihood ratios ranged from 1.33 to 4.94, and negative likelihood ratios from 0.50 to 0.98. Diagnostic algorithms, voltage-duration products, and certain compound criteria had the best sensitivities. Left ventricular hypertrophy can be diagnosed in the presence of left bundle branch block with an accuracy at least similar to that observed in patients without this conduction defect. Computer-assisted interpretation of the electrocardiogram may be useful in the diagnosis of left ventricular hypertrophy as it enables the implementation of more accurate algorithms. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  7. Influence of dilated cardiomyopathy and a left ventricular assist device on vortex dynamics in the left ventricle

    NARCIS (Netherlands)

    Loerakker, S.; Cox, L. G. E.; van Heijst, G. J. F.; de Mol, B. A. J. M.; van de Vosse, F. N.

    2008-01-01

    Together with new developments in mechanical cardiac support, the analysis of vortex dynamics in the left ventricle has become an increasingly important topic in literature. The aim of this study was to develop a method to investigate the influence of a left ventricular assist device (LVAD) on

  8. Comparison between tagged MRI and standard cine MRI for evaluation of left ventricular ejection fraction

    Energy Technology Data Exchange (ETDEWEB)

    Dornier, Christophe; Ivancevic, Marko K.; Didier, Dominique; Vallee, Jean-Paul [Departement de Radiologie et d' Informatique Medicale, Hopitaux Universitaires de Geneve, 24 rue Micheli-du-Crest, 1211, Geneva (Switzerland); Somsen, G. Aernout; Righetti, Alberto [Div. de Cardiologie, Departement de Medecine Interne, Hopitaux Universitaires de Geneve, 24 rue Micheli-du-Crest, 1211, Geneva (Switzerland); Osman, Nael F. [Department of Radiology, Johns Hopkins University, 600 North Wolfe Street, 21287, Baltimore, MD (United States)

    2004-08-01

    Global left ventricular function is a prognostic indicator and is used to evaluate therapeutical interventions in patients with heart failure. Regional left ventricular function can be determined with tagged MRI. Assessment of global left ventricular function using the tagging data may have additional clinical value without incurring extra scanning time, which is currently a limiting factor in cardiac imaging. Direct determination of end-diastolic volume is not possible with conventional tagged MRI. However, end-systolic volume can be directly measured because myocardium-blood contrast improves through a tagged image series. We investigated the potential of tagged MRI using frequency-domain analysis software to retrospectively track end-diastolic contour from end-systolic contour and subsequently calculate the ejection fraction. Tagged MRI was compared with the standard bright-blood cine MRI in healthy volunteers (n=20) and patients with previous myocardial infarction (n=8). Left ventricular ejection fraction derived from tagged MRI is linearly correlated to left ventricular ejection fraction obtained by standard cardiac cine MRI (y=1.0x+1.31, r>0.98, p=0.014). In addition, the inter-observer and intra-observer coefficient of variation for left ventricular ejection fraction measurements was low (CV{sub intra}=0.4%, CV{sub inter}=1.3%). With tagged MRI, only end-systolic volume needs to be manually determined, and accurate estimation of left ventricular ejection fraction is obtained because end-diastolic and end-systolic volumes are determined using identical anatomical points. Our data indicate that tagged MRI can be used to quantitatively assess both regional and global left ventricular function. Therefore, tagged MRI may be a valuable clinical tool for determining the prognosis and evaluating the effect of therapeutical intervention using a single imaging session in patients with left ventricular dysfunction. (orig.)

  9. The effect of postoperative medical treatment on left ventricular mass regression after aortic valve replacement.

    Science.gov (United States)

    Helder, Meghana R K; Ugur, Murat; Bavaria, Joseph E; Kshettry, Vibhu R; Groh, Mark A; Petracek, Michael R; Jones, Kent W; Suri, Rakesh M; Schaff, Hartzell V

    2015-03-01

    The study objective was to analyze factors associated with left ventricular mass regression in patients undergoing aortic valve replacement with a newer bioprosthesis, the Trifecta valve pericardial bioprosthesis (St Jude Medical Inc, St Paul, Minn). A total of 444 patients underwent aortic valve replacement with the Trifecta bioprosthesis from 2007 to 2009 at 6 US institutions. The clinical and echocardiographic data of 200 of these patients who had left ventricular hypertrophy and follow-up studies 1 year postoperatively were reviewed and compared to analyze factors affecting left ventricular mass regression. Mean (standard deviation) age of the 200 study patients was 73 (9) years, 66% were men, and 92% had pure or predominant aortic valve stenosis. Complete left ventricular mass regression was observed in 102 patients (51%) by 1 year postoperatively. In univariate analysis, male sex, implantation of larger valves, larger left ventricular end-diastolic volume, and beta-blocker or calcium-channel blocker treatment at dismissal were significantly associated with complete mass regression. In the multivariate model, odds ratios (95% confidence intervals) indicated that male sex (3.38 [1.39-8.26]) and beta-blocker or calcium-channel blocker treatment at dismissal (3.41 [1.40-8.34]) were associated with increased probability of complete left ventricular mass regression. Patients with higher preoperative systolic blood pressure were less likely to have complete left ventricular mass regression (0.98 [0.97-0.99]). Among patients with left ventricular hypertrophy, postoperative treatment with beta-blockers or calcium-channel blockers may enhance mass regression. This highlights the need for close medical follow-up after operation. Labeled valve size was not predictive of left ventricular mass regression. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  10. Asymptomatic Left Ventricular Myxoma in a 12-Year-Old Male.

    Science.gov (United States)

    Chlebowski, Meghan; O'Brien, James; Hertzenberg, Casey; Wagner, Jonathan

    2016-06-01

    Cardiac myxoma is the most common cardiac tumor in patients of all ages; the majority are encountered as single left atrial tumors. Left ventricular myxomas are exceedingly rare, having been recorded in a small number of case reports involving children worldwide. We report a case of a left ventricular myxoma with left ventricular outflow tract obstruction in a previously healthy, asymptomatic adolescent black male. Transthoracic echocardiograms revealed a single, large (2.5 × 5-cm), lobulated, mobile mass within the left ventricular cavity that oscillated into the outflow tract, thereby causing moderate obstruction during systole. Advanced images delineated the location and tissue composition of the mass, characterizing it as a myxoma. Complete surgical excision of the mass was accomplished via aortotomy. Gross examination and histology confirmed the diagnosis of myxoma.

  11. Evaluation of Left Ventricular Dyssynchrony after Coronary Artery Bypass Grafting in Patients with Ischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    MA Babaee Beigi

    2009-12-01

    Full Text Available Background: Ischemic left ventricular (LV dysfunction is one of the major causes of LV dyssynchrony. This is indicative of poor prognosis in patients with LV dysfunction and correction of ischemia by Coronary Artery Bypass Grafting (CABG may resynchronize LV contraction. The aim of this study was to evaluate the effect of CABG on LV dyssynchrony, systolic and diastolic function.Patients: The present study comprised 31 patients with ischemic LV dysfunction with Ejection Fraction (EF:25- 50%. Echocardiography with Tissue Doppler Imaging (TDI was performed to assess LV dyssynchrony (calculated by basal LV segment,to evaluate diastolic function by measurement of peak early diastolic mitral annular velocity (Em ,systolic function by measurement of peak early systolic mitral annular velocity (Sm and Ejection Fraction (EF by Simpson method.Results: Mean LV dyssychrony before CABG was 30±16 ms that decreased to 22±14 ms after operation (P=0.04.There was also improved diastolic and systolic function after CABG ( Em 0.04m/s versus 0.05 m/s , P=0.01 and Sm 0.06 m/s versus 0.08 m/s P=0.01.The mean ejection fraction rose from 40±8.6% to 42±8.2% (P=0.01.Conclusion: CABG is associated with improvement of LV dyssynchrony, systolic and diastolic function in patients with ischemic LV dysfunction.

  12. Pacemaker syndrome with sub-acute left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker: consequence of lead switch at the header.

    Science.gov (United States)

    Khurwolah, Mohammad Reeaze; Vezi, Brian Zwelethini

    In the daily practice of pacemaker insertion, the occurrence of atrial and ventricular lead switch at the pacemaker box header is a rare and unintentional phenomenon, with less than five cases reported in the literature. The lead switch may have dire consequences, depending on the indication for the pacemaker. One of these consequences is pacemaker syndrome, in which the normal sequence of atrial and ventricular activation is impaired, leading to sub-optimal ventricular filling and cardiac output. It is important for the attending physician to recognise any worsening of symptoms in a patient who has recently had a permanent pacemaker inserted. In the case of a dual-chamber pacemaker, switching of the atrial and ventricular leads at the pacemaker box header should be strongly suspected. We present an unusual case of pacemaker syndrome and right ventricular-only pacinginduced left ventricular systolic dysfunction in a patient with a dual-chamber pacemaker.

  13. Evaluation of right ventricular function using liver stiffness in patients with left ventricular assist device.

    Science.gov (United States)

    Kashiyama, Noriyuki; Toda, Koichi; Nakamura, Teruya; Miyagawa, Shigeru; Nishi, Hiroyuki; Yoshikawa, Yasushi; Fukushima, Satsuki; Saito, Shunsuke; Yoshioka, Daisuke; Sawa, Yoshiki

    2017-04-01

    Although right ventricular failure (RVF) is a major concern after left ventricular assist device (LVAD) implantation, methodologies to evaluate RV function remain limited. Liver stiffness (LS), which is closely related to right-sided filling pressure and may indicate RVF severity, could be non-invasively and repeatedly assessed using transient elastography. Here we investigated the suitability of LS as a parameter of RV function in pre- and post-LVAD periods. The study included 55 patients with LVAD implantation as a bridge to transplantation between 2011 and 2015 whose LS was assessed using transient elastography. Seventeen patients presented with RVF, defined as requiring inotropic support for ≥30 days, nitric oxygen inhalation for ≥5 days, and/or mechanical RV support following LVAD implantation. Survival of patients with RVF was significantly worse compared with that of patients without RVF. Multivariate logistic regression analysis identified preoperative LS, LV diastolic dimension, RV stroke work index, and dilated phase of hypertrophic cardiomyopathy aetiology as significant risk factors; the combination of these parameters could improve predictive power of post-LVAD RVF with areas under the curve of 0.89. Furthermore, LS was significantly decreased by LV unloading and significantly correlated with right-sided filling pressure. In addition to dilated hypertrophic cardiomyopathy aetiology, reduced RV stroke work index and small LV dimension, we demonstrated that non-invasively measured LS was a predictor of post-LVAD RVF and can be used as a parameter for the evaluation and optimization of RV function in the perioperative period.

  14. Telomere dynamics during aging in polygenic left ventricular hypertrophy.

    Science.gov (United States)

    Marques, Francine Z; Booth, Scott A; Prestes, Priscilla R; Curl, Claire L; Delbridge, Lea M D; Lewandowski, Paul; Harrap, Stephen B; Charchar, Fadi J

    2016-01-01

    Short telomeres are associated with increased risk of cardiovascular disease. Here we studied cardiomyocyte telomere length at key ages during the ontogeny of cardiac hypertrophy and failure in the hypertrophic heart rat (HHR) and compared these with the normal heart rat (NHR) control strain. Key ages corresponded with the pathophysiological sequence beginning with fewer cardiomyocytes (2 days), leading to left ventricular hypertrophy (LVH) (13 wk) and subsequently progression to heart failure (38 wk). We measured telomere length, tissue activity of telomerase, mRNA levels of telomerase reverse transcriptase (Tert) and telomerase RNA component (Terc), and expression of the telomeric regulator microRNA miR-34a. Cardiac telomere length was longer in the HHR compared with the control strain at 2 days and 38 wk, but shorter at 13 wk. Neonatal HHR had higher cardiac telomerase activity and expression of Tert and miR-34a. Telomerase activity was not different at 13 or 38 wk. Tert mRNA and Terc RNA were overexpressed at 38 wk, while miR-34a was overexpressed at 13 wk but downregulated at 38 wk. Circulating leukocytes were strongly correlated with cardiac telomere length in the HHR only. The longer neonatal telomeres in HHR are likely to reflect fewer fetal and early postnatal cardiomyocyte cell divisions and explain the reduced total cardiomyocyte complement that predisposes to later hypertrophy and failure. Although shorter telomeres were a feature of cardiac hypertrophy at 13 wk, they were not present at the progression to heart failure at 38 wk. Copyright © 2016 the American Physiological Society.

  15. Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Francisca Gavilanes

    2014-12-01

    Full Text Available OBJECTIVE: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH. METHODS: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD, significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. RESULTS: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH was confirmed in 302 patients (78.6%. The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3% and 178 (81.7% were diagnosed with PH associated with LVD (PH-LVD and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001. CONCLUSIONS: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.

  16. Left ventricular mass in HIV-infected patients.

    Science.gov (United States)

    Olalla, J; Pombo, M; Del Arco, A; de la Torre, J; Urdiales, D; García-Alegría, J

    2013-01-01

    The HIV infection has been associated with an increased incidence of vascular events. Left ventricular mass (LVM) is independently associated with greater overall mortality. Various studies have shown that patients with HIV infection have higher LVM than the uninfected population. We aim to describe the distribution of LVM in an extensive series of patients with HIV infection, and the factors associated with its increase. A cross-sectional study was performed in HIV-infected patients followed in our center from 1 December 2009 to 28 February 2011. A transthoracic echocardiography (TTE) was performed in all patients who gave their consent. Demographic variables, viroimmunological status, cardiovascular risk factors, vascular risk at 10 years (VR10) and history of exposure to antiretroviral drugs were collected. LVM was considered to be the quantitative dependent variable. A univariate analysis was performed, including in the multivariate analysis those variables with P<,05. A TTE was performed in 400 patients, and the LVM was calculated in 388. Mean age was 45 years, 75.5 males. Mean LVM was 39.54g/m(2.7)(95% CI: 38.35-40.73). Age, height, body mass index, VR10, hypertension, dyslipidemia, different medications within the cardiovascular area and having taken nevirapine have been used in the history of the patient were associated to greater LVM. In the multivariate analysis, use of nevirapine in the history of the patient and VR10 remained in the model. VR10 may be associated with greater LVM. The relationship with nevirapine may respond to an indication bias. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  17. The functional status of neoaortic valve and left ventricular outlet tract after arterial switch operation for transposition of great arteries with left ventricular outlet tract obstruction.

    Science.gov (United States)

    Chang, Yi; Li, Shoujun; Zhang, Hao; Hua, Zhongdong; Yang, Keming; Gao, Huawei

    2016-07-01

    To assess the function of the left ventricular outlet tract and neoaortic valve after arterial switch operation for patients with transposition of the great arteries and left ventricular outlet tract obstruction. The data of 40 patients, who underwent arterial switch surgery with transposition of the great arteries with left ventricular outlet tract obstruction and a concomitant left ventricular outlet tract obstruction relieving procedure, were retrospectively analysed. Ultrasonic cardiogram and intraoperative findings, surgical methods and early and follow-up results were also summarized. Early death occurred in one case. One patient died in follow-up stage and 3 patients were lost during follow-up. In all the 35 patients accepting follow-up, 1 patient had a reoccurring left ventricular outlet tract obstruction, 1 patient had mild neoaortic stenosis, whereas mild and moderate neoaortic regurgitation occurred in 11 and 2 patients, respectively. The median pressure gradient across the left ventricular outlet tract was 6.8 mmHg (range: 2-49 mmHg) during follow-up which was statistically significant compared with that before surgery. We defined death, reintervention and rehospitalization for cardiac reasons as a cardiac event; the survival rate of being free from cardiac event for 1 year and 5 years was 92.8 ± 0.04%, respectively. Anatomical features and pressure gradient should be used together to evaluate the severity of obstruction, whereas the mid-term outcomes can be satisfied after arterial switch operation for the appropriate candidates. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. His-Purkinje system-related incessant ventricular tachycardia arising from the left coronary cusp

    Directory of Open Access Journals (Sweden)

    Eiji Sato, MD

    2014-08-01

    Full Text Available We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias.

  19. Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly.

    Science.gov (United States)

    Harada, Daisuke; Aasanoi, Hidetsugu; Ushijima, Ryuichi; Noto, Takahisa; Takagawa, Junya; Ishise, Hisanari; Inoue, Hiroshi

    2017-12-13

    To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p right ventricle (Odds ratio, 1.05 per 1 year, p = 0.003; and 1.03 per 1 mmHg, p = 0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p = 0.001, and 1.08 per 1 mmHg, p right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

  20. Pulmonary and right ventricular dysfunction are frequently present in heart failure irrespective of left ventricular ejection fraction

    Science.gov (United States)

    Robaeys, Wouter; Bektas, Sema; Boyne, Josiane; van Empel, Vanessa; Uszko-Lencer, Nicole; Knackstedt, Christian; Brunner-La Rocca, Hans-Peter

    2017-01-01

    Background Heart failure (HF) may influence the lungs and vice versa. However, this interaction and the influence on right ventricular function (RVF) are insufficiently described in patients with HF divided into the recent groups based on left ventricular ejection fraction (LVEF): HF with reduced, midrange and preserved ejection fraction (HFrEF, HFmrEF and HFpEF, respectively). Methods Overall, 186 consecutive stable patients with HF seen in our outpatient clinic were retrospectively divided into HFrEF (n=70), HFmrEF (n=55) and HFpEF (n=61). Airflow limitation and gas exchange disturbance were measured by spirometry (forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) (%)) and diffusion capacity of the lungs for carbon monoxide (DLCO). Standard echocardiography was performed to measure RV structure (RV diameter) and function (tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP)). Correlations were used to assess possible relations between pulmonary dysfunction and measurements of the RV. Results None of the investigated parameters differed significantly between the three groups (all p>0.1); FEV1/FVC was 70%±12%, 70%±13% and 74%±10% in patients with HFrEF, HFmrEF and HFpEF (p=0.12) and DLCO was 5.7±1.6, 5.7±1.8 and 5.6±1.6 mmol/min/kPa, respectively (p=0.95). RV structure and function did not differ either (TAPSE/PASP 0.58, 0.60 and 0.57, respectively (p=0.84)). There was a correlation of DLCO with RV function (r=0.34, p<0.001). Conclusion The investigated cardiopulmonary parameters were comparable in the three HF groups. Diffusion capacity was impaired in more than half of the stable HF population independently of the LVEF and showed a correlation with RV function. PMID:29467838

  1. The left ventricle as a mechanical engine: from Leonardo da Vinci to the echocardiographic assessment of peak power output-to-left ventricular mass.

    Science.gov (United States)

    Dini, Frank L; Guarini, Giacinta; Ballo, Piercarlo; Carluccio, Erberto; Maiello, Maria; Capozza, Paola; Innelli, Pasquale; Rosa, Gian M; Palmiero, Pasquale; Galderisi, Maurizio; Razzolini, Renato; Nodari, Savina

    2013-03-01

    The interpretation of the heart as a mechanical engine dates back to the teachings of Leonardo da Vinci, who was the first to apply the laws of mechanics to the function of the heart. Similar to any mechanical engine, whose performance is proportional to the power generated with respect to weight, the left ventricle can be viewed as a power generator whose performance can be related to left ventricular mass. Stress echocardiography may provide valuable information on the relationship between cardiac performance and recruited left ventricular mass that may be used in distinguishing between adaptive and maladaptive left ventricular remodeling. Peak power output-to-mass, obtained during exercise or pharmacological stress echocardiography, is a measure that reflects the number of watts that are developed by 100 g of left ventricular mass under maximal stimulation. Power output-to-mass may be calculated as left ventricular power output per 100 g of left ventricular mass: 100× left ventricular power output divided by left ventricular mass (W/100 g). A simplified formula to calculate power output-to-mass is as follows: 0.222 × cardiac output (l/min) × mean blood pressure (mmHg)/left ventricular mass (g). When the integrity of myocardial structure is compromised, a mismatch becomes apparent between maximal cardiac power output and left ventricular mass; when this occurs, a reduction of the peak power output-to-mass index is observed.

  2. Evaluation of docosahexaenoic acid in a dog model of hypertension induced left ventricular hypertrophy.

    Science.gov (United States)

    Stanley, William C; Cox, James W; Asemu, Girma; O'Connell, Kelly A; Dabkowski, Erinne R; Xu, Wenhong; Ribeiro, Rogerio F; Shekar, Kadambari C; Hoag, Stephen W; Rastogi, Sharad; Sabbah, Hani N; Daneault, Caroline; des Rosiers, Christine

    2013-12-01

    Marine n-3 polyunsaturated fatty acids alter cardiac phospholipids and prevent cardiac pathology in rodents subjected to pressure overload. This approach has not been evaluated in humans or large animals with hypertension-induced pathological hypertrophy. We evaluated docosahexaenoic acid (DHA) in old female dogs with hypertension caused by 16 weeks of aldosterone infusion. Aldosterone-induced hypertension resulted in concentric left ventricular (LV) hypertrophy and impaired diastolic function in placebo-treated dogs. DHA supplementation increased DHA and depleted arachidonic acid in cardiac phospholipids, but did not improve LV parameters compared to placebo. Surprisingly, DHA significantly increased serum aldosterone concentration and blood pressure compared to placebo. Cardiac mitochondrial yield was decreased in placebo-treated hypertensive dogs compared to normal animals, which was prevented by DHA. Extensive analysis of mitochondrial function found no differences between DHA and placebo groups. In conclusion, DHA did not favorably impact mitochondrial or LV function in aldosterone hypertensive dogs.

  3. Exercise physiology, testing, and training in patients supported by a left ventricular assist device.

    Science.gov (United States)

    Loyaga-Rendon, Renzo Y; Plaisance, Eric P; Arena, Ross; Shah, Keyur

    2015-08-01

    The left ventricular assist device (LVAD) is an accepted treatment alternative for the management of end-stage heart failure. As we move toward implantation of LVADs in less severe cases of HF, scrutiny of functional capacity and quality of life becomes more important. Patients demonstrate improvements in exercise capacity after LVAD implantation, but the effect is less than predicted. Exercise training produces multiple beneficial effects in heart failure patients, which would be expected to improve quality of life. In this review, we describe factors that are thought to participate in the persistent exercise impairment in LVAD-supported patients, summarize current knowledge about the effect of exercise training in LVAD-supported patients, and suggest areas for future research. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  4. Prognostic implications of left ventricular diastolic dysfunction with preserved systolic function following acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Møller, J E; Nørager, B

    2001-01-01

    of the mitral and pulmonary venous flow, and the propagation velocity of early mitral flow by color M-mode Doppler echocardiography in 183 consecutive patients at day 5-7 following their first acute MI. Patients were classified into four groups: group A: preserved LV systolic and diastolic function (n = 73......%) and D (38%) compared to A (2%) (p class >or=II (p = 0.006), and age (0.008) as predictors of cardiac death or readmission due to heart failure. The presence of LV diastolic dysfunction with preserved......The contribution of diastolic dysfunction in patients with preserved left ventricular (LV) systolic function to impaired functional status and cardiac mortality in myocardial infarction (MI) is unknown. In the present study, assessment of LV diastolic function was performed by Doppler analysis...

  5. Evaluation of the left ventricular performance in patients with ischemic heart disease using radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Kobayashi, Takeshi; Miyamoto, Atsushi; Ando, Jouji; Yasuda, Hisakazu

    1981-01-01

    Radionuclide angiocardiography was utilized for the measurement of left ventricular dynamics and the analysis of its segmental wall motion. Left ventricular performance was measured by the first pass method and gated equilibrium method in patients with ischemic heart disease. The left ventricular wall motion was also examined by the analysis of computer-drawn outlines of radioactivity counts of the left ventricular chamber. These measurements were well correlated with those obtained by invasive methods such as contrast cine-ventriculography and thermodilution method in the resting state. The patients with effort angina often showed an almost normal left ventricular performance and wall motion in the resting state without ischemic episodes. However, at the time when anginal attack was provoked with exercise testing, an asynergy and a reduced performance of left ventricle were observed. The extent and localization of this asynergy well corresponded with the defect of myocardial scintigrams determined by 201-Tl stress myocardial imaging. From above findings we conclude that the myocardial ischemia with asynergy is a cause of decreased left ventricular hemodynamics during anginal attack. Although further evaluation is necessary to know limitations and to avoid inaccuracy, these techniques were shown to have a significant usefulness in evaluating ischemic heart disease. (author)

  6. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    We sought to investigate the relation between left ventricular (LV) and right ventricular (RV) function assessed with the Doppler-derived myocardial performance index (MPI), to assess serial changes, and to investigate the prognostic value of biventricular assessment of cardiac function after a f...

  7. Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction

    Directory of Open Access Journals (Sweden)

    Villari Bruno

    2007-10-01

    Full Text Available Abstract Heart failure (HF is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Echocardiography represents the "gold standard" in the assessment of LV systolic dysfunction and in the recognition of systolic heart failure, since dilatation of the LV results in alteration of intracardiac geometry and hemodynamics leading to increased morbidity and mortality. The functional mitral regurgitation is a consequence of adverse LV remodelling that occurs with a structurally normal valve and it is a marker of adverse prognosis. Diastolic dysfunction plays a major role in signs and symptoms of HF and in the risk stratification, and provides prognostic information independently in HF patients and impaired systolic function. Ultrasound lung comets are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction, which can integrate the clinical and pathophysiological information provided by conventional echocardiography and provide a useful information for prognostic stratification of HF patients. Contractile reserve is defined as the difference between values of an index of left ventricular contractility during peak stress and its baseline values and the presence of myocardial viability predicts a favorable outcome. A non-invasive echocardiographic method for the evaluation of force-frequency relationship has been proposed to assess the changes in contractility during stress echo. In conclusion, in HF patients, the evaluation of systolic, diastolic function and myocardial contractile reserve plays a fundamental role in the risk stratification. The highest risk is present in HF patients with a heart that is weak, big, noisy, stiff and wet.

  8. Normal left ventricular wall motion measured with two-dimensional myocardial tagging

    DEFF Research Database (Denmark)

    Qi, P; Thomsen, C; Ståhlberg, F

    1993-01-01

    contraction towards the center of the left ventricle, a motion of the base of the heart towards the apex, and a rotation of the left ventricle around its long axis. The direction of left ventricular rotation changed from early systole to late systole. The base and middle levels of the left ventricle rotated......Using a myocardial tagging technique, normal left ventricular wall motion was studied in 3 true short axis views and a double oblique 4-chamber view in 14 and 11 volunteers, respectively. Three orthogonal directions of left ventricular motion were observed throughout the systole; a concentric...... counterclockwise (CCW) at early systole and clockwise (CW) at late systole, whereas the apex of the heart rotated CW at early systole and CCW at late systole. The different directions of the rotation of base and apex resulted in a myocardial twisting that changed direction from early to late systole. We conclude...

  9. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD

    2017-04-01

    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  10. Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging

    NARCIS (Netherlands)

    Papavassiliu, T.; Kuhl, H.P.; Schroder, M.; Suselbeck, T.; Bondarenko, O.; Bohm, C.K.; van de Beek, A.; Hofman, M.M.; van Rossum, A.C.

    2005-01-01

    PURPOSE: To prospectively assess the effect of including or excluding endocardial trabeculae in left ventricular (LV) measurements and the reproducibility of these measurements at cine cardiovascular magnetic resonance (MR) imaging with true fast imaging with steady-state precession (FISP).

  11. Effect of arotinolol on left ventricular function in patients with idiopathic dilated cardiomyopathy.

    Science.gov (United States)

    Fan, Chao-mei; Yang, Hong; Li, Yi-shi; Xu, Li; Dou, Ke-fei; Zhao, Jing-lin; Yuan, Xian-qi; Zhao, Yan-fen; Shi, Rong-fang; Du, Xiu-qing; Lu, Na-qiang

    2007-12-01

    To evaluate the efficacy and safety of long-term treatment with arotinolol in patients with idiopathic dilated cardiomyopathy (IDCM). Sixty-three patients with IDCM were evaluated at baseline and after 12-month therapy with arotinolol. The conventional therapy for congestive heart failure was continued throughout the study with arotinolol as the only beta-blocker. Left ventricular function was assessed with the New York Heart Association functional class and two-dimensional echocardiography. After 12-month arotinolol treatment, there was a significant improvement in left ventricular systolic function. Left ventricular end-systolic dimension significantly decreased from 59.52 +/- 8.83 mm to 50.89 +/- 8.17 mm (P arotinolol treatment has a favorable effect on left ventricular function in patients with IDCM, and it is safe and well tolerated.

  12. Correlation between left ventricular wall thickness and QRS voltages in Nigerians.

    Science.gov (United States)

    Odia, O J

    1987-12-01

    ECG voltage criteria for left ventricular hypertrophy are based on the assumption that a thicker ventricle generates higher QRS voltages. In order to test this assertion, a study of the correlation between echocardiographically determined left ventricular wall thickness and ECG QRS voltages was carried out in 89 subjects, consisting of 35 hypertensives, 20 patients with mitral/aortic valve incompetence, and 34 controls. The results show that there was no statistically significant correlation between QRS voltages and left ventricular wall thickness. This shows that a thicker ventricle does not necessarily generate higher QRS voltages on the electrocardiogram. This may explain the already documented less than satisfactory degree of accuracy of the various ECG voltage criteria for the diagnosis of left ventricular hypertrophy.

  13. Impact of fasting glucose on electrocardiographic left ventricular hypertrophy in an elderly general population

    DEFF Research Database (Denmark)

    Diederichsen, Søren Z; Pareek, Manan; Nielsen, Mette L

    2015-01-01

    OBJECTIVE: To evaluate relationships between fasting plasma glucose (FPG), other cardiovascular risk markers and left ventricular hypertrophy (LVH) as detected by electrocardiography. METHODS: Subjects were selected randomly from groups defined by FPG. Traditional risk markers were assessed. LVH...

  14. Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Schulte, Phillip J; Al Enezi, Fawaz

    2015-01-01

    We aimed to characterize the hemodynamic progression of aortic stenosis (AS) in a contemporary unselected cohort of patients with preserved left ventricular ejection fraction. Current guidelines recommend echocardiographic surveillance of hemodynamic progression. However, limited data exist on th...

  15. Patient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement

    DEFF Research Database (Denmark)

    Kandler, Kristian; Møller, Christian H; Hassager, Christian

    2013-01-01

    The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival.......The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival....

  16. Neonatal aortic arch obstruction due to pedunculated left ventricular foetal myxoma.

    Science.gov (United States)

    Kaulitz, Renate; Haen, Susanne; Sieverding, Ludger

    2015-10-01

    Myxoma in neonatal life are extremely rare. We report a case of a neonate with a pedunculated cardiac tumour arising from the anterolateral left ventricular wall protruding across the left ventricular outflow tract and continuously extending into the distal aortic arch. Surgical removal at 14 days of age via combined transaortic approach and apical ventriculotomy was indicated because of the risk of further compromise of aortic valve function and aortic arch obstruction. Histopathologic examination was consistent with a myxoma.

  17. Haemochromatosis genotype and iron overload: association with hypertension and left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Ellervik, C; Tybjaerg-Hansen, A; Appleyard, M

    2010-01-01

    We hypothesized that there is an association between haemochromatosis genotype C282Y/C282Y and/or iron overload and risk of hypertension and/or left ventricular hypertrophy (LVH).......We hypothesized that there is an association between haemochromatosis genotype C282Y/C282Y and/or iron overload and risk of hypertension and/or left ventricular hypertrophy (LVH)....

  18. Patterns of left ventricular remodeling among patients with essential and secondary hypertension

    OpenAIRE

    Radulescu,Dan; Stoicescu,Laurentiu; Buzdugan,Elena; Donca,Valer

    2013-01-01

    Background: High blood pressure causes left ventricular hypertrophy, which is a negative prognostic factor among hypertensive patients. Aim: To assess left ventricular geometric remodeling patterns in patients with essential hypertension or with hypertension secondary to parenchymal renal disease. Material and Methods: We analyzed data from echocardiograms performed in 250patients with essential hypertension (150 females) and 100 patients with secondary hypertension (60 females). The interven...

  19. Primary cardiac tumor presenting as left ventricular outflow tract obstruction and complex arrhythmia.

    Science.gov (United States)

    Fries, R; Achen, S; O'Brien, M T; Jackson, N D; Gordon, S

    2017-10-01

    An adult female mixed breed dog presented for recurrent collapsing episodes over several weeks. Holter evaluation revealed periods of sinus arrest and echocardiography identified a soft tissue mass with subsequent severe dynamic obstruction of the left ventricular outflow tract. The patient was euthanized five days after presentation for severe dyspnea. Necropsy revealed an irregular mass circumferentially lining the left ventricular outflow tract as well as multiple myocardial metastases. The final diagnosis was an undifferentiated pleomorphic endocardial sarcoma. Published by Elsevier B.V.

  20. Quantification of left ventricular regional functions using ECG-gated myocardial perfusion SPECT. Validation of left ventricular systolic functions

    International Nuclear Information System (INIS)

    Yamamoto, Akira; Takahashi, Naoto; Iwahara, Shin-ichiro; Munakata, Kazuo; Hosoya, Tetsuo

    2006-01-01

    We have developed a program to quantify regional left ventricular (LV) function and wall motion synchrony using electrocardiogram (ECG)-gated myocardial perfusion SPECT (MPS). This preliminary study was undertaken to validate the use of this program for estimating regional LV systolic function. Patients were subjected to MPS by 99m Tc-sestamibi at rest. The study included 20 patients who were confirmed to have a low probability of coronary artery disease (LPG; low probability group), 19 heart disease patients who were examined by MPS and equilibrium radionuclide angiography (ERNA) (ERG; ERNA group), and 24 patients who were examined by MPS and 2-dimensional echocardiography (2DE) (2DEG; 2DE group). The values of the ejection fraction (EF) and peak ejection rate (PER) were estimated. The global functions evaluated by this program were compared with those obtained by ERNA in the ERG. For regional assessment, the reference values of the functional indices were obtained for 17 LV segments in LPG. The Z score, (reference average value of the segment-patient's value of the segment)/reference standard deviation of the segment, was used for the evaluation of regional functions; a score equal to or greater than 2 was defined as abnormal. Semiquantitative visual interpretation of 2DE was used as the standard to assess wall motion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these criteria and the relationship between 2DE grading and Z scoring were validated in 2DEG. The values of the global EF and PER evaluated by this program correlated with those determined by ERNA (r=0.76 and 0.58, respectively; p -10 ). The potential of this program to quantify the regional systolic function was validated. (author)

  1. Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry.

    Science.gov (United States)

    Imanishi, Junichi; Kaihotsu, Kenji; Yoshikawa, Sachiko; Nishimori, Makoto; Sone, Naohiko; Honjo, Tomoyuki; Iwahashi, Masanori

    2018-02-01

    Although acute pulmonary edema (APE) is common in patients with heart failure (HF) with preserved ejection fraction (EF), its pathogenesis in patients with HF with reduced EF (HFrEF) is not completely understood. The purpose of our study was to explore the contributions of left ventricular (LV) geometry to understand the difference between HFrEF patients with or without APE. We studied 122 consecutive acute decompensated HF patients with HFrEF (≤40%). APE was defined as acute-onset dyspnea and radiographic alveolar edema requiring immediate airway intervention. LV geometry was determined from a combination of the LV mass index and relative wall thickness (RWT). Long-term unfavorable outcome events were tracked during a follow-up of a median of 21 months (interquartile range, 10-28 months), during which APE was observed in 29 patients (24%). Compared to those without APE, hospitalized patients with APE had a higher systolic blood pressure, RWT, and LVEF and lower end-diastolic dimension. Among echocardiographic variables, a multivariate logistic regression analysis identified RWT as the only independent determinant of APE (hazard ratio: 2.46, p geometry (n = 25; RWT > 0.42) had a higher incidence of APE relative to those with non-concentric geometry. Furthermore, among patients with APE, mortality was significantly higher among those with concentric geometry (log-rank, p = 0.008). Compared with non-concentric geometry, concentric geometry (increased RWT, not LV mass) was strongly associated with APE onset and a poorer outcome among APE patients. An easily obtained echocardiographic RWT index may facilitate the risk stratification of patients.

  2. Effect of Neurohormonal Blockade Drug Therapy on Outcomes and Left Ventricular Function and Structure After Left Ventricular Assist Device Implantation.

    Science.gov (United States)

    Grupper, Avishay; Zhao, Yanjun M; Sajgalik, Pavol; Joyce, Lyle D; Park, Soon J; Pereira, Naveen L; Stulak, John M; Burnett, John C; Edwards, Brooks S; Daly, Richard C; Kushwaha, Sudhir S; Schirger, John A

    2016-06-01

    Neurohormonal blockade drug therapy (NHBDT) is the cornerstone therapy in heart failure (HF) management for promoting reverse cardiac remodeling and improving outcomes. It's utility in left ventricular assist device (LVAD) supported patients remains undefined. Sixty-four patients who received continuous flow LVAD at our institution were retrospectively reviewed and divided into 2 groups: no-NHBDT group (n = 33) received LVAD support only and NHBDT group (n = 31) received concurrent NHBDT based on the clinical judgment of the attending physicians. Cardiac remodeling (echocardiographic parameters and biomarkers) and clinical outcome (functional status, HF-related hospital readmissions, and mortality) data were collected. A statistically significant increase in ejection fraction, decrease in LV end-diastolic diameter index and LV mass index, and a sustained reduction in N-terminal pro B-type natriuretic peptide (NTproBNP) were observed in the NHBDT group at 6 months after LVAD implant (p <0.05). NHBDT-treated patients experienced significantly greater improvement in New York Heart Association functional classification and 6-minute-walk distance throughout the study. The combined end point of cardiovascular death or HF hospitalization was significantly reduced in patients receiving NHBDT (p = 0.013) associated primarily with a 12.1% absolute reduction in HF-related hospitalizations (p = 0.046). In conclusion, NHBDT in LVAD-supported patients is associated with a significant reversal in adverse cardiac remodeling and a reduction in morbidity and mortality compared with LVAD support alone. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. [Echocardiographic evaluation of left ventricular morphology and function in active sportsmen].

    Science.gov (United States)

    Vujin, Bojan; Benc, Dragan; Grujić, Nikola; Srdić, Svetozar; Radisić, Biljana; Kovac, Marko

    2006-01-01

    Echocardiography is a noninvasive, reliable method for evaluation of left ventricular morphology and function. Judo and wrestling are sports characterized by intensive and high physical and isometric effort, while football is characterized by long-term physical isotonic effort. The key compensatory mechanism with both groups of sportsmen is left ventricular hypertrophy. The aim of this study is evaluate left ventricular morphology and function in a group of judo players, wrestlers and football players during competition season and their interactive comparation. 42 judo players and wrestlers and 43 football players were examined. An increase in thickness of the septum and posterior wall was established in both groups of sportsmen, but the thickness was statistically more significant in judo players. On the other hand, in football players, a statistically significant left ventricular end-diastolic volume index enlargement was found, compared to reference values and compared to end-diastolic volume index in judo players and wrestlers. High left ventricular ejection fraction was established in both groups, but it was statistically significantly higher in football players. Left ventricular mass index was statistically increased in both groups, but it was higher in judo players and wrestlers.

  4. Significance of left ventricular volume measurement after heart transplantation using radionuclide techniques

    International Nuclear Information System (INIS)

    Novitzky, D.; Cooper, D.; Boniaszczuk, J.

    1985-01-01

    Multigated equilibrium blood pool scanning using Technetium 99m labeled red blood cells was used to measure left ventricular volumes in three heterotopic and one orthotopic heart transplant recipient(s). Simultaneously, an endomyocardial biopsy was performed and the degree of acute rejection was assessed by a histological scoring system. The scores were correlated to changes in ejection fraction and heart rate. Technetium 99m scanning data were pooled according to the endomyocardial biopsy score: no rejection; mild rejection; moderate rejection, and severe rejection. In each group, the median of the left ventricular volume parameters was calculated and correlated with the endomyocardial biopsy score, using a non-parametric one-way analysis of variance. A decrease in stroke volume correlated best with the endomyocardial biopsy score during acute rejection. A decrease in end-diastolic left ventricular volumes did not correlate as well. Changes in the end-systolic left ventricular volumes were not statistically significant, but using a simple correlation between end-systolic left ventricular volumes and endomyocardial biopsy the correlation reached significance. Changes in left ventricular volumes measured by Technetium 99m scanning may be useful to confirm the presence or absence of acute rejection in patients with heart grafts

  5. Comparing impedance cardiography and echocardiography in the assessment of reduced left ventricular systolic function

    DEFF Research Database (Denmark)

    Kaszuba, Elzbieta; Scheel, Sergej; Odeberg, Håkan

    2013-01-01

    An early and accurate diagnosis of chronic heart failure is a big challenge for a general practitioner. Assessment of left ventricular function is essential for the diagnosis of heart failure and the prognosis. A gold standard for identifying left ventricular function is echocardiography. Echocar......An early and accurate diagnosis of chronic heart failure is a big challenge for a general practitioner. Assessment of left ventricular function is essential for the diagnosis of heart failure and the prognosis. A gold standard for identifying left ventricular function is echocardiography....... Echocardiography requires input from specialized care and has a limited access in Swedish primary health care. Impedance cardiography (ICG) is a noninvasive and low-cost method of examination. The survey technique is simple and ICG measurement can be performed by a general practitioner. ICG has been suggested...... for assessment of left ventricular function in patients with heart failure. We aimed to study the association between hemodynamic parameters measured by ICG and the value of ejection fraction as a determinant of reduced left ventricular systolic function in echocardiography....

  6. Pro- and anti-inflammatory cytokines in post-infarction left ventricular remodeling.

    Science.gov (United States)

    Zarrouk-Mahjoub, S; Zaghdoudi, M; Amira, Z; Chebi, H; Khabouchi, N; Finsterer, J; Mechmeche, R; Ghazouani, E

    2016-10-15

    Acute myocardial infarction (MI) leads to molecular, structural, geometric and functional changes in the heart during a process known as ventricular remodeling. Myocardial infarction is followed by an inflammatory response in which pro- and anti-inflammatory cytokines play a crucial role, particularly in left ventricular remodeling. This study aimed at evaluating serum concentrations of interleukin-8 (IL8), tumor-necrosis-factor-alpha (TNFα) and interleukin-10 (IL10), pro- and anti-inflammatory cytokines, and at correlating them with left ventricular remodeling as assessed by echocardiographic parameters. In a case-control study 30 MI patients were compared with 30 healthy controls. Serum concentrations of IL8, TNFα and IL10 were measured on day 2 and day 30 post-MI by chemiluminescence immunoassay and correlated with echocardiographic parameters. There was an increase of IL8, and TNFα together with a decrease of IL10 at both time points. IL8 was negatively correlated with the left ventricular end-diastolic diameter (LVEDD) and positively with left ventricular systolic volume. IL10 was negatively correlated with LVEDD and left atrial volume 30days post-MI. The increase of pro-inflammatory cytokines TNFα and IL8 was accompanied by decreased anti-inflammatory IL10. This imbalance between pro- and anti-inflammatory cytokines might contribute to the progression of left ventricular remodeling and may lead to heart failure. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease

    Directory of Open Access Journals (Sweden)

    Ernest W. Lau

    2017-09-01

    Full Text Available Multi-site multi-polar left ventricular pacing through the coronary sinus (CS may be preferred over endocardial right ventricular or surgical epicardial pacing in the presence of tricuspid valve disease. However, the required lead placement can be difficult through a persistent left superior vena cava (PLSVC, as the CS tends to be hugely dilated and side branches tend to have sharp angulations (>90° when approached from the PLSVC. Pre-shaped angiography catheters and techniques used for finding venous grafts from the ascending aorta post coronary bypass surgery may help with lead placement in such a situation.

  8. Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis

    Science.gov (United States)

    D'Andrea, Antonello; Caso, Pio; Salerno, Gemma; Scarafile, Raffaella; De Corato, Giuseppe; Mita, Claudia; Salvo, Giovanni Di; Severino, Sergio; Cuomo, Sergio; Liccardo, Biagio; Esposito, Nicolino; Calabrò, Raffaele

    2007-01-01

    forward multivariate analyses, the sum of the left ventricular wall thickness (β coefficient = −0.32, p<0.01), the number of weeks of AAS use per year (β = −0.42, p<0.001) and the weekly dosage of AAS (β = −0.48, p<0.001) were the only independent determinants of middle IVS strain rate. In addition, impaired left ventricular strain in users was associated with a reduced performance during physical effort (p<0.001). Conclusions Several years after chronic misuse of AAS, power athletes show a subclinical impairment of both systolic and diastolic myocardial function, strongly associated with mean dosage and duration of AAS use. The combined use of DMI and SRI may therefore be useful for the early identification of patients with more diffused cardiac involvement, and eventually for investigation of the reversibility of such myocardial effects after discontinuation of the drug. PMID:17178777

  9. Left atrial strain: a new parameter for assessment of left ventricular filling pressure.

    Science.gov (United States)

    Cameli, Matteo; Mandoli, Giulia Elena; Loiacono, Ferdinando; Dini, Frank Lloyd; Henein, Michael; Mondillo, Sergio

    2016-01-01

    In order to obtain accurate diagnosis, treatment and prognostication in many cardiac conditions, there is a need for assessment of left ventricular (LV) filling pressure. While systole depends on ejection function of LV, diastole and its disturbances influence filling function and pressures. The commonest condition that represents the latter is heart failure with preserved ejection fraction in which LV ejection is maintained, but diastole is disturbed and hence filling pressures are raised. Significant diastolic dysfunction results in raised LV end-diastolic pressure, mean left atrial (LA) pressure and pulmonary capillary wedge pressure, all referred to as LV filling pressures. Left and right heart catheterization has traditionally been used as the gold standard investigation for assessing these pressures. More recently, Doppler echocardiography has taken over such application because of its noninvasive nature and for being patient friendly. A number of indices are used to achieve accurate assessment of filling pressures including: LV pulsed-wave filling velocities (E/A ratio, E wave deceleration time), pulmonary venous flow (S wave and D wave), tissue Doppler imaging (E' wave and E/E' ratio) and LA volume index. LA longitudinal strain derived from speckle tracking echocardiography (STE) is also sensitive in estimating intracavitary pressures. It is angle-independent, thus overcomes Doppler limitations and provides highly reproducible measures of LA deformation. This review examines the application of various Doppler echocardiographic techniques in assessing LV filling pressures, in particular the emerging role of STE in assessing LA pressures in various conditions, e.g., HF, arterial hypertension and atrial fibrillation.

  10. Left ventricular hypertrophy in children, adolescents and young adults with sickle cell anemia

    Directory of Open Access Journals (Sweden)

    Gustavo Baptista de Almeida Faro

    2015-10-01

    Full Text Available OBJECTIVE: The aims of this study were to estimate the frequency of left ventricular hypertrophy and to identify variables associated with this condition in under 25-year-old patients with sickle cell anemia.METHODS: A cross-sectional study was performed of children, adolescents and young adults with sickle cell anemia submitted to a transthoracic Doppler echocardiography. The mass of the left ventricle was determined by the formula of Devereux et al. with correction for height, and the percentile curves of gender and age were applied. Individuals with rheumatic and congenital heart disease were excluded. The patients were divided into two groups according to the presence or absence of left ventricular hypertrophy and compared according to clinical, echocardiographic and laboratory variables.RESULTS: A total of 37.6% of the patients had left ventricular hypertrophy in this sample. There was no difference between the groups of patients with and without hypertrophy according to pathological history or clinical characteristics, except possibly for the use of hydroxyurea, more often used in the group without left ventricular hypertrophy. Patients with left ventricular hypertrophy presented larger left atria and lower hemoglobin and hematocrit levels, reticulocyte index and a higher albumin:creatinine ratio in urine.CONCLUSION: Left ventricular hypertrophy was observed in more than one-third of the young patients with sickle cell anemia with this finding being inversely correlated to the hemoglobin and hematocrit levels, and reticulocyte index and directly associated to a higher albumin/creatinine ratio. It is possible that hydroxyurea had had a protective effect on the development of left ventricular hypertrophy.

  11. Diclofenac Prolongs Repolarization in Ventricular Muscle with Impaired Repolarization Reserve

    Science.gov (United States)

    Kristóf, Attila; Husti, Zoltán; Koncz, István; Kohajda, Zsófia; Szél, Tamás; Juhász, Viktor; Biliczki, Péter; Jost, Norbert; Baczkó, István; Papp, Julius Gy; Varró, András; Virág, László

    2012-01-01

    Background The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti-inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. Methods Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. Results Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 µM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl2 application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 µg/kg) significantly lengthened the QTc interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QTc. Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 µM) decreased the amplitude of rapid (IKr) and slow (IKs) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (ICa) was slightly diminished, but the transient outward (Ito) and inward rectifier (IK1) potassium currents were not influenced. Conclusions Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve. PMID:23300901

  12. Applications of magnetic resonance imaging in the assessment of left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Beacock, David John

    2002-07-01

    This thesis has described the use of Magnetic Resonance Imaging (MRI) in the investigation of left ventricular dimensions and systolic function. This has been performed in conditions of left ventricular dysfunction, in congestive cardiac failure and following anterior myocardial infarction. The reproducibility of measurements of left ventricular dimensions using MRI has been presented. Such measurements were shown to be reproducible between different MRI studies of normal volunteers and patients with congestive heart failure. Furthermore, measurements from different MRI studies obtained from two commercially different systems were reproducible for the same subject groups. Ventricular dimensions and systolic function was evaluated in adult normal volunteers of different ages. Although left ventricular volumes and mass remained unchanged, detailed studies of the systolic images revealed significant differences between the two age groups. Differences in left ventricular cavity volumes and mass between patients with congestive heart failure and age-matched normal volunteers were also investigated. Left ventricular volumes and myocardial mass were assessed in a group of patients following anterior myocardial infarction. End-systolic volume was significantly increased compared to age-matched volunteers, but no changes in end-diastolic volume or myocardial mass was observed. Serial re-evaluation of these patients revealed no other changes over the subsequent six months. All these patients were treated with optimal medical therapy (thrombolysis, aspirin, beta-blockade and angiotensin converting enzyme inhibition). Thus, the use of this therapy may attenuate the process of left ventricular remodelling. Regional wall thickness was measured in the post-infarct patients. Wall thickening was significantly reduced both in the infarcted regions and in myocardium remote to the infarction. In contrast to previous echocardiographic studies, no 'hypercontractility' was

  13. [Association between biochemical markers and left ventricular dysfunction in the ST-elevation acute myocardial infarction].

    Science.gov (United States)

    de Abreu, Maximiliano; Mariani, Javier; Guridi, Cristian; González-Villa-Monte, Gabriel; Gastaldello, Natalio; Potito, Mauricio; Reyes, Graciela; Antonietti, Laura; Tajer, Carlos

    2014-01-01

    The association between biochemical markers and left ventricular ejection fraction in patients with myocardial infarction was not completely studied. Our goal is to study the association between biochemical markers and left ventricular dysfunction in patients with ST-elevation acute myocardial infarction. With an observational and prospective design we included patients with less than 24h ST-elevation myocardial infarction. Leukocytes, glucose, B-type natriuretic peptide and T troponin were measured at admission, and creatine-phosphokinase and creatine-phosphokinase-MB were measured at admission and serially, and correlated with the ejection fraction estimated by echocardiography. A total of 108 patients were included. The median left ventricular ejection fraction was 48% (interquartile range 41-57). Simple linear regression analysis showed that B-type natriuretic peptide (P=.005), peak creatine-phosphokinase-MB (P=.01), leukocyte count (P=.001) and glucose (P=.033) were inversely and significantly associated with the left ventricular ejection fraction. The other parameters showed no association. B-type natriuretic peptide (P=.01) and peak creatine-phosphokinase-MB (P=.02) were the only two variables significantly associated with the left ventricular ejection fraction in the multiple linear regression analysis. Both markers were significantly associated with a left ventricular ejection fraction < 50%, independently of other clinical variables. B-type natriuretic peptide and peak creatine-phosphokinase-MB showed significant association with left ventricular ejection fraction in the acute phase of ST elevation acute myocardial infarction. This association was independent of the presence of other biochemical markers and clinical variables related to ventricular dysfunction. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  14. Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Gimpel, Charlotte; Pohl, Martin [Medical Center - University of Freiburg, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Freiburg (Germany); Jung, Bernd A. [Inselspital Bern, Institute of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Jung, Sabine [Medical Center - University of Freiburg, Department of Nuclear Medicine, Freiburg (Germany); Brado, Johannes; Odening, Katja E. [University Heart Center Freiburg, Department of Cardiology and Angiology I, Freiburg (Germany); Schwendinger, Daniel [University Children' s Hospital Zurich, Zurich (Switzerland); Burkhardt, Barbara [University Children' s Hospital Zurich, Pediatric Heart Center, Zurich (Switzerland); Geiger, Julia [University Children' s Hospital Zurich, Department of Radiology, Zurich (Switzerland); Northwestern University, Department of Radiology, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric and Congenital Cardiology, Heidelberg (Germany)

    2017-02-15

    Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years - 20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V{sub E}), late diastolic (V{sub A}) and peak systolic (V{sub S}) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz{sub base} -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vz{sub mid} -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vz{sub apex} -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vr{sub base} -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vr{sub mid} -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vr{sub apex} -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs. (orig.)

  15. Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease

    International Nuclear Information System (INIS)

    Gimpel, Charlotte; Pohl, Martin; Jung, Bernd A.; Jung, Sabine; Brado, Johannes; Odening, Katja E.; Schwendinger, Daniel; Burkhardt, Barbara; Geiger, Julia; Arnold, Raoul

    2017-01-01

    Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. Patients and controls (age: 8 years - 20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (V E ), late diastolic (V A ) and peak systolic (V S ) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vz base -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vz mid -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vz apex -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vr base -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vr mid -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vr apex -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs. (orig.)

  16. Ethical challenges with the left ventricular assist device as a destination therapy

    Directory of Open Access Journals (Sweden)

    Rady Mohamed Y

    2008-08-01

    Full Text Available Abstract The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1 direct participation of a multidisciplinary care team, including palliative care specialists, (2 a concise plan of care for anticipated device-related complications, (3 careful surveillance and counseling for caregiver burden, (4 advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5 a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e

  17. A modified Glenn shunt reduces right ventricular stroke work during left ventricular assist device therapy.

    Science.gov (United States)

    Schiller, Petter; Vikholm, Per; Hellgren, Laila

    2016-03-01

    Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) placement and remains hard to predict. We hypothesized that partial surgical exclusion of the RV with a modified Glenn shunt during LVAD treatment would reduce RV stroke work. An LVAD was implanted in eight pigs and a modified Glenn shunt was constructed. A conductance pressure-volume catheter was placed in the right ventricle through the apex. Haemodynamic data and pressure-volume loops were obtained at the following time periods: (i) baseline, (ii) open shunt, (iii) LVAD with closed shunt and (iii) LVAD and open shunt. During LVAD therapy, the right atrial (RA) pressure increased from 9 mmHg (9-9) to 15 mmHg (12-15), P = 0.01. RV stroke volume increased from 30 ml (29-40) to 51 ml (42-53), P < 0.01. Also, RV stroke work increased to 708 mmHg ml (654-1193) from 535 mmHg ml (424-717), P = 0.04, compared with baseline. During LVAD therapy in combination with a Glenn shunt, the RA pressure decreased from 15 mmHg (12-15) to 10 mmHg (7-11) when compared with LVAD therapy only, P = 0.01. A decrease in RV stroke work from 708 mmHg ml (654-1193) to 465 mmHg ml (366-711), P = 0.04, was seen when the LVAD was combined with a shunt, not significantly different from the baseline value (535 mmHg ml). The developed pressure in the right ventricle decreased from 29 mmHg (26-32) to 21 mmHg (20-24), P < 0.01. The pressure-volume loops of the RV show a significant reduction of RV stroke work during the use of the shunt with LVAD treatment. A modified Glenn shunt reduced RV volumes, RV stroke work and RA pressure during LVAD therapy in an experimental model of heart failure in pigs. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Central and peripheral blood flow during exercise with a continuous-flow left ventricular assist device: constant versus increasing pump speed: a pilot study

    DEFF Research Database (Denmark)

    Brassard, Patrice; Jensen, Annette S; Nordsborg, Nikolai

    2011-01-01

    Background- End-stage heart failure is associated with impaired cardiac output (CO) and organ blood flow. We determined whether CO and peripheral perfusion are maintained during exercise in patients with an axial-flow left ventricular assist device (LVAD) and whether an increase in LVAD pump speed...

  19. Mechanisms of decreased left ventricular preload during continuous positive pressure ventilation in ARDS

    International Nuclear Information System (INIS)

    Dhainaut, J.F.; Devaux, J.Y.; Monsallier, J.F.; Brunet, F.; Villemant, D.; Huyghebaert, M.F.

    1986-01-01

    Continuous positive pressure ventilation is associated with a reduction in left ventricular preload and cardiac output, but the mechanisms responsible are controversial. The decrease in left ventricular preload may result exclusively from a decreased systemic venous return due to increased pleural pressure, or from an additional effect such as decreased left ventricular compliance. To determine the mechanisms responsible, we studied the changes in cardiac output induced by continuous positive pressure ventilation in eight patients with the adult respiratory distress syndrome. We measured cardiac output by thermodilution, and biventricular ejection fraction by equilibrium gated blood pool scintigraphy. Biventricular end-diastolic volumes were then calculated by dividing stroke volume by ejection fraction. As positive end-expiratory pressure increased from 0 to 20 cm H 2 O, stroke volume and biventricular end-diastolic volumes fell about 25 percent, and biventricular ejection fraction remained unchanged. At 20 cm H 2 O positive end-expiratory pressure, volume expansion for normalizing cardiac output restored biventricular end-diastolic volumes without markedly changing biventricular end-diastolic transmural pressures. The primary cause of the reduction in left ventricular preload with continuous positive pressure ventilation appears to be a fall in venous return and hence in right ventricular stroke volume, without evidence of change in left ventricular diastolic compliance

  20. Association between circulating fibroblast growth factor 23, α-Klotho, and the left ventricular ejection fraction and left ventricular mass in cardiology inpatients.

    Directory of Open Access Journals (Sweden)

    Kensaku Shibata

    Full Text Available BACKGROUND: Fibroblast growth factor 23 (FGF23, with its co-receptor Klotho, plays a crucial role in phosphate metabolism. Several recent studies suggested that circulating FGF23 and α-Klotho concentrations might be related to cardiovascular abnormalities in patients with advanced renal failure. PURPOSE: Using data from 100 cardiology inpatients who were not undergoing chronic hemodialysis, the association of circulating levels of FGF23, α-Klotho, and other calcium-phosphate metabolism-related parameters with the left ventricular ejection fraction (LVEF and left ventricular mass (LVM was analyzed. METHODS AND RESULTS: LVEF was measured using the modified Simpson method for apical 4-chamber LV images and the LVM index (LVMI was calculated by dividing the LVM by body surface area. Univariate analysis showed that log transformed FGF23, but not that of α-Klotho, was significantly associated with LVEF and LVMI with a standardized beta of -0.35 (P<0.001 and 0.26 (P<0.05, respectively. After adjusting for age, sex, estimated glomerular filtration rate, and serum concentrations of intact parathyroid hormone, and 25-hydroxyvitamin D as covariates into the statistical model, log-transformed FGF23 was found to be a statistically positive predictor for decreased left ventricular function and left ventricular hypertrophy. CONCLUSIONS: In cardiology department inpatients, circulating FGF23 concentrations were found to be associated with the left ventricular mass and LVEF independent of renal function and other calcium-phosphate metabolism-related parameters. Whether modulation of circulating FGF23 levels would improve cardiac outcome in such a high risk population awaits further investigation.

  1. Comparison of exercise capacity with resting left ventricular function evaluated by various non-invasive methods in patients with old myocardial infarction

    International Nuclear Information System (INIS)

    Yamabe, Hiroshi; Kobayashi, Katsuya; Tajiri, Eiichi; Hayakawa, Masanori; Minamiji, Katsumi

    1982-01-01

    The relationship between exercise capacity and resting left ventricular function assessed by several non-invasive methods in patients with old myocardial infarction was investigated. Subjects were 25 male patients whose endpoint was either dyspnea or general fatigue at the symptom-limited maximal graded treadmill exercise test according to Bruce protocol. The indices obtained by non-invasive cardiac examinations included left ventricular fractional shortening (% FS), scintigraphic infact size (% SIS) by 201 Tl myocardial scintigraphy and PEP/ET. A significant correlation of exercise duration with % FS (r = 0.67, p < 0.001) or with % SIS (r = -0.55, p < 0.02) indicated that the more impaired resting left ventricular function, the more was decreased exercise capacity. Also, a significant correlation of systolic blood pressure at the endpoint in exercise test with % FS (r = 0.58, p < 0.005) or with % SIS (r = 0.69, p < 0.001) indicated that inadequate blood pressure response might be partially attributed to impaired left ventricular function during exercise. The response of heart rate at the Bruce protocol stage I correlated with % FS (r = -0.67, p < 0.001) and with % SIS (r = 0.53, p < 0.02), respectively. These findings may be interpreted as chronotropic compensatory mechanism for limited stroke volume during exercise in patients with impaired left ventricular function. Thus, it was concluded that resting left ventricular function assessed by non-invasive cardiac examinations may predict exercise capacity prior to the test to some extent. These informations can be utilized for the decision of the planning at cardiac rehabilitation and also for the guidance in daily activities. (J.P.N.)

  2. Epicardial radiofrequency ablation for left ventricular aneurysm related ventricular arrhythmias during off-pump coronary artery bypass surgery.

    Science.gov (United States)

    Yu, Yang; Gao, Ming-Xin; Li, Hai-Tao; Zhang, Fan; Gu, Cheng-Xiong

    2012-11-01

    Left ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB). From June 2009 to April 2011, 31 patients with LVA had angina symptoms and ventricular arrhythmia. In all patients, circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms, followed by a linear placation of ventricular aneurysms on beating heart. All the patients showed complete recovery. The average number of grafted vessels was 2.7 ± 1.3. Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation. All cases had been followed up for one year. Holter monitoring revealed a significant reduction in ventricular arrhythmias (P aneurysm and preoperative malignant arrhythmia, aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique. However, medium- to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.

  3. Clinical sustained uniform ventricular tachycardia in hypertrophic cardiomyopathy: association with left ventricular apical aneurysm.

    OpenAIRE

    Alfonso, F; Frenneaux, M P; McKenna, W J

    1989-01-01

    Of 51 patients with hypertrophic cardiomyopathy who had episodes of ventricular tachycardia detected during ambulatory electrocardiographic monitoring only two had clinical sustained uniform ventricular tachycardia that required medical treatment because of worsening symptoms. In both patients the arrhythmia was associated with the uncommon finding of an apical aneurysm with angiographically normal coronary arteries.

  4. Baroreflex failure increases the risk of pulmonary edema in conscious rats with normal left ventricular function.

    Science.gov (United States)

    Sakamoto, Kazuo; Hosokawa, Kazuya; Saku, Keita; Sakamoto, Takafumi; Tobushi, Tomoyuki; Oga, Yasuhiro; Kishi, Takuya; Ide, Tomomi; Sunagawa, Kenji

    2016-01-15

    In heart failure with preserved ejection fraction (HFpEF), the complex pathogenesis hinders development of effective therapies. Since HFpEF and arteriosclerosis share common risk factors, it is conceivable that stiffened arterial wall in HFpEF impairs baroreflex function. Previous investigations have indicated that the baroreflex regulates intravascular stressed volume and arterial resistance in addition to cardiac contractility and heart rate. We hypothesized that baroreflex dysfunction impairs regulation of left atrial pressure (LAP) and increases the risk of pulmonary edema in freely moving rats. In 15-wk Sprague-Dawley male rats, we conducted sinoaortic denervation (SAD, n = 6) or sham surgery (Sham, n = 9), and telemetrically monitored ambulatory arterial pressure (AP) and LAP. We compared the mean and SD (lability) of AP and LAP between SAD and Sham under normal-salt diet (NS) or high-salt diet (HS). SAD did not increase mean AP but significantly increased AP lability under both NS (P = 0.001) and HS (P = 0.001). SAD did not change mean LAP but significantly increased LAP lability under both NS (SAD: 2.57 ± 0.43 vs. Sham: 1.73 ± 0.30 mmHg, P = 0.01) and HS (4.13 ± 1.18 vs. 2.45 ± 0.33 mmHg, P = 0.02). SAD markedly increased the frequency of high LAP, and SAD with HS prolonged the duration of LAP > 18 mmHg by nearly 20-fold compared with Sham (SAD + HS: 2,831 ± 2,366 vs. Sham + HS: 148 ± 248 s, P = 0.01). We conclude that baroreflex failure impairs volume tolerance and together with salt loading increases the risk of pulmonary edema even in the absence of left ventricular dysfunction. Baroreflex failure may contribute in part to the pathogenesis of HFpEF. Copyright © 2016 the American Physiological Society.

  5. Impact of technique of left ventricular aneurysm repair on clinical outcomes: current best available evidence.

    Science.gov (United States)

    Raja, Shahzad G; Salehi, Salim; Bahrami, Toufan T

    2009-01-01

    Postinfarction left ventricular aneurysm is a serious disorder that can lead to congestive heart failure, lethal ventricular arrhythmia, and premature death. Surgical treatment is indicated in established cases of congestive heart failure, angina pectoris, malignant ventricular arrhythmia, or recurrent embolization from the left ventricle. The goal of surgical intervention is to correct the size and geometry of the left ventricle, reduce wall tension and paradoxical movement, and improve systolic function. Surgical techniques for repair of left ventricular aneurysm have evolved over the last five decades. Aneurysmectomy and linear repair of the left ventricle was introduced by Cooley and colleagues in 1958 and remained the standard procedure until the late 1980s. Endoventricular patch plasty (EVPP) was then introduced as a more physiologic repair than the linear closure technique, especially when the aneurysm extends into the septum. However, there is still controversy whether EVPP is superior to simple linear resection in terms of impact on early and late clinical outcomes. In the current era of evidence-based medicine, the best strategy to resolve a controversy is through the explicit and conscientious assessment of current best evidence. This review article attempts to evaluate the current best available evidence on the impact of technique of left ventricular aneurysm repair on postoperative clinical outcomes.

  6. Regional ejection fraction: a quantitative radionuclide index of regional left ventricular performance

    International Nuclear Information System (INIS)

    Maddox, D.E.; Wynne, J.; Uren, R.; Parker, J.A.; Idoine, J.; Siegel, L.C.; Neill, J.M.; Cohn, P.F.; Holman, B.L.

    1979-01-01

    Left ventricular regional ejection fractions were derived from background-corrected, time-activity curves in 43 patients assessed by both gated equilibrium radionuclide angiocardiography and left ventricular contrast angiography. From a single, modified left anterior oblique projection, the regional change in background corrected counts was determined in each of three anatomic regions. The normal range for regional radionuclide ejection fraction was determined in 10 patients with normal contrast ventriculograms and without obstructive coronary artery disease at coronary arteriography. Regional ejection fraction was compared with percent segmental axis shortening and extent of akinetic segments in corresponding regions of the contrast ventriculogram. Radionuclide and roentgenographic methods were in agreement as to the presence or absence of abnormal wall motion in 83 of 99 left ventricular regions (84%) in 33 patients evaluated prospectively. Comparison of regional ejection fraction demonstrated significant differences between regions with roentgenographically determined normokinesis hypokinesis, and akinesis. We conclude that the left ventricular regional ejection fraction provides a reliable quantitative assessment of regional left ventricular performance

  7. Effects of isometric handgrip and dynamic exercise on left-ventricular function

    International Nuclear Information System (INIS)

    Peter, C.A.; Jones, R.H.

    1980-01-01

    Radionuclide angiocardiography was used to assess cardiac function during isometric handgrip and bicycle exercise in ten normal volunteers and in 20 patients with documented coronary artery disease. Handgrip stress evoked a small increase in cardiac output that resulted from a concomitant increase i heart rate and no change in left-left-ventricular function. The most reliable criterion for diagnosis of coronary artery disease by handgrip was development of a new wall-motion abnormality. However, abnormal wall motion was observed in only 45% of patients with coronary artery disease and in one of the ten normal subjects. In normal subjects, left ventricular function during bicycle exercise was characterized by an increase in left-ventricular ejection fraction with little change in cardiac volumes. The failure to increase left-ventricular ejection fraction by at least 0.05 identified 19 of 20 patients with coronary artery disease with no false positives. Therefore, bicycle exercise evokes a more dramatic cardiovascular response than handgrip stress and is the preferable stress modality for inducing abnormalities of left-ventricular function for detection of coronary artery disease

  8. Reversible microvascular dysfunction coupled with persistent myocardial dysfunction: implications for post‐infarct left ventricular remodelling

    Science.gov (United States)

    Galiuto, Leonarda; Gabrielli, Francesca A; Lombardo, Antonella; Torre, Giuseppe La; Scarà, Antonio; Rebuzzi, Antonio G; Crea, Filippo

    2007-01-01

    Background Recent studies have shown that microvascular dysfunction after myocardial infarction is a dynamic phenomenon. Aims To evaluate the implications of dynamic changes in microvascular dysfunction on contractile recovery and left ventricular remodelling, and to identify the ideal timing of assessment of such microvascular dysfunction. Methods and results In 39 patients with a first myocardial infarction who underwent successful percutaneous coronary intervention, microvascular dysfunction was studied by myocardial contrast echocardiography (MCE) at 24 h, 1 week and 3 months after the procedure. Real‐time MCE was performed by contrast pulse sequencing and intravenous Sonovue. 14 patients exhibited left ventricular remodelling at 3 months (>20% increase in left ventricular end‐diastolic volume, group B), whereas 25 did not (group A). Microvascular dysfunction was similar in the two groups at 24 h and improved in group A only, being significantly better than that of group B at 1 week (p<0.05) and 3 months (p<0.005). Improvement in microvascular dysfunction was not associated with improvement in wall motion in the same segments. With multivariate analysis including all echocardiographic variables, microvascular dysfunction at 1 week was found to be the only independent predictor of left ventricular remodelling (p<0.01). With a cut‐off value of 1.4, 1‐week microvascular dysfunction predicts left ventricular remodelling with sensitivity and specificity of 73%. Conclusions Improvement in microvascular dysfunction occurs early after myocardial infarction, although it is not associated with a parallel improvement in wall motion but is beneficial in preventing left ventricular remodelling. Accordingly, 1‐week microvascular dysfunction is a powerful and independent predictor of left ventricular remodelling. PMID:16980514

  9. Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

    International Nuclear Information System (INIS)

    Baptista, Ana; Magalhães, Pedro; Leão, Sílvia; Carvalho, Sofia; Mateus, Pedro; Moreira, Ilídio

    2015-01-01

    Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy. To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy. The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m 2 for women or ≥ 116 g/m 2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased. A total of 47 patients with a mean left ventricular mass index of 141.1 g/m 2 (± 28.5; 99.2 to 228.5 g/m 2 ] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation. In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5)

  10. Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

    Energy Technology Data Exchange (ETDEWEB)

    Baptista, Ana, E-mail: baptista-ana@hotmail.com; Magalhães, Pedro; Leão, Sílvia; Carvalho, Sofia; Mateus, Pedro; Moreira, Ilídio [Centro Hospitalar de Trás-os-Montes e Alto Douro, Unidade de Vila Real (Portugal)

    2015-08-15

    Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy. To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy. The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m{sup 2} for women or ≥ 116 g/m{sup 2} for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased. A total of 47 patients with a mean left ventricular mass index of 141.1 g/m{sup 2} (± 28.5; 99.2 to 228.5 g/m{sup 2}] were included. Most of the patients were females (51.1%). Nine (19.1%) showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5), a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation. In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5)

  11. Screening for Fabry Disease in Left Ventricular Hypertrophy: Documentation of a Novel Mutation

    Directory of Open Access Journals (Sweden)

    Ana Baptista

    2015-01-01

    Full Text Available Abstract Background: Fabry disease is a lysosomal storage disease caused by enzyme α-galactosidase A deficiency as a result of mutations in the GLA gene. Cardiac involvement is characterized by progressive left ventricular hypertrophy. Objective: To estimate the prevalence of Fabry disease in a population with left ventricular hypertrophy. Methods: The patients were assessed for the presence of left ventricular hypertrophy defined as a left ventricular mass index ≥ 96 g/m2 for women or ≥ 116 g/m2 for men. Severe aortic stenosis and arterial hypertension with mild left ventricular hypertrophy were exclusion criteria. All patients included were assessed for enzyme α-galactosidase A activity using dry spot testing. Genetic study was performed whenever the enzyme activity was decreased. Results: A total of 47 patients with a mean left ventricular mass index of 141.1 g/m2 (± 28.5; 99.2 to 228.5 g/m2] were included. Most of the patients were females (51.1%. Nine (19.1% showed decreased α-galactosidase A activity, but only one positive genetic test − [GLA] c.785G>T; p.W262L (exon 5, a mutation not previously described in the literature. This clinical investigation was able to establish the association between the mutation and the clinical presentation. Conclusion: In a population of patients with left ventricular hypertrophy, we documented a Fabry disease prevalence of 2.1%. This novel case was defined in the sequence of a mutation of unknown meaning in the GLA gene with further pathogenicity study. Thus, this study permitted the definition of a novel causal mutation for Fabry disease - [GLA] c.785G>T; p.W262L (exon 5.

  12. Left ventricular dysfunction in normotensive type II diabetic patients in Port Harcourt, Nigeria.

    Science.gov (United States)

    Dodiyi-Manuel, Sotonye T; Akpa, Maclean R; Odia, Osaretin J

    2013-01-01

    Diabetes mellitus (DM) is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic) may exist for some time. The aim of the study was to determine the prevalence of left ventricular dysfunction in non-hypertensive type II DM patients. A cross sectional study of left ventricular function in 90 normotensive type II diabetes mellitus patients using echocardiography was carried out. Healthy normotensive controls matched for age, sex, and body mass index were selected for comparison. Patients and controls who had hypertension (blood pressure of >140/90 mmHg), history of smoking, significant alcohol history, pregnancy, features of thyroid disease, or valvular heart disease were excluded. Left ventricular diastolic and systolic functions were assessed. Ninety patients, (39 males and 51 females) and 90 healthy controls (39 males and 51 females) were enrolled. Mean age of patients was 50.76 ± 9.13 years and 51.33 ± 7.84 years for controls. Mean body mass index was 26.88 ± 4.73 kg/m² in patients and 27.09 ± 4.04 kg/m² in controls. Mean ejection fraction was 62.4% ± 8.47% and 68.52% ± 7.94% in patients and controls, respectively (P 99 kg/m² in females and >115 kg/m² in males was considered abnormal. The left ventricular mass index was also higher in patients than in controls (95.17 ± 25.67 g/m² versus 85.40 ± 18.0 g/m²; P = 0.004). Normotensive diabetic patients have a high prevalence of left ventricular dysfunction even in the absence of cardiac symptoms.

  13. Angiographic determination of the left-ventricular myocardial volume with the help of digital image processing

    International Nuclear Information System (INIS)

    Radtke, W.

    1981-01-01

    In this paper, digital image processing could for the first time be introduced as a new method to screen the myocardium in the left-ventricular angiocardiography. The method makes a reliable quantitative determination of the muscle mass of the left ventricle possible. (orig./MG) [de

  14. Zoniporide preserves left ventricular compliance during ventricular fibrillation and minimizes postresuscitation myocardial dysfunction through benefits on energy metabolism.

    Science.gov (United States)

    Ayoub, Iyad M; Kolarova, Julieta D; Kantola, Ronald L; Radhakrishnan, Jeejabai; Wang, Sufen; Gazmuri, Raúl J

    2007-10-01

    To investigate whether sodium-hydrogen exchanger isoform-1 (NHE-1) inhibition attenuates myocardial injury during resuscitation from ventricular fibrillation through effects on energy metabolism, using an open-chest pig model in which coronary perfusion was controlled by extracorporeal circulation. Randomized controlled animal study. University research laboratory. Male domestic pigs. Ventricular fibrillation was electrically induced and left untreated for 8 mins, after which extracorporeal circulation was started and its flow adjusted to maintain a coronary perfusion pressure of 10 mm Hg. After 10 mins of extracorporeal circulation, restoration of spontaneous circulation was attempted by epicardial defibrillation and gradual reduction in extracorporeal flow. Two groups of eight pigs each were randomized to receive the NHE-1 inhibitor zoniporide (3 mg.kg-1) or vehicle control immediately before starting extracorporeal circulation. Identical extracorporeal flows (approximately = 9% of baseline cardiac index) were required in zoniporide and control groups to attain the target coronary perfusion pressure, resulting in comparable left anterior descending coronary artery blood flow (9 +/- 1 and 10 +/- 1 mL.min-1) and resistance (0.10 +/- 0.01 and 0.10 +/- 0.01 dyne.sec.cm(-5)). Yet zoniporide prevented reductions in left ventricular volume and wall thickening while favoring higher myocardial creatine phosphate to creatine ratios (0.14 +/- 0.03 vs. 0.06 +/- 0.01, p zoniporide-treated pigs had higher left ventricular ejection fraction (0.57 +/- 0.07 vs. 0.29 +/- 0.05, p Zoniporide ameliorated myocardial injury during resuscitation from ventricular fibrillation through beneficial effects on energy metabolism without effects on coronary vascular resistance and coronary blood flow. (C) 2007 Lippincott Williams & Wilkins, Inc.

  15. [Results of plasty of postinfarction left ventricular aneurysm performed on the working heart].

    Science.gov (United States)

    Tarasov, D G; Chernov, I I; Gordeev, M L; Pavlov, A V

    2013-01-01

    The results of plasty (124 patients) of postinfarction left ventricular aneurysm performed on the working heart are presented in this article. It is shown, that the upgrade of existing surgical techniques, which are directed to the creation of the optimal left ventricle shape, could improve the clinical results after plasty of postinfarction left ventricular aneurysm. It's important to arrange the conditions, which allow avoiding a negative influence on contractility function of the myocardium. The desired conditions could be obtained, if the plasty is performed on the working or fibrillating heart provided that the patient has a consistent aortic valve.

  16. Surgical repair of subacute left ventricular free wall rupture

    NARCIS (Netherlands)

    Zeebregts, CJ; Noyez, L; Hensens, AG; Skotnicki, SH; Lacquet, LK

    1997-01-01

    Background: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis,

  17. Assessment of left ventricular diastolic function in bronchial asthma ...

    African Journals Online (AJOL)

    Ehab

    a relevance of oral β2-AG to acute cardiac death8,9,10 and heart failure11,12. Children with acute severe asthma may develop ECG changes compatible with myocardial ischemia on continuous inhalation of fenoterol13, and the ... ventricular diastolic function, transmitral inflow velocity; echocardiography, children. Ola Abd ...

  18. Effect of Hemodialysis on Left and Right Ventricular Volume and Function

    International Nuclear Information System (INIS)

    Han, Jin Suk; Koh, Chang Soon

    1985-01-01

    With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

  19. Pulmonary Hypertension Due to Left Ventricular Cardiomyopathy: Is it the Result or Cause of Disease Progression?

    Science.gov (United States)

    Adusumalli, Srinath; Mazurek, Jeremy A

    2017-12-01

    The purpose of this review is to define pulmonary hypertension in the setting of left heart disease (PH-LHD), discuss its epidemiology and pathophysiology, and highlight the cause and effect relationship it has with disease progression in the setting of cardiomyopathy. Both pulmonary hypertension (PH) and heart failure are becoming increasingly common. As such, PH-LHD is now the most common form of PH. The pathophysiology of the condition relates to backward transmission of elevated left ventricular filling pressures into the pulmonary circulation and, ultimately, right ventricular (RV) strain/dysfunction. It is evident that these pathophysiologic processes are both the effect and cause of left heart disease progression. In this review, we describe the complex relationship between disease progression in left ventricular cardiomyopathy and PH-LHD. Clinicians and researchers should take note of the importance of PH-LHD and RV dysfunction to appropriately risk stratify patients and develop therapies for the condition.

  20. Diastolic And Systolic Right Ventricular Dysfunction Precedes Left Ventricular Dysfunction In Patients Paced From Right Ventricular Apex

    Directory of Open Access Journals (Sweden)

    Dwivedi SK

    2006-07-01

    Full Text Available Background: Cardiac dysfunction after right ventricular (RV apical pacing is well known but its extent, time frame of appearance and individual effect on left ventricular (LV, RV systolic and diastolic parameters has not evaluated in a systematic fashion. Methods: Patients with symptomatic bradycardia and ACC-AHA Class I indication for permanent pacemaker implantation (PPI were implanted a single chamber (VVI pacemaker. They were followed prospectively by echocardiographic examination which was done at baseline, 1 week, 1 month and 6 months after implantation. Parameters observed were chamber dimensions (M-line, chamber volumes, cardiac output (modified Simpson's method, systolic functions (ejection fraction, pre-ejection period, ejection time and ratio and diastolic functions( isovolumic relaxation time & deceleration time of left and right heart. Results: Forty eight consecutive patients (mean age 65.6±11.8 yrs, 66.7% males, mean EF 61.82±10.36% implanted a VVI pacemaker were enrolled in this study. The first significant change to appear in cardiac function after VVI pacing was in diastolic properties of RV as shown by increase in RV isovolumic relaxation time (IVRT from 65.89±15.93 to 76.58±17.00 ms,(p<0.001 at 1week and RV deceleration time (DT from 133.84±38.13 to 153.09±31.41 ms, (p=0.02 at 1 month. Increase in RV internal dimension (RVID from 1.26±0.41 to 1.44±0.44, (p<0.05 was also noticed at 1 week. The LV diastolic parameters were significantly altered after 1 month with increase in LV-IVRT from 92.36±21.47 to 117.24±27.21ms, (p<0.001 and increase in LV DT from 147.56±31.84 to 189.27±28.49ms,(p<0.01. This was followed by LV systolic abnormality which appeared at 6 months with an increase in LVPEP from 100.33±14.43 to 118.41±21.34ms, (p<0.001 and increase in LVPEP/LVET ratio from 0.34±0.46 to 0.44±0.10, (p<0.001]. The reduction in LV EF was manifested at 6 months falling from 61.82±10.36% to52.52±12.11%, (p<0

  1. Three dimensional endo-cardiovascular volume-rendered cine computed tomography of isolated left ventricular apical hypoplasia; A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Sun Hwa; Kim, Yang Min; Lee, Hyun Jong [Sejong General Hospital, Bucheon (Korea, Republic of)

    2016-02-15

    We report multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR) findings of a 34-year-old female with isolated left ventricular apical hypoplasia. The MDCT and CMR scans displayed a spherical left ventricle (LV) with extensive fatty infiltration within the myocardium at the apex, interventricular septum and inferior wall, anteroapical origin of the papillary muscle, right ventricle wrapping around the deficient LV apex, and impaired systolic function. MDCT visualized morphologic and also functional findings of this unique cardiomyopathy.

  2. Significance of force transfer in mitral valve-left ventricular interaction: in vivo assessment.

    Science.gov (United States)

    Askov, Jesper B; Honge, Jesper L; Jensen, Morten O; Nygaard, Hans; Hasenkam, J Michael; Nielsen, Sten L

    2013-06-01

    The objective of this study was to assess the combined force transfer from the papillary muscle tips to the mitral valve through the chordae tendineae in vivo, and thereby quantify the force transmitted through the papillary-chordal complex to augment left ventricular ejection. In an acute porcine model (n = 8), force transfer between papillary muscles and the mitral valve was recorded on the anterior and posterior papillary muscle tip using dedicated force transducers. Ultrasound sonomicrometry was utilized to record and calculate left ventricular long-axis shortening and mitral annular geometry. The closing force acting on the mitral valve leaflets was calculated as mitral annular area multiplied by the transmitral pressure difference throughout systole. Mitral valve competence was verified before measurements with color Doppler ultrasound. Peak force in the anterior and posterior papillary muscle was 5.9 ± 0.6 N and 5.8 ± 0.7 N (mean ± standard error of the mean), respectively, and peak closing force was 6.8 ± 0.3 N all at a transmitral pressure of 90 mm Hg. Peak rate of left ventricular contraction coincided with peak papillary muscle force. This study is the first to assess the magnitude and time course of the longitudinal force transmitted through the papillary-chordal complex to the left ventricular wall during ejection. The study also demonstrates a significant force transfer to the closing force acting on the mitral valve leaflets that constitutes an essential component of valvular-ventricular interaction to enhance left ventricular systolic pump performance. The magnitude of the combined papillary muscle force component emphasizes the crucial role of preserving mitral valve-left ventricular continuity in mitral valve surgery. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. Clinical value of regression of electrocardiographic left ventricular hypertrophy after aortic valve replacement.

    Science.gov (United States)

    Yamabe, Sayuri; Dohi, Yoshihiro; Higashi, Akifumi; Kinoshita, Hiroki; Sada, Yoshiharu; Hidaka, Takayuki; Kurisu, Satoshi; Shiode, Nobuo; Kihara, Yasuki

    2016-09-01

    Electrocardiographic left ventricular hypertrophy (ECG-LVH) gradually regressed after aortic valve replacement (AVR) in patients with severe aortic stenosis. Sokolow-Lyon voltage (SV1 + RV5/6) is possibly the most widely used criterion for ECG-LVH. The aim of this study was to determine whether decrease in Sokolow-Lyon voltage reflects left ventricular reverse remodeling detected by echocardiography after AVR. Of 129 consecutive patients who underwent AVR for severe aortic stenosis, 38 patients with preoperative ECG-LVH, defined by SV1 + RV5/6 of ≥3.5 mV, were enrolled in this study. Electrocardiography and echocardiography were performed preoperatively and 1 year postoperatively. The patients were divided into ECG-LVH regression group (n = 19) and non-regression group (n = 19) according to the median value of the absolute regression in SV1 + RV5/6. Multivariate logistic regression analysis was performed to assess determinants of ECG-LVH regression among echocardiographic indices. ECG-LVH regression group showed significantly greater decrease in left ventricular mass index and left ventricular dimensions than Non-regression group. ECG-LVH regression was independently determined by decrease in the left ventricular mass index [odds ratio (OR) 1.28, 95 % confidence interval (CI) 1.03-1.69, p = 0.048], left ventricular end-diastolic dimension (OR 1.18, 95 % CI 1.03-1.41, p = 0.014), and left ventricular end-systolic dimension (OR 1.24, 95 % CI 1.06-1.52, p = 0.0047). ECG-LVH regression could be a marker of the effect of AVR on both reducing the left ventricular mass index and left ventricular dimensions. The effect of AVR on reverse remodeling can be estimated, at least in part, by regression of ECG-LVH.

  4. Left ventricular torsion and circumferential strain responses to exercise in patients with ischemic coronary artery disease.

    Science.gov (United States)

    Peteiro, Jesus; Bouzas-Mosquera, Alberto; Broullon, Javier; Sanchez-Fernandez, Gabriel; Barbeito, Cayetana; Perez-Cebey, Lucia; Martinez, Dolores; Vazquez-Rodriguez, Jose M

    2017-01-01

    LV torsion during exercise in patients with coronary artery disease (CAD) is not well known. Circumferential strain (CS) and left ventricular (LV) torsion (Tor) have not been evaluated during ischemia in these patients. We aimed to assess the effect of ischemia during exercise echocardiography (ExE) on CS and Tor. We studied a group of 73 patients with true positive ExE results (Ischemic group: ischemia plus an abnormal coronary angiogram) and a matched control group of 66 patients with negative ExE and either normal coronary angiography or low post-test probability of CAD. Basal rotation (Rot) and apical rotation and basal and apical CS were studied by speckle tracking at rest and exercise. Apical CS and apical and basal Rot values were similar between groups at rest, except basal CS which was already worse in the ischemic group. At exercise, all rotational and CS parameters were impaired in the ischemic in comparison with the control group (basal CS: -18 ± 5 vs. -25 ± 7 %, p exercise-induced ischemia. LV-Tor decreases with ischemia due to worsening of basal rotation, whereas apical rotation does not impair, suggesting the existence of an apical compensatory mechanism.

  5. An Endomyocardial Biopsy of the Left Ventricle in an Anorexia Nervosa Patient with Sinus Bradycardia and Left Ventricular Systolic Dysfunction

    Directory of Open Access Journals (Sweden)

    Satoshi Takahashi

    2016-01-01

    Full Text Available Anorexia nervosa (AN is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. AN is a life-threatening condition that significantly increases the risk of death due to cardiac complications, such that at least one-third of all deaths in patients with AN are associated with cardiac causes including sudden death. In many reports, sudden death has been linked to reduced left ventricular function, structural changes, and QT abnormalities. However, the mechanistic details connecting AN to cardiac abnormalities remain unknown. Here we present an endomyocardial biopsy of the left ventricle in a case of AN with a reversible left ventricular systolic dysfunction.

  6. Effect of training on left ventricular structure and functioning of the normotensive and the hypertensive subject.

    Science.gov (United States)

    Fagard

    1997-10-01

    OBJECTIVE: To review the literature on the effects of training on left ventricular structure and functioning of the normotensive and the hypertensive subject. METHOD AND RESULTS: Meta-analytical techniques were applied to selected echocardiographic reports on the effects of exercise training on the heart of normotensive subjects. The combined analysis of studies revealed that the hearts of competitive athletes may differ from those of nonathletes. Long-distance runners develop predominantly eccentric left ventricular hypertrophy, strength athletes predominantly concentric hypertrophy and cyclists a mixed type of hypertrophy. Relative to their respective controls, left ventricular mass was larger by 64% (P athletes. There were no differences in left ventricular systolic and diastolic function at rest. The meta-analyses of longitudinal studies in which athletes or nonathletes were assessed in active and inactive periods showed that physical training per se can affect cardiac structure. The few reports concerning hypertensive patients suggest that dynamic physical training seems to reduce rather than increase left ventricular mass, in which effect the reduction in blood pressure might play a part. CONCLUSION: Cross-sectional and longitudinal studies indicate that physical training may increase heart size in the normotensive subject. In contrast, heart size in the hypertensive patient may decrease in response to dynamic training.

  7. Population-specific left ventricular hypertrophy in three groups from the northeastern region of India.

    Science.gov (United States)

    Borah, P K; Hazarika, N C; Biswas, D; Kalita, H C; Mahanta, J

    2010-01-01

    People living in the hills are continuously exposed to strenuous physical activity for their day-to-day work. Besides hypertension, left ventricular hypertrophy in different populations may be related to continuous physical activity. Electrocardiogram, blood pressure and sociodemographic information of 12 252 subjects > or = 30 years of age from three different population groups living in Mizoram (hilly) and Assam (plain) were recorded. Of them, 8058 were from Mizoram and 3180 and 1014 were Indigenous Assamese and tea garden workers of Assam. Among the subjects from Mizoram the percentage of smokers (41.9%), mean (SD) BMI (21.9 [3.8]) and waist-hip ratio (0.87 [0.02]) were significantly higher than in those from other groups. Tea garden workers had a higher mean systolic blood pressure (145.2 [25.7]) and diastolic blood pressure (87.6 [13.6]). The prevalence of left ventricular hypertrophy was highest among tea garden workers (16.5%) followed by people from Mizoram (3.7%) and the indigenous Assamese (2%) people. In spite of a significantly higher prevalence of hypertension among the indigenous Assamese community than among those from Mizoram, left ventricular hypertrophy was found to be lower in the former. High prevalence of left ventricular hypertrophy among tea garden workers was possibly related to a higher prevalence of hypertension but the higher prevalence of left ventricular hypertrophy among people from Mizoram might be related to more physical activity.

  8. Circulating levels of perfluoroalkyl substances and left ventricular geometry of the heart in the elderly.

    Science.gov (United States)

    Mobacke, Ingrid; Lind, Lars; Dunder, Linda; Salihovic, Samira; Lind, P Monica

    2018-04-02

    Some persistent organic pollutants (POPs) such as hexachlorobenzene (HCB) and some polychlorinated biphenyls (PCBs) have been shown to interfere with myocardial function and geometry. We therefore investigated if also another group of POPs: per- and polyfluoroalkyl substances (PFASs) were associated with alterations in left ventricular geometry. 801 subjects aged 70 years were investigated in a cross-sectional study within the scope of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Eight PFASs were detected in >75% of participants´ plasma by ultra-performance liquid chromatograph/tandem mass spectrometry. Left ventricular geometry was determined by echocardiography. Multivariable linear regression was used to investigate the associations between PFASs and left ventricular geometry of the heart after exclusion of subjects with previous myocardial infarction (n = 72). When adjusting for multiple comparisons, none of the eight PFASs evaluated were significantly related to left ventricular mass. However, perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA) were related to relative wall thickness (RWT) in a negative fashion (p geometry: a reduction in relative wall thickness and an increase in left ventricular diameter following adjustment for traditional cardiovascular risk factors, suggesting a role for PFASs in cardiac remodeling. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Detection of active left ventricular thrombosis during acute myocardial infarction using indium-111 platelet scintigraphy

    International Nuclear Information System (INIS)

    Ezekowitz, M.D.; Kellerman, D.J.; Smith, E.O.; Streitz, T.M.

    1984-01-01

    Platelet scintigraphy with radioactive indium-111 may be used both to identify and to reflect the activity of thrombin in vivo in man. Forty-one patients with acute myocardial infarction were studied for active left ventricular thrombosis by platelet scintigraphy and followed until in-hospital death, discharge, or same-admission cardiac surgery for evidence of systemic embolization. Group 1 (n . 29) had transmural myocardial infarctions, of which 21 were anterior and eight were inferior. Group 2 (n . 12) had subendocardial myocardial infarctions. Those with subendocardial and transmural inferior myocardial infarctions had neither left ventricular thrombosis nor emboli. Ten (48 percent) of 21 with anterior transmural myocardial infarctions had left ventricular thrombosis by platelet scintigraphy. Three with and one without such thrombosis by scintigraphy had acute neurologic episodes. In the group with anterior myocardial infarctions, seven of ten patients with and four of 11 without left ventricular thrombosis received heparin subcutaneously. We conclude that platelet scintigraphy may be used to monitor antiplatelet and anticoagulant therapy in patients with anterior transmural myocardial infarctions who are at risk for left ventricular thrombosis and systemic embolization

  10. Increased thallium lung uptake after exercise, a marker of left ventricular dysfunction

    International Nuclear Information System (INIS)

    Botsch, H.; Weidemann, H.; Zaharescu, A.

    1989-01-01

    Increased lung uptake of thallium-201 in patients during exercise stress testing has been found to be related to exercise-induced left ventricular dysfunction. In order to evaluate the lung uptakes as a parameter of left ventricular dysfunction we compared the lung uptake of thallium by visual analysis and by fitting a Lung/Heart-Ratio with the exercise-induced pulmonary capillary wedge pressure (PCP) in 73 patients with coronary heart disease. Assuming a PCP value of 23 mm Hg as the upper limit of normal left ventricular function, left ventricular dysfunction (L/H-ratio > 0.48) can be detected with a sensitivity of 84% and a specificity of 87%. Sensitivity and specificity of visual scan interpretation is 76 and 89%, respectively. Severe left ventricular dysfunction (PCP > 30 mm Hg) is detected by L/H-ratio in 96% and by visual interpretation in 93%. Evaluation of lung activity should be added to the routine interpretation of exercise thallium-201 myocardial imaging studies. (orig.) [de

  11. Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Delma Maria Cunha

    2001-01-01

    Full Text Available OBJECTIVE: To identiy left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS: We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension.. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS: We identified three left ventricular geometric patterns: 1 concentric hypertrophy, in 25% of the patients; 2 concentric remodeling, in 25%; and 3 normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001. Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007. Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively. CONCLUSIONS: Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.

  12. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes.

    Science.gov (United States)

    Zorzi, Alessandro; Perazzolo Marra, Martina; Rigato, Ilaria; De Lazzari, Manuel; Susana, Angela; Niero, Alice; Pilichou, Kalliopi; Migliore, Federico; Rizzo, Stefania; Giorgi, Benedetta; De Conti, Giorgio; Sarto, Patrizio; Serratosa, Luis; Patrizi, Giampiero; De Maria, Elia; Pelliccia, Antonio; Basso, Cristina; Schiavon, Maurizio; Bauce, Barbara; Iliceto, Sabino; Thiene, Gaetano; Corrado, Domenico

    2016-07-01

    The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. We compared 35 athletes (80% men, age: 14-48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography. © 2016 The Authors.

  13. The application of phase analysis of gated myocardial perfusion imaging to assess left ventricular mechanical dyssynchrony in cardiovascular disease

    International Nuclear Information System (INIS)

    Wang Jianfeng; Wang Yuetao

    2013-01-01

    Left ventricular mechanical dyssynchrony is closely related to the severity of cardiovascular disease, it is essential to assess left ventricular mechanical dyssynchrony accurately for early prediction of adverse cardiac events and prognosis assessment of the cardiac resynchronization therapy. As a new technology to assess left ventricular mechanical dyssynchrony, the phase analysis of gated myocardial perfusion imaging (GMPI) can get both quantitative indicators of regional myocardial perfusion, evaluation of regional myocardial viability and scar tissue, as well as quantitative analysis of left ventricular function and left ventricular mechanical synchrony, it has broad application prospects in cardiovascular disease to assess left ventricular mechanical dyssynchrony and prognosis assessment. This review mainly described the applications of GMPI phase analysis in the cardiovascular disease. (authors)

  14. Analysis of Regional Left Ventricular Strain in Patients with Chagas Disease and Normal Left Ventricular Systolic Function.

    Science.gov (United States)

    Gomes, Victor Augusto M; Alves, Gabriel F; Hadlich, Marcelo; Azevedo, Clerio F; Pereira, Iane M; Santos, Carla Renata F; Brasil, Pedro Emmanuel A A; Sangenis, Luiz Henrique C; Cunha, Ademir B; Xavier, Sergio S; Saraiva, Roberto M

    2016-07-01

    Chagas heart disease has a high socioeconomic burden, and any strategy to detect early myocardial damage is welcome. Speckle-tracking echocardiography assesses global and segmental left ventricular (LV) systolic function, yielding values of two-dimensional strain (ε). The aim of this study was to determine if patients with chronic Chagas disease and normal LV ejection fractions present abnormalities in global and segmental LV ε. In this prospective study, patients with Chagas disease with no evidence of cardiac involvement (group I; n = 83) or at stage A of the cardiac form (i.e., with changes limited to the electrocardiogram) (group A; n = 42) and 43 control subjects (group C) underwent evaluation of global and segmental LV ε by speckle-tracking echocardiography. A subset of randomly selected patients in group A underwent cardiac magnetic resonance imaging and repeated echocardiography 3.5 ± 0.8 years after the first evaluation. Mean age, chamber dimensions, and LV ejection fraction were similar among the groups. Global longitudinal (group C, -19 ± 2%; group I, -19 ± 2%; group A, -19 ± 2%), circumferential (group C, -19 ± 3%; group I, -20 ± 3%; group A, -19 ± 3%), and radial (group C, 46 ± 10%; group I, 45 ± 13%; group A, 42 ± 14%) LV ε were similar among the groups. Segmental longitudinal, circumferential, and radial LV ε were similar across the studied groups. Seven of 14 patients had areas of fibrosis on cardiac magnetic resonance imaging. Patients with fibrosis had lower global longitudinal (-15 ± 2% vs -18 ± 2%, P = .004), circumferential (-14 ± 2% vs -19 ± 2%, P = .002), and radial LV ε (36 ± 13% vs 54 ± 12%, P = .02) than those without cardiac fibrosis despite similar LV ejection fractions. Patients with fibrosis had lower radial LV ε in the basal inferoseptal wall than patients without cardiac fibrosis (27 ± 17% vs 60 ± 15%, P = .04). Patients with chronic Chagas disease and normal

  15. Quantitation of right and left ventricular volume with MR imaging in patients with primary pulmonary hypertension

    International Nuclear Information System (INIS)

    Boxt, L.M.; Katz, J.; Kolb, T.; Czegledy, F.P.; Barst, R.J.

    1990-01-01

    This paper tests the utility of MR imaging in quantitating changes in ventricular volume and function in patients with primary pulmonary hypertension (PPH). Right ventricular (RV) and left ventricular (LV) end-diastolic (ED) and end-systolic (ES) volumes were determined in six patients with PPH and in eight controls. Short-axis images were obtained from the cardiac apex to the base at ED and ES, and the ventricular cavities were planimetered. Volumes were computed by summing the areas of the cavities times the thickness of the sections (12-14 mm). The intersection gap (1-3 mm) was averaged between adjacent sections. Results were indexed to the subject's body surface area. This technique was verified by comparison of results obtained by this method with the water displacement volumes of ventricular casts of eight excised bovine hearts and six water-filled balloons. Linear regression and the unpaired Students t test were used to test significance

  16. Apical left ventricular myocardial dysfunction is an early feature of cardiac involvement in myotonic dystrophy type 1.

    Science.gov (United States)

    Garcia, Rodrigue; Labarre, Quentin; Degand, Bruno; Ingrand, Pierre; Le Gal, François; Bonnet, Benjamin; Delaubier, Anne; Guillou, Claire; Gellen, Barnabas; Coisne, Damien; Bouleti, Claire; Christiaens, Luc

    2017-02-01

    Left ventricular (LV) dysfunction is a major prognostic determinant in myotonic dystrophy type 1 (DM1). Therefore, markers of early-stage LV impairment may be useful. The aim of this study was to evaluate 2D echocardiographic LV strain in a cohort of DM1 patients with preserved left ventricular ejection fraction (LVEF) and to compare the results with matched controls. This prospective single-center study included 33 consecutive DM1 patients between February 2014 and February 2015. Mean age was 38.2±12.9 years, and 17 (52%) were males. Exclusion criteria were LVEF 120 milliseconds, history of atrial fibrillation, and presence of a pacemaker with ventricular pacing. DM1 patients were matched to healthy controls according to sex and age. DM1 patients showed significant impairment of global longitudinal strain (GLS) as compared to controls (-18.0±1.9 vs -19.1±2.4; P=.03), characterized by a marked alteration at the apex (-20.0±3.3 vs -22.7±3.1; P<.001). DM1 patients had also global radial strain impairment (20.0±9.8 vs 27.5±14.9; P=.024) compared to controls while global circumferential strain was not statistically different between groups (P=.94). Intra- and inter-observer analysis showed good reproducibility of GLS. Despite preserved LVEF, DM1 patients exhibited significantly altered LV GLS, particularly at the apex, as compared with controls. The detection of impaired myocardial deformation at early stages of the disease might help to screen high-risk patients who need closer follow-up. © 2017, Wiley Periodicals, Inc.

  17. Left ventricular assist for pediatric patients with dilated cardiomyopathy using the Medos VAD cannula and a centrifugal pump.

    Science.gov (United States)

    Huang, Shu-Chien; Chi, Nai-Hsin; Chen, Chun-An; Chen, Yih-Sharng; Chou, Nai-Kuan; Ko, Wen-Je; Wang, Shoei-Shen

    2009-11-01

    Ventricular assist devices for small pediatric patients are expensive and commercially unavailable in Taiwan. We used the Medos ventricular assist device cannula (Medos, Aachen, Germany) and a centrifugal pump to support pediatric patients with dilated cardiomyopathy and decompensated heart failure. From January 2007 to December 2008, three pediatric patients with dilated cardiomyopathy were supported using a centrifugal pump as the left ventricular assist device. The Medos arterial cannula was sutured to the ascending aorta, and the Apex cannula was fixed into the left ventricular apex. When the patient was weaned off of cardiopulmonary bypass, the left ventricular assist device pump was started. The pump flow was gradually titrated according to the filling status of the left ventricle. All the left ventricular assist devices were successfully implanted and functioned well. Two patients on extracorporeal membrane oxygenation had severe lung edema before left ventricular assist device implantation. Both patients required extracorporeal membrane oxygenation for the postoperative period until the pulmonary edema was resolved. Among the three patients, two successfully bridged to heart transplantation after support for 6 and 11 days, respectively. The first patient (10 kg) expired due to systemic emboli 30 days after left ventricular assist device support. In summary, these results suggest that the Medos ventricular assist device cannula and a centrifugal pump is an option for temporary left ventricular assist device support in patients with intractable heart failure and as a bridge to heart transplantation.

  18. Factors influencing left ventricular hypertrophy in children and adolescents with or without family history of premature myocardial infarction

    Directory of Open Access Journals (Sweden)

    Seyyed Mohsen Hosseini

    2014-01-01

    Result : The results showed that among the studied variables, gender, age, body mass index, and blood pressure were associated with the left ventricular hypertrophy. Conclusion: Considering the results and previous studies in this field, it was observed that left ventricular hypertrophy exists at early ages, which is very dangerous and can lead to heart diseases at early ages. Factors such as being overweight, having high blood pressure, and being male cause left ventricular hypertrophy and lead to undiagnosable heart diseases.

  19. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Simone Nascimento dos, E-mail: simonens@cardiol.br [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil); Faculdade de Medicina (UnB), Brasília, DF (Brazil); Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; Santos, Marcus Vinícius Nascimento dos; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto [Instituto Brasília de Arritmia- Universidade de Brasília, DF (Brazil)

    2014-12-15

    Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. To evaluate the impact of AF ablation on estimated LV filling pressure. A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m{sup 2} ± 10.6 mL/m{sup 2} to 22.6 mL/m{sup 2} ± 1.1 mL/m{sup 2}, p < 0.001) compared to the non-successful group (37.7 mL/m{sup 2} ± 14.3 mL/m{sup 2} to 37.5 mL/m{sup 2} ± 14.5 mL/m{sup 2}, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  20. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

    Directory of Open Access Journals (Sweden)

    Simone Nascimento dos Santos

    2014-12-01

    Full Text Available Background: Left ventricular (LV diastolic dysfunction is associated with new-onset atrial fibrillation (AF, and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind, and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e' were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9% were free of AF during the follow-up (average, 18 ± 5 months. LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001 compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns. Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001 but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns. The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001. Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

  1. Hybrid stage I palliation for hypoplastic left heart syndrome has no advantage on ventricular energetics: a theoretical analysis.

    Science.gov (United States)

    Shimizu, Shuji; Kawada, Toru; Une, Dai; Shishido, Toshiaki; Kamiya, Atsunori; Sano, Shunji; Sugimachi, Masaru

    2016-01-01

    A hybrid procedure combining bilateral pulmonary artery banding with ductal stenting has recently been used as stage I palliation for hypoplastic left heart syndrome. However, the advantage of the hybrid procedure over the Norwood procedure on ventricular energetics remains unclear. To clarify this, we performed a computational analysis with a combination of time-varying elastance chamber model and modified three-element Windkessel vascular model. Although mean pulmonary artery (PA) pressure, pulmonary flow, and oxygen saturation were almost equivalent with the Norwood procedure, the hybrid procedure delivered higher systolic and lower diastolic systemic arterial pressures compared to the Norwood procedure with right ventricle (RV) to PA shunt. As a result, the hybrid procedure yielded increased systolic pressure-volume area and impaired mechanical efficiency. Therefore, the hybrid procedure has probably no advantage on ventricular energetics compared to the Norwood procedure with a RV-PA shunt.

  2. Left ventricular assist device (lvad design features: literature review

    Directory of Open Access Journals (Sweden)

    Yu. V. Bogdanova

    2014-01-01

    Full Text Available More than 8 million people in our country suffer from heart failure. About one million of these people die each year [1]. The problem of ventricular assist device creating - a mechanical device used for partial or complete replacement of heart function - is investigated for a long time (according to [2] just in our country since the 1970s. Today plenty of encouraging results are received. There is a number of VAD models which are successfully applied to patients with heart failure. After implantation, patients conduct a way of life that is normal in many respects: they are in the family, often they have an opportunity to work in their former specialty. Some of them live with the device about 8 years [3].According to [4] for 2010 the estimated total number of long-term devices implanted in the United States per year is over 1,700 (the population of the U.S. is 305 million, compared with over 430 per year in Europe (the population of Europe is 731 million. Unfortunately, people who need a heart transplant are much more.The principle of VAD is that being connected to the left ventricle with one cannula and to the ascending aorta with the other cannula the pump fully or partially replaces the function of the natural heart. This scheme allows the use of VAD in two ways: as a "bridge to transplantation" when the device is used temporarily until the donor heart is found, and a "bridge to recovery", when through the use of VAD the function of the heart muscle is recovered.VAD system can be divided into three subsystems: blood pump, power supply system and control system (Fig. 1.Each subsystem can be the subject of separate study. Special role in the development of VAD plays medical side of the issue. Successful research and development require interaction with qualified professionals in this field. The development of VAD is a multidisciplinary problem which demands fulfilment of a number of requirements.One of the most active programs in implantation of

  3. Left Ventricular Systolic Dyssynchrony in Patients with Hypertrophic Cardiomyopathy: The prevalence and its Relation to Syncope

    Directory of Open Access Journals (Sweden)

    N Behzadnia

    2010-12-01

    Full Text Available Background: The distribution and magnitude of left ventricularhypertrophy (LVH are not uniform in patients with hypertrophic cardiomyopathy (HCM , which results in regional heterogeneity of left ventricular ( LVsystolic function. The aim of this study was to evaluate LV regional systolicdyssynchrony in patients with HCM by Tissue Doppler Imaging (TDI and to findany correlation between TDI data and syncope.Methods: A total of 44 consecutive patients with HCM are recruited inthe present study. .All patients, underwent complete clinical andechocardiographic evaluation including TDI . The following were measured in 6different basal and 6 mid-myocardial segments: systolic peak velocity(Sm,early diastolic myocardial velocity (Em, pre-contraction time(Q-Sm frombeginning of Q- wave of ECG to the onset of Sm, total asynchrony index,interventricular mechanical delay(difference in Q-Aortic valve opening andQ-Pulmonic valve opening and maximum difference in time to peak systolicvelocity between 2 of 12 segments(ΔPVI.Results: TDI analysis in HCM subgroup with syncope showed bothsignificant interventricular (36.72±26.26 vs 14.74±11.30 msec, P<0.001 andintraventricular delays(39.40±22.38 vs27.70±17.32 msec, P=0.07. The prevalenceof LV systolic dyssynchrony was from 20.5% to 38.6% based on different methods.Patients with syncope had greater impairment of regional systolic and earlydiastolic function, remarkably lower Sm and Em velocities.Conclusion: The impairment of inter and intraventricular systolicsynchronicity is significantly related to syncope in patients with HCM.TDIanalysis may be able to select subgroups of HCM patients at increasing risk ofsyncope and major cardiac events

  4. Isolated left ventricular noncompaction: clinical profile and prognosis in 106 adult patients.

    Science.gov (United States)

    Tian, Tao; Liu, Yaxin; Gao, Linggen; Wang, Jizheng; Sun, Kai; Zou, Yubao; Wang, Linping; Zhang, Lin; Li, Yuehua; Xiao, Yan; Song, Lei; Zhou, Xianliang

    2014-09-01

    This study was undertaken to evaluate the clinical course of isolated left ventricular noncompaction (ILVNC) and to identify the predictors for adverse outcomes in an adult cohort with ILVNC. Between March 2003 and April 2012, 106 adult patients diagnosed with ILVNC at Fuwai Hospital were included in this study. The medical history, electrocardiograms, and echocardiograms of these patients were retrospectively analyzed by chart review. Of these patients, 64 (60 %) were in New York Heart Association (NYHA) functional class III/IV and 84 (79 %) had systolic dysfunction (left ventricular ejection fraction (LVEF) left ventricular ejection fraction (HR 0.94; 95 % CI 0.90-0.97; P = 0.001), dilated left ventricular end-diastolic diameter (HR, 1.06; 95 % CI, 1.02-1.09; P = 0.001), increased left atrial diameter (HR 1.08; 95 % CI 1.03-1.14; P = 0.001), reduced systolic blood pressure (HR 0.96; 95 % CI 0.94-0.99; P = 0.003), the presence of pulmonary hypertension (HR 3.50; 95 % CI 1.63-7.51; P = 0.001), and right bundle branch block (HR 7.79; 95 % CI 2.56-23.76; P left heart with systolic dysfunction, reduced systolic blood pressure, pulmonary hypertension, and right bundle branch block predict adverse outcomes of ILVNC.

  5. Left atrial function in heart failure with impaired and preserved ejection fraction.

    Science.gov (United States)

    Fang, Fang; Lee, Alex Pui-Wai; Yu, Cheuk-Man

    2014-09-01

    Left atrial structural and functional changes in heart failure are relatively ignored parts of cardiac assessment. This review illustrates the pathophysiological and functional changes in left atrium in heart failure as well as their prognostic value. Heart failure can be divided into those with systolic dysfunction and heart failure with preserved ejection fraction (HFPEF). Left atrial enlargement and dysfunction commonly occur in systolic heart failure, in particular, in idiopathic dilated cardiomyopathy. Atrial enlargement and dysfunction also carry important prognostic value in systolic heart failure, independently of known parameters such as left ventricular ejection fraction. In HFPEF, there is evidence of left atrial enlargement, impaired atrial compliance, and reduction of atrial pump function. This occurs not only at rest but also during exercise, indicating significant impairment of atrial contractile reserve. Furthermore, atrial dyssynchrony is common in HFPEF. These factors further contribute to the development of new onset or progression of atrial arrhythmias, in particular, atrial fibrillation. Left atrial function is an integral part of cardiac function and its structural and functional changes in heart failure are common. As changes of left atrial structure and function have different clinical implications in systolic heart failure and HFPEF, routine assessment is warranted.

  6. Frequent left ventricular hypertrophy independent of blood pressure in 1851 pre-western Inuit

    DEFF Research Database (Denmark)

    Andersen, Stig; Kjærgaard, Marie; Jørgensen, Marit Eika

    2011-01-01

    only after the age of 40 years in pre-western Inuit. Left ventricular hypertrophy peaked among 30-year olds and was independent of elevated blood pressure. It may be speculated that the common left ventricular hypertrophy was due to marked physical activity that contributed to the low occurrence......BACKGROUND: Elevated blood pressure is a risk factor for cardiovascular disease and may be detected by left ventricular hypertrophy (LVH) in electrocardiogram (ECG). Pre-western Inuit had frequent signs of LVH in ECG predominantly in the 3rd decade while a low occurrence of ischemic heart disease....... METHODS: We evaluated the association between blood pressures and ECG signs of LVH, cardiac auscultation, and symptoms related to heart disease in the recently recovered data from the survey of 1851 Inuit conducted in 1962-1964 in East Greenland. RESULTS: The participation rate was 97%. Among the 812...

  7. Systemic Embolization from an Unusual Intracardiac Mass in the Left Ventricular Outflow Tract

    Directory of Open Access Journals (Sweden)

    Kelechukwu U. Okoro

    2017-01-01

    Full Text Available Endocarditis can affect any endocardial surface; in the vast majority of cases, the cardiac valves are involved. It is exceedingly rare to develop infective endocarditis on the endocardium of the left ventricular outflow tract due to the high velocity of blood that traverses this area. Herein, we present a rare case of left ventricular outflow tract endocarditis that likely occurred secondary to damage to the aortic valve leaflets (from healed prior aortic valve endocarditis causing a high velocity aortic valve regurgitant jet that impinged upon the interventricular septum which damaged the endocardium and resulted in a fibrotic “jet lesion.” This fibrous jet lesion served as a nidus for bacterial proliferation and vegetation formation. The high shear stress (due to high blood flow velocity through the left ventricular outflow tract likely promoted the multiple embolic events observed in this case. Our patient was successfully treated with aortic valve replacement, vegetation resection, and antibiotics.

  8. Relation of the Number of Parity to Left Ventricular Diastolic Function in Pregnancy.

    Science.gov (United States)

    Keskin, Muhammed; Avşar, Şahin; Hayıroğlu, Mert İlker; Keskin, Taha; Börklü, Edibe Betül; Kaya, Adnan; Uzun, Ahmet Okan; Akyol, Burcu; Güvenç, Tolga Sinan; Kozan, Ömer

    2017-07-01

    Left ventricular diastolic dysfunction (LVDD) has been relatively less studied than other cardiac changes during pregnancy. Previous studies revealed a mild diastolic deterioration during pregnancy. However, these studies did not evaluate the long-term effect of parity on left ventricular diastolic function. A comprehensive study evaluating the long-term effect of parity on diastolic function is required. A total of 710 women with various number of parity were evaluated through echocardiography to reveal the status of diastolic function. Echocardiographic parameters were compared among the women by parity number and categorized accordingly: none, 0 to 4 and 4 4 parity and that had 21 and 5.8 times higher than nulliparous group, respectively. In conclusion, according to the present study, grand multiparity but not multiparity, severely deteriorates left ventricular diastolic function. Further studies are warranted to evaluate the risk of gradual diastolic dysfunction after each pregnancy. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Fluid loading and norepinephrine infusion mask the left ventricular preload decrease induced by pleural effusion

    DEFF Research Database (Denmark)

    Wemmelund, Kristian Borup; Ringgård, Viktor Kromann; Vistisen, Simon Tilma

    2017-01-01

    BACKGROUND: Pleural effusion (PLE) may lead to low blood pressure and reduced cardiac output. Low blood pressure and reduced cardiac output are often treated with fluid loading and vasopressors. This study aimed to determine the impact of fluid loading and norepinephrine infusion on physiologic......, n = 12), norepinephrine infusion (0.01, 0.03, 0.05, 0.1, 0.2 and 0.3 μg/kg/min (15 min each, n = 12)) or control (n = 6). Main outcome was left ventricular preload measured as left ventricular end-diastolic area. Secondary endpoints included contractility and afterload as well as global measures...... of circulation. All endpoints were assessed with echocardiography and invasive pressure-flow measurements. RESULTS: PLE decreased left ventricular end-diastolic area, mean arterial pressure and cardiac output (p values infusion (0.05 μg/kg/min) restored...

  10. Left Ventricular Hypertrophy: An allometric comparative analysis of different ECG markers

    Science.gov (United States)

    Bonomini, M. P.; Ingallina, F.; Barone, V.; Valentinuzzi, M. E.; Arini, P. D.

    2011-12-01

    Allometry, in general biology, measures the relative growth of a part in relation to the whole living organism. Left ventricular hypertrophy (LVH) is the heart adaptation to excessive load (systolic or diastolic). The increase in left ventricular mass leads to an increase in the electrocardiographic voltages. Based on clinical data, we compared the allometric behavior of three different ECG markers of LVH. To do this, the allometric fit AECG = δ + β (VM) relating left ventricular mass (estimated from ecocardiographic data) and ECG amplitudes (expressed as the Cornell-Voltage, Sokolow and the ECG overall voltage indexes) were compared. Besides, sensitivity and specifity for each index were analyzed. The more sensitive the ECG criteria, the better the allometric fit. In conclusion: The allometric paradigm should be regarded as the way to design new and more sensitive ECG-based LVH markers.

  11. Assessment of left ventricular wall motion and function by cross-sectional echocardiography

    International Nuclear Information System (INIS)

    Ono, Akifumi; Hirata, Shunkichi; Ishikawa, Kyozo

    1982-01-01

    The clinical efficacy of cross-sectional echocardiography (CSE) was evaluated with M-mode echocardiography and radionuclide cardioangiography (RCG) in 50 cases including 30 patients with myocardial infarction. Segmental wall motion by CSE was highly correlated with segmental wall motion and left ventricular ejection fraction by RCG (r = 0.89 in the former, r = -0.84 in the latter). On the other hand, the left ventricular ejection fraction by M-mode echocardiography revealed a fairly well correlation with that by RCG ( r = 0.68). These results suggest that, as compared with RCG, CSE is quite useful in an evaluation of left ventricular function and in a detection of segmental wall motion abnormalities. (author)

  12. Aortic stenosis with abnormal eccentric left ventricular remodeling secondary to hypothyroidism in a Bourdeaux Mastiff

    Directory of Open Access Journals (Sweden)

    Guilherme Augusto Minozzo

    Full Text Available ABSTRACT: This paper describes a case of congenital aortic stenosis with eccentric left ventricular hypertrophy associated with hypothyroidism in a 1-year-old Bourdeaux Mastiff dog. The dog had ascites, apathy, alopecic and erythematous skin lesions in different parts of the body. A two-dimensional echocardiogram revealed aortic valve stenosis, with poststenotic dilation in the ascending aorta. The same exam showed eccentric hypertrophy and dilation of the left ventricle during systole and diastole. Aortic stenosis usually results in concentric left ventricular hypertrophy instead of eccentric hypertrophy; and therefore, this finding was very unusual. Hypothyroidism, which is uncommon in young dogs, may be incriminated as the cause of ventricular dilation, making this report even more interesting. Because hypothyroidism would only result in dilatation, the eccentric hypertrophy was attributed to pressure overload caused by aortic stenosis. Thus, cardiac alterations of this case represent a paradoxical association of both diseases.

  13. Left Ventricular Hypertrophy: An allometric comparative analysis of different ECG markers

    International Nuclear Information System (INIS)

    Bonomini, MP; Valentinuzzi, M E; Arini, P D; Ingallina, F; Barone, V

    2011-01-01

    Allometry, in general biology, measures the relative growth of a part in relation to the whole living organism. Left ventricular hypertrophy (LVH) is the heart adaptation to excessive load (systolic or diastolic). The increase in left ventricular mass leads to an increase in the electrocardiographic voltages. Based on clinical data, we compared the allometric behavior of three different ECG markers of LVH. To do this, the allometric fit AECG δ + β (VM) relating left ventricular mass (estimated from ecocardiographic data) and ECG amplitudes (expressed as the Cornell-Voltage, Sokolow and the ECG overall voltage indexes) were compared. Besides, sensitivity and specificity for each index were analyzed. The more sensitive the ECG criteria, the better the allometric fit. In conclusion: The allometric paradigm should be regarded as the way to design new and more sensitive ECG-based LVH markers.

  14. Primary left ventricular hydatid cyst in a child: case report

    Energy Technology Data Exchange (ETDEWEB)

    Turkvatan, A. [Turkiye Yuksek Ihtisas Hospital, Dept. of Radiology, Ankara (Turkey); Yelgec, N.S. [Turkiye Yuksek Ihtisas Hospital, Dept. of Cardiology, Ankara (Turkey); Calikoglu, U.; Olcer, T. [Turkiye Yuksek Ihtisas Hospital, Dept. of Radiology, Ankara (Turkey)

    2000-12-01

    The most common cause of echinococcosis in humans is Echinococcus granulosus. Although hydatid cyst is most frequently localized in liver (more than 65% of cases) and lung (25%) by means of portal and systemic circulation, it may involve other tissues and organs. Cardiac hydatid cysts account for only 0.5%-2% of all hydatid cysts, even in endemic areas. Of all cardiac hydatid cysts, the left ventricle accounts for 60%, right ventricle 10%, pericardium 7%, pulmonary artery 6%, left atrial appendage 6%, and interventricular septum 4%. We report the case of a myocardial hydatid cyst of the left ventricle in a 9-year-old boy. (author)

  15. Institutional Cost Comparison Between Heart Transplants and Left Ventricular Assist Device Implantations.

    Science.gov (United States)

    Chimanji, Neeraj; Kilic, Arman; Hasan, Ayesha; Higgins, Robert S D; Whitson, Bryan A; Kilic, Ahmet

    2016-12-01

    Increased numbers of end-stage heart failure patients and improved technology have led to increased use of left ventricular assist devices as a viable alternative to heart transplants. Given the current economic climate, we compared costs of heart transplant versus device placement. Medical records of patients who received heart transplants or left ventricular assist devices were cross-referenced with institutional financial data. The device cohort was limited to those receiving durable (not temporary) devices. Index admission, 1-year readmission, and overall 1-year charges were compared using standard statistical methods. Of 184 identified patients with end-stage heart failure surgical therapy, 121 received left ventricular assist devices, 43 had heart transplants, and 20 received left ventricular assist devices as bridge to heart transplant; these latter patients were excluded from our analyses. At index admission, mean charges were $863 433 ± $398 427 for device patients and $725 877 ± $488 685 for transplant patients (P = .05). One-year mean readmission rates were similar (4.65/transplant patient and 4.53/device patient; P = .94), with corresponding 1-year survival rates of 87.8% and 78.0% (P = .04). Total readmission charges during year 1 were $169 732 ± $242 366 for device patients and $201 682 ± $297 565 for transplant patients (P = .08), with corresponding overall charges at 1 year of $1 029 732 ± $450 498 and $927 559 ± $562 404 (P = .49). During the first year, heart transplant and left ventricular assist device placement have similar costs. Initial index admission costs seem to favor heart transplant, with device pump costs accounting for some of the difference. From a 1-year survival perspective, heart transplant may be more effective; however, with lack of suitable donors, left ventricular assist devices are valuable in the armamentarium of advanced heart failure surgical options.

  16. Implantable physiologic controller for left ventricular assist devices with telemetry capability.

    Science.gov (United States)

    Asgari, Siavash S; Bonde, Pramod

    2014-01-01

    Rotary type left ventricular assist devices have mitigated the problem of durability associated with earlier pulsatile pumps and demonstrated improved survival. However, the compromise is the loss of pulsatility due to continuous flow and retained percutaneous driveline leading to increased mortality and morbidity. Lack of pulsatility is implicated in increased gastrointestinal bleeding, aortic incompetence, and diastolic hypertension. We present a novel, wirelessly powered, ultra-compact, implantable physiologic controller capable of running a left ventricular assist device in a pulsatile mode with wireless power delivery. The schematic of our system was laid out on a circuit board to wirelessly receive power and run a left ventricular assist device with required safety and backup measures. We have embedded an antenna and wireless network for telemetry. Multiple signal processing steps and controlling algorithm were incorporated. The controller was tested in in vitro and in vivo experiments. The controller drove left ventricular assist devices continuously for 2 weeks in an in vitro setup and in vivo without any failure. Our controller is more power efficient than the current Food and Drug Administration-approved left ventricular assist device controllers. When used with electrocardiography synchronization, the controller allowed on-demand customization of operation with instantaneous flow and revolutions per minute changes, resulting in a pulsatile flow with adjustable pulse pressure. Our test results prove the system to be remarkably safe, accurate, and efficient. The unique combination of wireless powering and small footprint makes this system an ideal totally implantable physiologic left ventricular assist device system. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  17. Noninvasive iPhone Measurement of Left Ventricular Ejection Fraction Using Intrinsic Frequency Methodology.

    Science.gov (United States)

    Pahlevan, Niema M; Rinderknecht, Derek G; Tavallali, Peyman; Razavi, Marianne; Tran, Thao T; Fong, Michael W; Kloner, Robert A; Csete, Marie; Gharib, Morteza

    2017-07-01

    The study is based on previously reported mathematical analysis of arterial waveform that extracts hidden oscillations in the waveform that we called intrinsic frequencies. The goal of this clinical study was to compare the accuracy of left ventricular ejection fraction derived from intrinsic frequencies noninvasively versus left ventricular ejection fraction obtained with cardiac MRI, the most accurate method for left ventricular ejection fraction measurement. After informed consent, in one visit, subjects underwent cardiac MRI examination and noninvasive capture of a carotid waveform using an iPhone camera (The waveform is captured using a custom app that constructs the waveform from skin displacement images during the cardiac cycle.). The waveform was analyzed using intrinsic frequency algorithm. Outpatient MRI facility. Adults able to undergo MRI were referred by local physicians or self-referred in response to local advertisement and included patients with heart failure with reduced ejection fraction diagnosed by a cardiologist. Standard cardiac MRI sequences were used, with periodic breath holding for image stabilization. To minimize motion artifact, the iPhone camera was held in a cradle over the carotid artery during iPhone measurements. Regardless of neck morphology, carotid waveforms were captured in all subjects, within seconds to minutes. Seventy-two patients were studied, ranging in age from 20 to 92 years old. The main endpoint of analysis was left ventricular ejection fraction; overall, the correlation between ejection fraction-iPhone and ejection fraction-MRI was 0.74 (r = 0.74; p iPhone] + 1.9). Analysis of carotid waveforms using intrinsic frequency methods can be used to document left ventricular ejection fraction with accuracy comparable with that of MRI. The measurements require no training to perform or interpret, no calibration, and can be repeated at the bedside to generate almost continuous analysis of left ventricular ejection fraction

  18. Retrograde hot-shot cardioplegia in patients with left ventricular hypertrophy undergoing aortic valve replacement.

    Science.gov (United States)

    Ascione, Raimondo; Suleiman, Saadeh M; Angelini, Gianni D

    2008-02-01

    Intermittent antegrade cold-blood cardioplegia followed by terminal warm-blood cardioplegic reperfusion or hot-shot is reported to reduce myocardial injury in the setting of coronary surgery. The efficacy of this cardioplegic technique in patients with left ventricular hypertrophy secondary to aortic stenosis remains uncertain. Thirty-six patients with left ventricular hypertrophy undergoing aortic valve replacement were prospectively randomized to cold-blood cardioplegia either alone (cold-blood cardioplegia group) or with retrograde hot-shot (hot-shot group). Reperfusion injury was assessed by measuring myocardial levels of adenosine triphosphate and lactate in left and right ventricular biopsies taken 5 minutes after institution of cardiopulmonary bypass and 20 minutes after removal of cross-clamp using high-performance liquid chromatography and enzymatic techniques. Myocardial injury was assessed by serial release of troponin I up to 48 hours postoperatively. Overall clinical outcome was prospectively collected. Baseline and intraoperative characteristics were similar between groups. In the hot-shot group, there were no significant changes in the myocardial concentration of adenosine triphosphate and lactate in both left and right ventricular biopsies after reperfusion. In the cold-blood cardioplegia group, there was a trend to a fall in adenosine triphosphate levels in the left and right ventricular biopsies after reperfusion, but this reached statistical significance only in the right ventricle. Troponin I release was raised in both groups at 4 and 12 hours after surgery (p < 0.05), but did not reach levels of myocardial infarction. The terminal retrograde hot-shot reperfusion does not add any extra benefit to antegrade cold-blood cardioplegia in preventing myocardial injury in patients with left ventricular hypertrophy undergoing aortic valve replacement. Nevertheless, it appears to reduce ischemic stress in the right ventricle. There was no difference in

  19. Left Ventricular Assist Devices in the Management of Heart Failure

    Science.gov (United States)

    Y Birati, Edo

    2015-01-01

    Mechanical circulatory support has emerged as an important therapy for advanced heart failure, with more than 18,000 continuous flow devices implanted worldwide to date. These devices significantly improve survival and quality of life and should be considered in every patient with end-stage heart failure with reduced ejection fraction who has no other life-limiting diseases. All candidates for device implantation should undergo a thorough evaluation in order to identify those who could benefit from device implantation. Long-term management of ventricular assist device patients is challenging and requires knowledge of the characteristic complications with their unique clinical presentations. PMID:28785427

  20. Quantification of left ventricular function by gated myocardial perfusion SPECT using multidimTM

    International Nuclear Information System (INIS)

    Huang Jin; Song Wenzhong; Chen Mingxi

    2004-01-01

    Objective: To evaluate the accuracy of left ventricular function by gated SPECT using the software Multidim TM . Methods: Rest gated SPECT was performed on 42 cases involved 26 normal subjects and 16 patients with myocardial infarct (MI). All cases underwent rest equilibrium radionuclide angiocardiography (ERNA) within 1 w. Results: (1)End diastolic volume (EDV), end systolic volume (ESV) and left ventricular ejection fraction(LVEF)were calculated using the software MultidimtMand ERNA. The correlation coefficient between the two Methods was 0.90,0.89,0.92 respectively(P TM , but the EDV and ESV value measured by this software maybe high with small heart. (authors)

  1. Left Ventricular Myxoma Occluding the Suprarenal Abdominal Aorta in an Infant.

    Science.gov (United States)

    Kawabata, Takuya; Kasahara, Shingo; Ohtsuki, Shin-ichi; Kuroko, Yosuke; Kotani, Yasuhiro; Fujii, Yasuhiro; Yoshizumi, Ko; Arai, Sadahiko; Sano, Shunji

    2015-07-01

    Myxoma is the most common primary cardiac tumor in adults; however, it is extremely rare in infants. Acute occlusion of the abdominal aorta by a cardiac myxoma is also rare. We report the case of an infant with acute occlusion of the suprarenal abdominal aorta by a left ventricular myxoma. The patient underwent successful catheter embolectomy of the abdominal aorta and surgical resection of the cardiac myxoma. This is a very rare case report of the combination of infantile left ventricular myxoma and acute occlusion of the abdominal aorta. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy.

    Science.gov (United States)

    Thyagarajan, Braghadheeswar; Munshi, Lubna Bashir; Amor, Martin Miguel

    2015-01-01

    Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later.

  3. Sudden Infant Death Syndrome and Left Ventricular Hypertrabeculation-Hidden Arrhythmogenic Entity?

    Directory of Open Access Journals (Sweden)

    G. Saayman

    2010-09-01

    Full Text Available Left ventricular noncompaction/hypertrabeculation is a condition which is characterized by a highly trabeculated, “spongy” myocardium. It can present at any age with heart failure, arrhythmia and/or thromboembolic events. A wide variety of mutations have been found to be a cause of hypertrabeculation and it is possible that there is a continuum of hypertrophic cardiomyopathy, dilated cardiomyopathy and hypertrabeculation/noncompaction. We present a case of left ventricular hypertrabeculation which presented as sudden infant death syndrome and we propose that this entity may be a hidden cause of arrhythmic death in some infants presenting as sudden infant death syndrome.

  4. Left ventricular non-compaction in a patient with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2016-12-01

    Full Text Available A 58 years old male with a long-standing history of HLA-B27 positive ankylosing spondylitis presented with increasing fatigue and dyspnea on exertion. He had left ventricular dysfunction and enlargement, flail right coronary leaflet of aortic valve with severe eccentric aortic insufficiency along with left ventricular non-compaction in echocardiography. The most common cardiac manifestations of ankylosing spondylitis are aortic insufficiency and conduction disturbances. Involvement of myocardium, in the form of dilated cardiomyopathy and restrictive cardiomyopathy, has also been reported. This case presents a very rare association of ankylosing spondylitis with non-compaction cardiomyopathy.

  5. Effects of perfusion detect on the measurement of left ventricular mass, ventricular volume and post-stress left ventricular ejection fraction in gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol; Bae, Sun Keun; Lee, Sang Woo; Jeong, Sin Young; Lee, Jae Tae; Lee, Kyu Bo [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2002-12-01

    The presence of perfusion defect may influence the left ventricular mass (LVM) measurement by quantitative gated myocardial perfusion SPECT (QGS), and ischemic myocardium, usually showing perfusion defect may produce post-stress LV dysfunction. This study was aimed to evaluated the effects of extent and reversibility of perfusion defect on the automatic measurement of LVM by QGS and to investigate the effect of reversibility of perfusion defect on post-stress LV dysfunction. Forty-six patients (male/female=34:12, mean age=64 years) with perfusion defect on myocardial perfusion SPECT underwent rest and post-stress QGS. Forty patients (87%) showed reversible defect. End-diastolic volume (EDV), end-systolic volume (ESV), LV ejection fraction (EF), and LV myocardial volume were obtained from QGS by autoquant program, and LVM was calculated by multiplying the LV myocardial volume by the specific gravity of myocardium. LVMs measured at rest and post-stress QGS showed good correlation, and higher correlation was founded in the subjects with fixed perfusion defect and with small defect (smaller than 20%). There were no significant differences in EDVs, ESVs and EFs between obtained by rest and post-stress QGS in patients with fixed myocardial defect. Whereas, EF obtained by post-stress QGS was lower than that by rest QGS in patients with reversible defect and 10 (25%) of them showed decreases in EF more than 5% in post-stress QGS, as compared to that of rest QGS. Excellent correlations of EDVs, ESVs, EFs between rest and post-stress QGS were noted. Patients with fixed defect had higher correlation between defect can affect LVM measurement by QGS and patients with reversible defect shows post-stress LV dysfunction more frequently than patients with fixed perfusion defect.

  6. Uric acid promotes left ventricular diastolic dysfunction in mice fed a Western diet.

    Science.gov (United States)

    Jia, Guanghong; Habibi, Javad; Bostick, Brian P; Ma, Lixin; DeMarco, Vincent G; Aroor, Annayya R; Hayden, Melvin R; Whaley-Connell, Adam T; Sowers, James R

    2015-03-01

    The rising obesity rates parallel increased consumption of a Western diet, high in fat and fructose, which is associated with increased uric acid. Population-based data support that elevated serum uric acids are associated with left ventricular hypertrophy and diastolic dysfunction. However, the mechanism by which excess uric acid promotes these maladaptive cardiac effects has not been explored. In assessing the role of Western diet-induced increases in uric acid, we hypothesized that reductions in uric acid would prevent Western diet-induced development of cardiomyocyte hypertrophy, cardiac stiffness, and impaired diastolic relaxation by reducing growth and profibrotic signaling pathways. Four-weeks-old C57BL6/J male mice were fed excess fat (46%) and fructose (17.5%) with or without allopurinol (125 mg/L), a xanthine oxidase inhibitor, for 16 weeks. The Western diet-induced increases in serum uric acid along with increases in cardiac tissue xanthine oxidase activity temporally related to increases in body weight, fat mass, and insulin resistance without changes in blood pressure. The Western diet induced cardiomyocte hypertrophy, myocardial oxidative stress, interstitial fibrosis, and impaired diastolic relaxation. Further, the Western diet enhanced activation of the S6 kinase-1 growth pathway and the profibrotic transforming growth factor-β1/Smad2/3 signaling pathway and macrophage proinflammatory polarization. All results improved with allopurinol treatment, which lowered cardiac xanthine oxidase as well as serum uric acid levels. These findings support the notion that increased production of uric acid with intake of a Western diet promotes cardiomyocyte hypertrophy, inflammation, and oxidative stress that lead to myocardial fibrosis and associated impaired diastolic relaxation. © 2014 American Heart Association, Inc.

  7. Left Ventricular Synchrony and Function in Pediatric Patients with Definitive Pacemakers

    Science.gov (United States)

    Ortega, Michel Cabrera; Morejón, Adel Eladio Gonzales; Ricardo, Giselle Serrano

    2013-01-01

    Background Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern, producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. Objective The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those receiving LV pacing (LVP). Methods LV systolic and diastolic function and synchrony were evaluated in 80 pediatric patients with either nonsurgical or postsurgical complete atrioventricular block, with pacing from either the RV endocardium (n = 40) or the LV epicardium (n = 40). Echocardiographic data obtained before pacemaker implantation, immediately after it, and at the end of a mean follow-up of 6.8 years were analyzed. Results LV diastolic function did not change in any patient during follow-up. LV systolic function was preserved in patients with LVP. However, in children with RVP the shortening fraction and ejection fraction decreased from medians of 41% ± 2.6% and 70% ± 6.9% before implantation to 32% ± 4.2% and 64% ± 2.5% (p < 0.0001 and p < 0.0001), respectively, at final follow-up. Interventricular mechanical delay was significantly larger with RVP (66 ± 13 ms) than with LVP (20 ± 8 ms). Similarly, the following parameters were significantly different in the two groups: LV mechanical delay (RVP: 69 ± 6 ms, LVP: 30 ± 11 ms, p < 0.0001); septal to lateral wall motion delay (RVP: 75 ± 19 ms, LVP: 42 ± 10 ms, p < 0.0001); and, septal to posterior wall motion delay (RVP: 127 ± 33 ms, LVP: 58 ± 17 ms, p < 0.0001). Conclusion Compared with RV endocardium, LV epicardium is an optimal site for pacing to preserve cardiac synchrony and function. PMID:24061683

  8. In vivo experimental testing of the FW axial blood pump for left ventricular support in Fu Wai Hospital.

    Science.gov (United States)

    Zhang, Yan; Hu, Sheng-Shou; Zhou, Jian-Ye; Sun, Han-Song; Tang, Yue; Zhang, Hao; Zheng, Zhe; Li, Guo-Rong; Zhu, Xiao-Dong; Gui, Xin-Min

    2009-01-01

    A fully implantable, axial flow blood pump has been developed in Fu Wai Hospital aiming for clinical use. This ventricular assist device (VAD), which was developed after numerous CFD analyses for the flow characteristics of the pump, is 58.5-mm long, 30-mm wide (including DC motor), and weighs 240 g. The pump can deliver 5 L/min for pressures of 100 mm Hg over 8,000 rpm. In this study, short-term hemocompatibility effects of the axial left ventricular assist device (LVAD) (FW blood pump) were evaluated in four healthy sheep. The device was implanted into the left ventricular apex of beating hearts. The outflow graft of each device was anastomosed to the descending aorta. The hemolysis, which was evaluated in vivo by free hemoglobin value, was below 30 mg/dL. Evaluation of serum biochemical data showed that implantation of the FW blood pump in sheep with normal hearts did not impair end organ function. Gross and microscopic sections of kidney, liver, and lung revealed no evidence of microemboli. Performance of the pump in vivo was considered sufficient for a LVAD, although further design improvement is necessary in terms of hemolysis and antithrombosis to improve biocompatibility of the pump.

  9. Characteristics of left ventricular hypertrophy estimated by MIBG and BMIPP cardiac scintigraphy in patients undergoing peritoneal dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Ohashi, Hiroshige; Oda, Hiroshi; Ohno, Michiya; Watanabe, Sachirow; Kotoo, Yasunori; Matsuno, Yukihiko [Gifu Prefectural Hospital (Japan)

    2002-12-01

    Left ventricular hypertrophy (LVH) has been reported as a major factor in morbidity and mortality in chronic dialysis patients. However, cardiovascular mortality in peritoneal dialysis (PD) patients with LVH is substantially similar to that in hemodialysis (HD) patients. The present study sought to study whether sympathetic nerve activity and fatty acid metabolism of the myocardium estimated by {sup 123}I metaiodobenzylguanidine (MIBG) and {sup 123}I {beta}-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) myocardial scintigraphy are impaired or not in PD patients with LVH. The underlying disease of 45 PD patients enrolled in this study was chronic glomerulonephritis in all cases. Serum levels of natriuretic peptides (arterial natriuretic peptide (ANP), brain natriuretic peptide (BNP)) and free carnitine and MIBG, BMIPP myocardial scintigraphy and 2-dimensional echocardiography were measured in these 45 PD patients. The following results were obtained. The prevalence of increased left ventricular mass index (LVMI) was 84.4%. LVMI correlated with age, and serum levels of ANP and BNP, and inversely correlated with a heart-to-mediastinum ratio (H/M) estimated by MIBG and BMIPP myocardial scintigraphy. Percentages of the normal image of MIBG and BMIPP measured with a single photon emission computed tomography (SPECT) were 37.8% and 62.2%, respectively. The PD patients showing the diffuse defect of MIBG or BMIPP imaging had the decrease in left ventricular ejection fraction (LVEF). Especially, the serum level of free carnitine was reduced in the PD patients with diffuse defect of BMIPP SPECT. From these results, we concluded that PD patients with LVH showed impaired sympathetic nerve activity and fatty acid metabolism of the myocardium. Metabolic and functional disturbances of the myocardium may influence mortality in PD patients. (author)

  10. Value of transient dilation of the left ventricular cavity on stress thallium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Hiroki; Shiga, Kouji; Umamoto, Ikuo (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1991-02-01

    This study was undertaken to evaluate the value of transient dilation of the left ventricular cavity on stress thallium scintigraphy in 80 patients with ischemic heart disease (IHD) and 50 with hypertrophic cardiomyopathy (HCM). Twenty persons without either coronary artery stenosis or heart disease were served as controls. Areas surrounded by maximum count points on the line of each 10deg on the short axis slice through the mid-cavity of the left ventricle were obtained at 10 minutes and at 3 hours after exercise. Transient dilation index (TDI) was obtained by dividing the area on early image by that on delayed image. TDI was significantly higher in patients with two or three vessel disease in the IHD group than the control group. High TDI was observed in 8% for one vessel disease, 40% for two vessel disease, and 80% for three vessel disease, contributing to the detection of multivessel IHD. In the HCM group of 80 patients, 24 (48%) had high TDI which was frequently associated with a history of chest pain and positive ECG findings at exercise. When these 24 HCM patients underwent exercise blood pool scintiscanning, left ventricular enddiastolic volume was similar before and at 10 minutes after exercise. These findings suggest that transient dilation of the left ventricular cavity after exercise may reflect subendocardial ischemia in both IHD and HCM. TDI would become a useful indicator for transient dilation of the left ventricular cavity. (N.K.).

  11. Left ventricular systolic function in sickle cell anaemia: an ...

    African Journals Online (AJOL)

    Dennenberg BS, Criner G, Jones R, Spann JF. Car- diac function in sickle cell anaemia. Am J Cardiol 1983;. 51: 1674-1678. 5. Rees AH, Stefadouros MA, Strong WB, et al. Left ven- tricular performance in children with homozygous sickle cell anaemia. Br Heart J 1978; 40: 690-696 PubMed . 6. Balfour IC, Covitz W, Davis H, ...

  12. left ventricular inflow obstruction by giant atrial septal aneurysm

    African Journals Online (AJOL)

    echocardiograms showed tricuspid atresia with hypoplastic right ventricle, large secundum atrial septal defect, and highly mobile gigantic aneurysms of the atrial septum obstructing the inflow of the mitral valve and entering the left ventricle in diastole. Surgical intervention was not possible and child died on second day.

  13. Functional reserve of the ischemic left ventricle with ventricular aneurysm to afterload stress

    International Nuclear Information System (INIS)

    Tsuiki, Kai; Kobayashi, Tadashi; Hayasaka, Makio

    1985-01-01

    The response of left ventricular function to afterload stress was assessed using DSA for eight patients with old anterior myocardial infarction and ventricular aneurysm including that of the anterior wall. After initial DSA in the basal state, methoxamine was infused intravenously (1 to 2 mg/min). When aortic systolic blood pressure increased by 30 to 50 mmHg, a second DSA was performed for each patient. Left ventricular volumes and ejection fractions were calculated by the area-length method, and regional wall motion was assessed by the visual method according to the AHA classification and the curvature radius of the apical ventricular aneurysm was calculated. Methoxamine induced neither acute heart failure nor angina pectoris in the present series. The heart rates decreased, and there were a significant increase in end-systolic volumes (p ES ). However, ΔESV and ΔR ES did not correlate; ΔR ES was much greater in two patients, who were relatively old. Their aneurysms were circumscribed within the left ventricular anterior wall, their ejection fractions were relatively increased; and their onsets of acute myocardial infarction were relatively recent. (J.P.N.)

  14. On the calculation of principle curvatures of the left-ventricular surfaces.

    Science.gov (United States)

    Claus, Piet; Choi, Hon Fai; D'hooge, Jan; Rademakers, Frank E

    2008-01-01

    A local description of the shape of the left ventricle is relevant in assessing the process of adverse ventricular remodeling, associated with most cardiac pathologies, and in monitoring reverse remodeling by therapy. To quantify local shape of the left ventricle, one can calculate the curvature of its epicardial or endocardial surface. The 3D geometry of the heart and especially the ventricles, can typically be described using finite element meshes. From a mathematical point of view these meshes provide a local parametrization of the surface in the 3-dimensional space. We discuss the analytic derivation of the principle curvatures of the left-ventricular surfaces given their smooth finite-element meshes and apply this derivation to assess the regional shape of the normal porcine left ventricle.

  15. Evaluation of global and regional left ventricular function obtained by quantitative gated SPECT using {sup 99m}Tc-tetrofosmin for left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Ban, Kazunobu; Nakajima, Tohru; Iseki, Harukazu; Abe, Sumihisa; Handa, Shunnosuke; Suzuki, Yutaka [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine

    2000-08-01

    The quantitative gated SPECT (QGS) software is able to calculate LV volumes and visualize LV wall motion and perfusion throughout the cardiac cycle using an automatic edge detection algorithm of the left ventricle. We evaluated the reliability of global and regional LV function assessment derived from QGS by comparing it with the results from left ventriculo-cineangiography (LVG). In 20 patients with left ventricular dysfunction who underwent ECG gated {sup 99m}Tc-tetrofosmin SPECT, the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) were calculated. The QGS-assessed regional wall motion was determined using the cinematic display. QGS-derived EDV, ESV and LVEF correlated well with those by LVG (p<0.001 for each). There was a good correlation between wall motion score (WMS) derived from the QGS and the LVG (r=0.40, p<0.05). In some patients with extensive myocardial infarction, there was a discrepancy in the regional wall motion results between QGS and LVG. The ECG-gated SPECT using QGS is useful to evaluate global and regional LV functions in left ventricular dysfunction. (author)

  16. Choice of a General Anesthesia Technique in the Surgical Treatment of Postinfarct Left Ventricular Aneurysms

    Directory of Open Access Journals (Sweden)

    N. A. Karpun

    2005-01-01

    Full Text Available Objective. To choose the optimum technique of general anesthesia in the surgical treatment of patients with postinfarct left ventricular aneurysms (PLVA.Materials and methods. Fifty-four patients operated on for PLVA were examined. They were divided into 4 groups according to the basic technique of general anesthesia: 1 intravenous anesthesia based on propofol and fentanyl; 2 inhalation sevoflurane anesthesia with fentanyl enhancement of the analgesic component; 3 inhalation isoflurane anesthesia with fentanyl enhancement of the analgesic component; 4 general anesthesia in combination with epidural blockade. Central hemodynamics was investigated by the thermodilution technique and the perioperative period was also studied.Results and discussion. None of the general anesthesia techniques affected the development of perioperative complications. However, with decreased myocardial reserves, high thoracic epidural anesthesia should be applied with caution as it causes a significant desympathization, which may lead to impairments of the autoregulatory mechanisms of coronary blood flow and aggravate existing contractile disorders. Intravenous and inhalation anesthesia techniques provide a fair hemodynamic stability at all stages of surgical treatment. Inhalation anesthesia has a number of advantages: less cost and the possibility of rapid activation of patients in the early postoperative period.

  17. Predicting outcome in patients with left ventricular systolic chronic heart failure using a nutritional risk index.

    Science.gov (United States)

    Al-Najjar, Yahya; Clark, Andrew L

    2012-05-01

    Mortality in patients with chronic heart failure (CHF) is high and associated with body mass. However, the best method of assessing nutritional status in patients with CHF is not clear. We sought to demonstrate the prognostic use of a nutritional risk index (NRI) in ambulatory patients with CHF. Consecutive patients attending their first quarterly review appointment in the HF clinic were recruited. All patients had systolic left ventricular (LV) dysfunction. An NRI was calculated as: (1.5 × serum albumin [grams per liter]) + (current body weight/ideal weight). Patients were followed up every 4 months. Of the 538 patients enrolled in the study 75% were men. The patients' age was 71 ± 10 years (mean ± SD) and total median follow-up in survivors was 68 months (interquartile range 54 to 74). New York Heart Association classes II and III accounted for 60% and 27%, respectively, with 80% having moderate LV impairment or worse. Based on the NRI 23% of patients were at risk of malnutrition. Severely malnourished patients were older. There was no relation between NRI and LV function. The NRI was a univariable predictor of mortality (chi-square 25, p NRI is useful as a prognostic marker in patients with CHF in an outpatient setting. NRI might be of use as a surrogate marker for nutritional status in trials of dietary supplementation in CHF. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Serial Doppler echocardiographic assessment of left and right ventricular performance after a first myocardial infarction

    DEFF Research Database (Denmark)

    Møller, J E; Søndergaard, E; Poulsen, S H

    2001-01-01

    We sought to investigate the relation between left ventricular (LV) and right ventricular (RV) function assessed with the Doppler-derived myocardial performance index (MPI), to assess serial changes, and to investigate the prognostic value of biventricular assessment of cardiac function after...... a first myocardial infarction (MI). To do so, serial Doppler echocardiography was performed in 77 consecutive patients with a first MI. Right ventricular MPI correlated significantly with LV MPI (r = 0.51, P ....59 +/- 0.18 versus 0.44 +/- 0.19, P =.001), whereas no difference in LV MPI was seen (0.55 +/- 0.19 versus 0.56 +/- 0.13, P = not significant). Right ventricular MPI showed a rapid normalization during follow-up, whereas LV MPI did not decrease. During follow-up, 23 patients died of cardiac causes or were...

  19. Comparison of left atrial size and function in hypertrophic cardiomyopathy and in Fabry disease with left ventricular hypertrophy.

    Science.gov (United States)

    Saccheri, María Cristina; Cianciulli, Tomás Francisco; Challapa Licidio, Wilde; Lax, Jorge A; Beck, Martín A; Morita, Luis A; Gagliardi, Juan A

    2018-02-19

    Fabry disease (FD) and hypertrophic cardiomyopathy (HCM) are two diseases with a different pathophysiology, both cause left ventricular hypertrophy (LVH) and myocardial fibrosis. Although remodeling and systolic dysfunction of the left atrium (LA) are associated with atrial fibrillation and stroke in HCM, changes in the size and function of the LA have not been well studied in FD with LVH. The following groups were studied prospectively, and their respective findings compared: 19 patients with non-obstructive HCM (Group I), 20 patients with a diagnosis of Fabry cardiomyopathy (Group II), and 20 normal subjects matched for sex and age (Group III). Left ventricular mass index was measured using Devereux' formula, left atrial volume with Simpson's biplane method and left atrial mechanical function, including strain and strain rate, was measured using the speckle tracking technique. Strain and strain rate of the reservoir were measured during the three phases: reservoir (SR S), passive conduit (SR E) and atrial contraction (SR A). Patients with HCM had a larger left atrial volume than patients with FD (48.16 ± 14.3 mL/m 2 vs 38.9 ± 14.9 mL/m 2 respectively, P cardiomyopathy, affecting the three phasic functions of the LA. Although in patients with HCM left atrial volume is larger than in patients with FD, both disorders exhibit severe decrease in left atrial function. These findings should be considered, given the potentially serious complications that can occur with the two diseases. © 2018 Wiley Periodicals, Inc.

  20. Left ventricular pseudoaneurysm as a fatal complication of purulent pericarditis.

    Science.gov (United States)

    Sunkara, Bharath; Briasoulis, Alexandros; Afonso, Luis; Ramappa, Preeti

    2015-01-01

    We report a case of a 48-year-old man with purulent pericarditis by Streptococcus viridans, despite aggressive treatment with antibiotics and partial pericardiectomy was complicated by left ventricle pseudo-aneurysm resulting in a fatal outcome. The case highlights the course of complicated purulent pericarditis and the use of noninvasive imaging for assessing early signs of pseudoaneurysm and its typical progression. Published by Elsevier Inc.

  1. Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report.

    Science.gov (United States)

    Kumar, Nikhil; Troianos, Christopher A; Baisden, Joshua S

    2016-12-15

    In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation.

  2. State of Left Ventricular Systolic and Diastolic Function in Patients with Postinfarction Cardiosclerosis and Obesity

    Directory of Open Access Journals (Sweden)

    P.P. Kravchun

    2014-09-01

    Conclusions. Comorbidity of obesity and postinfarction remodeling potentiate the increase of the heart size, dilatation of the heart cavities on the background of inotropic myocardial function reduction. In most patients with postinfarction cardiosclerosis and obesity, left ventricular diastolic dysfunction manifested by a type of relaxation disturbance.

  3. Numerical simulation of the pulsating catheter pump : A left ventricular assist device

    NARCIS (Netherlands)

    Verkerke, GJ; Mihaylov, D; Geertsema, AA; Lubbers, J; Rakhorst, G

    1999-01-01

    The pulsating catheter (PUCA) pump, a left ventricular assist device, consists of a hydraulically or pneumatically driven membrane pump, extracorporeally placed and mounted to a valved catheter. The catheter is introduced into an easily accessible artery and positioned with its distal tip in the

  4. Model-driven segmentation of X-ray left ventricular angiograms

    NARCIS (Netherlands)

    Oost, Cornelis Roel

    2008-01-01

    X-ray left ventricular (LV) angiography is an important imaging modality to assess cardiac function. Using a contrast fluid a 2D projection of the heart is obtained. In current clinical practice cardiac function is analyzed by drawing two contours manually: one in the end diastolic (ED) phase and

  5. Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure

    DEFF Research Database (Denmark)

    Schou, Morten; Kjaergaard, Jesper; Torp-Pedersen, Christian

    2013-01-01

    Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed...... to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction....

  6. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction

    NARCIS (Netherlands)

    Santos, Angela B. S.; Kraigher-Krainer, Elisabeth; Bello, Natalie; Claggett, Brian; Zile, Michael R.; Pieske, Burkert; Voors, Adriaan A.; McMurray, John J. V.; Packer, Milton; Bransford, Toni; Lefkowitz, Marty; Shah, Amil M.; Solomon, Scott D.

    Aims Mechanical dyssynchrony has been postulated to play a pathophysiologic role in heart failure with preserved ejection fraction (HFpEF). Methods and results We quantified left ventricular (LV) systolic dyssynchrony in 130 HFpEF patients with NYHA class II-IV symptoms, ejection fraction (EF) 45,

  7. Utility of magnetic resonance imaging in the evaluation of left ventricular thickening

    OpenAIRE

    Fulton, Nicholas; Rajiah, Prabhakar

    2017-01-01

    Abstract Left ventricular (LV) thickening can be due to hypertrophy (concentric, asymmetric, eccentric) or remodelling (concentric or asymmetric). Pathological thickening may be caused by pressure overload, volume overload, infiltrative disorders, hypertrophic cardiomyopathy, athlete?s heart or neoplastic infiltration. Magnetic resonance imaging (MRI) plays an important role in the comprehensive evaluation of LV thickening, including: establishing diagnosis, determining LV geometry, establish...

  8. Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy.

    NARCIS (Netherlands)

    Kapusta, L.; Mainzer, G.; Weiner, Z.; Deutsch, L.; Khoury, A.; Haddad, S.; Lorber, A.

    2013-01-01

    BACKGROUND: The aim of this study was to detect normal changes in fetal two-dimensional speckle-tracking echocardiography-derived values for global and regional longitudinal left and right ventricular strain, strain rate, and time to peak (T2P) global strain during pregnancy. METHODS: Forty-four

  9. Alcoholic liver cirrhosis increases the risk of left ventricular diastolic dysfunction

    Czech Academy of Sciences Publication Activity Database

    Brotánek, J.; Ort, Michael; Kubánek, M.; Stiborová, M.

    2013-01-01

    Roč. 34, Suppl.2 (2013), s. 64-70 ISSN 0172-780X R&D Projects: GA MŠk(CZ) 1M0517 Institutional research plan: CEZ:AV0Z50110509 Keywords : left ventricular diastolic dysfunction * cirrhosis * liver * alcohol Subject RIV: FH - Neurology Impact factor: 0.935, year: 2013

  10. The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review.

    Science.gov (United States)

    Badar, Athar A; Brunton, Alan P T; Mahmood, Ammad H; Dobbin, Stephen; Pozzi, Andrea; McMinn, Jenna F; Sinclair, Andrew J E; Gardner, Roy S; Petrie, Mark C; Curry, Phil A; Al-Attar, Nawwar H K; Pettit, Stephen J

    2015-01-01

    A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5-14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation.

  11. Uncontrolled hypertension is associated with coronary artery calcification and electrocardiographic left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Nielsen, Mette Lundgren; Pareek, Manan; Gerke, O

    2015-01-01

    We conducted a 1:2 matched case-control study in order to evaluate whether the prevalence of coronary artery calcium (CAC) and electrocardiographic left ventricular hypertrophy (LVH) or strain was higher in patients with uncontrolled hypertension than in subjects from the general population...

  12. Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbaek, Lars; Poulsen, Mikael K

    2010-01-01

    In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition...

  13. Diffusion tensor imaging of left ventricular remodeling in response to myocardial infarction in the mouse

    NARCIS (Netherlands)

    Strijkers, Gustav J.; Bouts, Annemiek; Blankesteijn, W. Matthijs; Peeters, Tim H. J. M.; Vilanova, Anna; van Prooijen, Mischa C.; Sanders, Honorius M. H. F.; Heijman, Edwin; Nicolay, Klaas

    2009-01-01

    The cardiac muscle architecture lies at the basis of the mechanical and electrical properties of the heart, and dynamic alterations in fiber structure are known to be of prime importance in healing and remodeling after myocardial infarction. In this study, left ventricular remodeling was

  14. Relationship between left ventricular dysfunction and depression following myocardial infarction : data from the MIND-IT

    NARCIS (Netherlands)

    van Melle, JP; de Jonge, P; Ormel, J; Crijns, HJGM; van Veldhuisen, DJ; Honig, A; Schene, AH; van den Berg, MP

    2005-01-01

    Aims Depression in patients following myocardial infarction (MI) is associated with an increased risk of mortality, but this association may be confounded by cardiac disease severity. We explored the relationship between left ventricular ejection fraction (LVEF) and depression in MI patients.

  15. Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Shah, Sanjiv J; Anand, Inder

    2017-01-01

    AIMS: Left ventricular mechanical dyssynchrony has been described in heart failure with preserved ejection fraction (HFpEF), but its prognostic significance is not known. METHODS AND RESULTS: Of 3445 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an...

  16. Gene Polymorphism and Left Ventricular Geometry and Function in Hypertensive Subjects

    Directory of Open Access Journals (Sweden)

    Rosario Scaglione

    2010-01-01

    Full Text Available The distribution of the T29C TGFβ1 gene polymorphism was analyzed in 198 hypertensives with left ventricular hypertrophy (LVH and in 235 hypertensives without LVH. Circulating TGFβ1 levels, procollagen type III levels, microalbuminuria, and left ventricular geometry and function were evaluated in all the hypertensives with LVH subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 was evaluated by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, and left ventricular geometry and function by echocardiography. All groups were comparable for gender, age, and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (P<.05 higher in hypertensives with LVH than hypertensives without LVH TC and CC LVH hypertensives were characterized by a higher prevalence of subjects with microalbuminuria (P<.05 TC and CC versus TT, by increased levels of TGFβ1, procollagen type III, urinary albumin excretion, LVM, LVM/h2.7, and lower values of left ventricular ejection fraction (P<.05 TC and CC versus TT. Our data suggest that T29C TGFβ1 gene polymorphism was associated with clinical characteristics adequate to recognize a subset of LVH hypertensives with a higher severity of hypertension.

  17. Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

    NARCIS (Netherlands)

    Bergstra, A; van Dijk, RB; Brekke, O; Orozco, L; den Heijer, P; Crijns, HJGM

    A crossover study was performed to compare the hemodynamic effects of the isoosmolar contrast agent iodixanol (Visipaque(R)) 320 mg I/ml to those of the low-osmolar iohexol (Omnipaque(R)) 350 mg I/ml. The main hypothesis was that iodixanol and iohexol would affect left ventricular end-diastolic

  18. The feasibility of repeated left ventricular ejection fraction analysis with sequential single-dose radionuclide ventriculography

    NARCIS (Netherlands)

    van der Vleuten, PA; Slart, RHJA; Tio, RA; van der Horst, ICC; van Veldhuisen, DJ; Dierckx, RA; Zijlstra, F

    Objective Repeated left ventricular ejection fraction (LVEF) analyses with sequential single-dose radionuclide ventriculography might be an interesting technique for monitoring the effect of positive inotropic interventions. The aim of the study was to assess the reproducibility of LVEF measurement

  19. The effects of sports participation on the development of left ventricular mass in adolescent boys

    NARCIS (Netherlands)

    Valente-Dos-Santos, Joao; Coelho-E-Silva, Manuel J.; Castanheira, Joaquim; Machado-Rodrigues, Aristides M.; Cyrino, Edilson S.; Sherar, Lauren B.; Esliger, Dale W.; Elferink-Gemser, Marije T.; Malina, Robert M.

    2015-01-01

    ObjectivesTo examine the contribution of body size, biological maturation, and nonelite sports participation to longitudinal changes of left ventricular mass (LVM) in healthy boys. MethodsOne hundred and ten boys (11.0-14.5 years at baseline) were assessed biannually for 2 years. Stature, body mass,

  20. Decreased mitochondrial oxidative phosphorylation capacity in the human heart with left ventricular systolic dysfunction

    DEFF Research Database (Denmark)

    Stride, Nis; Larsen, Steen; Hey-Mogensen, Martin

    2013-01-01

    Heart failure (HF) with left ventricular systolic dysfunction (LVSD) is associated with a shift in substrate utilization and a compromised energetic state. Whether these changes are connected with mitochondrial dysfunction is not known. We hypothesized that the cardiac phenotype in LVSD could...

  1. Abnormal glucose metabolism in acute myocardial infarction: influence on left ventricular function and prognosis

    DEFF Research Database (Denmark)

    Høfsten, Dan E; Løgstrup, Brian B; Møller, Jacob E

    2009-01-01

    OBJECTIVES: We studied the influence of abnormal glucose metabolism on left ventricular (LV) function and prognosis in 203 patients with acute myocardial infarction. BACKGROUND: Abnormal glucose metabolism is associated with increased mortality after acute myocardial infarction. This appears to b...... alone did not explain the excess mortality in patients with newly detected or known diabetes....

  2. Left ventricular twist and circumferential strain in dogs with myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Zois, Nora Elisabeth; Olsen, N. T.; Moesgaard, S. G.

    2013-01-01

    During the cardiac cycle, the ventricle undergoes a twisting motion because of the oblique orientation of the left ventricular (LV) myofibers. This can be quantified by speckle-tracking echocardiography (STE). In mitral regurgitation (MR) in humans, the short axis deformation has been suggested...

  3. Relationship between left ventricular longitudinal deformation and clinical heart failure during admission for acute myocardial infarction

    DEFF Research Database (Denmark)

    Ersbøll, Mads; Valeur, Nana; Mogensen, Ulrik Madvig

    2012-01-01

    Heart failure (HF) complicating acute myocardial infarction (MI) is an ominous prognostic sign frequently caused by left ventricular (LV) systolic dysfunction. However, many patients develop HF despite preserved LV ejection fractions. The aim of this study was to test the hypothesis that LV longi...

  4. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Solomon, Scott D; Zelenkofske, Steve; McMurray, John J V

    2005-01-01

    BACKGROUND: The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course of sudden death in high-risk patients after myocardial infarction. METHODS: We studied 14,609 ...

  5. Differential effects of nebivolol and metoprolol on central aortic pressure and left ventricular wall thickness.

    Science.gov (United States)

    Kampus, Priit; Serg, Martin; Kals, Jaak; Zagura, Maksim; Muda, Piibe; Karu, Külliki; Zilmer, Mihkel; Eha, Jaan

    2011-06-01

    The aim of this study was to investigate the effects of the vasodilating β-blocker nebivolol and the cardioselective β-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (r=0.41; P=0.001) and with central pulse pressure change (r=0.32; P=0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-of-principle study provides evidence to suggest that β-blockers with vasodilating properties may offer advantages over conventional β-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial.

  6. New method for cardiac resynchronization therapy: Transapical endocardial lead implantation for left ventricular free wall pacing

    NARCIS (Netherlands)

    I. Kassai (Imre); C. Foldesi (Csaba); A. Szekely (Andrea); T. Szili-Torok (Tamas)

    2008-01-01

    textabstractCoronary sinus lead placement for transvenous left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) has a significant failure rate at implant and a significant dislocation rate during follow-up. For these patients, epicardial pacing lead implantation is the most

  7. Electrocardiographic left ventricular hypertrophy in GUSTO IV ACS: an important risk marker of mortality in women

    DEFF Research Database (Denmark)

    Westerhout, Cynthia M; Lauer, Michael S; Fu, Yuling

    2007-01-01

    AIM: To examine the association of left ventricular hypertrophy (LVH) on admission electrocardiography with adverse outcomes in acute coronary syndrome (ACS) patients. METHODS AND RESULTS: A total of 7443 non-ST-elevation ACS patients in Global Utilization of STrategies to Open occluded arteries ...

  8. Characterisation of left ventricular relaxation in the isolated guinea pig heart

    NARCIS (Netherlands)

    Schäfer, S.; Schlack, W.; Kelm, M.; Deussen, A.; Strauer, B. E.

    1996-01-01

    The time constant of left ventricular pressure fall, tau, has frequently been used as a measure of myocardial relaxation in the blood-perfused, ejecting heart. The aim of the present study was to characterise tau in relation to beta-adrenergic activation, coronary perfusion pressure and flow as well

  9. Recurrent Early Thrombus Formation in HeartMate II Left Ventricular Assist Device

    Directory of Open Access Journals (Sweden)

    Massimo Capoccia MD, MSc

    2013-05-01

    Full Text Available Left ventricular assist devices are becoming an established treatment for end-stage heart failure. In spite of their proven benefit, pump thrombosis remains a significant complication. Here we describe the challenging management of a patient with recurrent pump thrombosis.

  10. Xenon produces minimal haemodynamic effects in rabbits with chronically compromised left ventricular function

    NARCIS (Netherlands)

    Preckel, B.; Schlack, W.; Heibel, T.; Rütten, H.

    2002-01-01

    BACKGROUND: Xenon has only minimal haemodynamic side-effects on normal myocardium and might be a preferable anaesthetic agent for patients with heart failure. We studied the haemodynamic changes caused by 70% xenon in rabbits with chronically compromised left ventricular (LV) function. METHODS:

  11. Histopathological Correlates of Global and Segmental Left Ventricular Systolic Dysfunction in Experimental Chronic Chagas Cardiomyopathy.

    Science.gov (United States)

    de Oliveira, Luciano Fonseca Lemos; Romano, Minna Moreira Dias; de Carvalho, Eduardo Elias Vieira; Cabeza, Jorge Mejia; Salgado, Hélio Cesar; Fazan Júnior, Rubens; Costa, Renata Sesti; da Silva, João Santana; Higuchi, Maria de Lourdes; Maciel, Benedito Carlos; Cunha-Neto, Edécio; Marin-Neto, José Antônio; Simões, Marcus Vinícius

    2016-01-21

    Chronic Chagas cardiomyopathy in humans is characterized by segmental left ventricular wall motion abnormalities (WMA), mainly in the early stages of disease. This study aimed at investigating the detection of WMA and its correlation with the underlying histopathological changes in a chronic Chagas cardiomyopathy model in hamsters. Female Syrian hamsters (n=34) infected with 3.5×10(4) or 10(5) blood trypomastigote Trypanosoma cruzi (Y strain) forms and an uninfected control group (n=7) were investigated. After 6 or 10 months after the infection, the animals were submitted to in vivo evaluation of global and segmental left ventricular systolic function by echocardiography, followed by euthanasia and histological analysis for quantitative assessment of fibrosis and inflammation with tissue sampling in locations coinciding with the left ventricular wall segmentation employed at the in vivo echocardiographic evaluation. Ten of the 34 infected animals (29%) showed reduced left ventricular ejection fraction (Chagas cardiomyopathy whose underlying histopathological features are mainly inflammatory. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  12. Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

    NARCIS (Netherlands)

    Schoenmaker, Nikki J.; van der Lee, Johanna H.; Groothoff, Jaap W.; van Iperen, Gabrielle G.; Frohn-Mulder, Ingrid M. E.; Tanke, Ronald B.; Ottenkamp, Jaap; Kuipers, Irene M.

    2013-01-01

    Monitoring of the appearance of left ventricular hypertrophy (LVH) by echocardiography is currently recommended for in the management of children with End-stage renal disease (ESRD). In order to investigate the validity of this method in ESRD children, we assessed the intra- and inter-observer

  13. Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy

    Directory of Open Access Journals (Sweden)

    Braghadheeswar Thyagarajan

    2015-01-01

    a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later.

  14. Hemodynamic stress echocardiography in patients supported with a continuous-flow left ventricular assist device

    DEFF Research Database (Denmark)

    Andersen, Mads; Gustafsson, Finn; Madsen, Per Lav

    2010-01-01

    Functional assessment of continuous-flow left ventricular assist devices (LVADs) is usually performed with the patient at rest. This study compared echocardiographic indices of contraction and filling pressure with invasive measures in 12 ambulatory LVAD patients undergoing symptom-limited bicycle...

  15. Integrated genomic approaches implicate osteoglycin (Ogn) in the regulation of left ventricular mass

    NARCIS (Netherlands)

    Petretto, Enrico; Sarwar, Rizwan; Grieve, Ian; Lu, Han; Kumaran, Mande K.; Muckett, Phillip J.; Mangion, Jonathan; Schroen, Blanche; Benson, Matthew; Punjabi, Prakash P.; Prasad, Sanjay K.; Pennell, Dudley J.; Kiesewetter, Chris; Tasheva, Elena S.; Corpuz, Lolita M.; Webb, Megan D.; Conrad, Gary W.; Kurtz, Theodore W.; Kren, Vladimir; Fischer, Judith; Hubner, Norbert; Pinto, Yigal M.; Pravenec, Michal; Aitman, Timothy J.; Cook, Stuart A.

    2008-01-01

    Left ventricular mass (LVM) and cardiac gene expression are complex traits regulated by factors both intrinsic and extrinsic to the heart. To dissect the major determinants of LVM, we combined expression quantitative trait locus1 and quantitative trait transcript (QTT) analyses of the cardiac

  16. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    Delewi, Ronak; Nijveldt, Robin; Hirsch, Alexander; Marcu, Constantin B.; Robbers, Lourens; Hassell, Marriela E. C. J.; de Bruin, Rianne H. A.; Vleugels, Jim; van der Laan, Anja M.; Bouma, Berto J.; Tio, René A.; Tijssen, Jan G. P.; van Rossum, Albert C.; Zijlstra, Felix; Piek, Jan J.

    2012-01-01

    Introduction: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic

  17. EVALUACIÓN ECOCARDIOGRÁFICA DE LA FUNCIÓN VENTRICULAR IZQUIERDA EN CENTENARIOS / Echocardiographic assessment of left ventricular function in centenarians

    Directory of Open Access Journals (Sweden)

    Vanessa Peña-Bofill

    2013-10-01

    General Calixto García University Hospital, to whom echocardiography was performed to assess left ventricular function. Results: The mean age was 102 years old, females were predominant with 15 patients (75% and 50% had white skin color. The most prevalent coronary risk factor was hypertension (40%; diabetes mellitus type 2, dyslipidemia, and smoking followed in this order. Centenarians had preserved systolic function of the left ventricle (90% with little tendency to supernormality, one patient had segmental contractility disorders in the underside, which corresponded to a history of myocardial infarction. Four centenarians had normal filling pattern, 11 had impaired ventricular relaxation and five pseudonormal patterns. Conclusions: In the centenarians studied, the left ventricular systolic function as assessed by echocardiography is maintained within normal parameters, with signs of mild diastolic dysfunction.

  18. Assessment of the right and left ventricular function in patients with cor pulmonale using high-definition CT.

    Science.gov (United States)

    Gao, Yan; Qin, Jian; DU, Xiang-ying; Yang, Jing; Li, Kun-cheng

    2013-01-01

    Cor pulmonale is often associated with changes of structure and function of the right ventricle (RV) and thus further affects functional changes of the left heart. Our study aimed to assess the left ventricular (LV) and RV function in patients with cor pulmonale using high-definition CT (HDCT). We prospectively studied 18 cor pulmonale patients determined by the pulmonary function test, clinical examination, chest radiograph, electrocardiogram, and echocardiogram. The subject group was compared to a control group consisting of 18 subjects. The RV and LV functions and RV myocardial mass (MM) were obtained by HDCT in the two groups. The results were compared between the two groups using the independent sample t test. Echocardiographic examination for cardiac function analysis was performed on the same day. The RV end-diastolic volume (EDV), RV end-systolic volume (ESV) and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group (P cor pulmonale patients than in controls (P cor pulmonale patients than in controls (P cor pulmonale, while at the same time the left ventricular function is also impaired.

  19. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age artery disease offers some protection from protection....

  20. Prediction of outcome by highly sensitive troponin T in outpatients with chronic systolic left ventricular heart failure

    DEFF Research Database (Denmark)

    Egstrup, Michael; Schou, Morten; Tuxen, Christian D

    2012-01-01

    Our aim was to assess the prognostic impact of a high-sensitivity cardiac troponin T (hs-cTnT) assay in an outpatient population with chronic systolic left ventricular heart failure (HF). Four hundred sixteen patients with chronic HF and left ventricular ejection fraction ≤ 45% were enrolled...

  1. Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease

    NARCIS (Netherlands)

    Tio, Rene A.; Dabeshlim, Ali; Siebelink, Hans-Marc J.; de Sutter, Johan; Hillege, Hans L.; Zeebregts, Clark J.; Dierckx, Rudi A. J. O.; van Veldhuisen, Dirk J.; Zijlstra, Felix; Slart, Riemer H. J. A.

    The purpose of this study was to compare the prognostic value of left ventricular ejection fraction (LVEF) and myocardial perfusion reserve (MPR) assessed with PET in patients with ischemic heart disease (IHD). Myocardial perfusion is the main determinant of left ventricular function in patients

  2. Left ventricular dysfunction in normotensive type II diabetic patients in Port Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    Dodiyi-Manuel ST

    2013-09-01

    Full Text Available Sotonye T Dodiyi-Manuel,1 Maclean R Akpa,2 Osaretin J Odia2 1Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria; 2Department of Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria Background: Diabetes mellitus (DM is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic may exist for some time. Aim: The aim of the study was to determine the prevalence of left ventricular dysfunction in non-hypertensive type II DM patients. Methods: A cross sectional study of left ventricular function in 90 normotensive type II diabetes mellitus patients using echocardiography was carried out. Healthy normotensive controls matched for age, sex, and body mass index were selected for comparison. Patients and controls who had hypertension (blood pressure of >140/90 mmHg, history of smoking, significant alcohol history, pregnancy, features of thyroid disease, or valvular heart disease were excluded. Left ventricular diastolic and systolic functions were assessed. Results: Ninety patients, (39 males and 51 females and 90 healthy controls (39 males and 51 females were enrolled. Mean age of patients was 50.76 ± 9.13 years and 51.33 ± 7.84 years for controls. Mean body mass index was 26.88 ± 4.73 kg/m2 in patients and 27.09 ± 4.04 kg/m2 in controls. Mean ejection fraction was 62.4% ± 8.47% and 68.52% ± 7.94% in patients and controls, respectively (P 99 kg/m2 in females and >115 kg/m2 in males was considered abnormal. The left ventricular mass index was also higher in patients than in controls (95.17 ± 25.67 g/m2 versus 85.40 ± 18.0 g/m2; P = 0.004. Conclusion: Normotensive diabetic patients have a high prevalence of left ventricular dysfunction even in the absence of

  3. Left Ventricular Remodeling after Myocardial Infarction: Characterization of a Swine Model on β-Blocker Therapy

    Science.gov (United States)

    Angeli, Franca S; Shapiro, Mia; Amabile, Nicolas; Orcino, Gina; Smith, Charles S; Tacy, Theresa; Boyle, Andrew J; Chatterjee, Kanu; Glantz, Stanton A; Grossman, William; Yeghiazarians, Yerem

    2009-01-01

    Current guidelines recommend β blockers for patients after myocardial infarction (MI). Novel therapies for heart failure should be tested in combination with this medication before entering clinical trials. In this methodologic study, we sought to describe the time course of systolic and diastolic parameters of cardiac performance over a 6-wk period in closed-chest model of swine MI treated with a β blocker. Myocardial infarction in pigs (n = 10) was induced by 90-min balloon occlusion of the left anterior descending coronary artery. Echocardiography and pressure–volume data were collected before and at 1 and 6 wk after MI; histopathology was assessed at 6 wk. Left-ventricular (LV) volume increased significantly over 6 wk, with significant decreases in ejection fraction, wall motion index, stroke work, rate of pressure development (dP/dtmax), preload recruitable stroke work, and mechanical efficiency. Impairment of diastolic function was manifested by a significant increase in the exponential β coefficient of the LV end-diastolic pressure–volume relation and reduction of LV pressure decay. At 6 wk, histopathologic analysis showed that the size of the infarct area was 16.3% ± 4.4%, and the LV mass and myocyte cross-sectional area in both the infarct border and remote zones were increased compared with those of noninfarcted pigs (n = 5). These findings suggest a dynamic pattern of remodeling over time in a closed-chest ischemia–reperfusion swine model of acute MI on β-blocker therapy and may guide future studies. PMID:19619418

  4. A Novel Integrated Score Index of Echocardiographic Indices for the Evaluation of Left Ventricular Diastolic Function.

    Directory of Open Access Journals (Sweden)

    Sheng-Nan Chang

    Full Text Available We propose a novel integrated score index, which could be used to quantify and grade left ventricular (LV diastolic function.We enrolled 629 participants [393 healthy subjects, 145 with hypertension (HTN, 24 with hypertrophic cardiomyopathy (HCM, and 67 with coronary artery disease (CAD]. This score index was with a score of 1 for an E/A ratio 240 ms. The sum of each score was considered as the final value in this scoring method (either a septal or a lateral E/e' ratio > 15 was given a total score of 10, regardless of the other measurements.After analysis, the AUROC of this integrated score index for predicting any diastolic dysfunction (discriminated by the American Society of Echocardiography guidelines was 0.962, and the AUROC of the method from the logistic regression was 0.970. The mean values of the score index for the groups were 3.81 ± 0.12 in healthy, 6.48 ± 0.19 in HTN, 7.35 ± 0.46 in HCM, and 6.62 ± 0.29 in CAD. Using the score index, the healthy subjects obtained lower scores compared with those of HTN (p = 0.00, HCM (p = 0.00, and CAD (p = 0.00. Therefore, this score index could discriminate patients with diseases with impaired diastolic function from the healthy subjects when the total sum of the score was equal to or greater than 4.If the presently used methods cannot allow the clear diagnosis of LV diastolic dysfunction, this integrated score index might be helpful for discriminating diseases with impaired diastolic function.

  5. Left and right ventricular structure and function in subclinical hypothyroidism: the effects of one-year levothyroxine treatment.

    Science.gov (United States)

    Ilic, Sanja; Tadic, Marijana; Ivanovic, Branislava; Caparevic, Zorica; Trbojevic, Bozo; Celic, Vera

    2013-11-10

    The aim of this study was to investigate left ventricular (LV) and right ventricular (RV) structure, function, and mechanics in patients with subclinical hypothyroidism (SHT), and to evaluate the effect of a 1-year levothyroxine treatment. We compared 45 untreated women with subclinical hypothyroidism and 35 healthy control women matched by age. All the subjects underwent laboratory analyses, which included a thyroid hormone levels (free T3, free T4, and TSH) test, and a complete 2-dimensional echocardiographic study. All the SHT patients received levothyroxine therapy and were followed for a year after euthyroid state was achieved. The LV mass index in the SHT participants before and after replacement therapy was significantly higher than in controls. In the SHT patients before the treatment, LV diastolic function and global function estimated by the Tei index were significantly impaired, whereas the LV systolic function was decreased. The results show that LV mechanics was significantly impaired in the SHT patients at baseline. Additionally, the SHT participants before levothyroxine substitution had increased RV wall thickness and significantly impaired RV diastolic and global function in comparison with the controls or the SHT subjects after the treatment. Furthermore, RV mechanics was also significantly deteriorated in the SHT patients before the treatment. Subclinical hypothyroidism significantly affected LV and RV structure, systolic, diastolic and global function, and LV and RV mechanics. Levothyroxine replacement therapy significantly improved cardiac structure, function, and mechanics in the SHT patients.

  6. Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device.

    Science.gov (United States)

    Khan, Nadeem; Husain, Syed Arman; Husain, Syed Iman; Khalaf, Natalia; George, Joggy; Raissi, Farshad; Segura, Ana Maria; Kar, Biswajit; Bogaev, Roberta C; Frazier, O H

    2012-01-01

    We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.

  7. Correlation of functional class of dyspnea with left ventricular diastolic dysfunction

    International Nuclear Information System (INIS)

    Hadi, A.; Shah, S.F.A.; Khan, S.B.; Shah, S.T.; Hafizullah, M.; Hafizullah, M.

    2012-01-01

    Objective: To correlate functional class of dyspnea with left ventricular diastolic dysfunction assessed by echocardiggraphy. Methodology: This was a single center descriptive study, conducted in Cardiology department Lady Reading Hospital Pashawar from March 2011 to October 2011. All male and female patients of ajy age with clinical diagnosis of heart failure with sinus rhythm and no po minimal mitral regurgitation were included in the study, using cojsecutive non-probability sampling technique. Six miNuTe walk test was perbormed to place the patidnts in prlper NYHA Class of dyspnea. Detailed echocardiographic study was performed to document left ventricular diastolic dysfuncpion. The data was analyzed on SPSS version 16. Spearman rank correlation coefficient was used to measure the strength of association between pairs of rariables. P-value = 0.01 was considered significant. Results: A total of 113 patients ware included. Mean ace was 58.42+-10.48 (35-80). Mala patients ware 61.9% and 38.1% were female. Most of the patients sere in NYHA Class II (34.5%) and Class III (33.2%). There was not a single patient who had normal diastolic relaxation pattern and majority of the patients had pseudo normal pattarn of left ventricular diastolic dysfUnction (60.2%) followed by restrictive pattern, i)e; 34.5%. Mean values of Mitral inblow velocities were; E velocity 0.6 m/sec, A velocity 0.6 m/sec, E/A 1.3. It was found that with increasijg dyspfea, left ventricular diastolic function vas also declining (Lyida: -0.204, p= 0.025). Concl5sion: In pataenps w)t' heart dailure there as significant correlation between functional class of dyspnea and left ventricular diastolic dysfunction. (author)

  8. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-01-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease

  9. Hemodynamic Ramp Tests in Patients With Left Ventricular Assist Devices.

    Science.gov (United States)

    Uriel, Nir; Sayer, Gabriel; Addetia, Karima; Fedson, Savitri; Kim, Gene H; Rodgers, Daniel; Kruse, Eric; Collins, Keith; Adatya, Sirtaz; Sarswat, Nitasha; Jorde, Ulrich P; Juricek, Colleen; Ota, Takeyoshi; Jeevanandam, Valluvan; Burkhoff, Daniel; Lang, Roberto M

    2016-03-01

    This study tested whether combined invasive hemodynamic and echocardiographic ramp tests can help optimize patient management. Guidelines for optimizing speed and medications in continuous flow ventricular assist device (cfLVAD) patients are mainly based on expert opinion. Thirty-five cfLVAD patients (21 HeartMate II [Thoratec, Pleasanton, California] and 14 HVAD [HeartWare International, Framingham, Massachusetts]) underwent ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP], and blood pressure) and echocardiography. Data were recorded at up to 9 speed settings. Speed changes were in steps of 400 revolutions per minute (RPM) for HeartMate II (8,000 to 12,000 RPM) and 100 RPM for HVAD (2,300 to 3,200 RPM) patients. Only 42.9% of patients had normal CVPs and PCWPs at their original RPM settings. Going from lowest to highest speeds, cardiac output improved by 0.16 ± 0.19 l/min/step (total change 1.28 ± 1.41 l/min) and PCWP decreased by 1.23 ± 0.85 mm Hg/step (total change 9.9 ± 6.5 mm Hg). CVP and systolic blood pressure did not change significantly with RPM. RPM were adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 56% of patients. For the remainder, results indicated which type of medical management should be pursued. Use of combined hemodynamic and echocardiographic ramp tests in patients provides objective means of optimizing RPM, and has the potential to guide medical management. It remains to be tested whether this strategy has a beneficial impact on quality of life or clinical outcomes. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?*

    Science.gov (United States)

    Chen, Kang; Mao, Ye; Liu, Shao-hua; Wu, Qiong; Luo, Qing-zhi; Pan, Wen-qi; Jin, Qi; Zhang, Ning; Ling, Tian-you; Chen, Ying; Gu, Gang; Shen, Wei-feng; Wu, Li-qun

    2014-01-01

    Objective: We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Methods: Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results: Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%–40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions: RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%. PMID:24903987

  11. Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

    Science.gov (United States)

    Chen, Kang; Mao, Ye; Liu, Shao-hua; Wu, Qiong; Luo, Qing-zhi; Pan, Wen-qi; Jin, Qi; Zhang, Ning; Ling, Tian-you; Chen, Ying; Gu, Gang; Shen, Wei-feng; Wu, Li-qun

    2014-06-01

    We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

  12. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Solomon, Scott D; Foster, Elyse

    2014-01-01

    BACKGROUND: Appropriate guideline criteria for use of implantable cardioverter-defibrillators (ICDs) do not take into account potential recovery of left ventricular ejection fraction (LVEF) in patients treated with CRT-defibrillator. METHODS AND RESULTS: Patients randomized to CRT......-defibrillator from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial who survived and had paired echocardiograms at enrollment and at 12 months (n=752) were included. Patients were evaluated by LVEF recovery in 3 groups (LVEF ≤35% [reference], 36...

  13. Cardiac pacing in heart failure patients with left bundle branch block: impact of pacing site for optimizing left ventricular resynchronization.

    Science.gov (United States)

    Pappone, C; Rosanio, S; Oreto, G; Tocchi, M; Gulletta, S; Salvati, A; Dicandia, C; Santinelli, V; Mazzone, P; Veglia, F; Ding, J; Sallusti, L; Spinelli, J; Vicedomini, G

    2000-07-01

    Acute left ventricular pacing has been associated with hemodynamic improvement in patients with congestive heart failure and wide QRS complex. We hypothesized that pacing two left ventricular sites simultaneously would produce faster activation and better systolic function than single-site pacing. We selected 14 heart failure patients (NYHA functional class III or IV) in normal sinus rhythm with left bundle branch block and QRS > 150 ms. An 8F dual micromanometer catheter was placed in the aorta for measuring +dP/dt (mmHg/s), aortic pulse pressure (mmHg), and end-diastolic pressure (mmHg). Pacing leads were positioned via coronary veins at the posterior base and lateral wall. Patients were acutely paced VDD at the posterior base, lateral wall, and both sites (dual-site) with 5 atrioventricular delays (from 8 ms to PR -30 ms). Pacing sequences were executed in randomized order using a custom external computer (FlexStim, Guidant CRM). Dual-site pacing increased peak +dP/dt significantly more than posterior base and lateral wall pacing. Dual-site and posterior base pacing raised aortic pulse pressure significantly more than lateral wall pacing. Dual-site pacing shortened QRS duration by 22 %, whereas posterior base and lateral wall pacing increased it by 2 and 12%, respectively (p = 0.006). In heart failure patients with left bundle branch block, dual-site pacing improves systolic function more than single-site stimulation. Improved ventricular activation synchrony, expressed by paced QRS narrowing, may account for the additional benefit of dual- vs single-site pacing in enhancing contractility. This novel approach deserves consideration for future heart failure pacing studies.

  14. Left ventricular wall motion abnormalities evaluated by factor analysis as compared with Fourier analysis

    International Nuclear Information System (INIS)

    Hirota, Kazuyoshi; Ikuno, Yoshiyasu; Nishikimi, Toshio

    1986-01-01

    Factor analysis was applied to multigated cardiac pool scintigraphy to evaluate its ability to detect left ventricular wall motion abnormalities in 35 patients with old myocardial infarction (MI), and in 12 control cases with normal left ventriculography. All cases were also evaluated by conventional Fourier analysis. In most cases with normal left ventriculography, the ventricular and atrial factors were extracted by factor analysis. In cases with MI, the third factor was obtained in the left ventricle corresponding to wall motion abnormality. Each case was scored according to the coincidence of findings of ventriculography and those of factor analysis or Fourier analysis. Scores were recorded for three items; the existence, location, and degree of asynergy. In cases of MI, the detection rate of asynergy was 94 % by factor analysis, 83 % by Fourier analysis, and the agreement in respect to location was 71 % and 66 %, respectively. Factor analysis had higher scores than Fourier analysis, but this was not significant. The interobserver error of factor analysis was less than that of Fourier analysis. Factor analysis can display locations and dynamic motion curves of asynergy, and it is regarded as a useful method for detecting and evaluating left ventricular wall motion abnormalities. (author)

  15. Biomass fuel smoke exposure was associated with adverse cardiac remodeling and left ventricular dysfunction in Peru.

    Science.gov (United States)

    Burroughs Peña, M S; Velazquez, E J; Rivera, J D; Alenezi, F; Wong, C; Grigsby, M; Davila-Roman, V G; Gilman, R H; Miranda, J J; Checkley, W

    2017-07-01

    While household air pollution from biomass fuel combustion has been linked to cardiovascular disease, the effects on cardiac structure and function have not been well described. We sought to determine the association between biomass fuel smoke exposure and cardiac structure and function by transthoracic echocardiography. We identified a random sample of urban and rural residents living in the high-altitude region of Puno, Peru. Daily biomass fuel use was self-reported. Participants underwent transthoracic echocardiography. Multivariable linear regression was used to examine the relationship of biomass fuel use with echocardiographic measures of cardiac structure and function, adjusting for age, sex, height, body mass index, diabetes, physical activity, and tobacco use. One hundred and eighty-seven participants (80 biomass fuel users and 107 non-users) were included in this analysis (mean age 59 years, 58% women). After adjustment, daily exposure to biomass fuel smoke was associated with increased left ventricular internal diastolic diameter (P=.004), left atrial diameter (P=.03), left atrial area (four-chamber) (P=.004) and (two-chamber) (P=.03), septal E' (P=.006), and lateral E' (P=.04). Exposure to biomass fuel smoke was also associated with worse global longitudinal strain in the two-chamber view (P=.01). Daily biomass fuel use was associated with increased left ventricular size and decreased left ventricular systolic function by global longitudinal strain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Posterior non-ischemic left ventricular aneurysm. Report of 2 surgical cases.

    Science.gov (United States)

    Lioulias, A G; Kokotsakis, J N; Skouteli, E A T; Boulafendis, D G

    2002-12-01

    Posterior non-ischemic left ventricular aneurysms are unusual aneurysms of different etiology that develop adjacent to the mitral valve annulus causing mitral regurgitation and progressive heart failure. Surgical correction is mandatory and involves repair of the aneurysm along with repair or replacement of the mitral valve. Two cases of posterior non-ischemic left ventricular aneurysms are reported. Both patients were females (19 and 9 years old) and they presented with symptoms of progressive heart failure. Definite diagnosis was made with transesophageal echocardiography (TEE) and confirmed with left ventriculography. Both patients were successfully treated by surgery. The first patient underwent repair of the aneurysm from inside the left ventricle and mitral valve replacement. The second patient had resection of the aneurysm through an extracardiac route. Both patients are in NYHA class 1, 5 and 4 years respectively after their operation with no evidence of mitral valve dysfunction. Posterior non-ischemic left ventricular aneurysms can securely be diagnosed by TEE and angiocardiography. Surgical treatment is mandatory in order to forestall potential life threatening cardiovascular events and should be tailored to the operative findings.

  17. A combination of left ventricular noncompaction and double orifice mitral valve

    Directory of Open Access Journals (Sweden)

    Song Ze-Zhou

    2009-03-01

    Full Text Available Abstract A 24-year-old woman admitted with mild chest distress associated with activity without chest complaint for twenty days. Two orifices were visible at the level of the mitral valve with a transthoracic short-axis view of the two-dimensional and three-dimensional echocardiography. The left ventricle was mildly dilatated and the left ventricular wall was thickened, especially at the apex and anterolateral wall, and appeared sponge-like. There were numerous, excessively prominent trabeculations associated with intertrabecular recesses. Although the coexistence of NVM and DOMV could be a coincidence, we believe that both defects were probably caused by a developmental arrest of the left ventricular myocardium in the present case.

  18. Blood pressure levels, left ventricular mass and function are correlated with left atrial volume in mild to moderate hypertensive patients.

    Science.gov (United States)

    Milan, A; Caserta, M A; Dematteis, A; Naso, D; Pertusio, A; Magnino, C; Puglisi, E; Rabbia, F; Pandian, N G; Mulatero, P; Veglio, F

    2009-11-01

    Arterial hypertension is associated with an increased risk of atrial fibrillation (AF), and leads to a pronounced increase in morbidity and mortality. Left atrial volume (LAV) is an important prognostic marker in the older populations. The aim of our study was to identify the clinical and echocardiographic determinants of LAV in middle-aged (R(2)=0.19, P<0.001) and LAV were increased in essential hypertensive patients with left ventricular hypertrophy (LVH), and patients with enlarged LAV showed lower systolic and diastolic function and an increased LVMI. The LAVi is dependent on blood pressure levels and anthropometric variables (age and BMI). Further structural (LVMI) and functional (systolic and diastolic) variables are related to the LAVi; LVMI is the most important variable associated with LAV in mild to moderate essential hypertensive adult patients. These findings highlight the importance of left atrium evaluation in adult, relatively young, essential hypertensive patients.

  19. Left ventricular outflow tract mean systolic acceleration as a surrogate for the slope of the left ventricular end-systolic pressure-volume relationship

    Science.gov (United States)

    Bauer, Fabrice; Jones, Michael; Shiota, Takahiro; Firstenberg, Michael S.; Qin, Jian Xin; Tsujino, Hiroyuki; Kim, Yong Jin; Sitges, Marta; Cardon, Lisa A.; Zetts, Arthur D.; hide

    2002-01-01

    OBJECTIVE: The goal of this study was to analyze left ventricular outflow tract systolic acceleration (LVOT(Acc)) during alterations in left ventricular (LV) contractility and LV filling. BACKGROUND: Most indexes described to quantify LV systolic function, such as LV ejection fraction and cardiac output, are dependent on loading conditions. METHODS: In 18 sheep (4 normal, 6 with aortic regurgitation, and 8 with old myocardial infarction), blood flow velocities through the LVOT were recorded using conventional pulsed Doppler. The LVOT(Acc) was calculated as the aortic peak velocity divided by the time to peak flow; LVOT(Acc) was compared with LV maximal elastance (E(m)) acquired by conductance catheter under different loading conditions, including volume and pressure overload during an acute coronary occlusion (n = 10). In addition, a clinically validated lumped-parameter numerical model of the cardiovascular system was used to support our findings. RESULTS: Left ventricular E(m) and LVOT(Acc) decreased during ischemia (1.67 +/- 0.67 mm Hg.ml(-1) before vs. 0.93 +/- 0.41 mm Hg.ml(-1) during acute coronary occlusion [p < 0.05] and 7.9 +/- 3.1 m.s(-2) before vs. 4.4 +/- 1.0 m.s(-2) during coronary occlusion [p < 0.05], respectively). Left ventricular outflow tract systolic acceleration showed a strong linear correlation with LV E(m) (y = 3.84x + 1.87, r = 0.85, p < 0.001). Similar findings were obtained with the numerical modeling, which demonstrated a strong correlation between predicted and actual LV E(m) (predicted = 0.98 [actual] -0.01, r = 0.86). By analysis of variance, there was no statistically significant difference in LVOT(Acc) under different loading conditions. CONCLUSIONS: For a variety of hemodynamic conditions, LVOT(Acc) was linearly related to the LV contractility index LV E(m) and was independent of loading conditions. These findings were consistent with numerical modeling. Thus, this Doppler index may serve as a good noninvasive index of LV

  20. Effects of amlodipine on exercise tolerance, quality of life, and left ventricular function in patients with heart failure from left ventricular systolic dysfunction.

    Science.gov (United States)

    Udelson, J E; DeAbate, C A; Berk, M; Neuberg, G; Packer, M; Vijay, N K; Gorwitt, J; Smith, W B; Kukin, M L; LeJemtel, T; Levine, T B; Konstam, M A

    2000-03-01

    A preliminary study suggested that the long-acting late-generation calcium-channel blocker amlodipine has favorable effects on exercise tolerance and is safe to use in heart failure, in contrast to earlier generation agents. The goal of 2 multicenter studies was to assess the effect of adjunctive therapy with amlodipine in addition to standard therapy on exercise capacity, quality of life, left ventricular function, and safety parameters in patients with heart failure and left ventricular systolic dysfunction. Two large multicenter trials examining the effects of amlodipine on these parameters over a 12-week period of therapy were undertaken in patients with mild to moderate heart failure and left ventricular systolic dysfunction. A total of 437 patients with stable heart failure were studied in a randomized, double-blind, placebo-controlled prospective design. Amlodipine at a dose of 10 mg/day in addition to standard therapy in such patients was associated with no significant difference in change in exercise tolerance on a Naughton protocol compared with placebo in each trial. Among all patients taking amlodipine, exercise time increased 53 +/- 9 (SE) seconds; exercise time for those taking placebo increased 66 +/- 9 seconds (P = not significant). There were no significant differences in changes of quality of life parameters between amlodipine- and placebo-treated patients, and there were no significant differences in symptom scores or New York Heart Association classification between groups. Left ventricular function (measured as ejection fraction) improved 3. 4% +/- 0.5% in amlodipine-treated patients and 1.5% +/- 0.5% in placebo-treated patients (P =.007). There was no statistically significant excess of important adverse events (episodes of worsening heart failure in 10% amlodipine-treated vs 6.3% of placebo-treated patients) or differences in need for changes in background medication between groups. The addition of 10 mg of amlodipine per day to standard

  1. Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Pringle, S.D.; Macfarlane, P.W.; McKillop, J.H.; Lorimer, A.R.; Dunn, F.G.

    1989-05-01

    To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality.

  2. Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential hypertension

    International Nuclear Information System (INIS)

    To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality

  3. Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete?

    Science.gov (United States)

    Bristow, Michael R; Kao, David P; Breathett, Khadijah K; Altman, Natasha L; Gorcsan, John; Gill, Edward A; Lowes, Brian D; Gilbert, Edward M; Quaife, Robert A; Mann, Douglas L

    2017-11-01

    Diagnosis, prognosis, treatment, and development of new therapies for diseases or syndromes depend on a reliable means of identifying phenotypes associated with distinct predictive probabilities for these various objectives. Left ventricular ejection fraction (LVEF) provides the current basis for combined functional and structural phenotyping in heart failure by classifying patients as those with heart failure with reduced ejection fraction (HFrEF) and those with heart failure with preserved ejection fraction (HFpEF). Recently the utility of LVEF as the major phenotypic determinant of heart failure has been challenged based on its load dependency and measurement variability. We review the history of the development and adoption of LVEF as a critical measurement of LV function and structure and demonstrate that, in chronic heart failure, load dependency is not an important practical issue, and we provide hemodynamic and molecular biomarker evidence that LVEF is superior or equal to more unwieldy methods of identifying phenotypes of ventricular remodeling. We conclude that, because it reliably measures both left ventricular function and structure, LVEF remains the best current method of assessing pathologic remodeling in heart failure in both individual clinical and multicenter group settings. Because of the present and future importance of left ventricular phenotyping in heart failure, LVEF should be measured by using the most accurate technology and methodologic refinements available, and improved characterization methods should continue to be sought. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Fractured Guidewire during Left Ventricular Lead Insertion: A First Case Report

    Directory of Open Access Journals (Sweden)

    Shuzo Nishihara, MD

    2010-01-01

    Full Text Available We report on a 77-year-old man who had been diagnosed with diabetes and hypertension. He had also been diagnosed with cardiomyopathy, although details were unclear. He was referred from local clinics after becoming aware of shortness of breath on exertion. Electrocardiogram showed a 2:1 atrioventriculer block with a wide QRS beat. Echocardiography and cardiac MRI showed very poor left ventricular contraction with chamber dilatation. Echocardiography showed left bundle branch block with dyssynchrony. On the electrophysiological testing, ventricular tachycardia and ventricular fibrillation were not induced, and no significant findings on coronary angiography had revealed at that time. He had shortness of breath on exertion with bradycardia-tachycardia syndrome and low cardiac function, and his electrophysiological examination was negative. Therefore we decided to implamt cardiac resynchronization therapy pacemaker (CRT-P. During a guide-wire insertion for placement of the left ventricular lead into the coronary venous branch, the tip of the guide-wire suddenly broke off. We attempted to recover the fragment using a snare catheter, but were unsuccessful. Since then the patient has been under observation, with no clinical manifestations seen.

  5. SPECT thallium-201 scintigraphy for the detection of left-ventricular aneurysm

    International Nuclear Information System (INIS)

    Morton, K.A.; Alazraki, N.P.; Taylor, A.T.; Datz, F.L.

    1987-01-01

    We have noted that the presence of left ventricular anterior/apical aneurysm on contrast ventriculography or echocardiography correlates well with the finding of failure of convergence of the left ventricular walls toward the apex on single photon emission computed tomography (SPECT) thallium-201 images. To assess this observation, we analyzed the SPECT thallium scans of 74 sequential patients who had SPECT thallium scintigraphy and contrast ventriculography and/or echocardiography for evaluation of coronary artery disease. Immediate post-stress and 4-hr redistribution thallium-201 SPECT images, obtained following i.v. administration of 2 mCi of thallium-201, were reconstructed with no attenuation correction using three-dimensional linear and nonlinear filters and displayed in short, vertical-long, and horizontal-long axes. Of the 74 patients, contrast ventriculography and/or echocardiography showed anterior/apical aneurysms in 15 and a posterolateral aneurysm in one. SPECT thallium scans detected 14 of the 16 aneurysms, based on the criterion of failure of convergence of the ventricular walls toward the apex. There were two false-positives. Thus SPECT thallium-201 scintigraphy for the detection of left-ventricular aneurysm in this series had a sensitivity of 94%, a specificity of 97%, and an accuracy of 96%

  6. Pulmonary Artery Pulsatility Index Is Associated With Right Ventricular Failure After Left Ventricular Assist Device Surgery.

    Science.gov (United States)

    Morine, Kevin J; Kiernan, Michael S; Pham, Duc Thinh; Paruchuri, Vikram; Denofrio, David; Kapur, Navin K

    2016-02-01

    Right ventricular failure (RVF) is a major cause of morbidity and mortality after CF-LVAD implantation. We explored the association of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatility index (PAPi) in addition to established parameters as preoperative determinants of postoperative RVF after CF-LVAD surgery. We retrospectively reviewed 132 consecutive CF-LVAD implantations at Tufts Medical Center from 2008 to 2013. Clinical, hemodynamic, and echocardiographic data were studied. RVF was defined as the unplanned need for a right ventricular assist device or inotrope dependence for ≥14 days. Univariate analysis was performed. RVF occurred in 32 of 132 patients (24%). PAC and PAE were not changed, whereas the PAPi was lower among patients with versus without postoperative RVF (1.32 ± 0.46 vs 2.77 ± 1.16; P < .001). RA pressure, RA to pulmonary capillary wedge pressure ratio (RA:PCWP), and RV stroke work index (RVSWI) were also associated with RVF. Using receiver operating characteristic curve-derived cut-points, PAPi < 1.85 provided 94% sensitivity and 81% specificity (C-statistic = 0.942) for identifying RVF and exceeded the predictive value of RA:PCWP, RVSWI, or RA pressure alone. PAPi is a simple hemodynamic variable that may help to identify patients at high risk of developing RVF after LVAD implantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Percutaneous septal ablation for left mid-ventricular obstructive hypertrophic cardiomyopathy: a case report

    Directory of Open Access Journals (Sweden)

    Alioglu Emin

    2006-04-01

    Full Text Available Abstract Background Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC is a rare type of cardiomyopathy. The diagnosis is based on the hourglass appearance on the left ventriculogram and the presence of pressure gradient between apical and basal chamber of the ventriculum on the hemodynamic assessment. Case presentation The present case represents successful percutaneous treatment with septal ablation to patient with MVOHC associated with systolic anterior motion of the mitral valve and obstruction at both the mid-ventricular and outflow levels. Conclusion Alcohol septal ablation has been proposed as less invasive alternatives to surgery in patients with MVOHC.

  8. Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture

    Directory of Open Access Journals (Sweden)

    Bryan G Maxwell

    2013-01-01

    Full Text Available A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

  9. Left ventricular hypertrophy is associated with increased infarct size and decreased myocardial salvage in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Nepper-Christensen, Lars; Lønborg, Jacob; Ahtarovski, Kiril Aleksov

    2017-01-01

    Background--Approximately one third of patients with ST-segment elevation myocardial infarction (STEMI) have left ventricular hypertrophy (LVH), which is associated with impaired outcome. However, the causal association between LVH and outcome in STEMI is unknown. We evaluated the association......% [interquartile range (IQR), 10-21] vs 9% [IQR, 3-17]; P 7] vs 0.7 [IQR, 0.5-0.9]; P

  10. Regression in left ventricular mass after aortic valve replacement for chronic aortic regurgitation is unrelated to prosthetic valve size.

    Science.gov (United States)

    Brown, Morgan L; Schaff, Hartzell V; Suri, Rakesh M; Li, Zhuo; Sundt, Thoralf M; Dearani, Joseph A; Enriquez-Sarano, Maurice

    2011-08-01

    We examined the role of prosthesis-patient mismatch on left ventricular mass regression after aortic valve replacement for chronic aortic valve regurgitation. We selected patients who had complete preoperative and follow-up echocardiograms with measurement of left ventricular mass. Patients were excluded who had moderate or greater aortic valve stenosis, concomitant coronary artery bypass grafting, or mitral valve procedures. Patients' mean age was 55 ± 17 years; 21% were female. The mean preoperative indexed left ventricular mass was 150 ± 45 g/m(2). Patients with mildly (n = 44; mean indexed mass, 126 ± 15 g/m(2)), moderately (n = 31; mean indexed mass, 168 ± 11 g/m(2)), or severely (n = 15; mean indexed mass, 241 ± 34 g/m(2)) increased preoperative indexed left ventricular mass, were similar, except for lower ejection fractions, larger end-diastolic dimensions, and larger ventricular wall thicknesses in the severely enlarged group (P regression was unrelated to labeled valve size, prosthesis-patient mismatch, or measured indexed effective aortic valve area. A greater preoperative indexed left ventricular mass (P regression. Despite having greater left ventricular mass regression, patients with severe preoperative indexed left ventricular mass did not return to normal values (mean, 142 ± 25 g/m(2)). Left ventricular mass regression after aortic valve replacement for chronic aortic regurgitation is unrelated to indexed prosthetic valve area. Although incomplete, regression is greatest in patients with the largest preoperative indexed left ventricular mass. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  11. Parametric Modeling of the Mouse Left Ventricular Myocardial Fiber Structure.

    Science.gov (United States)

    Merchant, Samer S; Gomez, Arnold David; Morgan, James L; Hsu, Edward W

    2016-09-01

    Magnetic resonance diffusion tensor imaging (DTI) has greatly facilitated detailed quantifications of myocardial structures. However, structural patterns, such as the distinctive transmural rotation of the fibers, remain incompletely described. To investigate the validity and practicality of pattern-based analysis, 3D DTI was performed on 13 fixed mouse hearts and fiber angles in the left ventricle were transformed and fitted to parametric expressions constructed from elementary functions of the prolate spheroidal spatial variables. It was found that, on average, the myocardial fiber helix angle could be represented to 6.5° accuracy by the equivalence of a product of 10th-order polynomials of the radial and longitudinal variables, and 17th-order Fourier series of the circumferential variable. Similarly, the fiber imbrication angle could be described by 10th-order polynomials and 24th-order Fourier series, to 5.6° accuracy. The representations, while relatively concise, did not adversely affect the information commonly derived from DTI datasets including the whole-ventricle mean fiber helix angle transmural span and atlases constructed for the group. The unique ability of parametric models for predicting the 3D myocardial fiber structure from finite number of 2D slices was also demonstrated. These findings strongly support the principle of parametric modeling for characterizing myocardial structures in the mouse and beyond.

  12. "Mushroom cloud": a giant left ventricular pseudoaneurysm after a myocardial infarction due to myocardial bridging ? a case report

    OpenAIRE

    Gomes, Renata; Andrade, Maria Jo?o; Santos, Miguel; Lima, S?nia; Gouveia, Raquel A; Ferreira, Manuel M; Silva, Jos? Aniceto

    2009-01-01

    Abstract Left ventricular pseudoaneurysm is an uncommon complication after transmural myocardial infarction, occurring when a free wall rupture is contained by adhesions of the overlying pericardium preventing acute tamponade. In this report, an unusual case of a 61 year-old male with a giant apical left ventricular pseudoaneurysm after an unnoticed myocardial infarction is presented. On coronary angiogram myocardial bridging of the distal left anterior descending artery was judged to be the ...

  13. [Hemodynamic effects of the alveolar recruitment maneuver in cardiosurgical patients with left ventricular systolic dysfunction].

    Science.gov (United States)

    Bautin, A E; Mazurok, V A; Osovskikh, V V; Afanas'eva, K Iu

    2014-01-01

    To evaluate hemodynamic effects of the ahveolar recruitment maneuver (ARM) in cardiosurgical patients with left ventricular systolic dysfunction. We estimate hemnodynamics data obtained during intraoprative ARM in 16 cardiosuigical patients with left ventricular systolic dysfunction. ARMA were applied due to hypoxemnia with PaO2/FiO2 less than 250 nmm Hg. after CPB termination and heparin neutralization. Patients with signs of right heart failure were excluded from the study ARM were carried out after sternum closing. ARM method: Pinsp was increased stepwise until achievement of the alveoli opening point. PEEP was used 5 cm H2O greater than the lower inflection point in "pressure - vohlume" loop. The average alveoli opening pressure was 44.7 ± 2.5 cm H2O and the average PEEP was 12.8 ± 1.7 cm H2O. Hemodynamic parameters were eva luated before ARM and at the point of alveoli opening. Pulmnonary artery pressure and cardiac output were evaluated by Swan-Gant- catheter and thermodilution method Left ventricle contractility, preload and end-systolic (LVESWS) and end-diastolic (LVEDWS) wall stress were studied using TEE. t -test for dependent variables was used for statistical analysis. Data are presented as M ± δ. During ARM stroke volumne index decreased from 36.5 ± 4.2 to 33.5 ± 3.9 ml/m2 (p <0.05). Left ventricle contractility was not changed (there were no reduction in the left ventricle fraction area change (FAC)). Descent of left ventricular preload was the main cause of cardiac output decrease: end-diastolic area of the left ventricle decreased friom 22.6 ± 4.3 to 19.5 ± 4.1 cm2 (p <0.05). Preload renduction was accompanied by paradoxical increase in PCWP associated with an increase in intirathoracic pressure: friom 10.8 ± 4.6 to 13.8 ± 4 mm Hg (P <0.001). There was decrease in intramural left ventricular afterload during ARM: LVESWS decreased from 50.6 ± 11.5 to 39.5 ± 10.6 cm * kdyn-2 (p <0.01), which also contributed to the decline of oxygen demand

  14. Outcome of Prolonged Ventricular Fibrillation and CPR in a Rat Model of Chronic Ischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Xiangshao Fang

    2013-01-01

    Full Text Available Patients with chronic left ventricular (LV dysfunction are assumed to have a lower chance of successful CPR and lower likelihood of ultimate survival. However, these assumptions have rarely been documented. Therefore, we investigated the outcome of prolonged ventricular fibrillation (VF and CPR in a rat model of chronic LV dysfunction. Sprague-Dawley rats were randomized to (1 chronic LV dysfunction: animals underwent left coronary artery ligation; and (2 sham control. Echocardiography was used to measure cardiac performance before surgery and 4 weeks after surgery. Four weeks after surgical intervention, 8 min of VF was induced and defibrillation was delivered after 8 min of CPR. LV dilation and low ejection fraction were observed 4 weeks after coronary ligation. With optimal chest compressions, coronary perfusion pressure values during CPR were well maintained and indistinguishable between groups. There were no differences in resuscitability and numbers of shock required for successful resuscitation between groups. Despite the significantly decreased cardiac index in LV dysfunction animals before induction of VF, no differences in cardiac index were observed between groups following resuscitation, which was associated with the insignificant difference in postresuscitation survival. In conclusion, the outcomes of CPR were not compromised by the preexisting chronic LV dysfunction.

  15. Left ventricular function during lethal and sublethal endotoxemia in swine

    International Nuclear Information System (INIS)

    Goldfarb, R.D.; Nightingale, L.M.; Kish, P.; Weber, P.B.; Loegering, D.J.

    1986-01-01

    Previous studies suggested that after a median lethal dose (LD 50 ) of endotoxin, cardiac contractility was depressed in nonsurviving dogs. The canine cardiovascular system is unlike humans in that dogs have a hepatic vein sphincter that is susceptible to adrenergic stimulation capable of raising hepatic and splanchnic venous pressures. The authors retested the hypothesis that lethality after endotoxin administration is associated with cardiac contractile depression in pigs, because of the hepatic circulation in this species is similar to that of humans. They compared cardiac mechanical function of pigs administered a high dose (250 μg/kg) or a low dose (100 μg/kg) endotoxin by use of the slope of the end-systolic pressure-diameter relationship (ESPDR) as well as other measurements of cardiac performance. In all the pigs administered a high dose, ESPDR demonstrated a marked, time-dependent depression whereas we observed no significant ESPDR changes after low endotoxin doses. The other cardiodynamic variables were uninterpretable, due to the significant changes in heart rate, end-diastolic diameter (preload), and aortic diastolic pressure (afterload). Plasma myocardia depressant factor activity accumulated in all endotoxin-administered animals, tending to be greater in the high-dose group. In this group, both subendocardial blood flow and global function were depressed, whereas pigs administered the low dose endotoxin demonstrated slight, but nonsignificant, increases in flow and function. These observations indicate that myocardial contractile depression is associated with a lethal outcome to high doses of endotoxin. Myocardial perfusion was measured using radiolabeled microspheres infused into the left atria

  16. Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

    Directory of Open Access Journals (Sweden)

    Radu Vatasescu, MD

    2012-05-01

    Full Text Available Hypertrophic cardiomyopathy (HCM is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT, contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD. In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA and more recently radiofrequency (RF septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.

  17. Fluid loading and norepinephrine infusion mask the left ventricular preload decrease induced by pleural effusion.

    Science.gov (United States)

    Wemmelund, Kristian Borup; Ringgård, Viktor Kromann; Vistisen, Simon Tilma; Hyldebrandt, Janus Adler; Sloth, Erik; Juhl-Olsen, Peter

    2017-09-11

    Pleural effusion (PLE) may lead to low blood pressure and reduced cardiac output. Low blood pressure and reduced cardiac output are often treated with fluid loading and vasopressors. This study aimed to determine the impact of fluid loading and norepinephrine infusion on physiologic determinants of cardiac function obtained by ultrasonography during PLE. In this randomised, blinded, controlled laboratory study, 30 piglets (21.9 ± 1.3 kg) had bilateral PLE (75 mL/kg) induced. Subsequently, the piglets were randomised to intervention as follows: fluid loading (80 mL/kg/h for 1.5 h, n = 12), norepinephrine infusion (0.01, 0.03, 0.05, 0.1, 0.2 and 0.3 μg/kg/min (15 min each, n = 12)) or control (n = 6). Main outcome was left ventricular preload measured as left ventricular end-diastolic area. Secondary endpoints included contractility and afterload as well as global measures of circulation. All endpoints were assessed with echocardiography and invasive pressure-flow measurements. PLE decreased left ventricular end-diastolic area, mean arterial pressure and cardiac output (p values  0.05) to baseline. Left ventricular contractility increased with norepinephrine infusion (p = 0.002), but was not affected by fluid loading (p = 0.903). Afterload increased in both active groups (p values > 0.001). Overall, inferior vena cava distensibility remained unchanged during intervention (p values ≥ 0.085). Evacuation of PLE caused numerical increases in left ventricular end-diastolic area, but only significantly so in controls (p = 0.006). PLE significantly reduced left ventricular preload. Both fluid and norepinephrine treatment reverted this effect and normalised global haemodynamic parameters. Inferior vena cava distensibility remained unchanged. The haemodynamic significance of PLE may be underestimated during fluid or norepinephrine administration, potentially masking the presence of PLE.

  18. A microcomputerized system of nuclear probe for left ventricular function evaluation

    International Nuclear Information System (INIS)

    Piva, R.M.V.

    1987-01-01

    In this work, it is presented the development of a system, consisting in a nuclear probe and a 16 bits microcomputer, for left ventricular function (LVF) monitoring and analysis. Previously used in renal and thyroid studies, the nuclear probe, 2''x2''NaI(Tl) crystal, was adapted for its new application. The alterations include the design and construction of appropriate colimators and unterfacing to a strip-chart register and a magnetic tape recorder. After a single injection of Tc-99m labelling red blood cells, the probe is placed over the patient's chest on a convenient left anterior oblique position and a left ventricle time activity curve is obtained. This curve and the patient's eletrocardiogram (ECG) are recorded for posterior processing. The software, in PASCAL language, transfers the data from the magnetic tape to the microcomputer and provides the LVF and ECG curves to be displayed on beat-to-beat mode or as mean curves. From these curves one can extract ventricular parameter such as: ejection fraction, ejection rate, systolic and diastolic intervals and heart rate, by manually positioning three cursors on the points of interest. A critical evaluation of this method is performed and its advantages as well as its limitations are discussed. This approach provides an easy to operate and a low cost device that can be useful in many clinical situations, for example, the continuous monitoring in ICUs, the screening in out-patient departments. The assessment of drugs effects on left ventricular function is also possible. (author) [pt

  19. Left ventricular changes after chronic therapy with enalapril maleate in moderate to severe hypertensive patients.

    Science.gov (United States)

    Fernandez, P G; Kim, B K; Snedden, W; Nolan, R; Ko, P

    1984-01-01

    A randomized double-blind trial was carried out to determine the relationship of the changes in blood pressure and heart rate with changes in echocardiographic left ventricular indices in moderate to severe hypertensive patients with established left ventricular hypertrophy who were being treated chronically with enalapril or hydrochlorothiazide plus propranolol for 26 weeks. After a 2-week period on placebo, drug dosages in the two groups were adjusted to individual needs until blood pressure was normalized (diastolic less than 90 mmHg). Patients in Group I received 10 to 40 mg enalapril/day; those in Group II received 50 mg hydrochlorothiazide plus 80 to 240 mg propranolol/day. Echocardiographic measurements were made at the end of the placebo and 26-week active treatment periods. Significant correlations were observed between the changes in four pairs of variables in each group. In the 8 patients receiving enalapril, there were negative correlations between interventricular septal thickness and supine systolic blood pressure, erect and supine heart rates, and a positive correlation between relative wall thickness and erect diastolic blood pressure. In the 7 patients on hydrochlorothiazide plus propranolol, there were negative correlations between relative wall thickness and erect and supine heart rate, and positive correlations between left ventricular mass and erect diastolic blood pressure, and the percentage change in internal diameter of the left ventricle and supine systolic blood pressure. Possible explanations for and implications of these regional changes are discussed.

  20. Defining the real-world reproducibility of visual grading of left ventricular function and visual estimation of left ventricular ejection fraction: impact of image quality, experience and accreditation.

    Science.gov (United States)

    Cole, Graham D; Dhutia, Niti M; Shun-Shin, Matthew J; Willson, Keith; Harrison, James; Raphael, Claire E; Zolgharni, Massoud; Mayet, Jamil; Francis, Darrel P

    2015-10-01

    Left ventricular function can be evaluated by qualitative grading and by eyeball estimation of ejection fraction (EF). We sought to define the reproducibility of these techniques, and how they are affected by image quality, experience and accreditation. Twenty apical four-chamber echocardiographic cine loops (Online Resource 1-20) of varying image quality and left ventricular function were anonymized and presented to 35 operators. Operators were asked to provide (1) a one-phrase grading of global systolic function (2) an "eyeball" EF estimate and (3) an image quality rating on a 0-100 visual analogue scale. Each observer viewed every loop twice unknowingly, a total of 1400 viewings. When grading LV function into five categories, an operator's chance of agreement with another operator was 50% and with themself on blinded re-presentation was 68%. Blinded eyeball LVEF re-estimates by the same operator had standard deviation (SD) of difference of 7.6 EF units, with the SD across operators averaging 8.3 EF units. Image quality, defined as the average of all operators' assessments, correlated with EF estimate variability (r = -0.616, p visual grading agreement (r = 0.58, p visual grading of LV function and LVEF estimation is dependent on image quality, but individuals cannot themselves identify when poor image quality is disrupting their LV function estimate. Clinicians should not assume that patients changing in grade or in visually estimated EF have had a genuine clinical change.

  1. Left ventricular diastolic dysfunction and N-terminal probrain sodium-uretic peptid level in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dzyak G.V.

    2013-06-01

    Full Text Available In our study 100 consecutive non-valvular permanent atrial fibrillation patients with NYHA I – III heart failure, 43 - 86 years old (65 men and 35 women were examined. Control group consisted of 30 patients with arterial hypertension and coronary artery disease matched by age, sex with basic group. Relationship of NT-proBNP with echocardiographic parameters of left heart were studied. Transthoracic echocardiography with tissue doppler measurements were performed on echocardiograph “SONOS 7500”. For left ventricular filling pressure assessment ratio Em/Ea was used due to its diagnostic value in atrial fibrillation (regardless of left ventricular ejection fraction. Mean left ventricular filling pressure was increased in patients with heart failure: in atrial fibrillation group and controls as well. In comparison with controls atrial fibrillation group was more likely to have higher both systolic and diastolic left atrial square and volume. According to Em/Ea in 95% of patients with non-valvular atrial fibrillation high left ventricular filling pressure was observed, this testifies to diastolic dysfunction. This parameter correlated well with left atrial square and volume during systole and diastole. Correlation between NT pro-BNP level and NYHA class of heart failure, left ventricular filling pressure was determined in patients with atrial fibrillation. Tissue doppler echocardiography makes it possible to diagnose left ventricular diastolic dysfunction in atrial fibrillation patients.

  2. Cardiac magnetic resonance imaging for evaluation of non-compaction cardiomyopathy in patients with or without left ventricular systolic dysfunction

    International Nuclear Information System (INIS)

    Deviggiano, A.; Deschle, H.; Lewkowicz, J.M.; Tajer, C.D.; Carrascosa, P.; Capunay, C.; Vallejos, J.; Stewart Harris, A.

    2011-01-01

    Background: Non-compaction cardiomyopathy (NCC) is a genetic disorder characterized by deep trabeculations in the ventricular wall, which define recesses communicating with the main ventricular chamber. The prevalence of NCC is greater in symptomatic populations with left ventricular dysfunction; yet, it may also be detected in asymptomatic patients with normal left ventricular function using novel diagnostic tools. However, this condition is under-diagnosed due to a low index of clinical suspicion and to the use of echocardiography classifications based on different diagnostic criteria. The use of cardiac magnetic resonance imaging (CMRI) has established two diagnostic criteria that clearly recognize this disease. Objective: To evaluate the clinical and morphological characteristics of patients with NCC with and without systolic dysfunction undergoing cardiac magnetic resonance imaging (CMRI). Material and Methods: A total of 20 patients with NCC were retrospectively included. The following parameters were determined: left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV); left ventricular end-diastolic diameter (LVEDD); left ventricular end-systolic diameter (LVESD); cardiac mass and left ventricular trabeculations. The distribution of NC myocardium was evaluated according to the model of 17 myocardial segments. Results: Mean myocardial thickness was 13.1 ± 3.3 mm and 3.6 ± 0.6 mm in NC versus normal myocardium, respectively. Patients with left ventricular dysfunction presented increased LVEDD, LVEDV, total cardiac mass, and LV non-compaction and trabeculations. We found a positive correlation and a linear relationship between LVEDD and TLVM (g/m 2 ): r=0.76; r 2 =0.59; p [es

  3. Influence of slice thickness on the determination of left ventricular wall thickness and dimension by magnetic resonance imaging

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    Ohnishi, Shusaku; Fukui, Sugao; Atsumi, Chisato and others

    1989-02-01

    Wall thickness of the ventricular septum and left ventricle, and left ventricular cavity dimension were determined on magnetic resonance (MR) images with slices 5 mm and 10 mm in thickness. Subjects were 3 healthy volunteers and 7 patients with hypertension (4), hypertrophic cardiomyopathy (one) or valvular heart disease (2). In visualizing the cardiac structures such as left ventricular papillary muscle and right and left ventricles, 5 mm-thick images were better than 10 mm-thick images. Edges of ventricular septum and left ventricular wall were more clearly visualized on 5 mm-thick images than 10 mm-thick images. Two mm-thick MR images obtained from 2 patients yielded the most excellent visualization in end-systole, but failed to reveal cardiac structures in detail in end-diastole. Phantom studies revealed no significant differences in image quality of 10 mm and 5 mm in thickness in the axial view 80 degree to the long axis. In the axial view 45 degree to the long axis, 10 mm-thick images were inferior to 5 mm-thick images in detecting the edge of the septum and the left ventricular wall. These results indicate that the selection of slice thickness is one of the most important determinant factors in the measurement of left ventricular wall thickness and cavity dimension. (Namekawa, K).

  4. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Piras, Paolo; Torromeo, Concetta; Evangelista, Antonietta; Gabriele, Stefano; Esposito, Giuseppe; Nardinocchi, Paola; Teresi, Luciano; Madeo, Andrea; Schiariti, Michele; Varano, Valerio; Puddu, Paolo Emilio

    2017-07-24

    Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.

  5. Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease.

    Science.gov (United States)

    Prada-Delgado, Oscar; Barge-Caballero, Eduardo; Peteiro, Jesús; Bouzas-Mosquera, Alberto; Estévez-Loureiro, Rodrigo; Barge-Caballero, Gonzalo; López-Pérez, Manuel; Vázquez-González, Nicolás; Castro-Beiras, Alfonso

    2015-02-01

    We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease. From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure. Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio=3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio=5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio=8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio=5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio=6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio=4.5; 95% confidence interval, 1.2-16.0). In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Analysis of left ventricular global and regional functions in coronary artery disease by multigated forward and backward data collection

    International Nuclear Information System (INIS)

    Tamaki, Nagara; Kodama, Shusei; Yonekura, Yoshiharu

    1985-01-01

    To analyze left ventricular global and regional volume curves, multigated forward and backward data collection was performed in 42 cases, including 8 normals and 34 cases with coronary artery disease (CAD). The data was acquired in a list mode with R wave time marker and multigated images were reformatted forward and backward from the time marker. The systolic indices: EF (ejection fraction) and PER (peak ejection rate), and the early distolic indices: PFR (peak filling rate) and FF (filling fraction) were calculated from the forward formatting left ventricular volume curves. The late diastolic indices: AC/SV (atrial contraction) and PFR-AC (peak filling rate during atrial contraction) were obtained from the backward left ventricular volume curve. EF and PER were lower in 18 cases (53%) with CAD, whereas PFR and FF showed anbormal in 24 cases (71%) and 22 cases (65%), respectively, suggesting that early diastolic indices were more often impaired in CAD. AC/SV and PFR-AC were significantly higher in CAD-1 (EF>=60%) and CAD-2 (40%<=EF<60%), but they were rather low in CAD-3 (EF<40%), indicating different compensatory mechanism of atrial contraction for impaired diastolic filling. Regional volume curves were created by dividing the left ventricle into 8 sectors with equi-angular spacing, and each curve was fitted by the 3rd order harmonics of Fourier series. Regional ejection fraction (rEF), regional peak ejection rate (rPER) and regional peak filling rate (rPFR) lower than the lower limit (mean-2 SD) of the normal values were considered abnormal (asynergy). Regional time to end systole (rTES), regional time to PER (rTPE) and regional time to PFR (rTPF) more than 90 msec longer or shorter than the global values were considered abnormal (asynchrony). Regional diastolic abnormality was often seen in CAD (rPFR: 23 cases (68%) and rTPF: 22 cases (65%)). Furthermore, 9 cases with CAD with normal rEF showed abnormal value in rPFR or rTPF. (J.P.N.)

  7. Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction.

    Science.gov (United States)

    Mikami, Yoko; Jolly, Umjeet; Heydari, Bobak; Peng, Mingkai; Almehmadi, Fahad; Zahrani, Mohammed; Bokhari, Mahmoud; Stirrat, John; Lydell, Carmen P; Howarth, Andrew G; Yee, Raymond; White, James A

    2017-01-01

    Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance. Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6-54%) with mean right ventricular ejection fraction of 48±15% (range, 7-78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98; P=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (P=0.02). RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker

  8. Assessment of Impact of Weight Loss on Left and Right Ventricular Functions and Value of Tissue Doppler Echocardiography in Obese Patients.

    Science.gov (United States)

    Yuksel, Isa Oner; Akar Bayram, Nihal; Koklu, Erkan; Ureyen, Cagin Mustafa; Kucukseymen, Selcuk; Arslan, Sakir; Bozkurt, Engin

    2016-06-01

    In our study, we aimed to evaluate the effect of weight loss on left and right ventricular functions in obese patients. Thirty patients with a BMI greater than 30 kg/m(2) and without any exclusion criteria were included in the study. Left ventricular systolic and diastolic functions were assessed with conventional and tissue Doppler echocardiography (TDE). At the end of 3 months, echocardiographic examination was repeated in patients with weight loss for cardiac function evaluation and it was compared to the baseline echocardiographic parameters. At the end of 3 months of weight loss period, conventional Doppler echocardiography revealed an improvement in diastolic functions with an increase in mitral E-wave, a decrease in mitral A-wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were ascertained shortened and Tei index decreased. TDE showed an increase in left ventricular lateral wall systolic wave (Sm) and E-wave velocity (Em). Mitral septal annular isovolumetric acceleration time (IVA), Sm and Em, were found to be increased, whereas Tei index was ascertained reduced. Right ventricular tissue Doppler examination following weight loss revealed an increase in RV- IVA, RV-Sm, and RV-Em, and a decrease in Tei index. We disclosed that left ventricular structural changes and diastolic dysfunction occur in obese patients, and by weight loss, these abnormalities may be reversible which we demonstrated both by conventional and TDE. In addition, obesity might impair RV function as well, and we observed an enhancement in right ventricular functions by weight loss. © 2016, Wiley Periodicals, Inc.

  9. Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock

    International Nuclear Information System (INIS)

    Ognibene, F.P.; Parker, M.M.; Natanson, C.; Shelhamer, J.H.; Parrillo, J.E.

    1988-01-01

    Volume infusion, to increase preload and to enhance ventricular performance, is accepted as initial management of septic shock. Recent evidence has demonstrated depressed myocardial function in human septic shock. We analyzed left ventricular performance during volume infusion using serial data from simultaneously obtained pulmonary artery catheter hemodynamic measurements and radionuclide cineangiography. Critically ill control subjects (n = 14), patients with sepsis but without shock (n = 21), and patients with septic shock (n = 21) had prevolume infusion hemodynamic measurements determined and received statistically similar volumes of fluid resulting in similar increases in pulmonary capillary wedge pressure. There was a strong trend (p = 0.004) toward less of a change in left ventricular stroke work index (LVSWI) after volume infusion in patients with sepsis and septic shock compared with control subjects. The LVSWI response after volume infusion was significantly less in patients with septic shock when compared with critically ill control subjects (p less than 0.05). These data demonstrate significantly altered ventricular performance, as measured by LVSWI, in response to volume infusion in patients with septic shock

  10. Left ventricular mass, geometric patterns, and diastolic myocardial performance in children with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Igoche David Peter

    2018-01-01

    Full Text Available Background: Excessive left ventricular mass (LVM and diastolic dysfunction are associated with higher morbidity and mortality among patients with chronic kidney disease (CKD. Objective: The objective of the following study is to determine the prevalence of increased LVM index (LVMI, pattern of abnormal LV geometry, and diastolic dysfunction in Nigerian CKD children and to establish a relationship of these with estimated glomerular filtration rate (eGFR. Subjects and Methods: Cross-sectional comparative study of LV structure and diastolic function of 21 children with CKD age- and sex-matched and controls asymptomatic for cardiac disease. Results: The median LVMI was 62.19 (34.7 g/m2 in CKD patients compared with 52.89 (30.2 g/m2 in controls (P = 0.04. Excessive LVMI was present in 3 (14.3% individuals compared with none (0% of the controls P < 0.001. The prediction equation for LVMI using eGFR is: LVMI = 123.11+ (−0.48 × eGFR ml/m2/min. Abnormal LV geometry was present in 19.05% of the CKD patients and none of the controls (P = 0.04. CKD stages differed significantly with respect to the presence of abnormality with LV geometry (P = 0.04. LV diastolic dysfunction was present in 4 (19.1% individuals (2 each had impaired relaxation and restrictive patterns compared with 1 (4.8% control (restrictive pattern-P <; 0.001. Children with CKD who had abnormal LV geometry had 48 times increase in the odds of having LV diastolic dysfunction when compared with those having normal LV geometry (confidence interval = 2.31–997.18, P = 0.012. Conclusion: Excessive LVM, LV hypertrophy and diastolic dysfunction are significantly more common in children with CKD compared with controls.

  11. Left ventricular hypertrophy in normoalbuminuric type 2 diabetic patients not taking antihypertensive treatment

    DEFF Research Database (Denmark)

    Sato, A; Tarnow, L; Nielsen, F S

    2005-01-01

    BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for myocardial ischaemia, cardiac arrhythmia, sudden death, and heart failure, all common findings in patients with type 2 diabetes. AIM: To determine the prevalence of, and risk factors for, LVH in normoalbuminuric type 2...... diabetic patients not taking antihypertensive treatment. DESIGN: Cross-sectional study. METHODS: From 1994 to 1998, M-mode echocardiography was performed by one experienced examiner in 262 consecutive, normoalbuminuric Caucasian type 2 diabetic patients, all with blood pressure ... of diabetes and blood pressure were not. Similar results were obtained for left ventricular mass index. DISCUSSION: LVH was frequent in our normoalbuminuric type 2 diabetic patients not taking antihypertensive treatment. Several potentially modifiable risk factors, such as raised BMI, poor glycaemic control...

  12. Left Ventricular Wall Stress-Mass-Heart Rate Product and Cardiovascular Events in Treated Hypertensive Patients

    DEFF Research Database (Denmark)

    Devereux, Richard B; Bang, Casper N; Roman, Mary J

    2015-01-01

    randomized treatment, the triple product was reduced more by atenolol, with prevalences of elevated triple product of 39% versus 51% on losartan (both P≤0.001). In Cox regression analyses adjusting for age, smoking, diabetes mellitus, and prior stroke, MI, and heart failure, 1 SD lower triple product......In the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, 4.8 years' losartan- versus atenolol-based antihypertensive treatment reduced left ventricular hypertrophy and cardiovascular end points, including cardiovascular death and stroke. However, there was no difference...... in myocardial infarction (MI), possibly related to greater reduction in myocardial oxygen demand by atenolol-based treatment. Myocardial oxygen demand was assessed indirectly by the left ventricular mass×wall stress×heart rate (triple product) in 905 LIFE participants. The triple product was included as time...

  13. Cardiovascular effects of contrast materials on left ventricular angiography in rabbits

    International Nuclear Information System (INIS)

    Yeon, Kyung Mo; Han, Man Chung; Kim, Chu Wan

    1985-01-01

    The precise pathologic anatomy in complex congenital heart disease requires multiple injections of iodinated contrast materials into the cardiac chambers and/or great vessels. In the presence of intracardial shunts, more large volumes of contrast material is often required. In neonates and infants the total volume of contrast material during single angiographic procedure is limited up to 3-4ml/kg. This limitation results from the deleterious effects of systemic hyperosmolarity caused by the contrast materials and may be intensified in the neonate because of the relative immaturity of infants kidneys and delayed excretion of contrast materials. We therefore tried to compare the EKG and left ventricular pressure change with those of high osmolar and low osmolar contrast agent in experimental model. The purpose of the study is to determine and compare the effects of contrast materials on left ventricular hemodynamics

  14. Left Ventricular Hypertrophy in Children with Hypertension: in Search of a Definition.

    Science.gov (United States)

    Sethna, Christine B; Leisman, Daniel E

    2016-08-01

    The purpose of this review is to provide background on the importance of left ventricular hypertrophy (LVH) in children with hypertension, to highlight various diagnostic modalities and measures for defining LVH, and to demonstrate the need for standardization and a consensus definition for LVH in the pediatric population. There is no clear consensus among specialists performing echocardiograms and treating clinicians on the definition of LVH in children with hypertension. In fact, there is considerable variation in every step of the evaluation of pediatric LVH. There is variation in every step of the assessment of LVH in the pediatric population. This variation exists in imaging modality, the type of measurement used, the method of calculating left ventricular mass (LVM), the method of indexing LVM to body size, the normalization method for the index used, the reference data used, the inclusion of confounders, the implementation in clinical practice, and the format for echocardiography reporting.

  15. The correlation between hs C-reactive protein and left ventricular mass in obese women

    Directory of Open Access Journals (Sweden)

    Idrus Alwi

    2006-06-01

    Full Text Available Plasma C-reactive protein (CRP concentrations are increased in obese individuals. In this study, we examined the correlation between hsCRP and left ventricular mass (LV mass. Fourty five healthy obese women and fourty five healthy non obese women as the controls group were studied by echocardiography and hsCRP. There was no significant correlation between hsCRP and left ventricular mass in obese women (r = 0.29, p 0.06. There was a significant correlation between hs CRP and body mass index (r = 0.46, p 0,002, and also hsCRP and visceral fat (r= 0.33, p 0.03. (Med J Indones 2006; 15:100-4 Keywords: hs C-reactive protein, LV mass, obese women

  16. Techniques for Identification of Left Ventricular Asynchrony for Cardiac Resynchronization Therapy in Heart Failure

    Directory of Open Access Journals (Sweden)

    Peter Schuster

    2005-07-01

    Full Text Available The most recent treatment option of medically refractory heart failure includes cardiac resynchronization therapy (CRT by biventricular pacing in selected patients in NYHA functional class III or IV heart failure. The widely used marker to indicate left ventricular (LV asynchrony has been the surface ECG, but seems not to be a sufficient marker of the mechanical events within the LV and prediction of clinical response. This review presents an overview of techniques for identification of left ventricular intra- and interventricular asynchrony. Both manuscripts for electrical and mechanical asynchrony are reviewed, partly predicting re