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Sample records for normal ejection fraction

  1. Ultrasonographic ejection fraction of normal gallbladder

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    Park, Jin Hun; Kim, Seung Yup; Park, Yaung Hee; Kang, Ik Won; Yoon, Jong Sup [Hangang Sacred Heart Hospital, Halym College, Chuncheon (Korea, Republic of)

    1984-06-15

    Real-time ultrasonography is a simple, accurate, noninvasive and potentially valuable means of studying gallbladder size and emptying. The authors calculated ultrasonographically the ejection fraction of 80 cases of normally functioning gallbladder on oral cholecystography, from June 1983 to April 1984, at the department of radiology, Hangang Sacred Heart Hospital. The results were obtained as follows; 1. Ultrasonographic Ejection Fraction at 30 minutes after the fatty meal was 73.1{+-}16.85. 2. There was no significant difference in age and sex, statistically.

  2. Ejection fraction response to exercise in patients with chest pain and normal coronary arteriograms

    International Nuclear Information System (INIS)

    Gibbons, R.L.; Lee, K.L.; Cobb, F.; Jones, R.H.

    1981-01-01

    In this study we describe the ejection fraction response to upright exercise using first-pass radionuclide angiocardiography in a group of 60 patients with chest pain, normal coronary ateriograms and normal resting ventricular function. A wide range of resting function (heart rate and ejection fraction) and exercise function (heart rate, ejection fraction, peak work load and estimated peak oxygen uptake) were measured. The ejection fraction response to exercise demonstrated wide variation, ranging from a decrease of 23% to an increase of 24%. Six of 22 clinical and radionuclide angiocardiographic variables (resting ejection fraction, peak work load, age, sex, body surface area and the change in end-diastolic volume index with exercise) were significant univariate predictors of the ejection fraction response to exercise. Multivariable analysis identified resting ejection fraction, the change in end-diastolic volume index with exercise and either sex or peak work load as variables that provided significant independent predictive information. These observations indicate that the ejection fraction response to exercise is a complex response that is influenced by multiple physiologic variables. The wide variation in this population suggests that the ejection fraction response to exercise is not a reliable test for the diagnosis of coronary artery disease because of its low specificity

  3. Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction.

    Science.gov (United States)

    Sanderson, John E

    2016-07-01

    Heart failure with a preserved ejection faction (HFpEF) is a growing and expensive cause of heart failure (HF) affecting particularly the elderly. It differs in substantial ways in addition to the normal left ventricular ejection fraction, from the more easily recognized form of heart failure with a reduced ejection fraction (HFrEF or 'systolic heart failure') and unlike HFrEF there have been little advances in treatment. In part, this relates to the complexity of the pathophysiology and identifying the correct targets. In HFpEF, there appears to be widespread stiffening of the vasculature and the myocardium affecting ventricular function (both systolic and diastolic), impeding ventricular suction, and thus early diastolic filling leading to breathlessness on exertion and later atrial failure and fibrillation. Left ventricular ejection fraction tends to gradually decline and some evolve into HFrEF. Most patients also have a mixture of several co-morbidities including hypertension, diabetes, obesity, poor renal function, lack of fitness, and often poor social conditions. Therefore, many factors may influence outcome in an individual patient. In this review, the epidemiology, possible causation, pathophysiology, the influence of co-morbidities and some of the many potential predictors of outcome will be considered.

  4. Prognostic significance of hemoglobin level in patients with congestive heart failure and normal ejection fraction.

    Science.gov (United States)

    Varadarajan, Padmini; Gandhi, Siddharth; Sharma, Sanjay; Umakanthan, Branavan; Pai, Ramdas G

    2006-10-01

    Previous studies have shown low hemoglobin (Hb) to have an adverse effect on survival in patients with congestive heart failure (CHF) and reduced left ventricular (LV) ejection fraction (EF); but its effect on survival in patients with CHF and normal EF is not known. This study sought to determine whether low Hb has an effect on survival in patients with both CHF and normal EF. Detailed chart reviews were performed by medical residents on 2,246 patients (48% with normal EF) with a discharge diagnosis of CHF in a large tertiary care hospital from 1990 to 1999. The CHF diagnosis was validated using the Framingham criteria. Mortality data were obtained from the National Death Index. Survival analysis was performed using Kaplan-Meier and Cox regression models. By Kaplan-Meier analysis, low Hb (< 12 gm/dl) compared with normal hemoglobin was associated with a lower 5-year survival in patients with CHF and both normal (38 vs. 50%, p = 0.0008) and reduced (35 vs. 48%, p = 0.0009) EF. Using the Cox regression model, low Hb was an independent predictor of mortality after adjusting for age, gender, renal dysfunction, diabetes mellitus, hypertension, and EF in both groups of patients. Low Hb has an independent adverse effect on survival in patients with CHF and both normal and reduced EF in both groups of patients.

  5. Systolic Strain Abnormalities to Predict Hospital Readmission in Patients With Heart Failure and Normal Ejection Fraction

    Science.gov (United States)

    Borer, Steven M.; Kokkirala, Aravind; O'Sullivan, David M.; Silverman, David I.

    2011-01-01

    Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. Methods Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Results One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1 versus -1.09 s-1, P = 0.545). E/e’ was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e’ (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. Conclusions Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e’ is a predictor of readmission in these patients. PMID:28352395

  6. Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

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    Messias, Leandro Rocha, E-mail: lmessias@cardiol.br; Ferreira, Aryanne Guimarães; Miranda, Sandra Marina Ribeiro de; Teixeira, José Antônio Caldas [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha de [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil); Messias, Ana Carolina Nader Vasconcelos [Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Maróstica, Elisabeth [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Hospital Procardíaco, Rio de Janeiro, RJ (Brazil)

    2016-05-15

    More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO{sub 2}). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO{sub 2} and 123I-MIBG scintigraphic parameters. Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

  7. Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

    International Nuclear Information System (INIS)

    Messias, Leandro Rocha; Ferreira, Aryanne Guimarães; Miranda, Sandra Marina Ribeiro de; Teixeira, José Antônio Caldas; Azevedo, Jader Cunha de; Messias, Ana Carolina Nader Vasconcelos; Maróstica, Elisabeth; Mesquita, Claudio Tinoco

    2016-01-01

    More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties. To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF. Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO 2 ). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months. After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO 2 and 123I-MIBG scintigraphic parameters. Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity

  8. Assessment of cardiac performance with quantitative radionuclide angiocardiography: sequential left ventricular ejection fraction, normalized left ventricular ejection rate, and regional wall motion

    International Nuclear Information System (INIS)

    Marshall, R.C.; Berger, H.J.; Costin, J.C.; Freedman, G.S.; Wolberg, J.; Cohen, L.S.; Gotischalk, A.; Zaret, B.L.

    1977-01-01

    Sequential quantitative first pass radionuclide angiocardiograms (RA) were used to measure left ventricular ejection fraction (LVEF) and left ventricular ejection rate (LVER), and to assess regional wall motion (RWM) in the anterior (ANT) and left anterior oblique (LAO) positions. Studies were obtained with a computerized multicrystal scintillation camera suitable for acquiring high count-rate data. Background was determined in a new fashion by selecting frames temporally from the left ventricular region of interest time-activity curve. A ''representative'' cardiac cycle was formed by summing together counts over three to six cardiac cycles. From this background corrected, high count-rate ''representative''cardiac cycle, LVEF, LVER, and RWM were determined. In 22 patients with normal sinus rhythm in the absence of significant valvular regurgitation, RA LVEF correlated well with that measured by contrast angiography (r = 0.95). LVER correlated well with LVEF measured at contrast angiography (r = 0.90) and allowed complete separation of those with normal (LVER = 3.4 +- 0.17 sec -1 ) and abnormal (LVER = 1.22 +- 0.11 sec -1 ) (P < 0.001) left ventricular performance. This separation was independent of background. Isoproterenol infusion in five normal subjects caused LVER to increase by 81 +- 17% while LVEF increased by 10 +- 2.0%. RWM was correctly defined in 21/22 patients and 89% of left ventricular segments with abnormal wall motion

  9. High coronary artery calcium score affects clinical outcome despite normal stress myocardial perfusion imaging and normal left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Madsen, Claus Juul; Andersen, Kim F; Zerahn, Bo

    2013-01-01

    Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS and to id......Normal myocardial perfusion imaging (MPI) indicates a low risk for cardiac death and new ischaemic events. However, the impact of normal MPI combined with a high coronary artery calcium score (CACS) is not clear. The aims of this study were to evaluate the risk of severely elevated CACS...

  10. Measurement of effective left ventricular ejection fraction by radiocardiography associated with cardiac chamber scanning

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    de Vernejoul, P; Fauchet, M; Rimbert, J -N; Gambini, D; Agnely, J [Hopital Necker-Enfants-Malades, 75 - Paris (France)

    1976-03-01

    Left ventricular ejection fraction is usually measured by cineangiocardiography. When radiocardiography and cardiac chamber scanning are associated, it allows an effective left ventricular ejection fraction assessment. Ejection fractions calculated by both methods are the same in normal subjects. They are different in the case of left valvular heart disease with insufficiency. The whole regurgitation fraction can be calculated from this difference.

  11. Measurement of effective left ventricular ejection fraction by radiocardiography associated with cardiac chamber scanning

    International Nuclear Information System (INIS)

    Vernejoul, Pierre de; Fauchet, Michel; Rimbert, J.-N.; Gambini, Denis; Agnely, Jacqueline

    1976-01-01

    Left ventricular ejection fraction is usually measured by cineangiocardiography. When radiocardiography and cardiac chamber scanning are associated, it allows an effective left ventricular ejection fraction assessment. Ejection fractions calculated by both methods are the same in normal subjects. They are different in the case of left valvular heart disease with insufficiency. The whole regurgitation fraction can be calculated from this difference [fr

  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

    %-50%, and >50%) on outcomes of ventricular tachyarrhythmias (VTAs), VTA ≥200 bpm, ICD shock, heart failure or death, and inappropriate ICD therapy by multivariable Cox models. A total of 7.3% achieved LVEF normalization (>50%). The average follow-up was 2.2±0.8 years. The risk of VTA was reduced in patients...... with LVEF >50% (hazard ratio [HR], 0.24; 95% confidence interval [CI], 0.07-0.82; P=0.023) and LVEF of 36% to 50% (HR, 0.44; 95% CI, 0.28-0.68; P50%, only 1 patient had VTA ≥200 bpm (HR, 0.16; 95% CI, 0.02-1.51), none were shocked by the ICD, and 2 died of nonarrhythmic...

  13. Comparing characteristics and clinical and echocardiographic outcomes in low-flow vs normal-flow severe aortic stenosis with preserved ejection fraction in an Asian population.

    Science.gov (United States)

    Ngiam, Jinghao Nicholas; Tan, Benjamin Yong-Qiang; Sia, Ching-Hui; Lee, Glenn K M; Kong, William K F; Chan, Yiong-Huak; Poh, Kian-Keong

    2017-05-01

    In severe aortic stenosis (AS), deterioration of left ventricular ejection fraction (LVEF) to 50%) and with paired echocardiography were studied. Univariate and multivariate analyses identified factors associated with LVEF deterioration. Clinical outcomes were determined on follow-up for more than 5 years. Significant LVEF deterioration (to <50%) was seen in 18% of low-flow (initial LVEF 63±8% to 32±9%) and 18% of normal-flow AS (61±7% to 31±12%). Independent factors in low-flow AS were hypertension (OR: 30.7, 95% CI: 2.0-467.6, P=.014) and higher end-systolic wall stress (OR: 1.086, 95% CI: 1.022-1.153, P=.008), compared to normal-flow, which were hypertension (OR: 15.9, 95% CI: 3.1-81.9, P=.001), higher septal E/E' ratio (OR: 1.16, 95% CI: 1.01-1.35, P=.043), lower septal S' velocity (OR: 0.204, 95% CI: 0.061-0.682, P=.010), and higher end-systolic wall stress (OR: 1.051, 95% CI: 1.001-1.104, P=.047). Overall, a third of the cohort experienced MACE, regardless of flow (log-rank 0.048, P=.827). However, aortic valve replacement (AVR) rates were lower in low-flow AS (20% vs 43%, P=.005). Low-flow AS despite normal LVEF appears similar to normal-flow in terms of LVEF deterioration and clinical outcomes in our Asian population. AVR rate was lower even though low-flow may not reflect less severe disease. © 2017, Wiley Periodicals, Inc.

  14. Prevalence of symptomatic heart failure with reduced and with normal ejection fraction in an elderly general population-the CARLA study.

    Directory of Open Access Journals (Sweden)

    Daniel Tiller

    Full Text Available BACKGROUND/OBJECTIVES: Chronic heart failure (CHF is one of the most important public health concerns in the industrialized world having increasing incidence and prevalence. Although there are several studies describing the prevalence of heart failure with reduced ejection fraction (HFREF and heart failure with normal ejection fraction (HFNEF in selected populations, there are few data regarding the prevalence and the determinants of symptomatic heart failure in the general population. METHODS: Cross-sectional data of a population-based German sample (1,779 subjects aged 45-83 years were analyzed to determine the prevalence and determinants of chronic SHF and HFNEF defined according to the European Society of Cardiology using symptoms, echocardiography and serum NT-proBNP. Prevalence was age-standardized to the German population as of December 31st, 2005. RESULTS: The overall age-standardized prevalence of symptomatic CHF was 7.7% (95%CI 6.0-9.8 for men and 9.0% (95%CI 7.0-11.5 for women. The prevalence of CHF strongly increased with age from 3.0% among 45-54- year-old subjects to 22.0% among 75-83- year-old subjects. Symptomatic HFREF could be shown in 48% (n = 78, symptomatic HFNEF in 52% (n = 85 of subjects with CHF. The age-standardized prevalence of HFREF was 3.8 % (95%CI 2.4-5.8 for women and 4.6 % (95%CI 3.6-6.3 for men. The age-standardized prevalence of HFNEF for women and men was 5.1 % (95%CI 3.8-7.0 and 3.0 % (95%CI 2.1-4.5, respectively. Persons with CHF were more likely to have hypertension (PR = 3.4; 95%CI 1.6-7.3 or to have had a previous myocardial infarction (PR = 2.5, 95%CI 1.8-3.5. CONCLUSION: The prevalence of symptomatic CHF appears high in this population compared with other studies. While more women were affected by HFNEF than men, more male subjects suffered from HFREF. The high prevalence of symptomatic CHF seems likely to be mainly due to the high prevalence of cardiovascular risk factors in this population.

  15. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

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    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-07-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis.

  16. Right ventricular ejection fraction during exercise in normal subjects and in coronary artery disease patients: assessment by multiple-gated equilibrium scintigraphy

    International Nuclear Information System (INIS)

    Maddahi, J.; Berman, D.S.; Matsuoka, D.T.; Waxman, A.D.; Forrester, J.S.; Swan, H.J.C.

    1980-01-01

    The response of right ventricular ejection fraction (RVEF) during exercise and its relationship to the location and extent of coronary artery disease are not fully understood. We have recently developed and validated a new method for scintigraphic evaluation of RVEF using rapid multiple-gated equilibrium scintigraphy and multiple right ventricular regions of interest. The technique has been applied during upright bicycle exercise in 10 normal subjects and 20 patients with coronary artery disease. Resting RVEF was not significantly different between the groups (0.49 +- 0.04 vs 0.47 +- 0.09, respectively, mean +- SD). In all 10 normal subjects RVEF rose (0.49 +- 0.04 to 0.66 +- 0.08, p < 0.01) at peak exercise. At peak exercise in coronary artery disease patients, the group RVEF remained unchanged (0.47 +- 0.09 to 0.50 +- 0.11, p = NS), but the individual responses varied. In the coronary artery disease patients, the relationship between RVEF response to exercise and exercise left ventricular function, septal motion and right coronary artery stenosis were studied. Significant statistical association was found only between exercise RVEF and right coronary artery stenosis. RVEF rose during exercise in seven of seven patients without right coronary artery stenosis (0.42 +- 0.06 to 0.58 +- 0.08, p = 0.001) and was unchanged or fell in 12 of 13 patients with right coronary artery stenosis (0.50 +- 0.09 to 0.45 +- 0.10, p = NS). We conclude that (1) in normal subjects RVEF increases during upright exercise and (2) although RVEF at rest is not necessarily affected by coronary artery disease, failure of RVEF to increase during exercise, in the absence of chronic obstructive pulmonary disease or valvular heart disease, may be related to the presence of significant right coronary artery stenosis

  17. Hyperdynamic left ventricular ejection fraction in the intensive care unit.

    Science.gov (United States)

    Paonessa, Joseph R; Brennan, Thomas; Pimentel, Marco; Steinhaus, Daniel; Feng, Mengling; Celi, Leo Anthony

    2015-08-07

    Limited information exists on the etiology, prevalence, and significance of hyperdynamic left ventricular ejection fraction (HDLVEF) in the intensive care unit (ICU). Our aim in the present study was to compare characteristics and outcomes of patients with HDLVEF with those of patients with normal left ventricular ejection fraction in the ICU using a large, public, deidentified critical care database. We conducted a longitudinal, single-center, retrospective cohort study of adult patients who underwent echocardiography during a medical or surgical ICU admission at the Beth Israel Deaconess Medical Center using the Multiparameter Intelligent Monitoring in Intensive Care II database. The final cohort had 2867 patients, of whom 324 had HDLVEF, defined as an ejection fraction >70%. Patients with an ejection fraction <55% were excluded. Compared with critically ill patients with normal left ventricular ejection fraction, the finding of HDLVEF in critically ill patients was associated with female sex, increased age, and the diagnoses of hypertension and cancer. Patients with HDLVEF had increased 28-day mortality compared with those with normal ejection fraction in multivariate logistic regression analysis adjusted for age, sex, Sequential Organ Failure Assessment score, Elixhauser score for comorbidities, vasopressor use, and mechanical ventilation use (odds ratio 1.38, 95% confidence interval 1.039-1.842, p =0.02). The presence of HDLVEF portended increased 28-day mortality, and may be helpful as a gravity marker for prognosis in patients admitted to the ICU. Further research is warranted to gain a better understanding of how these patients respond to common interventions in the ICU and to determine if pharmacologic modulation of HDLVEF improves outcomes.

  18. Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction.

    Science.gov (United States)

    Wu, Naqiong; Ma, Fenglian; Guo, Yuanlin; Li, Xiaoling; Liu, Jun; Qing, Ping; Xu, Ruixia; Zhu, Chenggang; Jia, Yanjun; Liu, Geng; Dong, Qian; Jiang, Lixin; Li, Jianjun

    2014-01-01

    Backround N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor in acute coronary artery disease (CAD). Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. A total of 658 consecutive patients were divided into two groups based on angiograms: CAD group (n = 484) and angiographic normal control group (n = 174). The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. The prevalence of risk factors such as age, male gender, diabetes mellitus (DM), dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD (OR:1.66 (95% CI: 1.06-2.61), P value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD (area under curve (AUC) = 0.56, 95% CI: 0.51-0.61). Furthermore, NT-proBNP was positively correlated with Gensini score (r = 0.14, P < 0.001) in patients with CAD. NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.

  19. Prevalence, clinical and echocardiographic characteristics of various flow and gradient patterns in mild or moderate aortic stenosis with normal left ventricular ejection fraction.

    Science.gov (United States)

    Tan, Yong-Qiang Benjamin; Ngiam, Jinghao Nicholas; Kong, William K F; Yeo, Tiong-Cheng; Poh, Kian-Keong

    2016-10-15

    Paradoxical low-flow aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) has only been described in severe AS. Controversy surrounds prognosis and management but no studies have reported this phenomenon in mild or moderate AS. We investigated the prevalence of flow and gradient patterns in this population, characterising their clinical and echocardiographic profile. Consecutive subjects (n=1362) with isolated AS: mild (n=462, aortic valve area≥1.5cm(2), 2.5m/snormal LVEF (≥50%) were studied. Subjects with low-flow (stroke volume index<35ml/m(2)) were identified. Univariate and multivariate analyses were employed to compare the flow and gradient patterns. In mild AS, 130 (28%) had low-flow. Lower left ventricular mass index (LVMI) (97.0±28.5vs116.4±2.3g/m(2),p<0.001), higher percentage of concentric remodelling (40%vs6%,p<0.001) and hypertrophy (43%vs40%,p<0.001) and lower end-systolic wall stress (ESWS) (57.6±1.60vs67.7±19.6dyn/cm(2),p=0.014) were independently associated with low-flow. Similarly, in moderate AS, 297 (33%) had low-flow. Older age (73.4±14.8vs69.5±16.5,p=0.027), lower LVMI (88.6±25.9vs118.0±36.5,p<0.001), higher percentage of concentric remodelling (46%vs8%,p<0.001) and lower ESWS (59.9±18.3vs70.5±19.7,p<0.001) were independently associated with low-flow. Despite moderate AS, most had lower mean pressure gradients, especially subjects with concentric remodelling. In the entire cohort, low-flow patients had more concentric remodelling (43%vs7%,p<0.001) and less eccentric hypertrophy (2%vs27%,p<0.001) compared to normal flow. Low-flow AS with normal LVEF is observed in mild or moderate AS, in up to a third of the cases. These patients had different LV structure compared to normal-flow, with more concentric remodelling. Further studies are warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Utility of Cardiovascular Magnetic Resonance-Derived Wave Intensity Analysis As a Marker of Ventricular Function in Children with Heart Failure and Normal Ejection Fraction.

    Science.gov (United States)

    Ntsinjana, Hopewell N; Chung, Robin; Ciliberti, Paolo; Muthurangu, Vivek; Schievano, Silvia; Marek, Jan; Parker, Kim H; Taylor, Andrew M; Biglino, Giovanni

    2017-01-01

    This study sought to explore the diagnostic insight of cardiovascular magnetic resonance (CMR)-derived wave intensity analysis to better study systolic dysfunction in young patients with chronic diastolic dysfunction and preserved ejection fraction (EF), comparing it against other echocardiographic and CMR parameters. Evaluating systolic and diastolic dysfunctions in children is challenging, and a gold standard method is currently lacking. Patients with presumed diastolic dysfunction [ n  = 18; nine aortic stenosis (AS), five hypertrophic, and four restrictive cardiomyopathies] were compared with age-matched control subjects ( n  = 18). All patients had no mitral or aortic incompetence, significant AS, or reduced systolic EF. E / A ratio, E / E ' ratio, deceleration time, and isovolumetric contraction time were assessed on echocardiography, and indexed left atrial volume (LAVi), acceleration time (AT), ejection time (ET), and wave intensity analyses were calculated from CMR. The latter was performed on CMR phase-contrast flow sequences, defining a ratio of the peaks of the early systolic forward compression wave (FCW) and the end-systolic forward expansion wave (FEW). Significant differences between patients and controls were seen in the E / E ' ratio (8.7 ± 4.0 vs. 5.1 ± 1.3, p  = 0.001) and FCW/FEW ratio (2.5 ± 1.6 vs. 7.2 ± 4.2 × 10 -5 m/s, p  wave intensity-derived ratio summarizing systolic and diastolic function could provide insight into ventricular function in children, on top of CMR and echocardiography, and it was here able to identify an element of ventricular dysfunction with preserved EF in a small group of young patients.

  1. The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

    Science.gov (United States)

    Kass, David A.; Kitzman, Dalane W.; Alvarez, Guy E.

    2009-01-01

    Background Heart failure with preserved ejection fraction (HFpEF) is the predominant form of HF among the elderly and in women. However, there are few if any evidence-based therapeutic options for HFpEF. The chief complaint of HFpEF is reduced tolerance to physical exertion. Recent data revealed that one potential mechanism of exertional intolerance in HFpEF patients is inadequate chronotropic response. Although there is considerable evidence demonstrating the benefits of rate-adaptive pacing (RAP) provided from implantable cardiac devices in patients with an impaired chronotropic response, the effect of RAP in HFpEF is unknown. Methods and Results The RESET study is a prospective, multi-center, double-blind, randomized with stratification, study assessing the effect of RAP on peak VO2 and quality of life. RAP therapy will be evaluated in a cross-over paired fashion for each patient within each study stratum. Study strata are based on patient beta-blocker usage at time of enrollment. The study is powered to assess the impact of pacing independently in both strata. Conclusions The RESET study seeks to evaluate the potential benefit of RAP in patients with symptomatic mild to moderate HFpEF and chronotropic impairment. Study enrollment began in July 2008. PMID:20123314

  2. Variability of left ventricular ejection fraction and volumes with quantitative gated SPECT: influence of algorithm, pixel size and reconstruction parameters in small and normal-sized hearts

    International Nuclear Information System (INIS)

    Hambye, Anne-Sophie; Vervaet, Ann; Dobbeleir, Andre

    2004-01-01

    Several software packages are commercially available for quantification of left ventricular ejection fraction (LVEF) and volumes from myocardial gated single-photon emission computed tomography (SPECT), all of which display a high reproducibility. However, their accuracy has been questioned in patients with a small heart. This study aimed to evaluate the performances of different software and the influence of modifications in acquisition or reconstruction parameters on LVEF and volume measurements, depending on the heart size. In 31 patients referred for gated SPECT, 64 2 and 128 2 matrix acquisitions were consecutively obtained. After reconstruction by filtered back-projection (Butterworth, 0.4, 0.5 or 0.6 cycles/cm cut-off, order 6), LVEF and volumes were computed with different software [three versions of Quantitative Gated SPECT (QGS), the Emory Cardiac Toolbox (ECT) and the Stanford University (SU-Segami) Medical School algorithm] and processing workstations. Depending upon their end-systolic volume (ESV), patients were classified into two groups: group I (ESV>30 ml, n=14) and group II (ESV 2 to 128 2 were associated with significantly larger volumes as well as lower LVEF values. Increasing the filter cut-off frequency had the same effect. With SU-Segami, a larger matrix was associated with larger end-diastolic volumes and smaller ESVs, resulting in a highly significant increase in LVEF. Increasing the filter sharpness, on the other hand, had no influence on LVEF though the measured volumes were significantly larger. (orig.)

  3. Air pollution and heart failure: Relationship with the ejection fraction

    Science.gov (United States)

    Dominguez-Rodriguez, Alberto; Abreu-Afonso, Javier; Rodríguez, Sergio; Juarez-Prera, Ruben A; Arroyo-Ucar, Eduardo; Gonzalez, Yenny; Abreu-Gonzalez, Pedro; Avanzas, Pablo

    2013-01-01

    AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m3 vs 4.50 ± 2.34 μg/m3, P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population. PMID:23538391

  4. Ejection fraction improvement and reverse remodeling achieved with Sacubitril/Valsartan in heart failure with reduced ejection fraction patients.

    Science.gov (United States)

    Almufleh, Aws; Marbach, Jeffrey; Chih, Sharon; Stadnick, Ellamae; Davies, Ross; Liu, Peter; Mielniczuk, Lisa

    2017-01-01

    Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). The effect of Sacubitril/Valsartan on ejection fraction (EF) and reverse remodeling parameters have not been previously described. We performed a single-center, retrospective, cohort study of HFrEF patients (n=48) who were treated with Sacubitril/Valsartan for a median duration of 3 months (Interquartile range 2-6 months). Clinical and echocardiographic parameters were reviewed at three time points (pre-baseline which was median of 18 months before starting Sacubitril/Valsartan, baseline before treatment started, and post-Sacubitril/Valsartan). Paired sample t-test and one-way repeated measures ANOVA were used for normally distributed data, while Wilcoxon Signed Rank test for non-normally distributed data. Sacubitril/Valsartan use was associated with an average 5% (±1.2) increase in EF, from a mean baseline of 25.33% to 30.14% (pSacubitril/Valsartan was found to improve EF and multiple measures of reverse remodeling beyond the effects of concomitant optimal medical therapy. Though these results are encouraging, our small sample, observational study requires confirmation in larger cohorts with longer follow-up periods.

  5. Murine Models of Heart Failure With Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Maria Valero-Muñoz, PhD

    2017-12-01

    Full Text Available Heart failure with preserved ejection fraction (HFpEF is characterized by signs and symptoms of heart failure in the presence of a normal left ventricular ejection fraction. Despite accounting for up to 50% of all clinical presentations of heart failure, the mechanisms implicated in HFpEF are poorly understood, thus precluding effective therapy. The pathophysiological heterogeneity in the HFpEF phenotype also contributes to this disease and likely to the absence of evidence-based therapies. Limited access to human samples and imperfect animal models that completely recapitulate the human HFpEF phenotype have impeded our understanding of the mechanistic underpinnings that exist in this disease. Aging and comorbidities such as atrial fibrillation, hypertension, diabetes and obesity, pulmonary hypertension, and renal dysfunction are highly associated with HFpEF, yet the relationship and contribution between them remains ill-defined. This review discusses some of the distinctive clinical features of HFpEF in association with these comorbidities and highlights the advantages and disadvantage of commonly used murine models used to study the HFpEF phenotype.

  6. Right Ventricular Ejection Fraction using ECG-Gated First Pass Cardioangiography

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Young Hee; Lee, Hae Giu; Lee, Sung Yong; Park, Suk Min; Chung, Soo Kyo; Yim, Jeong Ik; Bahk, Yong Whee; Shinn, Kyung Sub; Kim, Young Gyun; Kwon, Soon Seog [Catholic University College of Medicine, Seoul (Korea, Republic of)

    1993-03-15

    Radionuclide cardioangiography has been widely applied and has played major roles in moninvasive assessment of cardiac function. Three techniques, first-pass gated first and gated equilibrium methods have commonly been used to evaluate right ventricular ejection fraction which usually abnormal in the patients with cardiopulmonary disease. It has been known that the gated first pass method is most accurate method among the three techniques in assessment of fight ventricular ejection fraction. The radionuclide right ventricular ejection fraction values were determined in 13 normal subjects and in 15 patients with chronic obstructive pulmonary disease by the gated first pass method and compared with those of the first pass method because there has been no published data of fight ejection fraction by the gated first pass method were compared with the defects from the pulmonary function test performed in the patients with chronic obstructive pulmomary disease. The results were as follows; 1) The values of fight ventricular ejection fraction by the gated first pass method were 50.1 +- 6.1% in normal subjects and 38.5 +- 8.5 in the patients with chronic obstructive pulmonary disease. There was statistically significant difference between the right ventricular ejection fraction of each of the two groups (p<0.05) 2) The right ventricular ejection fraction by the gated first pass method was not linearly correlated ith FEV{sub 1}, VC. DLCO. and FVC as well as P{sub a}O2 and P{sub a}CO2 of the patients with chronic obstructive pulmonary disease. We concluded that right ventricular ejection fraction by the gated first pass method using radionuclide cardioangiography may be useful in clinical assessment of the right ventricular function.

  7. Assessment of poststress left ventricular ejection fraction by gated SPECT: comparison with equilibrium radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Acampa, Wanda; Liuzzi, Raffaele; De Luca, Serena; Capasso, Enza; Luongo, Luca; Cuocolo, Alberto; Caprio, Maria Grazia; Nicolai, Emanuele; Petretta, Mario

    2010-01-01

    We compared left ventricular (LV) ejection fraction obtained by gated SPECT with that obtained by equilibrium radionuclide angiocardiography in a large cohort of patients. Within 1 week, 514 subjects with suspected or known coronary artery disease underwent same-day stress-rest 99m Tc-sestamibi gated SPECT and radionuclide angiocardiography. For both studies, data were acquired 30 min after completion of exercise and after 3 h rest. In the overall study population, a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.82, p<0.0001) and after stress (r=0.83, p<0.0001). In Bland-Altman analysis, the mean differences in ejection fraction (radionuclide angiocardiography minus gated SPECT) were -0.6% at rest and 1.7% after stress. In subjects with normal perfusion (n=362), a good correlation between ejection fraction measured by gated SPECT and by radionuclide angiocardiography was observed at rest (r=0.72, p<0.0001) and after stress (r=0.70, p<0.0001) and the mean differences in ejection fraction were -0.9% at rest and 1.4% after stress. Also in patients with abnormal perfusion (n=152), a good correlation between the two techniques was observed both at rest (r=0.89, p<0.0001) and after stress (r=0.90, p<0.0001) and the mean differences in ejection fraction were 0.1% at rest and 2.5% after stress. In a large study population, a good agreement was observed in the evaluation of LV ejection fraction between gated SPECT and radionuclide angiocardiography. However, in patients with perfusion abnormalities, a slight underestimation in poststress LV ejection fraction was observed using gated SPECT as compared to equilibrium radionuclide angiocardiography. (orig.)

  8. 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

  9. Invasive hemodynamic characterization of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersen, Mads Jønsson; Borlaug, Barry A

    2014-01-01

    Recent hemodynamic studies have advanced our understanding of heart failure with preserved ejection fraction (HFpEF). Despite improved pathophysiologic insight, clinical trials have failed to identify an effective treatment for HFpEF. Invasive hemodynamic assessment can diagnose or exclude HFp...

  10. 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.)

  11. Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction

    NARCIS (Netherlands)

    Hoekstra, Tialda; Lesman-Leegte, Ivonne; van Veldhuisen, Dirk J.; Sanderman, Robbert; Jaarsma, Tiny

    Aims To compare quality of life (QoL) in heart failure (HF) patients with preserved ejection fraction (HF-PEF) and HF patients with reduced ejection fraction (HF-REF) in a well-defined HF population. Methods and results Patients with HF-PEF [left ventricular ejection fraction (LVEF) >= 40%] were

  12. Epidemiology of heart failure with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Vasan, Ramachandran S

    2014-01-01

    Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients...... with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause...

  13. Exercise physiology in heart failure and preserved ejection fraction.

    Science.gov (United States)

    Haykowsky, Mark J; Kitzman, Dalane W

    2014-07-01

    Recent advances in the pathophysiology of exercise intolerance in patients with heart failure with preserved ejection fraction (HFPEF) suggest that noncardiac peripheral factors contribute to the reduced peak V(o2) (peak exercise oxygen uptake) and to its improvement after endurance exercise training. A greater understanding of the peripheral skeletal muscle vascular adaptations that occur with physical conditioning may allow for tailored exercise rehabilitation programs. The identification of specific mechanisms that improve whole body and peripheral skeletal muscle oxygen uptake could establish potential therapeutic targets for medical therapies and a means to follow therapeutic response. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Performance of a fully automated program for measurement of left ventricular ejection fraction

    International Nuclear Information System (INIS)

    Douglass, K.H.; Tibbits, P.; Kasecamp, W.; Han, S.T.; Koller, D.; Links, J.M.; Wagner, H.H. Jr.

    1982-01-01

    A fully automated program developed by us for measurement of left ventricular ejection fraction from equilibrium gated blood studies was evaluated in 130 additional patients. Both of 6-min (130 studies) and 2-min (142 studies in 31 patients) gated blood pool studies were acquired and processed. The program successfully generated ejection fractions in 86% of the studies. These automatically generated ejection fractions were compared with ejection fractions derived from manually drawn regions the interest. When studies were acquired for 6-min with the patient at rest, the correlation between automated and manual ejection fractions was 0.92. When studies were acquired for 2-min, both at rest and during bicycle exercise, the correlation was 0.81. In 25 studies from patients who also underwent contrast ventriculography, the program successfully generated regions of interest in 22 (88%). The correlation between the ejection fraction determined by contrast ventriculography and the automatically generated radionuclide ejection fraction was 0.79. (orig.)

  15. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction

    DEFF Research Database (Denmark)

    Lauritsen, Josephine; Gustafsson, Finn; Abdulla, Jawdat

    2018-01-01

    AIMS: This study aimed to assess by a meta-analysis the clinical characteristics, all-cause and cardiovascular mortality, and hospitalization of patients with heart failure (HF) with mid-range ejection fraction (HFmrEF) compared with HF with reduced ejection fraction (HFrEF) and HF with preserved...

  16. 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.

  17. 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.)

  18. Insuficiência cardíaca com fração de ejeção normal Insuficiencia cardíaca con fracción de eyección normal Heart failure with normal ejection fraction

    Directory of Open Access Journals (Sweden)

    Meliza Goi Roscani

    2010-05-01

    multifactoriales, involucrando la rigidez pasiva del miocardio, la geometría ventricular, la fuerza de contención pericárdica y la interacción entre los ventrículos. Los objetivos principales del tratamiento son reducir la congestión venosa pulmonar, la frecuencia cardíaca y controlar las comorbilidades. Todavía no hay evidencias de que el uso de medicaciones específicas, como inhibidores de la enzima de conversión o betabloqueadores, interfieran en la mortalidad. Los factores de peor pronóstico incluyen la edad avanzada, presencia de disfunción renal, diabetes, clase funcional III y IV (NYHA y estado avanzado de disfunción diastólica, con patrón restrictivo al llenado ventricular. Otro aspecto viene cobrando espacio en la bibliografía es el cuestionamiento del papel de la disfunción sistólica en los cuadros de ICFEN. Todos estos aspectos se abordan detalladamente en la presente revisión.Heart failure with normal ejection fraction (HFNEF is a complex syndrome that has been broadly studied since the last decade. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods, such as hemodynamic study or echocardiogram, in the presence of a normal ejection fraction (EF. It affects primarily elderly individuals with comorbidities, such as systemic arterial hypertension, coronary failure and obesity. The physiopathological mechanisms are complex and multifactorial, involving the myocardial passive stiffness, the ventricular geometry, the pericardial restraint and the interaction between the ventricles. The main objectives of the treatment were to decrease the pulmonary venous congestion and the heart rate and control the comorbidities. There is no strong evidence that the use of specific medications, such as the angiotensin-converting enzyme inhibitors or beta-blockers can influence mortality. The poorer prognostic factors include advanced age, presence of kidney dysfunction, diabetes, functional class III and IV (NYHA and advanced

  19. Spironolactone in patients with heart failure and preserved ejection fraction.

    Science.gov (United States)

    Sánchez-Sánchez, C; Mendoza-Ruiz de Zuazu, H F; Formiga, F; Manzano, L; Ceresuela, L M; Carrera-Izquierdo, M; González Franco, Á; Epelde-Gonzalo, F; Cerqueiro-González, J M; Montero-Pérez-Barquero, M

    2015-01-01

    Aldosterone inhibitors have been shown to be beneficial for patients with systolic heart failure. However, the evidence from patients with heart failure and preserved ejection fraction (HFPEF) is limited. We evaluated the role of spironolactone in the prognosis of a cohort of patients with HFPEF. We analyzed the outcomes of patients hospitalized for HFPEF in 52 departments of internal medicine of the Spanish RICA registry according to those who did and did not take spironolactone. We recorded the posthospital mortality rate and readmissions at 1 year and performed a multivariate survival analysis. We included 1212 patients with HFPEF, with a mean age of 79 years (standard deviation, 7.9), (64.1% women), the majority of whom had hypertensive heart disease (50.7%). The patients treated with spironolactone, compared with those who were not treated with this diuretic, had a more advanced functional class, a higher number of readmissions (44.3 vs. 29.1%; p<0.001) and a higher rate in the combined variable of readmissions/mortality (39.0 vs. 29.0%; p=0.001). In the multivariate analysis, the administration of spironolactone was associated with an increase in readmissions (RR, 1.4; 95% CI, 1.16-1.78; p=0.001). For patients with HFPEF, the administration of spironolactone was associated with an increase in all-cause readmission, perhaps due to the higher rate of hyperpotassemia. Copyright © 2015. Published by Elsevier España, S.L.U.

  20. Determination of left ventricular ejection fraction by radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Hoeilund-Carlsen, P.F.; Rasmussen, S.; Hesse, B.; Dige-Petersen, H.; Folke, K.; Godtfredsen, J.; Jensen, G.; Fabricius, J.

    1982-01-01

    Radionuclide angiocardiography is a non-invasive gamma camera investigation for evaluation and quantification of heart performance. We investigated the reliability of the method in measuring left ventricular ejection fraction (EF). The accuracy was determined by measuring EF in 29 patients by both radionuclide angiocardiography and conventional single-plane cineventriculography. The two methods correlated well: r=0.92; y=0.86x+0.07. The precision of the method was evaluated as follows: The coefficient of variance was 6% for duplicate determinations performed on the same day (n=27) and 5% for determinations with 1-3 days interval (n=21). The interobserver variation expressed by the coefficient of variance was maximally 6% with the radionuclide method (n=29, three observers). The intraobserver variation was 4% compared to 9% with cineventriculography (P<0.01). Radionuclide angiocardiography is a reliable way of measuring EF. As the method is non-invasive, it is well suited for sequential determinations of EF in the same patient. (authors)

  1. Heart failure with preserved ejection fraction in women : The dutch queen of hearts program

    NARCIS (Netherlands)

    den Ruijter, H.; Pasterkamp, G.; Rutten, F. H.; Lam, C. S P; Chi, C.; Tan, K. H.; van Zonneveld, A. J.; Spaanderman, M.; de Kleijn, D. P V

    2015-01-01

    Heart failure (HF) poses a heavy burden on patients, their families and society. The syndrome of HF comes in two types: with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The latter is on the increase and predominantly present in women, especially the older ones. There

  2. Sildenafil and diastolic dysfunction after acute myocardial infarction in patients with preserved ejection fraction

    DEFF Research Database (Denmark)

    Andersen, Mads J; Ersbøll, Mads; Axelsson, Anna

    2013-01-01

    with diastolic dysfunction after myocardial infarction. METHODS AND RESULTS: Seventy patients with diastolic dysfunction and near normal left ventricular ejection fraction on echocardiography were randomly assigned sildenafil 40 mg thrice daily or matching placebo for 9 weeks. Before randomization and after 9......, and systemic vascular resistance index (resting, P=0.0002; peak exercise, P=0.007) and diastolic blood pressure (resting, P=0.005; peak exercise, P=0.02) were lower in the sildenafil group. Resting left ventricular end-diastolic volume index increased (P=0.001) within the sildenafil group but was unchanged...

  3. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    International Nuclear Information System (INIS)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H.

    2010-01-01

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean ± SD values for GBEF1 and GBEF2 were 52±17% and 52±16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible

  4. Reproducibility of gallbladder ejection fraction measured by fatty meal cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Muqbel, Kusai M.; Hani, M. N. Hani; Elheis, M. A.; Al-Omari, M. H. [School of Medicine, Jordan University of Science and Technology, Irbid (Jordan)

    2010-12-15

    There are conflicting data in the literature regarding the reproducibility of the gallbladder ejection fraction (GBEF) measured by fatty meal cholescintigraphy (CS). We aimed to test the reproducibility of GBEF measured by fatty meal CS. Thirty-five subjects (25 healthy volunteers and 10 patients with chronic abdominal pain) underwent fatty meal CS twice in order to measure GBEF1 and GBEF2. The healthy volunteers underwent a repeat scan within 1-13 months from the first scan. The patients underwent a repeat scan within 1-4 years from the first scan and were not found to have chronic acalculous cholecystitis (CAC). Our standard fatty meal was composed of a 60-g Snickers chocolate bar and 200 ml full-fat yogurt. The mean {+-} SD values for GBEF1 and GBEF2 were 52{+-}17% and 52{+-}16%, respectively. There was a direct linear correlation between the values of GBEF1 and GBEF2 for the subjects, with a correlation coefficient of 0.509 (p=0.002). Subgroup data analysis of the volunteer group showed that there was significant linear correlation between volunteer values of GBEF1 and GBEF2, with a correlation coefficient of 0.473 (p=0.017). Subgroup data analysis of the non-CAC patient group showed no significant correlation between patient values of GBEF1 and GBEF2, likely due to limited sample size. This study showed that fatty meal CS is a reliable test in gallbladder motility evaluation and that GBEF measured by fatty meal CS is reproducible

  5. New Classification for Heart Failure with Mildly Reduced Ejection Fraction; Greater clarity or more confusion?

    Directory of Open Access Journals (Sweden)

    Sunil Nadar

    2017-03-01

    Full Text Available The latest European Society of Cardiology (ESC guidelines for the diagnosis and management of heart failure include a new patient group for those with heart failure with mildly reduced ejection fraction (HFmrEF. By defining this group of patients as a separate entity, the ESC hope to encourage more research focusing on patients with HFmrEF. Previously, patients with this condition were caught between two classifications—heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Hopefully, the inclusion of new terminology will not increase confusion, but rather aid our understanding of heart failure, a complex clinical syndrome.

  6. Heart Failure with Preserved Ejection Fraction – Concept, Pathophysiology, Diagnosis and Challenges for Treatment

    Directory of Open Access Journals (Sweden)

    Lidija Veterovska Miljkovik

    2015-07-01

    Full Text Available Heart failure (HF with preserved left ventricular (LV ejection fraction (HFpEF occurs in 40 to 60% of the patients with HF, with a prognosis which is similar to HF with reduced ejection fraction (HFrEF. HFpEF pathophysiology is different from that of HFrEF, and has been characterized with diastolic dysfunction. Diastolic dysfunction has been defined with elevated left ventricular stiffness, prolonged iso-volumetric LV relaxation, slow LV filing and elevated LV end-diastolic pressure. Arterial hypertension occurs in majority cases with HFpEF worldwide. Patients are mostly older and obese. Diabetes mellitus and atrial fibrillation appear proportionally in a high frequency of patients with HFpEF. The HFpEF diagnosis is based on existence of symptoms and signs of heart failure, normal or approximately normal ejection and diagnosing of LV diastolic dysfunction by means of heart catheterization or Doppler echocardiography and/or elevated concentration of plasma natriuretic peptide. The present recommendations for HFpEF treatment include blood pressure control, heart chamber frequency control when atrial fibrillation exists, in some situations even coronary revascularization and an attempt for sinus rhythm reestablishment. Up to now, it is considered that no medication or a group of medications improve the survival of HFpEF patients. Due to these causes and the bad prognosis of the disorder, rigorous control is recommended of the previously mentioned precipitating factors for this disorder. This paper presents a universal review of the most important parameters which determine this disorder.

  7. Abnormal responses of ejection fraction to exercise, in healthy subjects, caused by region-of-interest selection

    International Nuclear Information System (INIS)

    Sorenson, S.G.; Caldwell, J.; Ritchie, J.; Hamilton, G.

    1981-01-01

    We performed serial exercise equilibrium radionuclide angiography in eight normal subjects with each subject executing three tests: control, after nitroglycerin, and after propranolol. The left-ventricular ejection fraction (EF) was calculated by two methods: (a) fixed region-of-interest (FROI) using a single end-diastolic ROI, and (b) variable region-of-interest (VROI) where an end-diastolic and end-systolic region of interest were used. Abnormal maximal EF responses occurred in five of eight subjects during control using FROI but in zero of eight employing VROI (p < 0.05). After nitroglycerin, three of eight subjects had abnormal responses by FROI, but zero of eight were abnormal by VROI (p < 0.05). After propranolol, blunted EF responses occurred in three of seven by both methods. Falsely abnormal EF responses to exercise RNA may occur due to the method of region-of-interest selection in normal subjects with normal or high ejection fractions

  8. The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction

    DEFF Research Database (Denmark)

    Boesgaard, Søren

    2012-01-01

    A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF).......A substantial proportion of patients with heart failure have preserved left ventricular ejection fraction (HF-PEF). Previous studies have reported mixed results whether survival is similar to those patients with heart failure and reduced EF (HF-REF)....

  9. Heart Failure: The Dilemma of the 40-50% Ejection Fraction Range

    Directory of Open Access Journals (Sweden)

    Michael Henein

    2017-01-01

    Full Text Available The common pathophysiology contributing to fluid retention and dyspnoea in heart failure is a non-compliant and stiff myocardium with raised left ventricular end-diastolic pressure. With the rapid development of newer imaging technologies, particularly echocardiography, our understanding of the syndrome of heart failure has significantly changed. The most important imaging sign in the early eighties was reduced ejection fraction (HFrEF, with low values being used as an explanation for the development of signs and symptoms. In the early 2000s, similar Doppler echocardiographic signs became frequently recognised in patients with heart failure symptoms and signs who proved to have a relatively maintained ejection fraction (EF of >40%, hence the description of the syndrome of “diastolic heart failure”. This was later rephrased as heart failure with normal ejection fraction (HFnEF and more recently as heart failure with preserved ejection fraction (HFpEF. Since then, HFpEF has attracted the interest of many cardiologists and scientists worldwide, searching for specific features and treatment options for the syndrome. As for the features, two important findings have now been established, the first showed that LV systolic function mainly at the subendocardial level was abnormal in HFpEF, particularly manifesting during stress/exercise when the increase in heart rate was not associated with a commensurate increase in stroke volume and a second observation of a significant impairment of left atrial function (i.e. myocardial strain and emptying fraction associated with increased left atrial pressures and the potential development of atrial arrhythmia in HFpEF. Such atrial abnormalities have been shown to be commonly associated with cavity enlargement and poor compliance. The latter observation has similarly been reported in patients with reduced EF. Despite the above similarities in cardiac physiology between HFpEF and HFrEF, treatments of the two

  10. Factor analysis of radionuclide ejection fraction response during exercise in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Yamamuro, Masashi

    1986-01-01

    In 204 patients with ischemic heart disease and 25 normal subjects who underwent exercise radionuclide ventriculography (RNV), multivariate analyses and other statistical methods were employed to study factors affecting changes in left ventricular ejection fraction (ΔEF). Twenty one variables were obtained from clinical diagnosis, cardiac catheterization, and RNV. Multivariate analyses showed that coronary score for the severity of coronary artery lesions was the most significant factor, followed by exercise duration, resting heart rate, the number of diseased vessels, and exercise heart rate. Statistically significant decrease in ΔEF was associated with regional wall motion abnormality, ECG changes, and chest pain. Lesions in the left main trunk and the proximal area of left anterior descending artery were greatly involved in the decrease of ΔEF. (Namekawa, K.)

  11. Extracting and analyzing ejection fraction values from electronic echocardiography reports in a large health maintenance organization.

    Science.gov (United States)

    Xie, Fagen; Zheng, Chengyi; Yuh-Jer Shen, Albert; Chen, Wansu

    2017-12-01

    The left ventricular ejection fraction value is an important prognostic indicator of cardiovascular outcomes including morbidity and mortality and is often used clinically to indicate severity of heart disease. However, it is usually reported in free-text echocardiography reports. We developed and validated a computerized algorithm to extract ejection fraction values from echocardiography reports and applied the algorithm to a large volume of unstructured echocardiography reports between 1995 and 2011 in a large health maintenance organization. A total of 621,856 echocardiography reports with a description of ejection fraction values or systolic functions were identified, of which 70 percent contained numeric ejection fraction values and the rest (30%) were text descriptions explicitly indicating the systolic left ventricular function. The 12.1 percent (16.0% for male and 8.4% for female) of these extracted ejection fraction values are <45 percent. Validation conducted based on a random sample of 200 reports yielded 95.0 percent sensitivity and 96.9 percent positive predictive value.

  12. Delayed Repolarization Underlies Ventricular Arrhythmias in Rats With Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Cho, Jae Hyung; Zhang, Rui; Kilfoil, Peter J; Gallet, Romain; de Couto, Geoffrey; Bresee, Catherine; Goldhaber, Joshua I; Marbán, Eduardo; Cingolani, Eugenio

    2017-11-21

    Heart failure with preserved ejection fraction (HFpEF) represents approximately half of heart failure, and its incidence continues to increase. The leading cause of mortality in HFpEF is sudden death, but little is known about the underlying mechanisms. Dahl salt-sensitive rats were fed a high-salt diet (8% NaCl) from 7 weeks of age to induce HFpEF (n=38). Rats fed a normal-salt diet (0.3% NaCl) served as controls (n=13). Echocardiograms were performed to assess systolic and diastolic function from 14 weeks of age. HFpEF-verified and control rats underwent programmed electrical stimulation. Corrected QT interval was measured by surface ECG. The mechanisms of ventricular arrhythmias (VA) were probed by optical mapping, whole-cell patch clamp to measure action potential duration and ionic currents, and quantitative polymerase chain reaction and Western blotting to investigate changes in ion channel expression. After 7 weeks of a high-salt diet, 31 of 38 rats showed diastolic dysfunction and preserved ejection fraction along with signs of heart failure and hence were diagnosed with HFpEF. Programmed electric stimulation demonstrated increased susceptibility to VA in HFpEF rats ( P hearts demonstrated prolonged action potentials ( P hearts. Susceptibility to VA was markedly increased in rats with HFpEF. Underlying abnormalities include QT prolongation, delayed repolarization from downregulation of potassium currents, and multiple reentry circuits during VA. Our findings are consistent with the hypothesis that potassium current downregulation leads to abnormal repolarization in HFpEF, which in turn predisposes to VA and sudden cardiac death. © 2017 American Heart Association, Inc.

  13. Gated cardiac imaging: manual calculations and observations of left ventricular ejection fraction

    International Nuclear Information System (INIS)

    Hawkins, T.; Keavey, P.M.

    1984-01-01

    Using gamma camera imaging, the fixed region and moving region methods of calculating left ventricular ejection fraction were studied. Data were obtained from gated blood pool studies on 125 cardiac patients with myocardial infarcts of varying extent and location. Ejection fractions ranged from 10 to 76%. The left anterior oblique angulation for optimal visualisation of the ventricles showed considerable patient variation. The authors conclude that a fixed angulation cannot be recommended and that there is little to justify it. Where the septum is not seen distinctly during setting up, a larger rather than smaller angle is generally advised. (U.K.)

  14. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure

    DEFF Research Database (Denmark)

    Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring

    2012-01-01

    Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF.......Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF....

  15. ECG-gated blood pool tomography in the determination of left ventricular volume, ejection fraction, and wall motion

    International Nuclear Information System (INIS)

    Underwood, S.R.; Ell, P.J.; Jarritt, P.H.; Emanuel, R.W.; Swanton, R.H.

    1984-01-01

    ECG-gated blood pool tomography promises to provide a ''gold standard'' for noninvasive measurement of left ventricular volume, ejection fraction, and wall motion. This study compares these measurements with those from planar radionuclide imaging and contrast ventriculography. End diastolic and end systolic blood pool images were acquired tomographically using an IGE400A rotating gamma camera and Star computer, and slices were reconstructed orthogonal to the long axis of the heart. Left ventricular volume was determined by summing the areas of the slices, and wall motion was determined by comparison of end diastolic and end systolic contours. In phantom experiments this provided an accurate measurement of volume (r=0.98). In 32 subjects who were either normal or who had coronary artery disease left ventricular volume (r=0.83) and ejection fraction (r=0.89) correlated well with those using a counts based planar technique. In 16 of 18 subjects who underwent right anterior oblique X-ray contrast ventriculography, tomographic wall motion agreed for anterior, apical, and inferior walls, but abnormal septal motion which was not apparent by contrast ventriculography, was seen in 12 subjects tomographically. All 12 had disease of the left anterior descending coronary artery and might have been expected to have abnormal septal motion. ECG-gated blood pool tomography can thus determine left ventricular volume and ejection fraction accurately, and provides a global description of wall motion in a way that is not possible from any single planar image

  16. Gallbladder ejection fraction using 99mTc-DISIDA scan in diabetic autonomic neuropathy

    International Nuclear Information System (INIS)

    Kim, Seong Jang; Kim, In Ju; Kim, Yong Ki; An, Jun Hyup; Yoo, Seok Dong

    2000-01-01

    We performed this study to evaluate the changes of gallbladder ejection fraction (GBEF) in diabetic patients with or without autonomic neuropathy. This study included 37 diabetic patients (25 women, 12 men, mean age 51 years) and 24 normal controls (10 women, 14 men, mean age 38 years). After intravenous injection of 185 MBq of 99m T c -DISIDA, serial anterior abdominal images were acquired before and after fatty meal. Regions of interest were applied on gallbladder and right hepatic lobe on 60 and 90 minute images to calculate GBEF. GBEF was significantly reduced in diabetes with autonomic neuropathy (43±12.3%) and without autonomic neuropathy (57.5±13.2%) compared with normal controls (68±11.6%, p 0.05). When 50.2% of GBEF was used as the criteria for diabetic autonomic neuropathy, the sensitivity and specificity were 80%, 76.5%, respectively. The area under receiver operating characteristic curve was 0.846. GBEF of diabetic patients with autonomic neuropathy was significantly reduced than that of diabetic patients without autonomic neuropathy.=20

  17. Inter-observer variation in estimates by nuclear angiography of left ventricular ejection fraction and ejection rate

    International Nuclear Information System (INIS)

    Young, K.C.; Railton, R.

    1980-01-01

    The recent decline in the cost of computing has led to the introduction of data processing of gamma-camera images in many medical centres, allowing the development and widespread use of radionuclide techniques for assessing left ventricular performance. Methods such as ECG-gated blood-pool imaging have the advantage of being less invasive than contrast ventriculography and do not rely on geometrical assumptions about the shape of the ventricle. A study has been made of the inter-observer variation in estimates of ejection fraction and average and maximum systolic contraction rates using a micro-computer (VIP-450 Video Image Processor, Ohio-Nuclear Limited, Rugby) to analyse gated blood-pool images of the left ventricle. (author)

  18. 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...

  19. Global ejection fraction and phase analysis assessed by radionuclide angiography during exercise and after isoproterenol infusion

    International Nuclear Information System (INIS)

    Righetti, A.; Ratib, O.; Merier, G.; Widmann, T.; Donath, A.

    1983-01-01

    Radionuclide angiography obtained during and following Isoproterenol infusion is a new approach for detecting latent myocardial ischemia. It is very sensitive and could be considered as an alternative to conventional exercice radionuclide angiography. The data presented show that phase analysis assessment of regional systolic wall motion is a better indicator than global ejection fraction for quantifying left ventricular dysfunction

  20. Awake craniotomy in a patient with ejection fraction of 10%: considerations of cerebrovascular and cardiovascular physiology.

    Science.gov (United States)

    Meng, Lingzhong; Weston, Stephen D; Chang, Edward F; Gelb, Adrian W

    2015-05-01

    A 37-year-old man with nonischemic 4-chamber dilated cardiomyopathy and low-output cardiac failure (estimated ejection fraction of 10%) underwent awake craniotomy for a low-grade oligodendroglioma resection under monitored anesthesia care. The cerebrovascular and cardiovascular physiologic challenges and our management of this patient are discussed. Published by Elsevier Inc.

  1. A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF)

    DEFF Research Database (Denmark)

    Hasenfuß, Gerd; Hayward, Chris; Burkhoff, Dan

    2016-01-01

    BACKGROUND: Heart failure with preserved ejection fraction (HFPEF) is a common, globally recognised, form of heart failure for which no treatment has yet been shown to improve symptoms or prognosis. The pathophysiology of HFPEF is complex but characterised by increased left atrial pressure, espec...

  2. Association between Hypotension, Low Ejection Fraction and Cognitive Performance in Cardiac Patients

    Directory of Open Access Journals (Sweden)

    Rebecca F. Gottesman

    2010-01-01

    Full Text Available Background and Purpose: Impaired cardiac function can adversely affect the brain via decreased perfusion. The purpose of this study was to determine if cardiac ejection fraction (EF is associated with cognitive performance, and whether this is modified by low blood pressure.

  3. Identification of ultrasound-contrast-agent dilution systems for ejection fraction measurements

    NARCIS (Netherlands)

    Mischi, M.; Jansen, A.H.M.; Kalker, A.A.C.M.; Korsten, H.H.M.

    2005-01-01

    Left ventricular ejection fraction is an important cardiac-efficiency measure. Standard estimations are based on geometric analysis and modeling; they require time and experienced cardiologists. Alternative methods make use of indicator dilutions, but they are invasive due to the need for

  4. Impact of Ejection Fraction on the Clinical Response to Cardiac Resynchronization Therapy in Mild Heart Failure

    DEFF Research Database (Denmark)

    Linde, Cecilia; Daubert, Claude; Abraham, William T

    2013-01-01

    Current guidelines recommend cardiac resynchronization therapy (CRT) in mild heart failure (HF) patients with QRS prolongation and ejection fraction (EF) ≤30%. To assess the effect of CRT in less severe systolic dysfunction, outcomes in the REsynchronization reVErses Remodeling in Systolic left v...

  5. Effect of energy window on cardiac ejection fraction

    International Nuclear Information System (INIS)

    Bacharach, S.L.; Green, M.V.; Bonow, R.O.; Findley, S.L.; Daube-Witherspoon, M.E.; Larson, S.M.

    1988-01-01

    ECG gated gamma-ray energy spectra from the left ventricle were created each 50 msec during the cardiac cycle. Nine of ten subjects were studied with a nonimaging Nal probe, and the tenth with a high-resolution Germanium detector. Placing multiple energy windows over the energy spectra, EF was found to vary with the energy window selected. Moving a 20% window across the photopeak produced a roughly linear increase in EF with energy (2.3 EF units per 10 keV increase in energy) in eight of the ten subjects. Dividing the photopeak into a low (126-140 keV) and high-energy (140-154 keV) portion gave significantly different EFs (high energy exceeding low energy by 17%). Increasing the width of a narrow window centered about the photopeak produced negligible change in EF. Examining the energy spectra showed that the small-angle scattered radiation (126-139 keV) was proportionately greater at end systole than at end diastole, after normalizing the spectra to the same photopeak area

  6. The relationship between mitral regurgitation and ejection fraction as predictors for the prognosis of patients with heart failure

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Torp-Pedersen, Christian; Hassager, Christian

    2011-01-01

    To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients.......To study whether there is interaction between mitral regurgitation (MR) and left ventricular ejection fraction (LVEF) in the mortality risk of heart failure (HF) patients....

  7. International Geographic Variation in Event Rates in Trials of Heart Failure With Preserved and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Køber, Lars; Jhund, Pardeep S

    2015-01-01

    BACKGROUND: International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF). METHODS AND RESULTS: We analyzed outcomes by international geographic reg...

  8. Differing prognostic value of pulse pressure in patients with heart failure with reduced or preserved ejection fraction

    DEFF Research Database (Denmark)

    Jackson, Colette E; Castagno, Davide; Maggioni, Aldo P

    2015-01-01

    ) and 5008 with HF-PEF (828 deaths). Pulse pressure was analysed in quintiles in a multivariable model adjusted for the previously reported Meta-Analysis Global Group in Chronic Heart Failure prognostic variables. Heart failure and reduced ejection fraction patients in the lowest pulse pressure quintile had...... in patients with HF-PEF [ejection fraction (EF) ≥ 50%] and HF-REF. METHODS AND RESULTS: Data from 22 HF studies were examined. Preserved left ventricular ejection fraction (LVEF) was defined as LVEF ≥ 50%. All-cause mortality at 3 years was evaluated in 27 046 patients: 22 038 with HF-REF (4980 deaths......AIMS: Low pulse pressure is a marker of adverse outcome in patients with heart failure (HF) and reduced ejection fraction (HF-REF) but the prognostic value of pulse pressure in patients with HF and preserved ejection fraction (HF-PEF) is unknown. We examined the prognostic value of pulse pressure...

  9. Determination of right ventricular ejection fraction in children with cystic fibrosis, using krypton-81m

    International Nuclear Information System (INIS)

    Piepsz, A.; Ham, H.R.; Millet, E.; Dab, I.

    1984-01-01

    The diagnosis of cor pulmonale and incipient heart failure remains difficult to assess in cystic fibrosis (CF) on the basis of the clinical as well as the biological parameters. The measurement of the right ventricular ejection fraction has been facilitated these last years by the introduction of the radionuclide methods. Methodological difficulties are however encountered when Tc-99m RBC are used, and are mainly related to heart chambers superposition (equilibrium method) or the low count density (first pass method). Few papers have been published on RVEF in cystic fibrosis and the results are somewhat contradictory. The authors have recently introduced a new method for the determination of RVEF, using equilibrium study during continuous injection of Kr-81m in glucose solution. This method offers several advantages related to an increased accuracy and a favorable dosimetry. In 25 patients aged 2 to 23 years with CF, one or more RVEF studies were performed. The severity of the disease was evaluated on the basis of the clinical Schwachman score, the lung function tests, the ventilation scan and the pa02. RVEF tended to decrease with the progression of the lung disease, although, owing to the spread of the results, no RVEF could be predicted on the basis of the other parameters. The decrease of RVEF in patients with advanced lung disease was moderate and terminal lung disease was sometimes associated with normal right heart contractility

  10. Enhancing ejection fraction measurement through 4D respiratory motion compensation in cardiac PET imaging

    Science.gov (United States)

    Tang, Jing; Wang, Xinhui; Gao, Xiangzhen; Segars, W. Paul; Lodge, Martin A.; Rahmim, Arman

    2017-06-01

    ECG gated cardiac PET imaging measures functional parameters such as left ventricle (LV) ejection fraction (EF), providing diagnostic and prognostic information for management of patients with coronary artery disease (CAD). Respiratory motion degrades spatial resolution and affects the accuracy in measuring the LV volumes for EF calculation. The goal of this study is to systematically investigate the effect of respiratory motion correction on the estimation of end-diastolic volume (EDV), end-systolic volume (ESV), and EF, especially on the separation of normal and abnormal EFs. We developed a respiratory motion incorporated 4D PET image reconstruction technique which uses all gated-frame data to acquire a motion-suppressed image. Using the standard XCAT phantom and two individual-specific volunteer XCAT phantoms, we simulated dual-gated myocardial perfusion imaging data for normally and abnormally beating hearts. With and without respiratory motion correction, we measured the EDV, ESV, and EF from the cardiac-gated reconstructed images. For all the phantoms, the estimated volumes increased and the biases significantly reduced with motion correction compared with those without. Furthermore, the improvement of ESV measurement in the abnormally beating heart led to better separation of normal and abnormal EFs. The simulation study demonstrated the significant effect of respiratory motion correction on cardiac imaging data with motion amplitude as small as 0.7 cm. The larger the motion amplitude the more improvement respiratory motion correction brought about on the EF measurement. Using data-driven respiratory gating, we also demonstrated the effect of respiratory motion correction on estimating the above functional parameters from list mode patient data. Respiratory motion correction has been shown to improve the accuracy of EF measurement in clinical cardiac PET imaging.

  11. Effect of exercise on circulating atrial natriuretic peptide and left ventricular ejection fraction in healthy persons and patients with coronary artery disease

    International Nuclear Information System (INIS)

    Nakamura, Tetsuya; Ichikawa, Shuichi; Sakamaki, Tetsuo; Suzuki, Tadashi; Iizuka, Toshio; Yagi, Atsuko; Kurashina, Toshiaki; Kumakura, Hisao; Murata, Kazuhiko

    1988-01-01

    Radionuclide angiographic measurements of left ventricular ejection fraction were performed at rest and during exercise in 10 normal persons and 11 patients with coronary artery disease. Exercise was continued on a supine bicycle exercise table up to a symptom-limited maximum. Plasma levels of atrial natriuretic peptide (ANP) were also determined at rest and during exercise. Ejection fraction in the normal volunteers was 59±3% (mean±SEM) at rest and increased significantly (p<0.01) to 69±3% during exercise. Ejection fraction in the patients was 47±5% at rest and did not change significantly during exercise (51±7%). Plasma ANP in the normals rose significantly (p<0.01) from 62±16 pg/ml at rest to 454±94 pg/ml during exercise. Plasma ANP in the patients also rose significantly (p<0.01) from 231±102 pg/ml to 794±170 pg/ml. The response of plasma ANP to exercise was enhanced significantly (p<0.05) in the patients as compared with the normals in relation to ejection fraction by analysis of covariance. In both the normals and the patients, plasma ANP was inversely and significantly correlated with ejection fraction during exercise (r=0.46, p<0.05, n=21), however, not at rest. Because it has been reported that plasma ANP is correlated positively with pulmonary artery wedge pressure, the estimation of plasma ANP during an exercise stress test might be used for the evaluation of cardiac reserve in coronary artery disease. (author)

  12. Clinical utility of semi-automated estimation of ejection fraction at the point-of-care

    DEFF Research Database (Denmark)

    Frederiksen, Christian Alcaraz; Juhl-Olsen, Peter; Hermansen, Johan Fridolf

    2015-01-01

    ultrasonography of the heart at the bedside performed by a novice examiner. Three assessments of ejection fraction were made: 1) Expert eyeballing by a single specialist in cardiology and expert in echocardiography; 2) Manual planimetry by an experienced examiner; 3) AutoEF by a novice examiner with limited...... experience in echocardiography. RESULTS: Expert eyeballing of ejection fraction was performed in 100% of cases. Manual planimetry was possible in 89% of cases and AutoEF was possible in 83% of cases. The correlation between expert eyeballing and AutoEF was r=0.82, p ... and for AutoEF it was r=0.82, p eyeballing and manual planimetry it was r=0.80, p

  13. High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Ellingsen, Øyvind; Halle, Martin; Conraads, Viviane

    2017-01-01

    Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial...... compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate...... ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left...

  14. Response of right ventricular ejection fraction to exercise stress in coronary artery disease

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1985-01-01

    The right ventricular (RV) response to exercise was assessed in 28 patients with coronary artery disease (CAD) and 9 normal subjects. The relationship between RV reserve, exercise left ventricular (LV) reserve and the presence of proximal right coronary artery (RCA) stenosis were evaluated. RV and LV ejection fraction (EF) were determined by multiple-gated equilibrium blood pool imaging with sup(99m)Tc in the modified left anterior oblique position. Graded supine exercise stress blood pool imaging was performed at the same position by using bicycle ergometer. For calculation of RVEF, variable ROIs were used. In normal subjects, both RVEF and LVEF increased significantly during exercise (%ΔRVEF 18.9+-5.9%, %ΔLVEF 16.3%+-4.7%). In CAD groups with and without RCA stenosis, LVEF and RVEF showed decrease or no change during exercise. Although magnitude of change in LVEF from rest to exercise (%ΔLVEF) was not significantly different in both CAD groups (4.1+-9.0% in cases with RCA disease and 6.2+-14.6% in cases without RCA disease), %ΔRVEF was different significantly (16.0+-14.3% in cases with RCA disease and 1.4+-14.1% in cases without RCA disease, p<0.05). In patients with RCA disease, 3 patients (25%) showed depression in RVEF with exercise regardless of the increase in LVEF. However, none of the patients without RCA disease showed depression in RVEF with the increment in LVEF during exercise. These findings suggested that proximal RCA stenosis is one major determinant of exercise RVEF response. But in 9 of 16 patients without RCA disease (56%) both RVEF and LVEF decreased during exercise. Besides, in patients without RCA disease there was a significant linear relationship between the direction and magnitude of change from rest to exercise of LVEF and RVEF (r=0.69). (J.P.N.)

  15. Estimation of global and regional ejection fraction of the left ventricle using a fully digitalised technique

    International Nuclear Information System (INIS)

    Tuengerthal, S.; Reifart, N.; Standke, R.; Lang, J.; Kollath, J.; Riemann, H.E.; Frankfurt Univ.; Frankfurt Univ.

    1984-01-01

    Subtraction angiocardiography (DSAK) with a fully digitalised system (DR 960) provides a well defined demonstration of the left ventricle after peripheral venous contrast injection. Cardiac volume and ejection fractions were calculated by a dedicated software programme and the findings correlated with cine ventriculography (CA) (r=0.91), biplane echo cardiography (2 DE) (r=0.77) and radionucleid ventriculography (RNV) (r=0.85); the method can be used even with reduced cardiac output (EF [de

  16. Evaluation of left ventricular ejection fraction by first pass radionuclide cardioangiography

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, T; Imai, Y; Kagawa, M; Hayashi, M; Kozuka, T [National Cardiovascular Center, Suita, Osaka (Japan)

    1980-02-01

    The left ventricular ejection fraction can be assessed by recording the passage of peripherally administered radioactive bolus through the heart which is first pass method. In this study, the accuracy and validity of first pass method were examined in the patients with cardiac catheterization. After sup(99m)Tc-HSA as a bolus was injected intravenouslly, the time-activity curve was recorded with a scintillation camera and online minicomputer system. The ejection fraction was calculated by the average of three cardiac cycles which corresponded to the left ventricular volume changes during each cardiac cycles. The results correlated well with those obtained by biplane cineangiography in the twenty patients without arrythmias (r = 0.89) and moreover, this technique was applied to the fifteen patients with atrial fibrillation such as mitral valvular diseases, congestive cardiomyopathy, Good correlation of the ejection fraction (r = 0.84) was obtained. The findings, however, demonstrated that the time-activity curve must be generated from the region of interest which fits the left ventricular blood pool precisely and must be corrected for the contribution arizing from noncardiac background structures (two matrix method). In conclusion, this noninvasive method appears particularly useful for serial evaluation of the patients with cardiac dysfunctions and would be available for the routine examination of ventricular functions.

  17. Benefits and Harms of Sacubitril in Adults With Heart Failure and Reduced Left Ventricular Ejection Fraction.

    Science.gov (United States)

    Aronow, Wilbert S; Shamliyan, Tatyana A

    2017-10-01

    The quality of evidence regarding patient-centered outcomes in adults with heart failure (HF) after sacubitril combined with valsartan has not been systematically appraised. We searched 4 databases in February 2017 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 1 meta-analysis and multiple publications of 2 randomized controlled trials (RCT) and 1 unpublished RCT. In adults with HF and reduced ejection fraction, low-quality evidence from 1 RCT of 8,432 patients suggests that sacubitril combined with valsartan reduces all-cause (number needed to treat [NNT] to prevent 1 event [NNTp] = 35) and cardiovascular mortality (NNTp = 32), hospitalization (NNTp = 11), emergency visits (NNTp = 69), and serious adverse effects, leading to treatment discontinuation (NNTp = 63) and improves quality of life when compared with enalapril. In adults with HF and preserved ejection fraction, very low-quality evidence from 1 RCT of 301 patients suggests that there are no differences in mortality, morbidity, or adverse effects between sacubitril combined with valsartan and valsartan alone. In conclusion, in adults with HF and reduced ejection fraction, to reduce cardiovascular mortality and hospitalizations and improve quality of life, clinicians may recommend sacubitril combined with valsartan over angiotensin-converting enzyme inhibitors. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery

    International Nuclear Information System (INIS)

    Fiser, W.P.; Thompson, B.W.; Thompson, A.R.; Eason, C.; Read, R.C.

    1983-01-01

    Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. The authors conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance

  19. Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

    Science.gov (United States)

    Asrar Ul Haq, Muhammad; Goh, Cheng Yee; Levinger, Itamar; Wong, Chiew; Hare, David L

    2015-01-01

    Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed. PMID:25698883

  20. 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.

  1. Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease

    International Nuclear Information System (INIS)

    Polak, J.F.; Holman, B.L.; Wynne, J.; Colucci, W.S.

    1983-01-01

    The predictive value of radionuclide ventriculography was studied in 34 patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease. In addition to left ventricular ejection fraction, right ventricular ejection fraction and extent of left ventricular paradox were obtained in an attempt to identify a subgroup at increased risk of mortality during the ensuing months. The 16 patients who were alive after a 2 year follow-up period had a higher right ventricular ejection fraction and less extensive left ventricular dyskinesia. When a right ventricular ejection fraction of less than 35% was used as a discriminant, mortality was significantly greater among the 21 patients with a depressed right ventricular ejection fraction (71 versus 23%), a finding confirmed by a life table analysis. It appears that the multiple factors contributing to the reduction in right ventricular ejection fraction make it a useful index not only for assessing biventricular function, but also for predicting patient outcome

  2. Echocardiographic right ventricle longitudinal contraction indices cannot predict ejection fraction in post-operative Fallot children.

    Science.gov (United States)

    Bonnemains, Laurent; Stos, Bertrand; Vaugrenard, Thibaud; Marie, Pierre-Yves; Odille, Freddy; Boudjemline, Younes

    2012-03-01

    To examine in a population of post-operative tetralogy of Fallot patients, the correlation between right ventricle (RV) ejection fractions (EF) computed from magnetic resonance imaging (MRI) and three echocardiographic indices of RV function: TAPSE, longitudinal strain and strain rate. Indeed, these patients present a pulmonary regurgitation which is responsible for progressive dilatation of the RV. An echocardiographic assessment of the RV function would be very useful in determining the timing of pulmonary revalvulation for Fallot patients. However, these indices are generally based on the ventricle contraction in the long axis direction which is impaired in this population and does not seem to correlate with the EF. Thirty-five post-operative tetralogy of Fallot patients and 20 patients with normal RVs were included. In both groups, RVEF, assessed by MRI, was compared with the three echocardiographic indices. Longitudinal strain and strain rates were computed both on the free wall and on the whole RV. No correlation was found between the echocardiographic indices and the MRI EF in our Fallot population. The accuracy of those indices as a diagnostic test of an altered RV was low with Younden's indices varying from -0.18 to 0.5 and areas under the Receiver Operating Characterictic (ROC) curves equal to 0.54 for tricuspid annulus plane systolic excursion, 0.59-0.62 for strain and 0.57-0.63 for strain rate. Three conventional echocardiographic indices based on RV longitudinal contraction failed to assess the EF in our population of post-operative tetralogy of Fallot patients.

  3. Evaluation of left ventricular ejection fraction using quantitative gated SPECT (QGS)

    International Nuclear Information System (INIS)

    Musa, M. A. A.

    2010-07-01

    Electrocardiographic ally gated myocardial perfusion SPECT (G SPECT) is a state-of the art technique for the combined evaluation of myocardial perfusion and left ventricular function within a single study. It is currently one of the most commonly performed cardiology procedures in a nuclear medicine department. Automation of the image processing and quantification has made this techniques highly reproducible, practical and user friendly in the clinical setting . In patients with coronary artery disease, gating enhances the diagnostic and prognostic capability of myocardial perfusion imaging provides incremental information over the the perfusion data, and has shown potentials for myocardial viability assessment and sequential follow-up after therapy. Evaluation of the left ventricular (L V) function is important in clinical cardiology. Quantifying the degree and extent of the L V functional abnormalities permits a systematic assessment of the disease process on the myocardial performance. The aim of this thesis is to evaluate left ventricular ejection fraction (LVEF) in patients with no evidence of ischemic response during the stress test. This investigation was carried out in view of the few reports concerning the findings ventricular function with gated SPECT in these situations in the normal population, which is relevant when considering the possibility of myocardial stunning. Method: We prospectively studied 30 selected patients, in difference age and gender. A one-day protocol was used, with injection 555 MBq - 1.11 MBq (15 - 30 mCi) of 99 mTc-M1 B1 at stress and rest. Gated perfusion SPECT was acquired 30 to 60 minutes after radiotracer injection in both condition and processed using QGSPECT software. Difference between stress and rest LVEF was calculated. Result and conclusion: rest LVEF was higher in the stress (exercise) group, A trend line was done in both groups and r-value was (0.9) and p=0.04 in acceptance value. Standard deviation of LVEF also was

  4. Evaluation of Right Ventricular Function with Radionuclide Cardiac Angiography - Right Ventricular Ejection Fraction in Chronic Obstructive Lung Disease

    International Nuclear Information System (INIS)

    Sohn, In; Shin, Sung Hae; Chung, June Key; Lee, Myung Chul; Cho, Bo Youn; Lee, Young Woo; Han, Yong Cheol; Koh, Chang Soon

    1982-01-01

    To evaluate the usefulness of radionuclide cardiac angiography in the assessment of the right ventricular function, we measured right ventricular ejection fraction (RVEF) using single pass method. In 12 normal persons, RVEF averaged 52.7±5.9% (mean±S.D.). In 25 patients with chronic obstructive lung disease, RVEF was 37.2±10.6% and significantly lower than that of normal person (p<0.01). All 10 patients with right ventricular failure had abnormal RVEF, which was significantly lower than that of 14 persons without right ventricular failure (27.6±5.7%, 43.9±8.5%, respectively, p<0.01). It concluded that RVEF measured by single pass radionuclide cardiac angiography was a useful, noninvasive method to assess right ventricular function.

  5. System modeling and identification in indicator dilution method for assessment of ejection fraction and pulmonary blood volume

    NARCIS (Netherlands)

    Bharath, H.N.; Prabhu, K.M.M.; Korsten, H.H.M.; Mischi, M.

    2012-01-01

    Clinically relevant cardiovascular parameters, such as pulmonary blood volume (PBV) and ejection fraction (EF), can be assessed through indicator dilution techniques. Among these techniques, which are typically invasive due to the need for central catheterization, contrast ultrasonography provides a

  6. The relationship between the parameters (Heart rate, Ejection fraction and BMI) and the maximum enhancement time of ascending aorta

    International Nuclear Information System (INIS)

    Jang, Young Ill; June, Woon Kwan; Dong, Kyeong Rae

    2007-01-01

    In this study, Bolus Tracking method was used to investigate the parameters affecting the time when contrast media is reached at 100 HU (T 100 ) and studied the relationship between parameters and T 100 because the time which is reached at aorta through antecubital vein after injecting contrast media is different from person to person. Using 64 MDCT, Cadiac CT, the data were obtained from 100 patients (male: 50, female: 50, age distribution: 21⁓81, average age: 57.5) during July and September, 2007 by injecting the contrast media at 4 ml∙sec -1 through their antecubital vein except having difficulties in stopping their breath and having arrhythmia. Using Somatom Sensation Cardiac 64 Siemens, patients’ height and weight were measured to know their mean Heart rate and BMI. Ejection Fraction was measured using Argus Program at Wizard Workstation. Variances of each parameter were analyzed depending on T 100 ’s variation with multiple comparison and the correlation of Heart rate, Ejection Fraction and BMI were analyzed, as well. According to T 100 ’s variation caused by Heart rate, Ejection Fraction and BMI variations, the higher patients’ Heart Rate and Ejection Fraction were, the faster T 100 ’s variations caused by Heart Rate and Ejection Fraction were. The lower their Heart Rate and Ejection Fraction were, the slower T 100 ’s variations were, but T 100 ’s variations caused by BMI were not affected. In the correlation between T 100 and parameters, Heart Rate (p⁄0.01) and Ejection Fraction (p⁄0.05) were significant, but BMI was not significant (p¤0.05). In the Heart Rate, Ejection Fraction and BMI depending on Fast (17 sec and less), Medium (18⁓21 sec), Slow (22 sec and over) Heart Rate was significant at Fast and Slow and Ejection Fraction was significant Fast and Slow as well as Medium and Slow (p⁄0.05), but BMI was not statistically significant. Of the parameters (Heart Rate, Ejection Fraction and BMI) which would affect T 100 , Heart

  7. Usefulness of acoustic quantification method in left ventricular volume and ejection fraction. Compared with ventriculography and scintigraphy

    International Nuclear Information System (INIS)

    Shibata, Takahiro; Honda, Youichi; Kashiwagi, Hidehiko

    1996-01-01

    Acoustic quantification method (AQ: on-line automated boundary detection system) has proved to have a good correlation with left ventriculography (LVG) and scintigraphy (SG) in patients with normal left ventricular (LV) function. The aim of this study is to determine whether AQ is also useful in patients with abnormal LV function. We examined 54 patients with LV asynergy. End-diastolic volumes with AQ, LVG and SG were 77, 135, 118 ml. A good correlation was found between AQ and LVG and SG (LVG; r=0.81, SG; r=0.68). End-systolic volumes with AQ, LVG and SG were 38, 64 and 57 ml. Left ventricular volumes obtained from AQ had a good correlation with LVG and SG, but were underestimated. LV ejection fraction obtained from AQ had good correlation with those with LVG and SG (LVG; r=0.84. SG; r=0.77). On-line AQ appears to be a useful noninvasive method for evaluation of the left ventricular ejection fraction, but care must be exercised when estimations of left ventricular volumes are made. (author)

  8. Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

    OpenAIRE

    Hummel, Scott L; Herald, John; Alpert, Craig; Gretebeck, Kimberlee A; Champoux, Wendy S; Dengel, Donald R; Vaitkevicius, Peter V; Alexander, Neil B

    2016-01-01

    Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure (HF). We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, functional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction (n = 25, age 75 ? 7 years) were compared to 25 healthy age- and gender-matched cont...

  9. Mid-range Ejection Fraction Does Not Permit Risk Stratification Among Patients Hospitalized for Heart Failure.

    Science.gov (United States)

    Gómez-Otero, Inés; Ferrero-Gregori, Andreu; Varela Román, Alfonso; Seijas Amigo, José; Pascual-Figal, Domingo A; Delgado Jiménez, Juan; Álvarez-García, Jesús; Fernández-Avilés, Francisco; Worner Diz, Fernando; Alonso-Pulpón, Luis; Cinca, Juan; Gónzalez-Juanatey, José Ramón

    2017-05-01

    European Society of Cardiology heart failure guidelines include a new patient category with mid-range (40%-49%) left ventricular ejection fraction (HFmrEF). HFmrEF patient characteristics and prognosis are poorly defined. The aim of this study was to analyze the HFmrEF category in a cohort of hospitalized heart failure patients (REDINSCOR II Registry). A prospective observational study was conducted with 1420 patients classified according to ejection fraction as follows: HFrEF, < 40%; HFmrEF, 40%-49%; and HFpEF, ≥ 50%. Baseline patient characteristics were examined, and outcome measures were mortality and readmission for heart failure at 1-, 6-, and 12-month follow-up. Propensity score matching was used to compare the HFmrEF group with the other ejection fraction groups. Among the study participants, 583 (41%) had HFrEF, 227 (16%) HFmrEF, and 610 (43%) HFpEF. HFmrEF patients had a clinical profile similar to that of HFpEF patients in terms of age, blood pressure, and atrial fibrillation prevalence, but shared with HFrEF patients a higher proportion of male participants and ischemic etiology, and use of class I drugs targeting HFrEF. All other features were intermediate, and comorbidities were similar among the 3 groups. There were no significant differences in all-cause mortality, cause of death, or heart failure readmission. The similar outcomes were confirmed in the propensity score matched cohorts. The HFmrEF patient group has characteristics between the HFrEF and HFpEF groups, with more similarities to the HFpEF group. No between-group differences were observed in total mortality, cause of death, or heart failure readmission. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Quantitative gated SPECT: the effect of reconstruction filter on calculated left ventricular ejection fractions and volumes

    International Nuclear Information System (INIS)

    Wright, Graham A.; McDade, Mark; Martin, William; Hutton, William

    2002-01-01

    Gated SPECT (GSPECT) offers the possibility of obtaining additional functional information from perfusion studies, including calculation of left ventricular ejection fraction (LVEF). The calculation of LVEF relies upon the identification of the endocardial surface, which will be affected by the spatial resolution and statistical noise in the reconstructed images. The aim of this study was to compare LVEFs and ventricular volumes calculated from GSPECT using six reconstruction filters. GSPECT and radionuclide ventriculography (RNVG) were performed on 40 patients; filtered back projection was used to reconstruct the datasets with each filter. LVEFs and volumes were calculated using the Cedars-Sinai QGS package. The correlation coefficient between RNVG and GSPECT ranged from 0.81 to 0.86 with higher correlations for smoother filters. The narrowest prediction interval was 11±2%. There was a trend towards higher LVEF values with smoother filters, the ramp filter yielding LVEFs 2.55±3.10% (p<0.001) lower than the Hann filter. There was an overall fall in ventricular volumes with smoother filters with a mean difference of 13.98±10.15 ml (p<0.001) in EDV between the Butterworth-0.5 and Butterworth-0.3 filters. In conclusion, smoother reconstruction filters lead to lower volumes and higher ejection fractions with the QGS algorithm, with the Butterworth-0.4 filter giving the highest correlation with LVEFs from RNVG. Even if the optimal filter is chosen the uncertainty in the measured ejection fractions is still too great to be clinically acceptable. (author)

  11. 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...... reported, a significant proportion of patients with mild and moderate AS progressed to higher grades within the currently recommended time windows for echocardiographic follow-up....... on the expected rate of progression and whether clinical variables are associated with accelerated progression in contemporarily managed patients with AS. We conducted a retrospective analysis of patients presenting with AS and explored the trajectory of AS mean gradient over time using generalized estimating...

  12. Risk factors for readmission to hospital in adult patients with heart failure and reduced ejection fraction

    DEFF Research Database (Denmark)

    Schjødt, Inge; Larsen, Palle; Johnsen, Søren Paaske

    2017-01-01

    REVIEW QUESTION/OBJECTIVE:: The objective of this systematic review is to identify and synthesize the best available evidence on risk factors associated with hospital readmission at different time points within the first year after heart failure (HF) hospitalization in patients suffering from HF...... with reduced ejection fraction (EF).More specifically, the question is: what are the risk factors for the prediction of hospital readmission within seven, 15, 30, 60, 90, 180 and 365 days of discharge in hospitalized patients with HF with reduced EF aged 18 years or older?...

  13. Measurement and comparison of left ventricular ejection fraction utilizing first transit and gated scintiangiography

    International Nuclear Information System (INIS)

    Fletcher, J.W.; Herbig, F.K.; Daly, J.L.; Walter, K.E.

    1975-01-01

    Paired serial radionuclide scans were used for determinations of left ventricular ejection fraction (LVEF) in open chest dogs with constant cardiac output and varying ventricular rates following the left atrial injection of 99m-Tc human serum albumin. Values of LVEF obtained by first transit (high frequency) data analysis and ECG-gated scintiphotography were obtained over a wide range of ventricular rate and stroke volume. The results of this study show no significant difference in LVEF as determined by both of these methods of data acquisition and analysis and demonstrate the feasibility of rapid serial determination of LVEF by radioisotope techniques

  14. Bi-temporal 3D active appearance models with applications to unsupervised ejection fraction estimation

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Pedersen, Dorthe

    2005-01-01

    in four-dimensional MRI. The theoretical foundation of our work is the generative two-dimensional Active Appearance Models by Cootes et al., here extended to bi-temporal, three-dimensional models. Further issues treated include correction of respiratory induced slice displacements, systole detection......, and a texture model pruning strategy. Cross-validation carried out on clinical-quality scans of twelve volunteers indicates that ejection fraction and cardiac blood pool volumes can be estimated automatically and rapidly with accuracy on par with typical inter-observer variability....

  15. The reproducibility and variability of sequential left ventricular ejection fraction measurements by the nuclear stethoscope

    International Nuclear Information System (INIS)

    Kurata, Chinori; Hayashi, Hideharu; Kobayashi, Akira; Yamazaki, Noboru

    1986-01-01

    We evaluated the reproducibility and variability of sequential left ventricular ejection fraction (LVEF) measurements by the nuclear stethoscope in 72 patients. The group as a whole demonstrated excellent reproducibility (r = 0.96). However, repeat LVEF measurements by the nuclear stethoscope at 5-minute interval showed around 9 % absolute difference, at 95 % confidence levels, from one measurement to the next. The finding indicates that a change in LVEF greater than 9 % is necessary for determining an acute effect of an intervention in individual cases. (author)

  16. Automatic determination of the regional ejection fraction of the left ventricle (gated bloodpool)

    International Nuclear Information System (INIS)

    Feser, J.A.

    1982-01-01

    The left ventricular volume curve and the ejection fraction are calculated according to the ''sliding region of interest'' method in which the ventricle contour is redetermined for every single picture of the various phases of the heart beat. The original set of data, consisting of 32 pictures in 64 x 64 matrix resolution, is processed by a three-dimensional filtering process in space (x,y) and time (t). The ventricle contour is determined by convolution of the filtered images with a 7-point Laplacian operator in 4 independent directions. The atrial and ventricular phase histograms are then calculated on the basis of this contour. (WU) [de

  17. Factors influencing the variations of ejection fraction during exercise in chronic aortic regurgitation

    International Nuclear Information System (INIS)

    Bassand, J.P.; Faivre, R.; Berthout, P.; Maurat, J.P.; Cardot, J.C.; Verdenet, J.; Bidet, R.

    1987-01-01

    The influence of left ventricular volume variations and regurgitant fraction variations upon left ventricular ejection fraction during exercise was examined using equilibrium radionuclide angiography in patients suffering from aortic regurgitation. Ejection fraction (EF), regurgitant fraction (RF), end diastolic volume (EDV) and end systolic volume (ESV) variations from rest to peak exercise were determined in 44 patients suffering from chronic aortic regurgitation (AR) and in 8 healthy volunteers (C). In C, EF increased (+0.10±0.03, P<0.01) and ESV decreased significantly (-23%±12%, P<0.01), RF and EDV did not vary significantly. In AR patients, EF, EDV and ESV did not vary significantly because of important scattering of individual values. Changes in EF and ESV were inversely correlated (r=-0.79, P<0.01) and RF decreased significantly (-0.12±0.10, P<0.01). Volumes and EF changes during exercise occurred in three different ways. In a 1st subgroup of 7 patients, EF increased (+0.09±0.03, P<0.05) in conjunction with a reduction of ESV (-24%±12%, P<0.05) without a significant change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04±0.07, P<0.01) in association with an increase in ESV (+17%±16%, P<0.01) and no changes in EDV. In a 3rd subgroup of 15 patients, EF decreased (-0.02±0.06, P<0.01) despite a reduction in ESV (-7%±6%, P<0.01) because of a dramatic EDV decrease (-10%±6%, P<0.05). In this subgroup, changes in EF were inversely correlated with changes in ESV (r=-0.55, P<0.01) and positively related to EDV variations (r=0.42, P=0.02). EDV changes were weakly, but significantly, correlated to RF decrease (r=0.39, P<0.05). We conclude that changes in left ventricular ejection fraction during exercise in patients with chronic aortic regurgitation are significantly related in some patients to changes in ventricular loading conditions as well as contractile state. (orig./MG)

  18. Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography

    International Nuclear Information System (INIS)

    Coriat, P.; Mundler, O.; Bousseau, D.; Fauchet, M.; Rous, A.C.; Echter, E.; Viars, P.

    1986-01-01

    To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin

  19. The reverse remodeling response to sacubitril/valsartan therapy in heart failure with reduced ejection fraction.

    Science.gov (United States)

    Martens, Pieter; Beliën, Hanne; Dupont, Matthias; Vandervoort, Pieter; Mullens, Wilfried

    2018-05-17

    Major classes of medical therapy for heart failure with reduced ejection fraction (HFrEF) induce reverse remodeling. The revere remodeling response to sacubitril/valsartan remains unstudied. We performed a single-center, prospective assessor-blinded study to determine the reverse remodeling response of sacubitril/valsartan therapy in HFrEF patients with a class I indication (New York heart Association [NYHA]-class II-IV, Left ventricular ejection fraction [LVEF] sacubitril/valsartan were optimized to individual tolerance. Echocardiographic images were assessed offline by 2 investigators blinded to both the clinical data and timing of echocardiograms. One-hundred-twenty-five HFrEF patients (66 ± 10 years) were prospectively included. The amount of RAS-blocker before and after switch to sacubitril/valsartan was similar(P = .290), indicating individual optimal dosing of sacubitril/valsartan. Over a median(IQR) follow-up of 118(77-160) days after initiation of sacubitril/valsartan, LVEF improved (29.6 ± 6% vs 34.8 ± 6%; P sacubitril/valsartan leading to more reverse remodeling. Switching therapy in eligible HFrEF patients from a RAS-blocker to sacubitril/valsartan induces beneficial reverse remodeling of both metrics of systolic as diastolic function. © 2018 John Wiley & Sons Ltd.

  20. 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.

  1. Assessment of relationship between regional perfusion and ventricular function in patients with severely depressed ejection fraction

    International Nuclear Information System (INIS)

    Teresinska, A.; Konieczna, S.; Szumilak, B.; Gosiewska-Marcinkowska, E.; Potocka, J.

    1998-01-01

    Patients with low ventricular (LV) ejection fraction (EF) and with regional or global LV dysfunction, considered for myocardial revascularization, are often submitted to myocardial perfusion study to ptrove perfusion preserved and to approximate viability. The aim of this work is to evaluate, to what extent SPECT with Tc-99m-MIBI (SPECT-MIBI) additionally differentiatesa and enlarges the information on LV contractility achieved from radioisotopic ventriculography (RNV). Seventy-three patients with EF=0.11-0.35 (mean: 0.26 ± 0.06, calculated from RNV) were studied. Planar gated RNV and SPECT-MIBI were performed within 2 months (mean: 15 ± 14 days). RNV, after in vivo red cells labeling with Tc-99m, was recorded in rest in LAO45 and RAO30 views. Global EF and contractility of 5 regions (anterior, posterior, lateral walls, septum and apex) were evaluated. Assessment was performed by means of LV in 'cine' mode,m ED and ES outlines and amplitude-phase images. Regional contractility abnormalities were classified as dyskinesis, akinesis and hypokinesis. SPECT-MIBI was performed in rest and stress. Perfusion abnormalities in 5 above mentioned regions was classified as large (more intense than 50% of myocardial maximum) or small persistent defects (DEFpers), large or small partially reversible defects (DEFpart-rev), large or small completely reversible defects (DEFrev). Hypokinesis was detected in 23-35 regions (65%) , dyskinesis - in 63 (17%), akinesis - in 37 (10%), normokinesis - in 27 (7%). In dyskinetic regions, there existed large DEFpers (79%) or large DEFpart-rev (21%). In akinetic regions, there also existed large DEFpers (68%) or large DEFpart-rev (32%). In hypokinetic regions, there were no perfusion defects (31% of regions), small DEFpers, DEFrev and DEFpart-rev (42%) and also large DEFpers (27%). In most of normokinetic regions, different types of perfusion defects were observed (large DEFpers existed in 26% of regions). In summary: In dyskinetic and akinetic

  2. Reduced systolic performance by tissue Doppler in patients with preserved and abnormal ejection fraction: new insights in chronic heart failure.

    Science.gov (United States)

    García, Edgar H; Perna, Eduardo R; Farías, Eduardo F; Obregón, Ricardo O; Macin, Stella M; Parras, Jorge I; Agüero, Marcelo A; Moratorio, Diego A; Pitzus, Ariel E; Tassano, Eduardo A; Rodriguez, Leonardo

    2006-04-04

    Tissue Doppler imaging (TDI) is useful in the evaluation of systolic and diastolic function. It allows assessment of ventricular dynamics in its longitudinal axis. We sought to investigate the difference in systolic and diastolic longitudinal function in patients with chronic heart failure (CHF) with normal and reduced ejection fraction. One hundred ten outpatients with CHF and 68 controls were included. Ejection fraction (EF) was obtained and longitudinal systolic (S) and diastolic (E' and A') wall velocities were recorded from basal septum. Group A (controls) were normal and CHF patients were classified by EF in Group B1: > 45% and B2: < or = 45%. In A, B1 and B2 the mean S peak was 7.74; 5.45 and 4.89 cm/s (p<0.001); the mean E' peak was 8.56; 5.72 and 6.1 cm/s (p<0.001); and the mean A' peak was 10.2; 7.3 and 5.3 cm/s (p<0.001). Also, isovolumic contraction and relaxation time were different among control and CHF groups, (both p<0.001). The most useful parameters for identifying diastolic CHF were IVRT and S peak, with area under ROC curves of 0.93 and 0.89. The cut-off of 115 ms for IVRT and 5.8 cm/s for S peak showed a sensitivity of 94 and 97%, with a specificity of 82 and 73%, respectively. These findings suggest that impairment of left ventricular systolic function is present even in those with diastolic heart failure, and that abnormalities may have an important role to identifying the condition.

  3. Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography

    Directory of Open Access Journals (Sweden)

    Manouras Aristomenis

    2009-08-01

    Full Text Available Abstract Background Visual assessment of left ventricular ejection fraction (LVEF is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE and triplane echocardiography (TPE using quantitative real-time three-dimensional echocardiography (RT3DE as the reference method. Methods Thirty patients were enrolled in the study. Eyeballing EF was assessed using apical 4-and 2 chamber views and TP mode by two experienced readers blinded to all clinical data. The measurements were compared to quantitative RT3DE. Results There were an excellent correlation between eyeballing EF by 2D and TP vs 3DE (r = 0.91 and 0.95 respectively without any significant bias (-0.5 ± 3.7% and -0.2 ± 2.9% respectively. Intraobserver variability was 3.8% for eyeballing 2DE, 3.2% for eyeballing TP and 2.3% for quantitative 3D-EF. Interobserver variability was 7.5% for eyeballing 2D and 8.4% for eyeballing TP. Conclusion Visual estimation of LVEF both using 2D and TP by an experienced reader correlates well with quantitative EF determined by RT3DE. There is an apparent trend towards a smaller variability using TP in comparison to 2D, this was however not statistically significant.

  4. Visually estimated ejection fraction by two dimensional and triplane echocardiography is closely correlated with quantitative ejection fraction by real-time three dimensional echocardiography.

    Science.gov (United States)

    Shahgaldi, Kambiz; Gudmundsson, Petri; Manouras, Aristomenis; Brodin, Lars-Ake; Winter, Reidar

    2009-08-25

    Visual assessment of left ventricular ejection fraction (LVEF) is often used in clinical routine despite general recommendations to use quantitative biplane Simpsons (BPS) measurements. Even thou quantitative methods are well validated and from many reasons preferable, the feasibility of visual assessment (eyeballing) is superior. There is to date only sparse data comparing visual EF assessment in comparison to quantitative methods available. The aim of this study was to compare visual EF assessment by two-dimensional echocardiography (2DE) and triplane echocardiography (TPE) using quantitative real-time three-dimensional echocardiography (RT3DE) as the reference method. Thirty patients were enrolled in the study. Eyeballing EF was assessed using apical 4-and 2 chamber views and TP mode by two experienced readers blinded to all clinical data. The measurements were compared to quantitative RT3DE. There were an excellent correlation between eyeballing EF by 2D and TP vs 3DE (r = 0.91 and 0.95 respectively) without any significant bias (-0.5 +/- 3.7% and -0.2 +/- 2.9% respectively). Intraobserver variability was 3.8% for eyeballing 2DE, 3.2% for eyeballing TP and 2.3% for quantitative 3D-EF. Interobserver variability was 7.5% for eyeballing 2D and 8.4% for eyeballing TP. Visual estimation of LVEF both using 2D and TP by an experienced reader correlates well with quantitative EF determined by RT3DE. There is an apparent trend towards a smaller variability using TP in comparison to 2D, this was however not statistically significant.

  5. 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

  6. Computer-based assessment of right ventricular regional ejection fraction in patients with repaired Tetralogy of Fallot

    Science.gov (United States)

    Teo, S.-K.; Wong, S. T.; Tan, M. L.; Su, Y.; Zhong, L.; Tan, Ru-San

    2015-03-01

    After surgical repair for Tetralogy of Fallot (TOF), most patients experience long-term complications as the right ventricle (RV) undergoes progressive remodeling that eventually affect heart functions. Thus, post-repair surgery is required to prevent further deterioration of RV functions that may result in malignant ventricular arrhythmias and mortality. The timing of such post-repair surgery therefore depends crucially on the quantitative assessment of the RV functions. Current clinical indices for such functional assessment measure global properties such as RV volumes and ejection fraction. However, these indices are less than ideal as regional variations and anomalies are obscured. Therefore, we sought to (i) develop a quantitative method to assess RV regional function using regional ejection fraction (REF) based on a 13-segment model, and (ii) evaluate the effectiveness of REF in discriminating 6 repaired TOF patients and 6 normal control based on cardiac magnetic resonance (CMR) imaging. We observed that the REF for the individual segments in the patient group is significantly lower compared to the control group (P < 0.05 using a 2-tail student t-test). In addition, we also observed that the aggregated REF at the basal, mid-cavity and apical regions for the patient group is significantly lower compared to the control group (P < 0.001 using a 2-tail student t-test). The results suggest that REF could potentially be used as a quantitative index for assessing RV regional functions. The computational time per data set is approximately 60 seconds, which demonstrates our method's clinical potential as a real-time cardiac assessment tool.

  7. Measurement of left ventricular ejection fraction using gated 99mTc-sestamibi myocardial planar images: Comparison to contrast ventriculography

    International Nuclear Information System (INIS)

    Parker, D.A.; Lloret, R.L.; Barilla, F.; Douthat, L.; Gheorghiade, M.

    1991-01-01

    Using the new myocardial perfusion agent 99mTc-sestamibi and multigated acquisition on a nuclear medicine gamma camera, the left ventricular ejection fraction (LVEF) was derived in 13 patients with coronary artery disease (CAD). Cross-sectional activity profiles were used to measure the left ventricle from end-diastolic and end-systolic images. Several different geometric methods were then utilized to derive ejection fractions from the nuclear data. Comparison of the resultant ejection fractions to those obtained from contrast ventriculography showed significant correlation for all geometric methods (P less than 0.01, Sy X x = 6.2 to 9.6). The authors conclude that in patients with CAD one or more of these simple geometric methods can provide a useful estimate of the LVEF when performing 99mTc-sestamibi multigated myocardial perfusion imaging

  8. Clinical significance of right ventricular ejection fraction in cases with atrial septal defect

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Seiki; Nishimura, Tsunehiko; Hayashida, Kouhei; Uehara, Toshiisa

    1989-04-01

    Right ventricular ejection fraction (RVEF) assessed by cardiac radionuclide angiography has been applied to evaluate ventricular function such as ischemic, valvular and congenital heart disease. Using this modality, previous reports also suggest that there is good correlation between RVEF and mean pulmonary arterial pressure (mPA) from catheterization findings in mitral valvular disease and chronic obstructive lung disease. In this study, cardiac RI angiography were performed on 33 adult patients with atrial septal defect (ASD). RVEF is not so good correlation (r=-0.42) with mPA, but in cases within pulmonary to systemic ratio (Qp/Qs) less than 2.0 limits, there is good correlation between RVEF and mPA (n=9, r=-0.71). As a conclusion, in ASD, both afterload assessed by mPA and preload assessed by Qp/Qs decrease RVEF. (author).

  9. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Rossing, Kasper; Bosselmann, Helle Skovmand; Gustafsson, Finn

    2016-01-01

    and Results Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFr......Background Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF. Methods.......6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin. Conclusion CE-MS based urine proteome analysis served as a sensitive tool...

  10. Atrial fibrillation in heart failure with preserved ejection fraction: Insights into mechanisms and therapeutics.

    Science.gov (United States)

    Patel, Ravi B; Vaduganathan, Muthiah; Shah, Sanjiv J; Butler, Javed

    2017-08-01

    Atrial fibrillation (AF) and heart failure (HF) often coexist, and the outcomes of patients who have both AF and HF are considerably worse than those with either condition in isolation. Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical entity and accounts for approximately one-half of current HF. At least one-third of patients with HFpEF are burdened by comorbid AF. The current understanding of the relationship between AF and HFpEF is limited, but the clinical implications are potentially important. In this review, we explore 1) the pathogenesis that drives AF and HFpEF to coexist; 2) pharmacologic therapies that may attenuate the impact of AF in HFpEF; and 3) future directions in the management of this complex syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Varying effects of recommended treatments for heart failure with reduced ejection fraction

    DEFF Research Database (Denmark)

    Thomsen, Marius Mark; Lewinter, Christian; Køber, Lars

    2016-01-01

    The aim of this paper is to evaluate the treatment effects of recommended drugs and devices on key clinical outcomes for patients with heart failure with reduced ejection fraction (HFREF). Randomized controlled trials (RCTs) listed in the 2012 HF guideline from the European Society of Cardiology...... as well as the 2013 HF guideline from the American College of Cardiology Foundation and American Heart Association were evaluated for use in the meta-analysis. RCTs written in English evaluating recommended drugs and devices for the treatment of patients with HFREF were included. Meta-analyses, based...... on the outcomes of all-cause mortality and hospitalization because of HF, were performed with relative risk ratio as the effect size. In the identified 47 RCTs, patients were on average 63 years old and 22% were female. Drugs targeting the renin-angiotensin-aldosterone system, beta-blockers, cardiac...

  12. Measurement of left ventricular ejection fraction in pediatric patients using the nuclear stethoscope

    International Nuclear Information System (INIS)

    Spicer, R.L.; Rabinovitch, M.; Rosenthal, A.; Pitt, B.

    1984-01-01

    Left ventricular (LV) ejection fraction (EF) was measured in 25 patients, aged 2 weeks to 20 years (mean 8.6 years), using a portable nonimaging scintillation stethoscope. Technically satisfactory studies were obtained in 23 patients. LVEF was validated by cineangiography in 19 patients and by standard gated blood pool scintigraphy in 4. EF measured by the nuclear stethoscope correlated well with values obtained by cineangiography or scintigraphy over a wide range of EF values (18 to 79%). In children younger than 5 years (n . 11), the correlation was less satisfactory than in those older than 5 years. Although modifications in the instrument and further clinical trials with the stethoscope are needed before the device becomes clinically useful to pediatric cardiologists, our data indicate that the nuclear stethoscope can provide reliable assessment of LVEF in pediatric patients

  13. Extracellular matrix remodeling in patients with ischemic chronic heart failure with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2015-04-01

    Full Text Available Aim. To identify features, relationships between parameters of the extracellular matrix and renal function in 110 patients with ischemic chronic heart failure the activity of collagen metabolism markers (MMP-9, TIMP-1, PICP, cystatin C, structural and functional parameters of the heart were studied using ELISA, echocardiography. Results. It was established that imbalance in the system MMP/TIMP in ischemic heart failure with preserved left ventricular ejection fraction leads to disruption of the extracellular matrix structural functional sufficiency, increases functional failure and is associated with impaired renal function. Conclusion. Correlation analysis showed significant relationships between MMP/TIMP and GFR, cystatin C, indicating that the significant role of extracellular matrix imbalance in the development of renal dysfunction in patients with ischemic chronic heart failure.

  14. Clinical validation of fully automated computation of ejection fraction from gated equilibrium blood-pool scintigrams

    International Nuclear Information System (INIS)

    Reiber, J.H.C.; Lie, S.P.; Simoons, M.L.; Hoek, C.; Gerbrands, J.J.; Wijns, W.; Bakker, W.H.; Kooij, P.P.M.

    1983-01-01

    A fully automated procedure for the computation of left-ventricular ejection fraction (EF) from cardiac-gated Tc-99m blood-pool (GBP) scintigrams with fixed, dual, and variable ROI methods is described. By comparison with EF data from contrast ventriculography in 68 patients, the dual-ROI method (separate end-diastolic and end-systolic contours) was found to be the method of choice; processing time was 2 min. Success score of dual-ROI procedure was 92% as assessed from 100 GBP studies. Overall reproducibility of data acquisition and analysis was determined in 12 patients. Mean value and standard deviation of differences between repeat studies (average time interval 27 min) were 0.8% and 4.3% EF units, respectively, (r=0.98). The authors conclude that left-ventricular EF can be computed automatically from GBP scintigrams with minimal operator-interaction and good reproducibility; EFs are similar to those from contrast ventriculography

  15. Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction.

    Science.gov (United States)

    Sandhu, Alexander T; Ollendorf, Daniel A; Chapman, Richard H; Pearson, Steven D; Heidenreich, Paul A

    2016-11-15

    Sacubitril-valsartan therapy reduces cardiovascular mortality compared with enalapril therapy in patients with heart failure with reduced ejection fraction. To evaluate the cost-effectiveness of sacubitril-valsartan versus angiotensin-converting enzyme inhibitor therapy in patients with chronic heart failure. Markov decision model. Clinical trials, observational analyses, reimbursement data from the Centers for Medicare & Medicaid Services, drug pricing databases, and Centers for Disease Control and Prevention life tables. Patients at an average age of 64 years, New York Heart Association (NYHA) class II to IV heart failure, and left ventricular ejection fraction of 0.40 or less. Lifetime. Societal. Treatment with sacubitril-valsartan or lisinopril. Life-years, quality-adjusted life-years (QALYs), costs, heart failure hospitalizations, and incremental cost-effectiveness ratios. The sacubitril-valsartan group experienced 0.08 fewer heart failure hospitalization, 0.69 additional life-year, 0.62 additional QALY, and $29 203 in incremental costs, equating to a cost per QALY gained of $47 053. The cost per QALY gained was $44 531 in patients with NYHA class II heart failure and $58 194 in those with class III or IV heart failure. Sacubitril-valsartan treatment was most sensitive to the duration of improved outcomes, with a cost per QALY gained of $120 623 if the duration was limited to the length of the trial (median, 27 months). No variations in other parameters caused the cost to exceed $100 000 per QALY gained. The benefit of sacubitril-valsartan is based on a single clinical trial. Treatment with sacubitril-valsartan provides reasonable value in reducing cardiovascular mortality and morbidity in patients with NYHA class II to IV heart failure. U.S. Department of Veterans Affairs and Institute for Clinical and Economic Review.

  16. Cardiac I123-MIBG Correlates Better than Ejection Fraction with Symptoms Severity in Systolic Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, Sandra M.; Moscavitch, Samuel D.; Carestiato, Larissa R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Felix, Renata M. [Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Rodrigues, Ronaldo C.; Messias, Leandro R. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Azevedo, Jader C. [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Nóbrega, Antonio Cláudio L.; Mesquita, Evandro Tinoco [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Mesquita, Claudio Tinoco, E-mail: ctinocom@cardiol.br [Programa de Pós-Graduação em Ciências Cardiovasculares, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rio de Janeiro, RJ (Brazil); Departamento de Medicina Nuclear, Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2013-07-15

    The association of autonomic activation, left ventricular ejection fraction (LVEF) and heart failure functional class is poorly understood. Our aim was to correlate symptom severity with cardiac sympathetic activity, through iodine-123-metaiodobenzylguanidine ({sup 123}I-MIBG) scintigraphy and with LVEF in systolic heart failure (HF) patients without previous beta-blocker treatment. Thirty-one patients with systolic HF, class I to IV of the New York Heart Association (NYHA), without previous beta-blocker treatment, were enrolled and submitted to {sup 123}I-MIBG scintigraphy and to radionuclide ventriculography for LVEF determination. The early and delayed heart/mediastinum (H/M) ratio and the washout rate (WR) were performed. According with symptom severity, patients were divided into group A, 13 patients in NYHA class I/II, and group B, 18 patients in NYHA class III/IV. Compared with group B patients, group A had a significantly higher LVEF (25% ± 12% in group B vs. 32% ± 7% in group A, p = 0.04). Group B early and delayed H/M ratios were lower than group A ratios (early H/M 1.49 ± 0.15 vs. 1.64 ± 0.14, p = 0.02; delayed H/M 1.39 ± 0.13 vs. 1.58 ± 0.16, p = 0.001, respectively). WR was significantly higher in group B (36% ± 17% vs. 30% ± 12%, p= 0.04). The variable that showed the best correlation with NYHA class was the delayed H/M ratio (r= -0.585; p=0.001), adjusted for age and sex. This study showed that cardiac {sup 123}I-MIBG correlates better than ejection fraction with symptom severity in systolic heart failure patients without previous beta-blocker treatment.

  17. Right and left ventricular ejection fraction at rest and during exercise assessed with radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Dahlstroem, J.A.

    1982-01-01

    Right (RVEF) and left ventricular ejection fraction (LVEF) assessed with radionuclide angiocardiography were compared to simultaneously obtained catheterization results at rest and during exercise in patients with pulmonary hypertension and ischemic heart disease. Blood pool imaging was performed with red blood cells (RBC) labelled with 99 Tcsup(m) in vivo as this method gave more stable 99 Tcsup(m) levels in blood compared to 99 Tcsup(m)-labelled human serum albumin and because it was more convenient than labelling RBC in vitro. RVEF measured with first pass (FP) technique and equilibrium (EQ) technique correlated well at rest, r = 0.86, and during exercise, r = 0.91. The FP technique had the best reproducibility and reference values at rest were 49+-5 per cent increasing with exercise. When 99 Tcsup(m) and 133 Xe were compared to assess RVEF with FP technique, the correlation was good, r = 0.88. LVEF assessed with EQ technique and a fixed end-diastolic region of interest was very reproducible at rest and during exercise; reference values at rest were 56+-8 per cent increasing with exercise. In 10 patients with pulmonary hypertension significant negative correlations were found between RVEF assessed with FP technique and pressures in pulmonary artery and right atrium. Abnormal RVEF was found in all patients with right ventricular disfunction. In 22 patients with recent myocardial infarction measurements of LVEF detected left ventricular disfunction better than did measurement of pulmonary artery diastolic pressure. During effort angina in another 10 patients all had abnormal LVEF and abnormal hemodynamics. By combining ejection fraction and stroke volume, ventricular volumes were calculated at rest and during exercise. (author)

  18. Evaluation of right ventricular ejection fraction by first-pass radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Uehara, Toshiisa; Nishimura, Tsunehiko; Naito, Hiroaki; Hayashida, Kohei; Kozuka, Takahiro

    1981-01-01

    Left ventricular ejection fraction (LVEF) obtained by radionuclide angiocardiography is a convenient and good parameter of the left ventricular function. Right ventricular ejection fraction (RVEF) also seems to be a good parameter of the right ventricular function. RVEF calculated from volumetry with contrast right ventriculography is not necessarily correct because of the complex figure of the right ventricle. On the other hand, the method of calculation of RVEF with radionuclide angiocardiography has the advantage of being able to ignore the complexity of figure of RV, because RI counts extracted from the time-activity curve represent changes in ventricular volume. In this study, we developped an original method to calculate RVEF with first pass method. After setting of region of interest (ROI) of RV, background and ROI for correction of motion of tricuspid valve, we calculated RVEF with these time-activity curves, Since we found that too rapid infusion of RI made the time-activity curve of RV too steep, and too slow infusion of RI made the background of lung field too high, the appropriate infusion rate was required to get correct value of RVEF. In addition, the time-activity curve often became steep or flat in dependence of the speed of venous return and cardiac output of patients. In order to avoid the effect of infusion speed, the time-activity curve was fitted to linear curves and the value of RVEF was corrected. The validity of these methods was confirmed in our study. As the result, RVEF obtained with our methods appeared to have good correlation with that obtained from volumetry of contrast right ventriculography (r = 0.77) and to be very useful in clinical estimation of right ventricular function. (author)

  19. Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Mogensen, Ulrik M; Jhund, Pardeep S

    2017-01-01

    in Heart Failure With Preserved Ejection Fraction) according to history of diabetes mellitus. Cox regression models were used to estimate hazard ratios for cardiovascular outcomes adjusted for known predictors, including age, sex, natriuretic peptides, and comorbidity. Echocardiographic data were available...... versus 29 kg/m2), worse Minnesota Living With Heart Failure score (48 versus 40), higher median N-terminal pro-B-type natriuretic peptide concentration (403 versus 320 pg/mL; all Pdifference in left ventricular ejection fraction. Patients with diabetes...

  20. B-Type Natriuretic Peptide and Prognosis in Heart Failure Patients With Preserved and Reduced Ejection Fraction

    NARCIS (Netherlands)

    van Veldhuisen, Dirk J.; Linssen, Gerard C. M.; Jaarsma, Tiny; van Gilst, Wiek H.; Hoes, Arno W.; Tijssen, Jan G. P.; Paulus, Walter J.; Voors, Adriaan A.; Hillege, Hans L.

    2013-01-01

    Objectives This study sought to determine the prognostic value of B-type natriuretic peptide (BNP) in patients with heart failure with preserved ejection fraction (HFPEF), in comparison to data in HF patients with reduced left ventricular (LV) EF ( Background Management of patients with HFPEF is

  1. CMR reference values for left ventricular volumes, mass, and ejection fraction using computer-aided analysis : The Framingham Heart Study

    NARCIS (Netherlands)

    Chuang, Michael L.; Gona, Philimon; Hautvast, Gilion L.T.F.; Salton, Carol J.; Breeuwer, Marcel; O'Donnell, Christopher J.; Manning, Warren J.

    Purpose To determine sex-specific reference values for left ventricular (LV) volumes, mass, and ejection fraction (EF) in healthy adults using computer-aided analysis and to examine the effect of age on LV parameters. Materials and Methods We examined data from 1494 members of the Framingham Heart

  2. High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction.

    Science.gov (United States)

    Ellingsen, Øyvind; Halle, Martin; Conraads, Viviane; Støylen, Asbjørn; Dalen, Håvard; Delagardelle, Charles; Larsen, Alf-Inge; Hole, Torstein; Mezzani, Alessandro; Van Craenenbroeck, Emeline M; Videm, Vibeke; Beckers, Paul; Christle, Jeffrey W; Winzer, Ephraim; Mangner, Norman; Woitek, Felix; Höllriegel, Robert; Pressler, Axel; Monk-Hansen, Tea; Snoer, Martin; Feiereisen, Patrick; Valborgland, Torstein; Kjekshus, John; Hambrecht, Rainer; Gielen, Stephan; Karlsen, Trine; Prescott, Eva; Linke, Axel

    2017-02-28

    Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT ( P =0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P =0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P =0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake ( P =0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P =0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure. URL: http

  3. Effects of projection and background correction method upon calculation of right ventricular ejection fraction using first-pass radionuclide angiography

    International Nuclear Information System (INIS)

    Caplin, J.L.; Flatman, W.D.; Dymond, D.S.

    1985-01-01

    There is no consensus as to the best projection or correction method for first-pass radionuclide studies of the right ventricle. We assessed the effects of two commonly used projections, 30 degrees right anterior oblique and anterior-posterior, on the calculation of right ventricular ejection fraction. In addition two background correction methods, planar background correction to account for scatter, and right atrial correction to account for right atrio-ventricular overlap were assessed. Two first-pass radionuclide angiograms were performed in 19 subjects, one in each projection, using gold-195m (half-life 30.5 seconds), and each study was analysed using the two methods of correction. Right ventricular ejection fraction was highest using the right anterior oblique projection with right atrial correction 35.6 +/- 12.5% (mean +/- SD), and lowest when using the anterior posterior projection with planar background correction 26.2 +/- 11% (p less than 0.001). The study design allowed assessment of the effects of correction method and projection independently. Correction method appeared to have relatively little effect on right ventricular ejection fraction. Using right atrial correction correlation coefficient (r) between projections was 0.92, and for planar background correction r = 0.76, both p less than 0.001. However, right ventricular ejection fraction was far more dependent upon projection. When the anterior-posterior projection was used calculated right ventricular ejection fraction was much more dependent on correction method (r = 0.65, p = not significant), than using the right anterior oblique projection (r = 0.85, p less than 0.001)

  4. Application of the four formula of software ECToolbox for the assessment of left ventricular ejection fraction in myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Xia Wei; Ni Jing; Zhuang Juhua; Hu Cuihua

    2014-01-01

    Objective: To compare the four formula of software programs ECToolbox for the assessment of left ventricular ejection fraction (LVEF) with equilibrium radionuclide ventriculography. And to calculate the normal cutoff values for the four formula. Methods: A total of 103 patients (59 men, 44 women) were recruited into the study. Thirty-eight patients had known CAD and sixty-five were referred with suspicion of CAD. All the patients underwent equilibrium radionuclide ventriculograph (ERNV) and ECG-gated myocardial perfusion SPECT (GMPS) as the standard protocol. LVEF values were separately calculated with formula R_0, R_1, R_2, R_3 of ECToolbox software, and the results were compared with LVEF values from ERNV. The normal cutoff values for the four formula were calculated by using normal cutoff values greater than or equal to 50% in ERNV as the classifying variable. Results: The mean LVEF on ERNV was 54.6% ± 17.5%. The mean LVEF values for formula R_0, R_1, R_2, R_3 were 64.1% ± 15.7%, 56.3% ± 15.1%, 69.9% ± 17.9%, 56.3% ± 13.6%, respectively. On correlation analysis, a very strong positive correlation was observed between LVEF values derived by ERNV and those derived by the four formula (all of r values were greater than 0.85, P O.05). Normal cutoff values for LVEF on R_0, R_1, R_2, R_3 were 56.5%, 51.5%, 64.5%, 52.5%, respectively, using a 50% or more cutoff value on ERNV. Conclusion: A strong correlation was observed among the four formula of ECToolbox software programs when compared with ERNV. However, there are subtle differences in the objective values of LVEF generated by individual calculation methods, which must be taken into account for clinical studies. (authors)

  5. Noncardiac Comorbidities in Heart Failure With Reduced Versus Preserved Ejection Fraction

    Science.gov (United States)

    Mentz, Robert J.; Kelly, Jacob P.; von Lueder, Thomas G.; Voors, Adriaan A.; Lam, Carolyn S. P.; Cowie, Martin R.; Kjeldsen, Keld; Jankowska, Ewa A.; Atar, Dan; Butler, Javed; Fiuzat, Mona; Zannad, Faiez; Pitt, Bertram; O’Connor, Christopher M.

    2014-01-01

    Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved EF (HFpEF) or heart failure with reduced EF (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum. PMID:25456761

  6. Tensor Factorization for Precision Medicine in Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Luo, Yuan; Ahmad, Faraz S; Shah, Sanjiv J

    2017-06-01

    Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome that may benefit from improved subtyping in order to better characterize its pathophysiology and to develop novel targeted therapies. The United States Precision Medicine Initiative comes amid the rapid growth in quantity and modality of clinical data for HFpEF patients ranging from deep phenotypic to trans-omic data. Tensor factorization, a form of machine learning, allows for the integration of multiple data modalities to derive clinically relevant HFpEF subtypes that may have significant differences in underlying pathophysiology and differential response to therapies. Tensor factorization also allows for better interpretability by supporting dimensionality reduction and identifying latent groups of data for meaningful summarization of both features and disease outcomes. In this narrative review, we analyze the modest literature on the application of tensor factorization to related biomedical fields including genotyping and phenotyping. Based on the cited work including work of our own, we suggest multiple tensor factorization formulations capable of integrating the deep phenotypic and trans-omic modalities of data for HFpEF, or accounting for interactions between genetic variants at different omic hierarchies. We encourage extensive experimental studies to tackle challenges in applying tensor factorization for precision medicine in HFpEF, including effectively incorporating existing medical knowledge, properly accounting for uncertainty, and efficiently enforcing sparsity for better interpretability.

  7. Heart failure with preserved ejection fraction: mechanisms, clinical features, and therapies.

    Science.gov (United States)

    Sharma, Kavita; Kass, David A

    2014-06-20

    The clinical syndrome comprising heart failure (HF) symptoms but with a left ventricular ejection fraction (EF) that is not diminished, eg, HF with preserved EF, is increasingly the predominant form of HF in the developed world, and soon to reach epidemic proportions. It remains among the most challenging of clinical syndromes for the practicing clinician and scientist alike, with a multitude of proposed mechanisms involving the heart and other organs and complex interplay with common comorbidities. Importantly, its morbidity and mortality are on par with HF with reduced EF, and as the list of failed treatments continues to grow, HF with preserved EF clearly represents a major unmet medical need. The field is greatly in need of a more unified approach to its definition and view of the syndrome that engages integrative and reserve pathophysiology beyond that related to the heart alone. We need to reflect on prior treatment failures and the message this is providing, and redirect our approaches likely with a paradigm shift in how the disease is viewed. Success will require interactions between clinicians, translational researchers, and basic physiologists. Here, we review recent translational and clinical research into HF with preserved EF and give perspectives on its evolving demographics and epidemiology, the role of multiorgan deficiencies, potential mechanisms that involve the heart and other organs, clinical trials, and future directions. © 2014 American Heart Association, Inc.

  8. Precision Medicine for Heart Failure with Preserved Ejection Fraction: An Overview.

    Science.gov (United States)

    Shah, Sanjiv J

    2017-06-01

    There are few proven therapies for heart failure with preserved ejection fraction (HFpEF). The lack of therapies, along with increased recognition of the disorder and its underlying pathophysiology, has led to the acknowledgement that HFpEF is heterogeneous and is not likely to respond to a one-size-fits-all approach. Thus, HFpEF is a prime candidate to benefit from a precision medicine approach. For this reason, we have assembled a compendium of papers on the topic of precision medicine in HFpEF in the Journal of Cardiovascular Translational Research. These papers cover a variety of topics relevant to precision medicine in HFpEF, including automated identification of HFpEF patients; machine learning, novel molecular approaches, genomics, and deep phenotyping of HFpEF; and clinical trial designs that can be used to advance precision medicine in HFpEF. In this introductory article, we provide an overview of precision medicine in HFpEF with the hope that the work described here and in the other papers in this special theme issue will stimulate investigators and clinicians to advance a more targeted approach to HFpEF classification and treatment.

  9. Sacubitril/Valsartan: A Review in Chronic Heart Failure with Reduced Ejection Fraction.

    Science.gov (United States)

    McCormack, Paul L

    2016-03-01

    Sacubitril/valsartan (Entresto™; LCZ696) is an orally administered supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, which was recently approved in the US and the EU for the treatment of chronic heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF). In the large, randomized, double-blind, PARADIGM-HF trial, sacubitril/valsartan reduced the incidence of death from cardiovascular causes or first hospitalization for worsening heart failure (composite primary endpoint) significantly more than the angiotensin converting enzyme (ACE) inhibitor enalapril. Sacubitril/valsartan was also superior to enalapril in reducing death from any cause and in limiting the progression of heart failure. Sacubitril/valsartan was generally well tolerated, with no increase in life-threatening adverse events. Symptomatic hypotension was significantly more common with sacubitril/valsartan than with enalapril; the incidence of angio-oedema was low. Therefore, sacubitril/valsartan is a more effective replacement for an ACE inhibitor or an ARB in the treatment of HFrEF, and is likely to influence the basic approach to treatment.

  10. [Sacubitril/valsartan, a new and effective treatment for heart failure with reduced ejection fraction].

    Science.gov (United States)

    Senni, Michele; Trimarco, Bruno; Emdin, Michele; De Biase, Luciano

    2017-01-01

    Despite significant therapeutic advances, patients with chronic heart failure and reduced ejection fraction (HFrEF) remain at high risk for heart failure progression and death. The PARADIGM-HF study, the largest outcome trial in HFrEF, has shown improved cardiovascular outcomes with sacubitril/valsartan (Entresto®, Novartis), previously known as LCZ696, compared with angiotensin-converting enzyme (ACE) inhibitor therapy, possibly leading us to a new era for heart failure treatment. Sacubitril/valsartan represents a first-in-class drug acting through inhibition of angiotensin receptor and neprilysin, thus modulating the renin-angiotensin-aldosterone system and vasoactive substances such as natriuretic peptides. This approach can be considered a "paradigm shift" from neurohumoral inhibition to neurohumoral modulation. Based on the PARADIGM-HF results, the European Society of Cardiology and the American Heart Association/American College of Cardiology guidelines proposed a substitution of ACE-inhibitor/angiotensin receptor blocker therapy rather than an "add-on" strategy in HFrEF. Sacubitril/valsartan can be considered a milestone in cardiovascular therapy, like aspirin, statins, beta-blockers. Of course there are many questions that arise spontaneously from this trial, three recognized experts can help us to answer them.

  11. The Nitrate-nitrite-NO pathway and its implications for Heart Failure and Preserved Ejection Fraction

    Science.gov (United States)

    Chirinos, Julio A.; Zamani, Payman

    2016-01-01

    The pathogenesis of exercise intolerance in patients with heart failure and preserved ejection fraction (HFpEF) is likely multifactorial. In addition to cardiac abnormalities (diastolic dysfunction, abnormal contractile reserve, chronotropic incompetence), several peripheral abnormalities are likely to be involved. These include abnormal pulsatile hemodynamics, abnormal arterial vasodilatory responses to exercise, and abnormal peripheral O2 delivery, extraction and utilization. The nitrate-nitrite-NO pathway is emerging as a potential target to modify key physiologic abnormalities, including late systolic LV load from arterial wave reflections (which has deleterious short- and long-term consequences for the LV), arterial vasodilatory reserve, muscle O2 delivery, and skeletal muscle mitochondrial function. In a recently completed randomized trial, the administration of a single dose of exogenous inorganic nitrate has been shown exert various salutary arterial hemodynamic effects, ultimately leading to enhanced aerobic capacity in patients with HFpEF. These effects have the potential for both immediate improvements in exercise tolerance and for long-term “disease-modifying” effects. In this review, we provide an overview of key mechanistic contributors to exercise intolerance in HFpEF, and of the potential therapeutic role of drugs that target the nitrate-nitrite-NO pathway. PMID:26792295

  12. Measurement of the ejection fraction of the left ventricle with the isotope stethoscope

    Energy Technology Data Exchange (ETDEWEB)

    Marving, J.; Hoeilund-Carlsen, P.F.; Jensen, G. (Koebenhavns Amts Sygehus, Glostrup (Denmark))

    1982-01-01

    Non-invasive measurements of left ventricular ejection fraction was performed in 21 patients by two observers with the Nuclear Stethoscope, a new, mobile, non-imaging single probe equipment. sup 99mTc was used for erythrocyte-labelling. Measurements were carried out in two different ways: beat-to-beat mode (i.e. for individual beats or a few beats at a time) and by ventricular function mode (i.e. for a composite beat, registered over a preselected period of time). There was good correlation between the two Nuclear Stethoscope modes (r=0.97) and between these and a simultaneous measurement made by gammacamera (r=0.90 and r=0.88). Despite uncertainties in the determination of correct background-level and centering over the left ventricle, there was no difference between the accuracy of the results of the two observers, compared with gammacamera measurements. The Nuclear Stethoscope is considerably cheaper than a gammacamera with computer-system, it is simple to operate, and can easily be used at the bedside, even in severely ill patients. A special feature is its capability of measuring sudden alterations in heart contractility on a beat-to-beat basis. Clinically it can be employed for both diagnostic purposes and for the monitoring of spontaneous courses and the effect of therapeutic interventions.

  13. Measurement of the ejection fraction of the left ventricle with the isotope stethoscope

    International Nuclear Information System (INIS)

    Marving, J.; Hoeilund-Carlsen, P.F.; Jensen, G.

    1982-01-01

    Non-invasive measurements of left ventricular ejection fraction was performed in 21 patients by two observers with the Nuclear Stethoscope, a new, mobile, non-imaging single probe equipment. sup 99mTc was used for erythrocyte-labelling. Measurements were carried out in two different ways: beat-to-beat mode (i.e. for individual beats or a few beats at a time) and by ventricular function mode (i.e. for a composite beat, registered over a preselected period of time). There was good correlation between the two Nuclear Stethoscope modes (r=0.97) and between these and a simultaneous measurement made by gammacamera (r=0.90 and r=0.88). Despite uncertainties in the determination of correct background-level and centering over the left ventricle, there was no difference between the accuracy of the results of the two observers, compared with gammacamera measurements. The Nuclear Stethoscope is considerably cheaper than a gammacamera with computer-system, it is simple to operate, and can easily be used at the bedside, even in severely ill patients. A special feature is its capability of measuring sudden alterations in heart contractility on a beat-to-beat basis. Clinically it can be employed for both diagnostic purposes and for the monitoring of spontaneous courses and the effect of therapeutic interventions. (authors)

  14. Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery.

    Science.gov (United States)

    Machado, Lucia R; Meneghelo, Zilda M; Le Bihan, David C S; Barretto, Rodrigo B M; Carvalho, Antonio C; Moises, Valdir A

    2014-11-06

    Left atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR. We enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre- and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of ≥ 25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR. LARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m2 to 49.7 mL/m2 (p <0.001). These patients had a smaller preoperative left ventricular systolic volume (p =0.022) and a higher left ventricular ejection fraction (LVEF) (p =0.034). LVEF was identified as the only preoperative variable significantly associated with LARR (odds ratio, 1.086; 95% confidence interval, 1.002-1.178). A LVEF cutoff value of 63.5% identified patients with LARR of ≥ 25% with a sensitivity of 71.7% and a specificity of 56.3%. LARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.

  15. Left ventricular ejection fraction determined by gated Tl-201 perfusion SPECT and quantitative software

    International Nuclear Information System (INIS)

    Hyun, In Young; Kim, Sung Eun; Seo, Jeong Kee; Hong, Eui Soo; Kwan, Jun; Park, Keum Soo; Lee, Woo Hyung

    2000-01-01

    We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-Tl-SPECT) with those by gated blood pool (GBP) scan. Eighteen subjects underwent g-Tl-SPECT and GBP scan. After reconstruction of g-Tl-SPECT, we measured EF with Cedars software. The comparison of the EF with g-Tl-SPECT and GBP scan was assessed by correlation analysis and Bland Altman plot. The estimates of EF were significantly different (p<0.05) with g-Tl-SPECT (40%±14%) and GBP scan (43%±14%). There was an excellent correlation of EF between g-Tl-SPECT and GBP scan (r=3D0.94, p<0.001). The mean difference of EF between GBP scan and g-Tl-SPECT was +3.2%. Ninety-five percent limits of agreement were ±9.8%. EF between g-Tl-SPECT and GBP scan were in poor agreement. The estimates of EF by g-Tl-SPECT was well correlated with those by GBP scan. However, EF of g-Tl-SPECT doesn't agree with EF of GBP scan. EF of g-Tl-SPECT can't be used interchangeably with EF of GBP scan.=20

  16. Left ventricle ejection fraction obtained by radioisotopic angiocardiography. Correlation between the values of the conventional ventriclegraphy

    International Nuclear Information System (INIS)

    Ascer, E.; Pimentel Filho, W.A.; Martins, L.R.F.; Marioni Filho, H.; Queiroga Filho, A.F.; Alonso, G.; Germek, O.A.; Thom, A.F.; Souza, J.E.M.R.

    1983-01-01

    Forty-two patients with clinical signs of coronary insuficiency underwent cineangiographic and radioisotopic examinations with the purpose of analysing the correlation between the values of left ventricle ejection fraction (LVEF) obtained by both methods. The values of EF obtained by the hemodynamic method (HEMO) ranged from 0.14 to 0.85 (x-bar = 0.566) and by radioisotopic method (RM) from 0.22 to 0.89 (x-bar = 0.573). The Student T test did not demonstrate statistically significant differences between the two methods (mean of differences = 0.007; t = 0.38 and p ≥ 0.353). A regression equation was obtained in order to estimate the EF by HEMO deriving from results obtained by RM (y = 0.11 + 0.80x) and to estimate the EF through RN from the results obtained by HEMO (x = 0.08 + 0.86y), where y = hemodynamic method and x = radioisotopic method. The authors conclude that the calculation of the EF by the methods used showed a good correlation and that this fact is evidenced by the elevated Pearson's correlation coefficient (r = 0.833). (author) [pt

  17. 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...... models assessed the association of dyssynchrony with the composite outcome of cardiovascular death or heart failure hospitalization. Mean age was 70 ± 10 years, LVEF was 60 ± 8%, and QRS duration was 101 ± 27 ms. Worse dyssynchrony, reflected in SD T2P LS, was associated with wider QRS, prior myocardial...... with the composite outcome in unadjusted analysis [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.021, per 10 ms increase], but not after adjusting for clinical characteristics, or after further adjustment for LVEF, AF, NYHA class, stroke, heart rate, creatinine, haematocrit, and QRS duration...

  18. [Interest of tricuspid annular displacement (TAD) in evaluation of right ventricular ejection fraction].

    Science.gov (United States)

    Hugues, T; Ducreux, D; Bertora, D; Berthier, F; Lemoigne, F; Padovani, B; Gibelin, P

    2010-04-01

    The ultrasound assessment of RV structure and function is often sub-optimal. The range of excursions of the mitral or tricuspid annulus measured in millimetre by 2D or TM-mode in centimetre per second by DTI-mode echocardiography has been shown to reflect the systolic function of both ventricles. We studied a new technique based on a tissue tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement (TAD) (QLAB, Philips Medical Imaging). Twenty-six patients (pts) referred for magnetic resonance imaging (MRI) and 44 control subjects underwent a complete transthoracic echocardiography. MRI of the right ventricular ejection fraction (RVEF) was correlated by linear regression with TAD. Sixteen pts (61.5%) exhibited right ventricular systolic dysfunction (MRI RVEFTAD (R(2)=0,65; pTAD TAD values exceeding this cut-off point (mean: 16.9+/-1.64mm; range: 13.3 to 24.8mm). Negative correlation was found between TAD and age (R(2)=0,36; pTAD with MRI RVEF. TAD is a simple, rapid, and non-invasive tool for right ventricular systolic function assessment.

  19. Comparison of left ventricular ejection fraction by 201Tl gated SPECT and gated blood pool scan

    International Nuclear Information System (INIS)

    Lau, W.F.E.; Kelly, M.J.; O'Donnell, M.; Kalff, V.; Van Every, B.

    2000-01-01

    Full text: The aim of this study was to evaluate left ventricular ejection fraction (LVEF) determination by the Germano 201 Tl gated-SPECT myocardial perfusion (TLGSMP) method using gated blood pool scintigraphy (GBPS) as a reference. 21 patients underwent both TLGSMP and GBPS within eight days of each other from June 1997 to Jan 2000. Acquisition of TLGSMP was performed on a GE Optima NX dual head camera using Tl-201 dose of 1.5MBq/Kg and imaging time of 45 cardiac cycles/step with 16 steps/90 Deg of rotation per detector. All LVEF results were determined using a GE Genie workstation. GBPS results were compared with TLGSMP results for LVEF obtained from the reinjection images using automated Germano processing, and from the stress images using automatic and manual processing. Duplicate automatic analysis by a second observer produced identical mean TLGSMP LVEF results (r = 0.99). Stress TLGSMP LVEF by the automatic and manual processing correlate well (r = 0.99) but the manual LVEF is significantly lower. In conclusion LVEF determination using TLGSMP is highly reproducible and is also accurate when applied to reinjection data. Both manual processing and the use of stress data lead to underestimation of LVEF. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  20. Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more.

    Science.gov (United States)

    Duncker, D; Veltmann, C

    2018-05-09

    In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.

  1. Validity of automated measurement of left ventricular ejection fraction and volume using the Philips EPIQ system.

    Science.gov (United States)

    Hovnanians, Ninel; Win, Theresa; Makkiya, Mohammed; Zheng, Qi; Taub, Cynthia

    2017-11-01

    To assess the efficiency and reproducibility of automated measurements of left ventricular (LV) volumes and LV ejection fraction (LVEF) in comparison to manually traced biplane Simpson's method. This is a single-center prospective study. Apical four- and two-chamber views were acquired in patients in sinus rhythm. Two operators independently measured LV volumes and LVEF using biplane Simpson's method. In addition, the image analysis software a2DQ on the Philips EPIQ system was applied to automatically assess the LV volumes and LVEF. Time spent on each analysis, using both methods, was documented. Concordance of echocardiographic measures was evaluated using intraclass correlation (ICC) and Bland-Altman analysis. Manual tracing and automated measurement of LV volumes and LVEF were performed in 184 patients with a mean age of 67.3 ± 17.3 years and BMI 28.0 ± 6.8 kg/m 2 . ICC and Bland-Altman analysis showed good agreements between manual and automated methods measuring LVEF, end-systolic, and end-diastolic volumes. The average analysis time was significantly less using the automated method than manual tracing (116 vs 217 seconds/patient, P Automated measurement using the novel image analysis software a2DQ on the Philips EPIQ system produced accurate, efficient, and reproducible assessment of LV volumes and LVEF compared with manual measurement. © 2017, Wiley Periodicals, Inc.

  2. Value of Age, Creatinine, and Ejection Fraction (ACEF Score) in Assessing Risk in Patients Undergoing Percutaneous Coronary Interventions in the 'All-Comers' LEADERS Trial

    NARCIS (Netherlands)

    Wykrzykowska, Joanna J.; Garg, Scot; Onuma, Yoshinobu; de Vries, Ton; Goedhart, Dick; Morel, Marie-Angele; van Es, Gerrit-Anne; Buszman, Pawel; Linke, Axel; Ischinger, Thomas; Klauss, Volker; Corti, Roberto; Eberli, Franz; Wijns, William; Morice, Marie-Claude; Di Mario, Carlo; van Geuns, Robert Jan; Juni, Peter; Windecker, Stephan; Serruys, Patrick W.

    2011-01-01

    Background-The age, creatinine, and ejection fraction (ACEF) score (age/left ventricular ejection fraction+1 if creatinine >2.0 mg/dL) has been established as an effective predictor of clinical outcomes in patients undergoing elective coronary artery bypass surgery; however, its utility in

  3. New approach for simplified and automated measurement of left ventricular ejection fraction by ECG gated blood pool scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Inagaki, Suetsugu; Adachi, Haruhiko; Sugihara, Hiroki; Katsume, Hiroshi; Ijichi, Hamao; Okamoto, Kunio; Hosoba, Minoru

    1984-12-01

    Background (BKG) correction is important but debatable in the measurement of Left ventricular ejection fraction (LVEF) with ECG gated blood pool scintigraphy. We devised a new simplified BKG processing (fixed BKG method) without BKG region-of-interest (ROI) assignment, and the accuracy and reproducibility were assessed in 25 patients with various heart diseases and 5 normal subjects by comparison with LVEF obtained by contrast levolgraphy (LVG-EF). Four additional protocols for LVEF measurement with BKG-ROI assignment were also assessed for reference. LVEF calculated using the fixed BKG ratio of 0.64 (BKG count rates were 64%) of end-diastolic count rates of LV) with ''Fixed'' LV-ROI was best correlated with LVG-EF (r = 0.936, p < 0.001) and most approximated (Fixed BKG ratio method EF: 61.1 +- 20.1, LVG-EF: 61.2 +- 20.4% (mean +- SD)) among other protocols. The wide availability of the fixed value of 0.64 was tested in various diseases, body size and end-diastolic volume by LVG, and the results were to be little influenced by them. Furthermore, fixed BKG method produced lower inter-and intra- observer variability than other protocols requiring BKG-ROI assignment, probably due to its simplified processing. In conclusion, fixed BKG ratio method simplifies the measurement of LVEF, and is feasible for automated processing and single probe system.

  4. Left ventricular global longitudinal strain is predictive of all-cause mortality independent of aortic stenosis severity and ejection fraction.

    Science.gov (United States)

    Ng, Arnold C T; Prihadi, Edgard A; Antoni, M Louisa; Bertini, Matteo; Ewe, See Hooi; Ajmone Marsan, Nina; Leung, Dominic Y; Delgado, Victoria; Bax, Jeroen J

    2017-07-28

    Left ventricular (LV) global longitudinal strain (GLS) may identify subclinical myocardial dysfunction in patients with aortic stenosis (AS). The aims of the present retrospective single centre study were to determine the independent prognostic value of LV GLS over LV ejection fraction (EF) and the role of LV GLS to further risk stratify severe AS patients before aortic valve replacement. A total of 688 patients (median age 72 years, 61.2% men) with mild (n = 130), moderate (n = 264) and severe AS (n = 294) were included. LV GLS was determined by 2D speckle tracking echocardiography. A total of 114 (16.6%) patients died before surgery during the study. When patients with severe AS and normal LVEF were dichotomized based on the median LV GLS value (-14.0%), patients with normal LVEF and 'preserved' LV GLS of ≤ -14% had significantly higher survival than patients with 'impaired' LV GLS of > -14%. There was no difference in survival between patients with normal LVEF but 'impaired' LV GLS ( > -14%) and patients with impaired LVEF (log-rank P = 0.34). LV GLS was independently associated with all-cause mortality on multivariable Cox regression analysis (hazard ratio 1.17, 95% confidence interval 1.09-1.26; P optimal timing of aortic valve replacement. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  5. Predicting changes in flow category in patients with severe aortic stenosis and preserved left ventricular ejection fraction on medical therapy.

    Science.gov (United States)

    Ngiam, Jinghao Nicholas; Kuntjoro, Ivandito; Tan, Benjamin Y Q; Sim, Hui-Wen; Kong, William K F; Yeo, Tiong-Cheng; Poh, Kian-Keong

    2017-11-01

    Controversy surrounds the prognosis and management of patients with paradoxical low-flow severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). It was not certain if patients in a particular flow category remained in the same category as disease progressed. We investigated whether there were switches in categories and if so, their predictors. Consecutive subjects (n = 203) with isolated severe AS and paired echocardiography (>180 days apart) were studied. They were divided into 4 groups, based on their flow categories and if they progressed on subsequent echocardiography to switch or remain in the same flow category. Univariate analyses of clinical and echocardiographic parameters identified predictors of these changes in flow category. One hundred eighteen were normal flow (SVI ≥ 35 mL/m 2 ), while 85 were low flow on index echocardiography. In the patients with normal flow, 33% switched to low flow. This was associated with higher valvuloarterial impedance (Zva, P 4.77 mm Hg/mL/m 2 , AUC = 0.81 [95% CI:0.75-0.87, P < .001]). In patients with low flow, 25% switched to normal flow, which was associated with lower Zva and higher SAC and the switch was predicted by a higher initial mean transaortic pressure gradient. A significant number of patients switched flow categories in severe AS with preserved LVEF on subsequent echocardiography. Changes in flow were reflected by respective changes in Zva and SAC. Identifying echocardiographic predictors of a switch in category may guide prognostication and management of such patients. © 2017, Wiley Periodicals, Inc.

  6. Measurement of left ventricular ejection fraction with ionic sup(113m)In and a cardiac probe

    Energy Technology Data Exchange (ETDEWEB)

    Liu, X.; Harrison, K.S.; Wagner, H.N. Jr.

    1982-09-01

    Left ventricular ejection fraction (LVEF) was measured with a cardiac probe (Nuclear Stethoscope. Bios Inc., Valhalla, New York) and sup(113m)In in 28 normal subjects and 86 patients with coronary artery disease (CAD). In 20 normal subjects sup(99m)TC-RBCs were compared with sup(113m)In, which binds to transferrin after IV injection. With sup(99m)Tc-RBCs average LVEF was 57+-7% (1 SD); with sup(113m)In, average LEVF was 55+-8% (N.S.). Sequential measurements at different times over 60 min revealed good reproducibility. Comparison of LVEF's obtained using sup(99m)Tc-RBCs with a gamma camera and cardiac probe revealed a good correlation. The correlation coefficients were 0.92 in 25 patients with CAD and 0.95 in 10 patients with LV wall motion abnormalities. The LVEF obtained using a cardiac probe and sup(113m)In increased in 28 normals from 57+-9% to 64+-13% (P<0.001) during handgrip exercise, while the LVEF decreased from 45+-9% to 41+-10% (P<0.01) in patients with acute myocardial infarction 4-7 weeks after episode, from 48+-11 to 40+-12% (P<0.001) in patients with old myocardial infarction, and from 52+-9 to 42+-9% (P<0.001) in patients with angina pectoris. The cardiac probe and sup(113m)In provide a useful alternate means of determining left ventricular dysfunction in facilities where sup(99m)Tc and a gamma camera computer system are not readily available.

  7. Measurement of left ventricular ejection fraction with ionic sup(113m)In and a cardiac probe

    International Nuclear Information System (INIS)

    Liu, X.; Harrison, K.S.; Wagner, H.N. Jr.

    1982-01-01

    Left ventricular ejection fraction (LVEF) was measured with a cardiac probe (Nuclear Stethoscope. Bios Inc., Valhalla, New York) and sup(113m)In in 28 normal subjects and 86 patients with coronary artery disease (CAD). In 20 normal subjects sup(99m)TC-RBCs were compared with sup(113m)In, which binds to transferrin after IV injection. With sup(99m)Tc-RBCs average LVEF was 57+-7% (1 SD); with sup(113m)In, average LEVF was 55+-8% (N.S.). Sequential measurements at different times over 60 min revealed good reproducibility. Comparison of LVEF's obtained using sup(99m)Tc-RBCs with a gamma camera and cardiac probe revealed a good correlation. The correlation coefficients were 0.92 in 25 patients with CAD and 0.95 in 10 patients with LV wall motion abnormalities. The LVEF obtained using a cardiac probe and sup(113m)In increased in 28 normals from 57+-9% to 64+-13% (P<0.001) during handgrip exercise, while the LVEF decreased from 45+-9% to 41+-10% (P<0.01) in patients with acute myocardial infarction 4-7 weeks after episode, from 48+-11 to 40+-12% (P<0.001) in patients with old myocardial infarction, and from 52+-9 to 42+-9% (P<0.001) in patients with angina pectoris. The cardiac probe and sup(113m)In provide a useful alternate means of determining left ventricular dysfunction in facilities where sup(99m)Tc and a gamma camera computer system are not readily available. (orig.)

  8. Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction.

    Science.gov (United States)

    Choi, Ki Hong; Lee, Ga Yeon; Choi, Jin-Oh; Jeon, Eun-Seok; Lee, Hae-Young; Cho, Hyun-Jai; Lee, Sang Eun; Kim, Min-Seok; Kim, Jae-Joong; Hwang, Kyung-Kuk; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok-Min; Choi, Dong-Ju; Yoo, Byung-Su; Kim, Kye Hun; Park, Hyun-Young; Cho, Myeong-Chan; Oh, Byung-Hee

    2018-03-01

    There are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%). Between March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF. In de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HR adj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HR adj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HR adj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HR adj 0.70, 95% CI 0.52 to 0.96, p=0.02). HFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1  year after hospitalisation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted

  9. Correlation between sleep apnea syndrome and heart failure depending on ejection fraction

    Directory of Open Access Journals (Sweden)

    Carmen Loredana Ardelean

    2016-12-01

    Full Text Available OBJECTIVES The aim of this study was to analyze the correlations between sleep apnea syndrome(SAS and heart failure(HF in patients with preserved or reduced ejection fraction(EF. MATERIALS AND METHODS We evaluated 51 patients with suspected SAS and HF in sleep lab in Timișoara. General data was collected using sleep questionnaires, anthropometric measurements, somnography for apnea-hypopnea index, oxygen desaturation index, echocardiographic data, comorbidities and lab tests. RESULTS Creatinine -1.1±0.2 vs 1.4±0.7, p=0.05; stroke-23% vs 4%, p=0.04; aortic insufficiency-11.5% vs 36%, p=0.04; tricuspid insufficiency-46.1% vs 80%, p=0.01. Differences between groups regarding anthropometric measurements, somnographic index, lipidic profile were not statistically significant.. CONCLUSIONS Patients with SAS-IC with preserved EF have a higher risk of stroke events. Patients with IC with EF<50% had a significantly increased risk of developing a life-long chronic kidney disease. The SAS-IC population with low EF is at a higher risk of developing aortic and tricuspid insufficiency. REFERENCES 1. Douglas T. Sleep Apnea and Heart Failure. Part1: Obstructive Sleep Apnea. Circulation.2003.107:1671-1678. 2. Takatoshi K, Douglas TB. Obstructive Sleep Apnea and Heart Failure-Pathophysiologic and Therapeutic Implication. Journal of the American College of Cardiology. 2011; 57:doi: 10.1016/j.jacc.2010.08.627 3. Ferrier K, Campbell A, Yee B et al. Sleepdisordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest. 2005;128:2116–2122.

  10. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction.

    Directory of Open Access Journals (Sweden)

    Kasper Rossing

    Full Text Available Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF.Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972 discriminated between HFrEF patients (N = 94, sensitivity = 93.6% and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%. Interestingly, HFrEF103 showed low sensitivity (12.6% in individuals with diastolic left ventricular dysfunction (N = 176. The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin.CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure.

  11. Influence of atrial fibrillation on the mortality of patients with heart failure with preserved ejection fraction.

    Science.gov (United States)

    Franco, Jonathan; Formiga, Francesc; Cepeda, Jose; Llacer, Pau; Arévalo-Lorido, Juan; Cerqueiro, Jose; González-Franco, Alvaro; Epelde, Francesc; Manzano, Luis; Montero Pérez-Barquero, Manuel

    2018-05-23

    The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF. Prospective observational study in 1,971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one year follow-up. A total of 1,177 (59%) patients had AF, mean age 80.3 (7.8) years and 1,233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; P=.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; P=.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1,716; 95% CI 1,099-2,681; P=.018). In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. Peak Exercise Oxygen Uptake Predicts Recurrent Admissions in Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Palau, Patricia; Domínguez, Eloy; Núñez, Eduardo; Ramón, José María; López, Laura; Melero, Joana; Sanchis, Juan; Bellver, Alejandro; Santas, Enrique; Bayes-Genis, Antoni; Chorro, Francisco J; Núñez, Julio

    2018-04-01

    Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome with an elevated risk of morbidity and mortality. To date, there is scarce evidence on the role of peak exercise oxygen uptake (peak VO 2 ) for predicting the morbidity burden in HFpEF. We sought to evaluate the association between peak VO 2 and the risk of recurrent hospitalizations in patients with HFpEF. A total of 74 stable symptomatic patients with HFpEF underwent a cardiopulmonary exercise test between June 2012 and May 2016. A negative binomial regression method was used to determine the association between the percentage of predicted peak VO 2 (pp-peak VO 2 ) and recurrent hospitalizations. Risk estimates are reported as incidence rate ratios. The mean age was 72.5 ± 9.1 years, 53% were women, and all patients were in New York Heart Association functional class II to III. Mean peak VO 2 and median pp-peak VO 2 were 10 ± 2.8mL/min/kg and 60% (range, 47-67), respectively. During a median follow-up of 276 days [interquartile range, 153-1231], 84 all-cause hospitalizations in 31 patients (41.9%) were registered. A total of 15 (20.3%) deaths were also recorded. On multivariate analysis, accounting for mortality as a terminal event, pp-peak VO 2 was independently and linearly associated with the risk of recurrent admission. Thus, and modeled as continuous, a 10% decrease of pp-peak VO 2 increased the risk of recurrent hospitalizations by 32% (IRR, 1.32; 95%CI, 1.03-1.68; P = .028). In symptomatic elderly patients with HFpEF, pp-peak VO 2 predicts all-cause recurrent admission. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Effects of beta-blockers on heart failure with preserved ejection fraction: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Feng Liu

    Full Text Available BACKGROUND: Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF. METHODS: A search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%, being assigned to beta-blockers treatment and non-beta-blockers control group were included. RESULTS: A total of 12 clinical studies (2 randomized controlled trials and 10 observational studies involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 - 0.95; P < 0.001. Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization were not affected by this treatment (P=0.26, P=0.97, and P=0.88 respectively. CONCLUSIONS: The beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.

  14. Relationship between plasma xanthine oxidoreductase activity and left ventricular ejection fraction and hypertrophy among cardiac patients.

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    Yuki Fujimura

    Full Text Available Xanthine oxidoreductase (XOR, which catalyzes purine catabolism, has two interconvertible forms, xanthine dehydrogenase and xanthine oxidase, the latter of which produces superoxide during uric acid (UA synthesis. An association between plasma XOR activity and cardiovascular and renal outcomes has been previously suggested. We investigated the potential association between cardiac parameters and plasma XOR activity among cardiology patients.Plasma XOR activity was measured by [13C2,15N2]xanthine coupled with liquid chromatography/triplequadrupole mass spectrometry. Among 270 patients who were not taking UA-lowering drugs, XOR activity was associated with body mass index (BMI, alanine aminotransferase (ALT, HbA1c and renal function. Although XOR activity was not associated with serum UA overall, patients with chronic kidney disease (CKD, those with higher XOR activity had higher serum UA among patients without CKD. Compared with patients with the lowest XOR activity quartile, those with higher three XOR activity quartiles more frequently had left ventricular hypertrophy. In addition, plasma XOR activity showed a U-shaped association with low left ventricular ejection fraction (LVEF and increased plasma B-type natriuretic peptide (BNP levels, and these associations were independent of age, gender, BMI, ALT, HbA1C, serum UA, and CKD stages.Among cardiac patients, left ventricular hypertrophy, low LVEF, and increased BNP were significantly associated with plasma XOR activity independent of various confounding factors. Whether pharmaceutical modification of plasma XOR activity might inhibit cardiac remodeling and improve cardiovascular outcome should be investigated in future studies.

  15. Assessment of the background count to measure the left ventricular ejection fraction with a nuclear stethoscope

    International Nuclear Information System (INIS)

    Doi, Mayumi; Hiroe, Michiaki; Marumo, Fumiaki; Itoh, Haruki; Taniguchi, Koichi.

    1993-01-01

    The nuclear stethoscope is a newly developed device for monitoring left ventricular ejection fraction (EF) with a pair of cadmium telluride detector for both left ventricular count (first channel) and background count (second channel). Although it is useful for evaluating the cardiac function during exercise, the methodology of the calculation for distinguishing the net ventricular blood count from the background count has not been established yet. In order to establish a reasonable method to calculate EF, we measured EF using a nuclear stethoscope and conventional gated blood pool scintigraphy in 20 healthy volunteers. All subjects underwent two supine ergometer exercise tests consisting of the 3 stages for the nuclear stethoscope and blood pool scintigraphy. The EF was determined with the following three methods for the nuclear stethoscope: 1) Cut-off level was fixed at 70% of first channel, 2) Cut-off level at 75%, and 3) Cut-off level was determined by the background count obtained from second channel. There was a poor relationship between the EFs obtained from gated blood scintigraphy and the EFs from the nuclear stethoscope calculated by any of these methods. Regarding the EF calculated using the background count, however, the delta values of EF between rest and any of the 3 stages during exercise correlated closely to those EF from blood scintigraphy. When we apply the EF-at-rest value obtained from blood pool scintigraphy to analysis with the nuclear stethoscope, the EFs of 3 stages indicated good correlation (Stage I r=0.91, Stage II r=0.82, Stage III r=0.69). These results suggest that detecting the background count is useful in order to measure the left ventricular EF with the nuclear stethoscope. Since the absolute value of EF does not necessarily correlate to that from blood pool scintigraphy in this mehod, it is recommended to evaluate only the changing values of the EF. (author)

  16. Assessment of the background count to measure the left ventricular ejection fraction with a nuclear stethoscope

    Energy Technology Data Exchange (ETDEWEB)

    Doi, Mayumi; Hiroe, Michiaki; Marumo, Fumiaki (Tokyo Medical and Dental Univ. (Japan). School of Medicine); Itoh, Haruki; Taniguchi, Koichi

    1993-06-01

    The nuclear stethoscope is a newly developed device for monitoring left ventricular ejection fraction (EF) with a pair of cadmium telluride detector for both left ventricular count (first channel) and background count (second channel). Although it is useful for evaluating the cardiac function during exercise, the methodology of the calculation for distinguishing the net ventricular blood count from the background count has not been established yet. In order to establish a reasonable method to calculate EF, we measured EF using a nuclear stethoscope and conventional gated blood pool scintigraphy in 20 healthy volunteers. All subjects underwent two supine ergometer exercise tests consisting of the 3 stages for the nuclear stethoscope and blood pool scintigraphy. The EF was determined with the following three methods for the nuclear stethoscope: (1) Cut-off level was fixed at 70% of first channel, (2) Cut-off level at 75%, and (3) Cut-off level was determined by the background count obtained from second channel. There was a poor relationship between the EFs obtained from gated blood scintigraphy and the EFs from the nuclear stethoscope calculated by any of these methods. Regarding the EF calculated using the background count, however, the delta values of EF between rest and any of the 3 stages during exercise correlated closely to those EF from blood scintigraphy. When we apply the EF-at-rest value obtained from blood pool scintigraphy to analysis with the nuclear stethoscope, the EFs of 3 stages indicated good correlation (Stage I r=0.91, Stage II r=0.82, Stage III r=0.69). These results suggest that detecting the background count is useful in order to measure the left ventricular EF with the nuclear stethoscope. Since the absolute value of EF does not necessarily correlate to that from blood pool scintigraphy in this mehod, it is recommended to evaluate only the changing values of the EF. (author).

  17. Left ventricular ejection fraction and volumes as measured by 3D echocardiography and ultrafast computed tomography

    International Nuclear Information System (INIS)

    Vieira, Marcelo Luiz Campos; Nomura, Cesar H.; Tranchesi Junior, Bernardino; Oliveira, Wercules A. de; Naccarato, Gustavo; Serpa, Bruna S.; Passos, Rodrigo B.D.; Funari, Marcelo B. G.; Fischer, Claudio H.; Morhy, Samira S.

    2009-01-01

    Background: Real-time three-dimensional echocardiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. Objective: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. Methods: Thirty nine consecutive patients (27 men, mean age of 57+- 12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95% CI, p 5 .58)%; end-diastolic volume ranged from 49.6 to 178.2 (87+-27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1+-13.6) ml. CT scan measurements: LVEF ranged from 53 to 86% (67.8+-7.78); end-diastolic volume ranged from 51 to 186 (106.5+-30.3) ml; end-systolic volume ranged from 7 to 72 (35.5+-13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95% CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95% CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95% CI 0.6673 to 0.8975). Conclusion: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series. (author)

  18. Renin-Angiotensin Activation and Oxidative Stress in Early Heart Failure with Preserved Ejection Fraction

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    Smita I. Negi

    2015-01-01

    Full Text Available Animal models have suggested a role of renin-angiotensin system (RAS activation and subsequent cardiac oxidation in heart failure with preserved ejection fraction (HFpEF. Nevertheless, RAS blockade has failed to show efficacy in treatment of HFpEF. We evaluated the role of RAS activation and subsequent systemic oxidation in HFpEF. Oxidative stress markers were compared in 50 subjects with and without early HFpEF. Derivatives of reactive oxidative metabolites (DROMs, F2-isoprostanes (IsoPs, and ratios of oxidized to reduced glutathione (Eh GSH and cysteine (Eh CyS were measured. Angiotensin converting enzyme (ACE levels and activity were measured. On univariate analysis, HFpEF was associated with male sex (p=0.04, higher body mass index (BMI (p=0.003, less oxidized Eh CyS (p=0.001, lower DROMs (p=0.02, and lower IsoP (p=0.03. Higher BMI (OR: 1.3; 95% CI: 1.1–1.6 and less oxidized Eh CyS (OR: 1.2; 95% CI: 1.1–1.4 maintained associations with HFpEF on multivariate analysis. Though ACE levels were higher in early HFpEF (OR: 1.09; 95% CI: 1.01–1.05, ACE activity was similar to that in controls. HFpEF is not associated with significant systemic RAS activation or oxidative stress. This may explain the failure of RAS inhibitors to alter outcomes in HFpEF.

  19. The importance of integrated left atrial evaluation: From hypertension to heart failure with preserved ejection fraction.

    Science.gov (United States)

    Beltrami, Matteo; Palazzuoli, Alberto; Padeletti, Luigi; Cerbai, Elisabetta; Coiro, Stefano; Emdin, Michele; Marcucci, Rossella; Morrone, Doralisa; Cameli, Matteo; Savino, Ketty; Pedrinelli, Roberto; Ambrosio, Giuseppe

    2018-02-01

    Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools. The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed. In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk. Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies. © 2017 John Wiley & Sons Ltd.

  20. Reproducibility in the analysis of multigated radionuclide studies of left ventricular ejection fraction

    International Nuclear Information System (INIS)

    Gjorup, T.; Kelbaek, H.; Vestergaard, B.; Fogh, J.; Munck, O.; Jensen, A.M.

    1989-01-01

    The authors determined the reproducibility (the standard deviation [SD]) in the analysis of multigated radionuclide studies of left ventricular ejection fraction (LVEF). Radionuclide studies from a consecutive series of 38 patients suspected of ischemic heart disease were analyzed independently by four nuclear medicine physiologists and four laboratory technicians. Each study was analyzed three times by each of the observers. Based on the analyses of the eight observers, the SD could be estimated by the use of a variance component model for LVEF determinations calculated as the average of the analyses of an arbitrary number of observers making an arbitrary number of analyses. This study presents the SDs for LVEF determinations based on the analyses of one to five observers making one to five analyses each. The SD of a LVEF determination decreased from 3.96% to 2.98% when an observer increased his number of analyses from one to five. A more pronounced decrease in the SD from 3.96% to 1.77% was obtained when the LVEF determinations were based on the average of a single analysis made by one to five observers. However, when dealing with the difference between LVEF determinations from two studies, the highest reproducibility was obtained if the LVEF determinations at both studies were based on the analyses made by the same observer. No significant difference was found in the reproducibility of analyses made by nuclear medicine physicians and laboratory technicians. Our study revealed that to increase the reproducibility of LVEF determinations, special efforts should be made to standardize the outlining of the end-systolic region interest

  1. Prognostic Estimation of Advanced Heart Failure With Low Left Ventricular Ejection Fraction and Wide QRS Interval.

    Science.gov (United States)

    Oh, Changmyung; Chang, Hyuk-Jae; Sung, Ji Min; Kim, Ji Ye; Yang, Wooin; Shim, Jiyoung; Kang, Seok-Min; Ha, Jongwon; Rim, Se-Joong; Chung, Namsik

    2012-10-01

    Cardiac resynchronization therapy (CRT) has been known to improve the outcome of advanced heart failure (HF) but is still underutilized in clinical practice. We investigated the prognosis of patients with advanced HF who were suitable for CRT but were treated with conventional strategies. We also developed a risk model to predict mortality to improve the facilitation of CRT. Patients with symptomatic HF with left ventricular ejection fraction ≤35% and QRS interval >120 ms were consecutively enrolled at cardiovascular hospital. After excluding those patients who had received device therapy, 239 patients (160 males, mean 67±11 years) were eventually recruited. During a follow-up of 308±236 days, 56 (23%) patients died. Prior stroke, heart rate >90 bpm, serum Na ≤135 mEq/L, and serum creatinine ≥1.5 mg/dL were identified as independent factors using Cox proportional hazards regression. Based on the risk model, points were assigned to each of the risk factors proportional to the regression coefficient, and patients were stratified into three risk groups: low- (0), intermediate-(1-5), and high-risk (>5 points). The 2-year mortality rates of each risk group were 5, 31, and 64 percent, respectively. The C statistic of the risk model was 0.78, and the model was validated in a cohort from a different institution where the C statistic was 0.80. The mortality of patients with advanced HF who were managed conventionally was effectively stratified using a risk model. It may be useful for clinicians to be more proactive about adopting CRT to improve patient prognosis.

  2. Heart Failure With Preserved Ejection Fraction in Diabetes: Mechanisms and Management.

    Science.gov (United States)

    Meagher, Patrick; Adam, Mohamed; Civitarese, Robert; Bugyei-Twum, Antoinette; Connelly, Kim A

    2018-05-01

    Diabetes mellitus (DM) is a major cause of heart failure in the Western world, either secondary to coronary artery disease or from a distinct entity known as "diabetic cardiomyopathy." Furthermore, heart failure with preserved ejection fraction (HFpEF) is emerging as a significant clinical problem for patients with DM. Current clinical data suggest that between 30% and 40% of patients with HFpEF suffer from DM. The typical structural phenotype of the HFpEF heart consists of endothelial dysfunction, increased interstitial and perivascular fibrosis, cardiomyocyte stiffness, and hypertrophy along with advanced glycation end products deposition. There is a myriad of mechanisms that result in the phenotypical HFpEF heart including impaired cardiac metabolism and substrate utilization, altered insulin signalling leading to protein kinase C activation, advanced glycated end products deposition, prosclerotic cytokine activation (eg, transforming growth factor-β activation), along with impaired nitric oxide production from the endothelium. Moreover, recent investigations have focused on the role of endothelial-myocyte interactions. Despite intense research, current therapeutic strategies have had little effect on improving morbidity and mortality in patients with DM and HFpEF. Possible explanations for this include a limited understanding of the role that direct cell-cell communication or indirect cell-cell paracrine signalling plays in the pathogenesis of DM and HFpEF. Additionally, integrins remain another important mediator of signals from the extracellular matrix to cells within the failing heart and might play a significant role in cell-cell cross-talk. In this review we discuss the characteristics and mechanisms of DM and HFpEF to stimulate potential future research for patients with this common, and morbid condition. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Low diastolic blood pressure and adverse outcomes in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Tsujimoto, Tetsuro; Kajio, Hiroshi

    2018-07-15

    It remains unknown whether a low diastolic blood pressure (DBP) increases the risks of cardiovascular events and death in patients with heart failure with preserved ejection fraction (HFpEF). We used data from the TOPCAT trial. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure. Hazard ratios (HRs) were analyzed for DBPs of <60, 60-69, 70-79, and ≥90 mm Hg in comparison with a DBP of 80-89 mm Hg using multivariable Cox proportional hazard models. This study included 3417 patients with HFpEF who had a controlled blood pressure. In the mean follow-up period of 3.0 years, 881 patients experienced at least one confirmed primary outcome event. Compared with patients with a DBP of 80-89 mm Hg, the adjusted HRs for primary outcome events were significantly higher in those with DBPs of <60 mm Hg (HR: 2.19 [95% confidence interval,1.72-2.78]) and 60-69 mm Hg (HR: 1.52 [1.23-1.87]). Similarly, the adjusted HRs for all-cause death, major cardiovascular events, and hospitalization for heart failure, but not stroke, were significantly higher in patients with a DBP of <70 mm Hg. A relationship between a low DBP and adverse outcomes was found in HFpEF patients with a systolic blood pressure of ≥120 mm Hg; however, a low systolic blood pressure with a DBP of ≥70 mm Hg was not associated with these event risks. A low DBP increased the risks of adverse outcomes in patients with HFpEF. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  4. Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography.

    Science.gov (United States)

    Huded, Chetan P; Masri, Ahmad; Kusunose, Kenya; Goodman, Andrew L; Grimm, Richard A; Gillinov, A Marc; Johnston, Douglas R; Rodriguez, L Leonardo; Popovic, Zoran B; Svensson, Lars G; Griffin, Brian P; Desai, Milind Y

    2018-04-12

    In asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction, we sought to assess the incremental prognostic value of resting valvuloarterial impedence (Zva) and left ventricular global longitudinal strain (LV-GLS) to treadmill stress echocardiography. We studied 504 such patients (66±12 years, 78% men, 32% with coronary artery disease who underwent treadmill stress echocardiography between 2001 and 2012. Clinical and exercise variables (% of age-sex predicted metabolic equivalents [%AGP-METs]) were recorded. Resting Zva ([systolic arterial pressure+mean aortic valve gradient]/[LV-stroke volume index]) and LV-GLS (measured offline using Velocity Vector Imaging, Siemens) were obtained from the baseline resting echocardiogram. Death was the primary outcome. There were no major adverse cardiac events during treadmill stress echocardiography. Indexed aortic valve area, Zva, and LV-GLS were 0.46±0.1 cm 2 /m 2 , 4.5±0.9 mm Hg/mL per m 2 and -16±4%, respectively; only 50% achieved >100% AGP-METs. Sixty-four percent underwent aortic valve replacement. Death occurred in 164 (33%) patients over 8.9±3.6 years (2 within 30 days of aortic valve replacement). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio or HR 1.06), lower % AGP-METS (HR 1.16), higher Zva (HR 1.25) and lower LV-GLS (HR 1.12) were associated with higher longer-term mortality, while aortic valve replacement (HR 0.45) was associated with improved survival (all P statistic from 0.65 to 0.69 and 0.75, respectively, both P stress echocardiography, LV-GLS and ZVa offer incremental prognostic value. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. Severe aortic stenosis patients with preserved ejection fraction according to flow and gradient classification: Prevalence and outcomes.

    Science.gov (United States)

    González Gómez, Ariana; Fernández-Golfín, Covadonga; Monteagudo, Juan Manuel; Izurieta, Carlos; Hinojar, Rocío; García, Ana; Casas, Eduardo; Jiménez-Nacher, José Julio; Moya, José Luis; Ruiz, Soledad; Zamorano, José Luis

    2017-12-01

    Clinicians often encounter patients with apparently discordant echocardiographic findings, severe aortic stenosis (SAS) defined by aortic valve area (AVA) despite a low mean gradient. A new classification according to flow state and pressure gradient has been proposed. We sought to assess the prevalence, characteristics and outcomes of patients with asymptomatic SAS with preserved left-ventricular ejection fraction (LVEF) according to flow and gradient. In total 442 patients with SAS (AVAigradient (≥ or Gradient (LF/LG): 21.3%(n=94); Normal Flow/Low Gradient (NF/LG): 32.1%(n=142); Low Flow/High Gradient (LF/HG): 6.8%(n=30); Normal Flow/High Gradient (NF/HG): 39,8%(n=176). Mean follow-up time was 20.5months (SD=10.3). Primary combined endpoint was cardiovascular mortality and hospital admission for SAS related symptom, secondary endpoint was aortic valve replacement (AVR), comparing HG group to LF/LG group. During follow-up 17 (18%) of LF/LG patients and 21 (10.2%) of HG patients met the primary endpoint. A lower free of event survival (cardiovascular mortality and hospital admission) was observed in patients with LF/LG AS (Breslow, p=0.002). Significant differences were noted between groups with a lower AVR free survival in the LF/LG group compared to HG groups (Breslow, p=0.002). Our study confirms the high prevalence and worse prognosis of LF/LG SAS. Clinicians must be aware of this entity to ensure appropriate patient management. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  6. On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure

    Directory of Open Access Journals (Sweden)

    Carpenter JP

    2011-09-01

    Full Text Available Abstract Background Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM patients. Treatment effects with improved left ventricular (LV ejection fraction (EF have been observed in patients without overt heart failure, but it is unclear whether these changes are clinically meaningful. Methods This retrospective study of a UK database of TM patients modelled the change in EF between serial scans measured by cardiovascular magnetic resonance (CMR to the relative risk (RR of future development of heart failure over 1 year. Patients were divided into 2 strata by baseline LVEF of 56-62% (below normal for TM and 63-70% (lower half of the normal range for TM. Results A total of 315 patients with 754 CMR scans were analyzed. A 1% absolute increase in EF from baseline was associated with a statistically significant reduction in the risk of future development of heart failure for both the lower EF stratum (EF 56-62%, RR 0.818, p Conclusion These data show that during treatment with iron chelators for cardiac siderosis, small increases in LVEF in TM patients are associated with a significantly reduced risk of the development of heart failure. Thus the iron chelator induced improvements in LVEF of 2.6% to 3.1% that have been observed in randomized controlled trials, are associated with risk reductions of 25.5% to 46.4% for the development of heart failure over 12 months, which is clinically meaningful. In cardiac iron overload, heart mitochondrial dysfunction and its relief by iron chelation may underlie the changes in LV function.

  7. 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, J H; Aldershvile, J

    1988-01-01

    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 ...... are reliable. The discrepancy between the non-invasive and invasive LVEF values raises the question, whether LVEF is overestimated by cardioangiography or underestimated by radionuclide cardiography....

  8. Risk Related to Pre–Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction

    Science.gov (United States)

    Kristensen, Søren L.; Preiss, David; Jhund, Pardeep S.; Squire, Iain; Cardoso, José Silva; Merkely, Bela; Martinez, Felipe; Starling, Randall C.; Desai, Akshay S.; Lefkowitz, Martin P.; Rizkala, Adel R.; Rouleau, Jean L.; Shi, Victor C.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; Packer, Milton

    2016-01-01

    Background— The prevalence of pre–diabetes mellitus and its consequences in patients with heart failure and reduced ejection fraction are not known. We investigated these in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. Methods and Results— We examined clinical outcomes in 8399 patients with heart failure and reduced ejection fraction according to history of diabetes mellitus and glycemic status (baseline hemoglobin A1c [HbA1c]: 6.5%) and known diabetes mellitus compared with those with HbA1csacubitril/valsartan) compared with enalapril was consistent across the range of HbA1c in the trial. Conclusions— In patients with heart failure and reduced ejection fraction, dysglycemia is common and pre–diabetes mellitus is associated with a higher risk of adverse cardiovascular outcomes (compared with patients with no diabetes mellitus and HbA1c <6.0%). LCZ696 was beneficial compared with enalapril, irrespective of glycemic status. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255. PMID:26754626

  9. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction.

    Directory of Open Access Journals (Sweden)

    Mehdi Sanatkar

    2013-07-01

    Full Text Available The aim of this study was to assess the effect of spinal block with low dose of bupivacaine and sufentanil on patients with low cardiac output who underwent lower limb surgery. Fifteen patients who had ejection fraction less than 40% (group 1 were compared with 65 cases with ejection fraction more than 40% (group 2 in our study. Our subjects underwent spinal block with 7.5 mg hyperbaric bupivacaine 0.5% and 5 µg sufentanil. We recorded early events such as hypotension, bradycardia, vasopressor need and ST segment change in our cases. The average mean arterial pressure decreased 13% (110 mmHg to 95.7 mmHg in group 1 and 20% (160 mmHg to 128 mmHg in group 2 (P<0.001. Hypotension due to spinal anesthesia was observed in none of our subjects in both groups and none of our cases need to vasopressor support. All patients remained alert, and no ST segment changes were observed in two groups. In our study none of subjects complained of pain intraoperatively. The subjects were without complaints during the spinal anesthetic in both groups. Spinal block with low dose local anesthetic and sufentanil was a safe and effective method for lower limb surgery in patients with low ejection fraction.

  10. Ergospirometry and Echocardiography in Early Stage of Heart Failure with Preserved Ejection Fraction and in Healthy Individuals

    Directory of Open Access Journals (Sweden)

    Eduardo Lima Garcia

    2015-01-01

    Full Text Available Abstract Background: Heart failure with preserved ejection fraction is a syndrome characterized by changes in diastolic function; it is more prevalent among the elderly, women, and individuals with systemic hypertension (SH and diabetes mellitus. However, in its early stages, there are no signs of congestion and it is identified in tests by adverse remodeling, decreased exercise capacity and diastolic dysfunction. Objective: To compare doppler, echocardiographic (Echo, and cardiopulmonary exercise test (CPET variables - ergospirometry variables - between two population samples: one of individuals in the early stage of this syndrome, and the other of healthy individuals. Methods: Twenty eight outpatients diagnosed with heart failure according to Framingham’s criteria, ejection fraction > 50% and diastolic dysfunction according to the european society of cardiology (ESC, and 24 healthy individuals underwent Echo and CPET. Results: The group of patients showed indexed atrial volume and left ventricular mass as well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant reduction in peak oxygen consumption and increased VE/VCO2 slope, even having similar left ventricular sizes in comparison to those of the sample of healthy individuals. Conclusion: There are significant differences between the structural and functional variables analyzed by Echo and CPET when comparing two population samples: one of patients in the early stage of heart failure with ejection fraction greater than or equal to 50% and another of healthy individuals.

  11. Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction.

    Science.gov (United States)

    Hummel, Scott L; Herald, John; Alpert, Craig; Gretebeck, Kimberlee A; Champoux, Wendy S; Dengel, Donald R; Vaitkevicius, Peter V; Alexander, Neil B

    2016-07-01

    Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure (HF). We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, functional mobility, and physical activity in older adults with HF and reduced ejection fraction. Older adults with HF and reduced ejection fraction (n = 25, age 75 ± 7 years) were compared to 25 healthy age- and gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake (VO2peak), oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go (GUG), Comfortable Gait Speed (CGS), Unipedal Stance (US)], and self-reported physical activity (PA). Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

  12. Usefulness of the troponin-ejection fraction product to differentiate stress cardiomyopathy from ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Nascimento, Francisco O; Yang, Solomon; Larrauri-Reyes, Maiteder; Pineda, Andres M; Cornielle, Vertilio; Santana, Orlando; Heimowitz, Todd B; Stone, Gregg W; Beohar, Nirat

    2014-02-01

    The presentation of stress cardiomyopathy (SC) with nonobstructive coronary artery disease mimics that of ST-segment elevation myocardial infarction (STEMI) due to coronary occlusion. No single parameter has been successful in differentiating the 2 entities. We thus sought to develop a noninvasive clinical tool to discriminate between these 2 conditions. We retrospectively reviewed 59 consecutive cases of SC at our institution from July 2005 through June 2011 and compared those with 60 consecutives cases of angiographically confirmed STEMI treated with primary percutaneous coronary intervention in the same period. All patients underwent acute echocardiography, and the peak troponin I level was determined. The troponin-ejection fraction product (TEFP) was derived by multiplying the peak troponin I level and the echocardiographically derived left ventricular ejection fraction. Comparing the SC and STEMI groups, the mean left ventricular ejection fraction at the time of presentation was 30 ± 9% versus 44 ± 11%, respectively (p statistic 0.91 ± 0.02, p <0.001). In conclusion, for patients not undergoing emergent angiography, the TEFP may be used with high accuracy to differentiate SC with nonobstructive coronary artery disease from true STEMI due to coronary occlusion. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Normalization at the field level: fractional counting of citations

    OpenAIRE

    Leydesdorff, Loet; Opthof, Tobias

    2010-01-01

    Van Raan et al. (2010; arXiv:1003.2113) have proposed a new indicator (MNCS) for field normalization. Since field normalization is also used in the Leiden Rankings of universities, we elaborate our critique of journal normalization in Opthof & Leydesdorff (2010; arXiv:1002.2769) in this rejoinder concerning field normalization. Fractional citation counting thoroughly solves the issue of normalization for differences in citation behavior among fields. This indicator can also be used to obtain ...

  14. Semi-automatic segmentation of gated blood pool emission tomographic images by watersheds: application to the determination of right and left ejection fractions

    International Nuclear Information System (INIS)

    Mariano-Goulart, D.; Collet, H.; Kotzki, P.-O.; Zanca, M.; Rossi, M.

    1998-01-01

    Tomographic multi-gated blood pool scintigraphy (TMUGA) is a widely available method which permits simultaneous assessment of right and left ventricular ejection fractions. However, the widespread clinical use of this technique is impeded by the lack of segmentation methods dedicated to an automatic analysis of ventricular activities. In this study we evaluated how a watershed algorithm succeeds in providing semi-automatic segmentation of ventricular activities in order to measure right and left ejection fractions by TMUGA. The left ejection fractions of 30 patients were evaluated both with TMUGA and with planar multi-gated blood pool scintigraphy (PMUGA). Likewise, the right ejection fractions of 25 patients were evaluated with first-pass scintigraphy (FP) and with TMUGA. The watershed algorithm was applied to the reconstructed slices in order to group together the voxels whose activity came from one specific cardiac cavity. First, the results of the watershed algorithm were compared with manual drawing around left and right ventricles. Left ejection fractions evaluated by TMUGA with the watershed procedure were not significantly different (p=0.30) from manual outlines whereas a small but significant difference was found for right ejection fractions (p=0.004). Then right and left ejection fractions evaluated by TMUGA (with the semi-automatic segmentation procedure) were compared with the results obtained by FP or PMUGA. Left ventricular ejection fractions evaluated by TMUGA showed an excellent correlation with those evaluated by PMUGA (r=0.93; SEE=5.93%; slope=0.99; intercept = 4.17%). The measurements of these ejection fractions were significantly higher with TMUGA than with PMUGA (P<0.01). The interoperator variability for the measurement of left ejection fractions by TMUGA was 4.6%. Right ventricular ejection fractions evaluated by TMUGA showed a good correlation with those evaluated by FP (r = 0.81; SEE = 6.68%; slope = 1.00; intercept = 0.85%) and were not

  15. Evaluation of the Efficiency of Alveolar Opening in Cardiosurgical Patients with Low Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Yu. G Zorina

    2009-01-01

    Full Text Available Objective: to determine the optimum alveolar opening parameters for the improvement of postoperative pulmonary oxygenizing function in patients with a left ventricular ejection fraction (LVEF of less or more than 40% after aortocoronary bypass surgery (ACBS. Subjects and methods. Twenty patients with a LVEF of less than 40% after ACBS and with postoperative pulmonary oxygenizing dysfunction (PaO2/FiO2 less than 250 (Group 1 were examined. A control group consisted of 20 patients with a LVEF of more than 40% (Group 2. Gas exchange, respiration biomechanics, and central hemodynamic (CH parameters were monitored (a Vigilance monitor (Edvard LifeScience. Alveolar mobilization was carried out on Drager Evita-2 apparatuses in the BIPAP mode, by taking into account the previous artificial ventilation (AV parameters. The low pressure phase corresponded to the positive end-expiratory pressure (PEEP with volume AV, the high pressure phase was Pplato; the duration of both phases — that of inspiration and expiration (the high pressure phase was inspiration time; the low pressure phase was expiration time. Then the values of Pplato and PEEP were simultaneously increased by 2 cm H2O with a duration of 10 breathing cycles, by continuously monitoring Vt and SaO2 over this interval. By continuously monitoring Vt, a stepwise increase in PEEP and Pplato was continued until there was a Vt reduction or a negative impact of AV on CH. All alveoli were considered to be open when the maximum Vt and SaO2 were achieved. Conclusion. In Group 1 patients with Pinsp of 27—30 cm H2O, PEEP of 10—12 cm H2O, there are increases in PaO2/FiO2 and Cst. In Group 2, the increase of PaO2/FiO2 and Cst is observed with Pinsp of 30—35 cm H2O and PEEP 12—14 cm H2O. With these AV indices, there is an allowable hemodynamic reduction that results in no negative consequences and development of cardiovascular events. After switching to AV in an individually chosen mode, all

  16. THE ROLE OF FACTORS AFFECTING THE FORMATION OF CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION

    Directory of Open Access Journals (Sweden)

    M. V. Kurkina

    2017-01-01

    Full Text Available Aim. To study the combination and contribution of risk factors (age, hypertension (HT, obesity, diabetes mellitus, chronic kidney disease (CKD, length of illness leading to the formation of chronic heart failure (CHF with preserved ejection fraction (EF.Material and methods. The study included 100 hypertensive patients (aged 40 to 80 years with concomitant obesity or diabetes or CKD. Patients were divided into 4 groups depending on the presence of one major and/or several concomitant diseases. Echocardiography, assessment of large arterial vessels stiffness indices (SI m/s, CAVI m/s, and determination of small muscle arteries tonus (RI% were performed in all patients.Results. Remodeling of the left ventricle (LV and left atrial (LA was observed in all patients with comorbid status, as well as reduction in diastolic function. The LV myocardial mass index in the first group was 117.2±31.4 g/m2, in the second one – 125.9±27.4 g/m2, in the third group – 121.5±15.6 g/m2 and in the fourth one – 126.1±11.5 g/m2. A significant increase in the LA volume index was founded in the first group  – 33.4±3.9 ml/m2, in the second one – 39.6±9.1 ml/m2, in the third group – 38.1±5.2 ml/m2 and in the fourth one – 39.8±6.6 ml/m2 (р<0.05. The parameters reflecting the rigidity of large arterial vessels (SI m/s, CAVI m/s also exceeded the threshold values in each group; significant differences SI were between the first and fourth, second  and fourth groups  (р<0.05, CAVI between the first and third groups  (р<0.05. A significant correlation was found between CAVI and age (r=0.63, which indicated an increase in arterial stiffness with age.Conclusions. In the formation of CHF with preserved EF, additional factors enhance the changes associated with LV remodeling and LA overload. These changes occur with a progressive decrease in LV diastolic function and increase in myocardial stiffness. HT and obesity are the main contributors to the

  17. Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction

    Science.gov (United States)

    Jorapur, Vinod; Lamas, Gervasio A; Sadowski, Zygmunt P; Reynolds, Harmony R; Carvalho, Antonio C; Buller, Christopher E; Rankin, James M; Renkin, Jean; Steg, Philippe Gabriel; White, Harvey D; Vozzi, Carlos; Balcells, Eduardo; Ragosta, Michael; Martin, C Edwin; Srinivas, Vankeepuram S; Wharton III, William W; Abramsky, Staci; Mon, Ana C; Kronsberg, Shari S; Hochman, Judith S

    2010-01-01

    AIM: To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF). METHODS: Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF. RESULTS: Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181). CONCLUSION: A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF. PMID:20885993

  18. Heart rate index: an indicator of left ventricular ejection fraction. Comparison of left ventricular ejection fraction and variables assessed by exercise test in patients studied early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Haedersdal, C; Pedersen, F H; Svendsen, Jesper Hastrup

    1992-01-01

    The present study compares the variables assessed by standard exercise test with the left ventricular ejection fraction (LVEF) measured by multigated radionuclide angiocardiography (MUGA) in 77 patients early after myocardial infarction. The exercise test and MUGA were performed within two weeks...... at rest, 4) rise in systolic blood pressure, 5) rate pressure product at rest, 6) rise in rate pressure product, 7) ratio (rHR) between maximal rate pressure product and rate pressure product at rest, 8) total exercise time. The heart rate was corrected for effects caused by age (heart index (HR...

  19. Right heart ejection fraction, ventricular volumes, and left to right cardiac shunt measurements with a conventional Anger camera in congenital heart disease

    International Nuclear Information System (INIS)

    Cook, S.A.; Go, R.T.; MacIntyre, W.J.; Moodie, D.S.; Houser, T.S.; Ceimo, J.; Underwood, D.; Yiannikas, J.

    1982-01-01

    The object of this investigation was to demonstrate that a conventional Anger camera can be used for measurement of right heart ejection fraction, ventricular volumes and left to right shunts in routine clinical determinations. The automatic selection of chamber and lung regions, the recirculation subtraction of recirculation, and the filtering of the right heart ejection fraction dilution curves are all done entirely without operator intervention. Thus, this entire evaluation has been incorporated into the routine procedures of patient care

  20. Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction

    Science.gov (United States)

    Margulies, Kenneth B.; Hernandez, Adrian F.; Redfield, Margaret M.; Givertz, Michael M.; Oliveira, Guilherme H.; Cole, Robert; Mann, Douglas L.; Whellan, David J.; Kiernan, Michael S.; Felker, G. Michael; McNulty, Steven E.; Anstrom, Kevin J.; Shah, Monica R.; Braunwald, Eugene; Cappola, Thomas P.

    2016-01-01

    IMPORTANCE Abnormal cardiac metabolism contributes to the pathophysiology of advanced heart failure with reduced left ventricular ejection fraction (LVEF). Glucagon-like peptide 1 (GLP-1) agonists have shown cardioprotective effects in early clinical studies of patients with advanced heart failure, irrespective of type 2 diabetes status. OBJECTIVE To test whether therapy with a GLP-1 agonist improves clinical stability following hospitalization for acute heart failure. DESIGN, SETTING, AND PARTICIPANTS Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with established heart failure and reduced LVEF who were recently hospitalized. Patients were enrolled between August 2013 and March 2015 at 24 US sites. INTERVENTIONS The GLP-1 agonist liraglutide (n = 154) or placebo (n = 146) via a daily subcutaneous injection; study drug was advanced to a dosage of 1.8 mg/d during the first 30 days as tolerated and continued for 180 days. MAIN OUTCOMES AND MEASURES The primary end point was a global rank score in which all patients, regardless of treatment assignment, were ranked across 3 hierarchical tiers: time to death, time to rehospitalization for heart failure, and time-averaged proportional change in N-terminal pro-B-type natriuretic peptide level from baseline to 180 days. Higher values indicate better health (stability). Exploratory secondary outcomes included primary end point components, cardiac structure and function, 6-minute walk distance, quality of life, and combined events. RESULTS Among the 300 patients who were randomized (median age, 61 years [interquartile range {IQR}, 52–68 years]; 64 [21%] women; 178 [59%] with type 2 diabetes; median LVEF of 25% [IQR, 19%–33%]; median N-terminal pro-B-type natriuretic peptide level of 2049 pg/mL [IQR, 1054–4235 pg/mL]), 271 completed the study. Compared with placebo, liraglutide had no significant effect on the primary end point (mean rank of 146 for the liraglutide group vs 156 for the

  1. Cardiac Amyloidosis and its New Clinical Phenotype: Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Mesquita, Evandro Tinoco; Jorge, Antonio José Lagoeiro; Souza, Celso Vale; Andrade, Thais Ribeiro de

    2017-07-01

    Heart failure with preserved ejection fraction (HFpEF) is now an emerging cardiovascular epidemic, being identified as the main phenotype observed in clinical practice. It is more associated with female gender, advanced age and comorbidities such as hypertension, diabetes, obesity and chronic kidney disease. Amyloidosis is a clinical disorder characterized by the deposition of aggregates of insoluble fibrils originating from proteins that exhibit anomalous folding. Recently, pictures of senile amyloidosis have been described in patients with HFpEF, demonstrating the need for clinical cardiologists to investigate this etiology in suspect cases. The clinical suspicion of amyloidosis should be increased in cases of HFPS where the cardio imaging methods are compatible with infiltrative cardiomyopathy. Advances in cardio imaging methods combined with the possibility of performing genetic tests and identification of the type of amyloid material allow the diagnosis to be made. The management of the diagnosed patients can be done in partnership with centers specialized in the study of amyloidosis, which, together with the new technologies, investigate the possibility of organ or bone marrow transplantation and also the involvement of patients in clinical studies that evaluate the action of the new emerging drugs. Resumo A insuficiência cardíaca com fração de ejeção preservada (ICFEP) é hoje uma epidemia cardiovascular emergente, sendo identificada como o principal fenótipo observado na prática clínica. Está mais associado ao sexo feminino, idade avançada e a comorbidades como hipertensão arterial, diabetes, obesidade e doença renal crônica. A amiloidose é uma desordem clínica caracterizada pelo depósito de agregados de fibrilas insolúveis originadas de proteínas que apresentam dobramento anômalo. Recentemente, têm sido descritos quadros de amiloidose senil em pacientes com ICFEP, demonstrando a necessidade de os cardiologistas clínicos investigarem

  2. Noninvasive prediction of left ventricular end-diastolic pressure in patients with coronary artery disease and preserved ejection fraction.

    Science.gov (United States)

    Abd-El-Aziz, Tarek A

    2012-01-01

    The aim of this study was to compare 3 different available methods for estimating left ventricular end-diastolic pressure (LVEDP) noninvasively in patients with coronary artery disease and preserved left ventricular ejection fraction (EF). We used 3 equations for noninvasive estimation of LVEDP: The equation of Mulvagh et al., LVEDP(1) = 46 - 0.22 (IVRT) - 0.10 (AFF) - 0.03 (DT) - (2 ÷ E/A) + 0.05 MAR; the equation of Stork et al., LVEDP(2) = 1.06 + 15.15 × Ai/Ei; and the equation of Abd-El-Aziz, LVEDP(3) = [0.54 (MABP) × (1 - EF)] - 2.23. ( A, A-wave velocity; AFF, atrial filling fraction; Ai, time velocity integral of A wave; DT, deceleration time; E, E-wave velocity; Ei, time velocity integral of E wave; IVRT, isovolumic relaxation time; MABP, mean arterial blood pressure; MAR, time from termination of mitral flow to the electrocardiographic R wave; Ti, time velocity integral of total wave.) LVEDP measured by catheterization was correlated with LVEDP(1) (r = 0.52, P Aziz, LVEDP = [0.54 MABP × (1 - EF)] - 2.23, appears to be the most accurate, reliable, and easily applied method for estimating LVEDP noninvasively in patients with preserved left ventricular ejection fraction and an LVEDP < 20 mm Hg. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Aortic insufficiency and hydralazine: behaviour of left ventricular ejection fraction and of stroke index ratio at rest and during exercise

    International Nuclear Information System (INIS)

    Sole, C.; Florenzano, F.; Morales, B.; Neubauer, S.; Escobar, E.; Mollerach, F.; Mollerach, A.; Avella, O.

    1982-01-01

    The gated blood pool ventriculography in patients undergoing in vivo red blood cells labelling with 99mTc-pertechnetate, was evaluated critically as a form of quantifying aortic valvular regurgitation (AVR) and was applicated in severe aortic insufficiency (AI) to determine the effects of Hydralazine at rest and during exercise on the ventricular function parameters thus obtained. The beneficious effects of Hydralazine on left ventricular performance in patients with AI, have already been reported. The results confirm this too, but using a non-invasive method. These beneficious effects of Hydralazine in patients with AI were proved to be a consequence of significant increase in left ventricular ejection fraction (LVEF)

  4. Effects of gender, ejection fraction and weight on cardiac force development in patients undergoing cardiac surgery--an experimental examination.

    Science.gov (United States)

    Bening, Constanze; Weiler, Helge; Vahl, Christian-Friedrich

    2013-11-18

    It has long been recognized that differences exist between men and women in the impact of risc factors, symptoms, development and outcome of special diseases like the cardiovascular disease. Gender determines the cardiac baseline parameters like the number of cardiac myocyte, size and demand and may suggest differences in myofilament function among genders, which might be pronounced under pathological conditions. Does gender impact and maybe impair the contractile apparatus? Are the differences more prominent when other factors like weight, age, ejection fraction are added?Therefore we performed a study on 36 patients (21 male, 15 female) undergoing aortic valve replacement (AVR) or aortocoronary bypass operation (CABG) to examine the influence of gender, ejection fraction, surgical procedure and body mass index (BMI) on cardiac force development. Tissue was obtained from the right auricle and was stored in a special solution to prevent any stretching of the fibers. We used the skinned muscle fiber model and single muscle stripes, which were mounted on the "muscle machine" and exposed to a gradual increase of calcium concentration calculated by an attached computer program. 1.) In general female fibers show more force than male fibers: 3.9 mN vs. 2.0 mN (p = 0.03) 2.) Female fibers undergoing AVR achieved more force than those undergoing CABG operation: 5.7 mN vs. 2.8 mN (p = 0.02) as well as male fibers with AVR showed more force values compared to those undergoing CABG: 2.0 mN vs. 0.5 mN (p = 0.01). 3.) Male and female fibers of patients with EF > 55% developed significantly more force than from those with less ejection fraction than 30%: p = 0.002 for the male fibers (1.6 vs. 2.8 mN) and p = 0.04 for the female fibers (5.7 vs. 2.8 mN). 4.) Patients with a BMI between 18 till 25 develop significant more force than those with a BMI > 30: Females 5.1 vs. 2.6 mN; p 0.03, Males 3.8 vs. 0.8 mN; p 0.04). Our data suggest that female patients undergoing AVR or CABG

  5. Changes in left ventricular systolic function in patients with chronic heart failure with preserved ejection fraction and cardiorenal anemic syndrome

    Directory of Open Access Journals (Sweden)

    Vasylenko V.A.

    2015-09-01

    Full Text Available The feature of chronic heart failure (CHF in elderly people is increasing incidence of heart failure with preserved left ventricular ejection fraction (LVEF which is associated with age. Such patients account for almost half of the total number of patients with heart failure. Cardiorenal syndrome (CRS is associated with an increased risk of mortality in patients with CHF. The impact of CRS on the structural and functional condition of the heart in these patients is studied insufficiently. The study involved 103 patients with CHF II-IV NYHA with preserved LVEF (>45% and CRS (hemoglobin <120 g/l and fractional shortening size.

  6. Changing the treatment of heart failure with reduced ejection fraction: clinical use of sacubitril-valsartan combination

    Science.gov (United States)

    Kaplinsky, Edgardo

    2016-01-01

    Despite significant therapeutic advances, patients with chronic heart failure (HF) remain at high risk of morbidity and mortality. Sacubitril valsartan (previously known as LCZ696) is a new oral agent approved for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction. It is described as the first in class angiotensin receptor neprilysin inhibitor (ARNI) since it incorporates the neprilysin inhibitor, sacubitril and the angiotensin II receptor antagonist, valsartan. Neprilysin is an endopeptidase that breaks down several vasoactive peptides including natriuretic peptides (NPs), bradykinin, endothelin and angiotensin II (Ang-II). Therefore, a natural consequence of its inhibition is an increase of plasmatic levels of both, NPs and Ang-II (with opposite biological actions). So, a combined inhibition of these both systems (Sacubitril / valsartan) may enhance the benefits of NPs effects in HF (natriuresis, diuresis, etc) while Ang-II receptor is inhibited (reducing vasoconstriction and aldosterone release). In a large clinical trial (PARADIGM-HF with 8442 patients), this new agent was found to significantly reduce cardiovascular and all cause mortality as well as hospitalizations due to HF (compared to enalapril). This manuscript reviews clinical evidence for sacubitril valsartan, dosing and cautions, future directions and its considered place in the therapy of HF with reduced ejection fraction. PMID:28133468

  7. Comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, I.M.; Abdel-Dayem, H.M.; Mohammed, M.M.J.; Simo, M.; Yousef, A.M.; Badruddosa, M.; Mahmood, A.R.; Sayed, M.E.

    1986-04-01

    First-pass radionuclide angiography (FPRA) in the 30/sup 0/ right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45/sup 0/ left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r=0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r=0.86), but not in VHD (r=0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA.

  8. A comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease

    International Nuclear Information System (INIS)

    Hassan, I.M.; Abdel-Dayem, H.M.; Mohammed, M.M.J.; Simo, M.; Yousef, A.M.; Badruddosa, M.; Mahmood, A.R.; Sayed, M.E.

    1986-01-01

    First-pass radionuclide angiography (FPRA) in the 30 0 right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45 0 left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r=0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r=0.86), but not in VHD (r=0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA. (orig.)

  9. Cardiosphere-Derived Cells Reverse Heart Failure With Preserved Ejection Fraction in Rats by Decreasing Fibrosis and Inflammation

    Directory of Open Access Journals (Sweden)

    Romain Gallet, MD

    2016-01-01

    Full Text Available The pathogenesis of heart failure with a preserved ejection fraction (HFpEF is unclear. Myocardial fibrosis, inflammation, and cardiac hypertrophy have been suggested to contribute to the pathogenesis of HFpEF. Cardiosphere-derived cells (CDCs are heart-derived cell products with antifibrotic and anti-inflammatory properties. This study tested whether rat CDCs were sufficient to decrease manifestations of HFpEF in hypertensive rats. Starting at 7 weeks of age, Dahl salt-sensitive rats were fed a high-salt diet for 6 to 7 weeks and randomized to receive intracoronary CDCs or placebo. Dahl rats fed normal chow served as controls. High-salt rats developed hypertension, left ventricular (LV hypertrophy, and diastolic dysfunction, without impairment of ejection fraction. Four weeks after treatment, diastolic dysfunction resolved in CDC-treated rats but not in placebo. The improved LV relaxation was associated with lower LV end-diastolic pressure, decreased lung congestion, and enhanced survival in CDC-treated rats. Histology and echocardiography revealed no decrease in cardiac hypertrophy after CDC treatment, consistent with the finding of sustained, equally-elevated blood pressure in CDC- and placebo-treated rats. Nevertheless, CDC treatment decreased LV fibrosis and inflammatory infiltrates. Serum inflammatory cytokines were likewise decreased after CDC treatment. Whole-transcriptome analysis revealed that CDCs reversed changes in numerous transcripts associated with HFpEF, including many involved in inflammation and/or fibrosis. These studies suggest that CDCs normalized LV relaxation and LV diastolic pressure while improving survival in a rat model of HFpEF. The benefits of CDCs occurred despite persistent hypertension and cardiac hypertrophy. By selectively reversing inflammation and fibrosis, CDCs may be beneficial in the treatment of HFpEF.

  10. Role of Myocardial Collagen in Severe Aortic Stenosis With Preserved Ejection Fraction and Symptoms of Heart Failure.

    Science.gov (United States)

    Echegaray, Kattalin; Andreu, Ion; Lazkano, Ane; Villanueva, Iñaki; Sáenz, Alberto; Elizalde, María Reyes; Echeverría, Tomás; López, Begoña; Garro, Asier; González, Arantxa; Zubillaga, Elena; Solla, Itziar; Sanz, Iñaki; González, Jesús; Elósegui-Artola, Alberto; Roca-Cusachs, Pere; Díez, Javier; Ravassa, Susana; Querejeta, Ramón

    2017-10-01

    We investigated the anatomical localization, biomechanical properties, and molecular phenotype of myocardial collagen tissue in 40 patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure. Two transmural biopsies were taken from the left ventricular free wall. Mysial and nonmysial regions of the collagen network were analyzed. Myocardial collagen volume fraction (CVF) was measured by picrosirius red staining. Young's elastic modulus (YEM) was measured by atomic force microscopy in decellularized slices to assess stiffness. Collagen types I and III were measured as C I VF and C III VF, respectively, by confocal microscopy in areas with YEM evaluation. Compared with controls, patients exhibited increased mysial and nonmysial CVF and nonmysial:mysial CVF ratio (P < .05). In patients, nonmysial CVF (r = 0.330; P = .046) and the nonmysial:mysial CVF ratio (r = 0.419; P = .012) were directly correlated with the ratio of maximal early transmitral flow velocity in diastole to early mitral annulus velocity in diastole. Both the C I VF:C III VF ratio and YEM were increased (P ≤ .001) in nonmysial regions compared with mysial regions in patients, with a direct correlation (r = 0.895; P < .001) between them. These findings suggest that, in patients with severe aortic stenosis with preserved ejection fraction and symptoms of heart failure, diastolic dysfunction is associated with increased nonmysial deposition of collagen, predominantly type I, resulting in increased extracellular matrix stiffness. Therefore, the characteristics of collagen tissue may contribute to diastolic dysfunction in these patients. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zheng, Sean Lee; Chan, Fiona T; Nabeebaccus, Adam A; Shah, Ajay M; McDonagh, Theresa; Okonko, Darlington O; Ayis, Salma

    2018-03-01

    Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO 2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis

    Science.gov (United States)

    Zheng, Sean Lee; Chan, Fiona T; Nabeebaccus, Adam A; Shah, Ajay M; McDonagh, Theresa; Okonko, Darlington O; Ayis, Salma

    2018-01-01

    Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group. PMID:28780577

  13. Cost-effectiveness Analysis of Sacubitril/Valsartan vs Enalapril in Patients With Heart Failure and Reduced Ejection Fraction.

    Science.gov (United States)

    Gaziano, Thomas A; Fonarow, Gregg C; Claggett, Brian; Chan, Wing W; Deschaseaux-Voinet, Celine; Turner, Stuart J; Rouleau, Jean L; Zile, Michael R; McMurray, John J V; Solomon, Scott D

    2016-09-01

    The angiotensin receptor neprilysin inhibitor sacubitril/valsartan was associated with a reduction in cardiovascular mortality, all-cause mortality, and hospitalizations compared with enalapril. Sacubitril/valsartan has been approved for use in heart failure (HF) with reduced ejection fraction in the United States and cost has been suggested as 1 factor that will influence the use of this agent. To estimate the cost-effectiveness of sacubitril/valsartan vs enalapril in the United States. Data from US adults (mean [SD] age, 63.8 [11.5] years) with HF with reduced ejection fraction and characteristics similar to those in the PARADIGM-HF trial were used as inputs for a 2-state Markov model simulated HF. Risks of all-cause mortality and hospitalization from HF or other reasons were estimated with a 30-year time horizon. Quality of life was based on trial EQ-5D scores. Hospital costs combined Medicare and private insurance reimbursement rates; medication costs included the wholesale acquisition cost for sacubitril/valsartan and enalapril. A discount rate of 3% was used. Sensitivity analyses were performed on key inputs including: hospital costs, mortality benefit, hazard ratio for hospitalization reduction, drug costs, and quality-of-life estimates. Hospitalizations, quality-adjusted life-years (QALYs), costs, and incremental costs per QALY gained. The 2-state Markov model of US adult patients (mean age, 63.8 years) calculated that there would be 220 fewer hospital admissions per 1000 patients with HF treated with sacubitril/valsartan vs enalapril over 30 years. The incremental costs and QALYs gained with sacubitril/valsartan treatment were estimated at $35 512 and 0.78, respectively, compared with enalapril, equating to an incremental cost-effectiveness ratio (ICER) of $45 017 per QALY for the base-case. Sensitivity analyses demonstrated ICERs ranging from $35 357 to $75 301 per QALY. For eligible patients with HF with reduced ejection fraction, the Markov

  14. Noninvasive Assessment of Preload Reserve Enhances Risk Stratification of Patients With Heart Failure With Reduced Ejection Fraction.

    Science.gov (United States)

    Matsumoto, Kensuke; Onishi, Akira; Yamada, Hirotsugu; Kusunose, Kenya; Suto, Makiko; Hatani, Yutaka; Matsuzoe, Hiroki; Tatsumi, Kazuhiro; Tanaka, Hidekazu; Hirata, Ken-Ichi

    2018-05-01

    The leg-positive pressure maneuver can safely and noninvasively apply preload stress without increase in total body fluid volume. The purpose of this study was to determine whether preload stress could be useful for risk stratification of patients with heart failure with reduced ejection fraction. For this study, 120 consecutive patients with heart failure with reduced ejection fraction were prospectively recruited. The stroke work index was estimated as product of stroke volume index and mean blood pressure, and the E/e' ratio was calculated to estimate ventricular filling pressure. The echocardiographic parameters were obtained both at rest and during leg-positive pressure stress. During the median follow-up period of 20 months, 30 patients developed adverse cardiovascular events. During preload stress, stroke work index increased significantly (from 3280±1371 to 3857±1581 mm Hg·mL/m 2 ; P <0.001) along with minimal changes in ventricular filling pressure (E/e', from 16±10 to 17±9; P <0.05) in patients without cardiovascular events. However, patients with cardiovascular events showed impairment of Frank-Starling mechanism (stroke work index, from 2863±969 to 2903±1084 mm Hg·mL/m 2 ; P =0.70) and a serious increase in E/e' ratio (from 19±11 to 25±14; P <0.001). Both the patients without contractile reserve and those without diastolic reserve exhibited worse event-free survival than the others ( P <0.001). In a Cox proportional-hazards analysis, the changes in stroke work index (hazard ratio: 0.44 per 500 mm Hg·mL/m 2 increase; P =0.001) and in E/e' (hazard ratio: 2.58 per 5-U increase; P <0.001) were predictors of cardiovascular events. Contractile reserve and diastolic reserve during leg-positive pressure stress are important determinants of cardiovascular outcomes for patients with heart failure with reduced ejection fraction. © 2018 American Heart Association, Inc.

  15. Analytical formulae in fractionated irradiation of normal tissue

    International Nuclear Information System (INIS)

    Kozubek, S.

    1982-01-01

    The new conception of the modeling of the cell tissue kinetics after fractionated irradiation is proposed. The formulae given earlier are compared with experimental data on various normal tissues and further adjustments are considered. The tissues are shown to exhibit several general patterns of behaviour. The repopulation, if it takes place, seems to start after some time, independently of fractionation in first approximation and can be treated as simple autogenesis. The results are compared with the commonly used NSD conception and the well-known Cohen cell tissue kinetic model

  16. High Right Ventricular Stroke Work Index Is Associated with Worse Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction.

    Science.gov (United States)

    Kanjanahattakij, Napatt; Sirinvaravong, Natee; Aguilar, Francisco; Agrawal, Akanksha; Krishnamoorthy, Parasuram; Gupta, Shuchita

    2018-01-01

    In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8-12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure - mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR. Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = -1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = -1.74, 95% CI -3.37 to -0.11, p = 0.04). High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association. © 2018 S. Karger AG, Basel.

  17. Left ventricular filling rate change as an earlier indicator than ejection fraction of chemotherapeutic cardiotoxicity in cancer paptents' nuclear medicine MUGA scans

    International Nuclear Information System (INIS)

    Miko, T.G.

    2004-01-01

    According to Wang Siegel has long suggested that an earlier indicator of damage to the hearts of cancer patients undergoing potentially cardiotoxic chemotherapy could be change in the left ventricular filling rate (LVFT) rather than dependence on the left ventricular ejection fraction (LVEF) as a measure for when to discontinue chemotherapy. Currently ejection fraction obtained by performing the nuclear medicine MUGA scan is the gold standard for determining further treatment of patients with these cardiotoxic agents. We are seeking to see if changes in filling rate (LVFR) are an earlier indicator of cardiotoxicity by performing a retrospective analysis of MUGA scans performed at our facility pre- and post-chemotherapy and performing a statistical analysis of changes in ejection fraction us filling rate in patients known to have cardiotoxic changes due to chemotherapy. (authors)

  18. Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction

    DEFF Research Database (Denmark)

    Cannon, Jane A.; Shen, Li; Jhund, Pardeep S.

    2017-01-01

    Aims: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril....... As neprilysin is also one of many enzymes clearing amyloid-β peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context...... of other recently conducted HFrEF trials. Methods and results: In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103 mg b.i.d. or enalapril 10 mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory...

  19. Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography

    International Nuclear Information System (INIS)

    Brown, J.M.; White, C.J.; Sobol, S.M.; Lull, R.J.

    1983-01-01

    The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function

  20. Increased left ventricular ejection fraction after a meal: potential source of error in performance of radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.M.; White, C.J.; Sobol, S.M.; Lull, R.J.

    1983-06-01

    The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

  1. The impact of coronary artery disease and left ventricular ejection fraction on the prognosis of patients with peripheral artery disease.

    Science.gov (United States)

    Tsujimura, Takuya; Iida, Osamu; Ishihara, Takayuki; Fujita, Masashi; Masuda, Masaharu; Okamoto, Shin; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Takahara, Mitsuyoshi; Uematsu, Masaaki

    2017-11-01

    The impact of the severity of coronary artery disease (CAD) and left ventricular ejection fraction (LVEF) on the prognosis of patients with peripheral artery disease (PAD) has not been systematically studied. We retrospectively analysed 622 patients with PAD (intermittent claudication (IC): n = 446; critical limb ischaemia (CLI): n = 176). The association of SYNTAX score and LVEF with mortality was analysed using the Cox proportional hazard model. In patients with IC, a high SYNTAX score was significantly associated with mortality, whereas reduced LVEF was significantly associated with mortality in patients with CLI. The prognostic impact of CAD and LVEF appears different between patients with IC and CLI. © 2017 Royal Australasian College of Physicians.

  2. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes

    Science.gov (United States)

    Senni, Michele; Paulus, Walter J.; Gavazzi, Antonello; Fraser, Alan G.; Díez, Javier; Solomon, Scott D.; Smiseth, Otto A.; Guazzi, Marco; Lam, Carolyn S. P.; Maggioni, Aldo P.; Tschöpe, Carsten; Metra, Marco; Hummel, Scott L.; Edelmann, Frank; Ambrosio, Giuseppe; Stewart Coats, Andrew J.; Filippatos, Gerasimos S.; Gheorghiade, Mihai; Anker, Stefan D.; Levy, Daniel; Pfeffer, Marc A.; Stough, Wendy Gattis; Pieske, Burkert M.

    2014-01-01

    The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed. PMID:25104786

  3. Exercise testing in asymptomatic or minimally symptomatic aortic regurgitation: relationship of left ventricular ejection fraction to left ventricular filling pressure during exercise

    International Nuclear Information System (INIS)

    Boucher, C.A.; Wilson, R.A.; Kanarek, D.J.; Hutter, A.M. Jr.; Okada, R.D.; Liberthson, R.R.; Strauss, H.W.; Pohost, G.M.

    1983-01-01

    Exercise radionuclide angiography is being used to evaluate left ventricular function in patients with aortic regurgitation. Ejection fraction is the most common variable analyzed. To better understand the rest and exercise ejection fraction in this setting, 20 patients with asymptomatic or minimally symptomatic severe aortic regurgitation were studied. All underwent simultaneous supine exercise radionuclide angiography and pulmonary gas exchange measurement and underwent rest and exercise measurement of pulmonary artery wedge pressure (PAWP) during cardiac catheterization. Eight patients had a peak exercise PAWP less than 15 mm Hg (group 1) and 12 had a peak exercise PAWP greater than or equal to 15 mm Hg (group 2). Group 1 patients were younger and more were in New York Heart Association class I. The two groups had similar cardiothoracic ratios, changes in ejection fractions with exercise, and rest and exercise regurgitant indexes. Using multiple regression analysis, the best correlate of the exercise PAWP was peak oxygen uptake (r . -0.78, p less than 0.01). No other measurement added significantly to the regression. When peak oxygen uptake was excluded, rest and exercise ejection fraction also correlated significantly (r . -0.62 and r . -0.60, respectively, p less than 0.01). Patients with asymptomatic or minimally symptomatic severe aortic regurgitation have a wide spectrum of cardiac performance in terms of the PAWP during exercise. The absolute rest and exercise ejection fraction and the level of exercise achieved are noninvasive variables that correlate with exercise PAWP in aortic regurgitation, but the change in ejection fraction with exercise by itself is not

  4. Evaluation of training nurses to perform semi-automated three-dimensional left ventricular ejection fraction using a customised workstation-based training protocol.

    Science.gov (United States)

    Guppy-Coles, Kristyan B; Prasad, Sandhir B; Smith, Kym C; Hillier, Samuel; Lo, Ada; Atherton, John J

    2015-06-01

    We aimed to determine the feasibility of training cardiac nurses to evaluate left ventricular function utilising a semi-automated, workstation-based protocol on three dimensional echocardiography images. Assessment of left ventricular function by nurses is an attractive concept. Recent developments in three dimensional echocardiography coupled with border detection assistance have reduced inter- and intra-observer variability and analysis time. This could allow abbreviated training of nurses to assess cardiac function. A comparative, diagnostic accuracy study evaluating left ventricular ejection fraction assessment utilising a semi-automated, workstation-based protocol performed by echocardiography-naïve nurses on previously acquired three dimensional echocardiography images. Nine cardiac nurses underwent two brief lectures about cardiac anatomy, physiology and three dimensional left ventricular ejection fraction assessment, before a hands-on demonstration in 20 cases. We then selected 50 cases from our three dimensional echocardiography library based on optimal image quality with a broad range of left ventricular ejection fractions, which was quantified by two experienced sonographers and the average used as the comparator for the nurses. Nurses independently measured three dimensional left ventricular ejection fraction using the Auto lvq package with semi-automated border detection. The left ventricular ejection fraction range was 25-72% (70% with a left ventricular ejection fraction nurses showed excellent agreement with the sonographers. Minimal intra-observer variability was noted on both short-term (same day) and long-term (>2 weeks later) retest. It is feasible to train nurses to measure left ventricular ejection fraction utilising a semi-automated, workstation-based protocol on previously acquired three dimensional echocardiography images. Further study is needed to determine the feasibility of training nurses to acquire three dimensional echocardiography

  5. Two-dimensional speckle-tracking strain echocardiography in long-term heart transplant patients: a study comparing deformation parameters and ejection fraction derived from echocardiography and multislice computed tomography.

    Science.gov (United States)

    Syeda, Bonni; Höfer, Peter; Pichler, Philipp; Vertesich, Markus; Bergler-Klein, Jutta; Roedler, Susanne; Mahr, Stephane; Goliasch, Georg; Zuckermann, Andreas; Binder, Thomas

    2011-07-01

    Longitudinal strain determined by speckle tracking is a sensitive parameter to detect systolic left ventricular dysfunction. In this study, we assessed regional and global longitudinal strain values in long-term heart transplants and compared deformation indices with ejection fraction as determined by transthoracic echocardiography (TTE) and multislice computed tomographic coronary angiography (MSCTA). TTE and MSCTA were prospectively performed in 31 transplant patients (10.6 years post-transplantation) and in 42 control subjects. Grey-scale apical views were recorded for speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. The presence of coronary artery disease (CAD) was assessed by MSCTA. Strain analysis was performed in 1168 segments [496 in transplant patients (42.5%), 672 in control subjects (57.7%)]. Global longitudinal peak systolic strain was significantly lower in the transplant recipients than in the healthy population (-13.9 ± 4.2 vs. -17.4 ± 5.8%, PSimpsons method) was 60.7 ± 10.1%/60.2 ± 6.7% in transplant recipients vs. 64.7 ± 6.4%/63.0 ± 6.2% in the healthy population, P=ns. Even though 'healthy' heart transplants without CAD exhibit normal ejection fraction, deformation indices are reduced in this population when compared with control subjects. Our findings suggests that strain analysis is more sensitive than assessment of ejection fraction for the detection of abnormalities of systolic function.

  6. Evaluation of impaired left ventricular ejection fraction and increased dimensions by multiple neurohumoral plasma concentrations

    DEFF Research Database (Denmark)

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

    2001-01-01

    failure. METHODS: Forty-eight patients with symptomatic heart failure were examined with blood samples and magnetic resonance imaging along with 20 age and gender-matched normal controls. RESULTS: In multiple regression analyses, BNP was the strongest independent marker for LV end-diastolic (r=0.71, P....0001), and end-systolic (r=0.75, Pr=0.69, Pr=-0.78, Pr=0.76, Pr=0.78, Pr=0.71, P....0001 (ENDO/BNP)], and ALDO for LVEF [r=-0.81, P

  7. 13N-Ammonia pet-derived ventricular synchrony correlates with myocardial perfusion reserve better than left ventricular ejection fraction : A study in infarcted patients

    NARCIS (Netherlands)

    Juarez-Orozco, Luis Eduardo; Slart, Riemer; Tio, Rene A.; Inarra-Talboy, Fernando; Monroy, Andrea; Ayala-German, AnaGabriela; Dierckx, Rudi A.; Rosas, Erick Alexanderson

    2016-01-01

    Background: PET myocardial perfusion allows myocardial perfusion reserve (MPR) quantification as well as left ventricular ejection fraction (LVEF) and synchrony estimation through phase analysis. There is a relationship between MPR and LVEF and both have proven prognostic value in coronary artery

  8. Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Gheorghiade, Mihai; Greene, Stephen J; Butler, Javed

    2015-01-01

    IMPORTANCE: Worsening chronic heart failure (HF) is a major public health problem. OBJECTIVE: To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF). DESIGN, ...

  9. Resting and exercise haemodynamics in relation to six-minute walk test in patients with heart failure and preserved ejection fraction

    DEFF Research Database (Denmark)

    Wolsk, Emil; Kaye, David; Borlaug, Barry A

    2018-01-01

    AIMS: Patients with heart failure and preserved ejection fraction (HFpEF) are characterized by functional impairment and an abnormal haemodynamic response to exercise. The six-minute walk test (6MWT) serves as a standardized test for functional capacity quantification in heart failure patients, a...

  10. Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine Kiilerich; Alhede, Christina; Crowley, Anna Lisa

    2018-01-01

    BACKGROUND: Impaired cardiac function is the main predictor of poor outcome in infective endocarditis (IE). Global longitudinal strain (GLS) derived from two-dimensional strain echocardiography has proven superior in prediction of long-term outcome as compared to left ventricular ejection fraction...

  11. Is cardiac resynchronization therapy an option in heart failure patients with preserved ejection fraction? Justification for the ongoing KaRen project.

    Science.gov (United States)

    Donal, Erwan; Lund, Lars; Linde, Cecilia; Daubert, Jean-Claude

    2010-01-01

    The relevance of electrical and mechanical dyssynchrony has been demonstrated in heart failure with reduced ejection fraction. Preserved ejection fraction is present in as many as 50% of patients with chronic heart failure. Recent small studies suggest that both electrical and mechanical left ventricular dyssynchrony are sometimes present in patients with heart failure and preserved ejection fraction (HFPEF). These data remain controversial and a robust validation of this hypothesis has to be achieved. In the present paper, we review in detail the concepts and try to justify the ongoing KaRen registry. This is a prospective, multicentre, international, observational study to characterize the prevalence of electrical or mechanical dyssynchrony in HFPEF and the resultant effect on prognosis. Patients are enrolled currently at the time of an acute congestive episode. The diagnosis of HFPEF is made according to clinical data, natriuretic peptides and echocardiography for the measurement of ejection fraction. Once stabilized, patients return for a hospital check-up. They undergo clinical and biological evaluation, electrocardiography and Doppler echocardiography. Thereafter, patients are followed every six months, for at least 18 months for mortality, and heart failure-related and non-cardiovascular hospitalizations. KaRen aims to characterize electrical and mechanical dyssynchrony and to assess its prognostic impact in HFPEF. The results may improve our understanding of HFPEF and generate answers to the question of whether or not dyssynchrony could be a target for cardiac resynchronization therapy in HFPEF. Copyright 2010 Elsevier Masson SAS. All rights reserved.

  12. Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method.

    Science.gov (United States)

    Lakatos, Bálint; Tősér, Zoltán; Tokodi, Márton; Doronina, Alexandra; Kosztin, Annamária; Muraru, Denisa; Badano, Luigi P; Kovács, Attila; Merkely, Béla

    2017-03-27

    Three major mechanisms contribute to right ventricular (RV) pump function: (i) shortening of the longitudinal axis with traction of the tricuspid annulus towards the apex; (ii) inward movement of the RV free wall; (iii) bulging of the interventricular septum into the RV and stretching the free wall over the septum. The relative contribution of the aforementioned mechanisms to RV pump function may change in different pathological conditions.Our aim was to develop a custom method to separately assess the extent of longitudinal, radial and anteroposterior displacement of the RV walls and to quantify their relative contribution to global RV ejection fraction using 3D data sets obtained by echocardiography.Accordingly, we decomposed the movement of the exported RV beutel wall in a vertex based manner. The volumes of the beutels accounting for the RV wall motion in only one direction (either longitudinal, radial, or anteroposterior) were calculated at each time frame using the signed tetrahedron method. Then, the relative contribution of the RV wall motion along the three different directions to global RV ejection fraction was calculated either as the ratio of the given direction's ejection fraction to global ejection fraction and as the frame-by-frame RV volume change (∆V/∆t) along the three motion directions.The ReVISION (Right VentrIcular Separate wall motIon quantificatiON) method may contribute to a better understanding of the pathophysiology of RV mechanical adaptations to different loading conditions and diseases.

  13. Fractionation of elements by particle size of ashes ejected from Copahue Volcano, Argentina.

    Science.gov (United States)

    Gómez, Dario; Smichowski, Patricia; Polla, Griselda; Ledesma, Ariel; Resnizky, Sara; Rosa, Susana

    2002-12-01

    The volcano Copahue, Neuquén province, Argentina has shown infrequent explosive eruptions since the 18th century. Recently, eruptive activity and seismicity were registered in the period July-October, 2000. As a consequence, ash clouds were dispersed by winds and affected Caviahue village located at about 9 km east of the volcano. Samples of deposited particles from this area were collected during this episode for their chemical analysis to determine elements of concern with respect to the health of the local population and its environment. Different techniques were used to evaluate the distribution of elements in four particle size ranges from 36 to 300 microm. X-ray powder diffraction (XRD) was selected to detect major components namely, minerals, silicate glass, fragments of rocks and sulfurs. Major and minor elements (Al, Ca, Cl, Fe, K, Mg, Mn, Na, S, Si and Ti), were detected by energy dispersive X ray analysis (EDAX). Trace element (As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, U, V and Zn) content was quantified by inductively coupled plasma-mass spectrometry (ICP-MS). Nuclear activation analysis (NAA) was employed for the determination of Ce, Co, Cs, Eu, Hf, La, Lu, Rb, Sc, Sm, Ta and Yb. An enrichment was observed in the smallest size fraction of volcanic ashes for four elements (As, Cd, Cu and Sb) of particular interest from the environmental and human health point of view.

  14. Measurement of left ventricular ejection fraction from gated technetium-99m sestamibi myocardial images

    International Nuclear Information System (INIS)

    Boonyaprapa, S.; Ekmahachai, M.; Thanachaikun, N.; Jaiprasert, W.; Sukthomya, V.; Poramatikul, N.

    1995-01-01

    Sixty patients underwent SPET imaging with MIBI. Immediately after SPET acquisition ECG-gated 99m Tc-MIBI perfusion images were acquired using 24 planar images per R-R interval. A new method for measurement of LVEF from the ECG-gated 99m Tc-MIBI perfusion images was developed. To validate the method, LVEF derived from MIBI perfusion images was compared with that from conventional radionuclide ventriculography in all 60 patients. Forty patients had evidence of myocardial infarction and 20 had normal perfusion on MIBI imaging. There was no statistically significant difference between LVEF computed from 99m Tc-MIBI perfusion images and that from radionuclide ventriculography (r=0.7062, P 99m Tc-MIBI perfusion images can be obtained at the same time as assessment of myocardial perfusion and in the same orientation and metabolism of the myocardium, thereby permitting more accurate and realistic prognosis and diagnosis in patients with coronary artery disease. (orig.)

  15. Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study.

    Science.gov (United States)

    Donal, Erwan; Lund, Lars H; Oger, Emmanuel; Hage, Camilla; Persson, Hans; Reynaud, Amélie; Ennezat, Pierre-Vladimir; Bauer, Fabrice; Sportouch-Dukhan, Catherine; Drouet, Elodie; Daubert, Jean-Claude; Linde, Cecilia

    2014-02-01

    Karolinska Rennes (KaRen) is a prospective observational study to characterize heart failure patients with preserved ejection fraction (HFpEF) and to identify prognostic factors for long-term mortality and morbidity. To report characteristics and echocardiography at entry and after 4-8 weeks of follow-up. Patients were included following an acute heart failure presentation with B-type natriuretic peptide (BNP)>100 ng/L or N-terminal pro-BNP (NT-proBNP)>300 ng/L and left ventricular ejection fraction (LVEF)>45%. The mean ± SD age of 539 included patients was 77 ± 9 years and 56% were women. Patient history included hypertension (78%), atrial tachyarrhythmia (44%), prior heart failure (40%) and anemia (37%), but left bundle branch block was rare (3.8%). Median NT-proBNP was 2448 ng/L (n=438), and median BNP 429 ng/L (n=101). Overall, 101 patients did not return for the follow-up visit, including 13 patients who died (2.4%). Apart from older age (80 ± 9 vs. 76 ± 9 years; P=0.006), there were no significant differences in baseline characteristics between patients who did and did not return for follow-up. Mean LVEF was lower at entry than follow-up (56% vs. 62%; P<0.001). At follow-up, mean E/e' was 12.9 ± 6.1, left atrial volume index 49.4±17.8mL/m(2). Mean global left ventricular longitudinal strain was -14.6 ± 3.9%; LV mass index was 126.6 ± 36.2g/m(2). Patients in KaRen were old with slight female dominance and hypertension as the most prevalent etiological factor. LVEF was preserved, but with increased LV mass and depressed LV diastolic and longitudinal systolic functions. Few patients had signs of electrical dyssynchrony (ClinicalTrials.gov.- NCT00774709). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Agreement of left ventricular ejection fraction and volumes between adenosine stress TL-201 gated SPECT and echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Pai, M. S. [College of Medicine, Univ. of Ewha, Seoul (Korea, Republic of); Moon, D. H.; Kim, H. M.; Yang, Y. J.; Kang, D. H. [Asan Medical Center, Seoul (Korea, Republic of)

    2003-07-01

    Electrocardiogram-gated TI-201 SPECT measurements of left ventricular ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) have shown high correlation with conventional methods. However, how much these parameters measured by TI-201 gated SPECT differ from those by echocardiography has not been assessed. Adenosine stress (Ad-G) and redistribution TI-201 gated SPECT (Re-G) and resting echocardiography were conducted in 337 patients (184 male, 153 female). EDV, ESV and LVEF measured by QGS software were compared with the results by echocardiography. Patients with arrhythmia (atrial fibrillation or frequent premature contractions) or evidence of fixed or reversible perfusion defects on TI-201 SPECT were excluded. EF, EDV and ESV measured by Ad-G (63.3{+-}9.8,73.8{+-}30.2,29.1{+-}20.1) and Re-G (65.2{+-}11.6,69.1{+-}30.1,26.5{+-}20.3) correlated well with those by Echo (61.4{+-}7.9,78.3{+-}2.7, 30.7{+-} 17.5 ; r of Ad-G=0.547, 0.850, 0.827, p<0.001 ; r of Re-G=0.585, 0.838, 0.819, p<0.001). However the difference (mean, SD, SEE of Echo - gated SPECT) was statistically significant (EF: Ad-G=1.71, 8.92, 0.48, Re-G=3.59, 10.39, 0.56, p<0.001 ; EDV: Ad-G=4.75, 16.21, 0.88, Re-G=9.53, 16.77, 0.91, p<0.001 ; ESV: Ad-G=1.75, 11.35, 0.61, p<0.05, Re-G=4.29, 11.7, 0.63, p<0.001). Bland-Altman plots showed that the difference of EDV and ESV did not vary in any systematic way over the range of measurement, whereas the difference of EF increased with increasing average EF by Echo and gated-SPECT. The difference of EF, EDV, and ESV between Ad-G and Echo was significantly smaller than those between Re-G and Echo (p<0.001). Gated TI-201 SPECT underestimates EDV and ESV over a wide range of volume. As a result, EF by gated TI-201 SPECT is overestimated especially in patients with small LV volume. Ad-G is preferable to Re-G in assessing left ventricular ejection fraction and volume in place of Echo because of smaller bias.

  17. Cardiac lipid content is unresponsive to a physical activity training intervention in type 2 diabetic patients, despite improved ejection fraction

    Directory of Open Access Journals (Sweden)

    Leiner Tim

    2011-05-01

    Full Text Available Abstract Background Increased cardiac lipid content has been associated with diabetic cardiomyopathy. We recently showed that cardiac lipid content is reduced after 12 weeks of physical activity training in healthy overweight subjects. The beneficial effect of exercise training on cardiovascular risk is well established and the decrease in cardiac lipid content with exercise training in healthy overweight subjects was accompanied by improved ejection fraction. It is yet unclear whether diabetic patients respond similarly to physical activity training and whether a lowered lipid content in the heart is necessary for improvements in cardiac function. Here, we investigated whether exercise training is able to lower cardiac lipid content and improve cardiac function in type 2 diabetic patients. Methods Eleven overweight-to-obese male patients with type 2 diabetes mellitus (age: 58.4 ± 0.9 years, BMI: 29.9 ± 0.01 kg/m2 followed a 12-week training program (combination endurance/strength training, three sessions/week. Before and after training, maximal whole body oxygen uptake (VO2max and insulin sensitivity (by hyperinsulinemic, euglycemic clamp was determined. Systolic function was determined under resting conditions by CINE-MRI and cardiac lipid content in the septum of the heart by Proton Magnetic Resonance Spectroscopy. Results VO2max increased (from 27.1 ± 1.5 to 30.1 ± 1.6 ml/min/kg, p = 0.001 and insulin sensitivity improved upon training (insulin stimulated glucose disposal (delta Rd of glucose improved from 5.8 ± 1.9 to 10.3 ± 2.0 μmol/kg/min, p = 0.02. Left-ventricular ejection fraction improved after training (from 50.5 ± 2.0 to 55.6 ± 1.5%, p = 0.01 as well as cardiac index and cardiac output. Unexpectedly, cardiac lipid content in the septum remained unchanged (from 0.80 ± 0.22% to 0.95 ± 0.21%, p = 0.15. Conclusions Twelve weeks of progressive endurance/strength training was effective in improving VO2max, insulin sensitivity

  18. Copeptin in patients with heart failure and preserved ejection fraction: a report from the prospective KaRen-study.

    Science.gov (United States)

    Hage, Camilla; Lund, Lars H; Donal, Erwan; Daubert, Jean-Claude; Linde, Cecilia; Mellbin, Linda

    2015-01-01

    Underlying mechanisms of heart failure (HF) with preserved ejection fraction (HFPEF) remain unknown. We explored copeptin, a biomarker of the arginine vasopressin system, hypothesising that copeptin in HFPEF is elevated, associated with diastolic dysfunction and N-terminal pro-brain natriuretic peptide (NT-proBNP) and predictive of HF hospitalisation and mortality. In a prospective observational substudy of the The Karolinska Rennes (KaRen) 86 patients with symptoms of acute HF and ejection fraction (EF) ≥45% were enrolled. After 4-8 weeks, blood sampling and echocardiography was performed. Plasma-copeptin was analysed in 86 patients and 62 healthy controls. Patients were followed in median 579 days (quartile 1; quartile 3 (Q1;Q3) 276;1178) regarding the composite end point all-cause mortality or HF hospitalisation. The patients with HFPEF had higher copeptin levels, median 13.56 pmol/L (Q1;Q3 8.56;20.55) than controls 5.98 pmol/L (4.15;9.42; p<0.001). Diastolic dysfunction, assessable in 75/86 patients, was present in 45 and absent in 30 patients. Copeptin did not differ regarding diastolic dysfunction and did not correlate with cardiac function but with NT-proBNP (r=0.223; p value=0.040). In univariate Cox regression analysis log copeptin predicted the composite end point (HR 1.56 (95% CI 1.03 to 2.38; p value=0.037)) but not after adjusting for NT-proBNP (HR 1.39 (95% CI 0.91 to 2.12; p value=0.125)). In the present patients with HFPEF, copeptin is elevated, correlates with NT-proBNP but not markers of diastolic dysfunction, and has prognostic implications, however blunted after adjustment for NT-proBNP. The HFPEF pathophysiology may be better reflected by markers of neurohormonal activation than by diastolic dysfunction. ClinicalTrials.gov NCT00774709.

  19. Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study.

    Science.gov (United States)

    Donal, Erwan; Lund, Lars H; Oger, Emmanuel; Reynaud, Amélie; Schnell, Frédéric; Persson, Hans; Drouet, Elodie; Linde, Cecilia; Daubert, Claude

    2016-01-01

    KaRen is a multicentre study designed to characterize and follow patients with heart failure and preserved ejection fraction (HFpEF). In a subgroup of patients with clinical signs of congestion but left ventricular ejection fraction (LVEF) >45%, we sought to describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. Exercise-induced changes in echo parameters might improve our ability to characterize HFpEF patients. Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT-pro-BNP >300 pg/mL (BNP > 100 pg/mL) and LVEF > 45% and reassessed by exercise echo-Doppler after 4-8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow-up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty-six patients (43%) died or were hospitalized for HF (primary outcome). The mean ± SD workload was 45 ± 14 watts (W). Mean ± SD resting LVEF and LV global longitudinal strain was 57.6 ± 9.5% and -14.5 ± 4.2%, respectively. Mean ± SD resting E/e' was 11.3 ± 4.7 and 13.1 ± 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P = 0.03). Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 ± 0.5 and 3.7 ± 0.5 m/s (P = 0.01). Exercise TR was independently associated with HF-hospitalization or death after adjustment on baseline clinical and biological characteristics. Exercise echocardiography may contribute to identify HFpEF patients and especially high-risk ones. Our study suggested a prognostic value of TR recorded during an exercise. That was demonstrated independently of the value of resting E/e'. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions

  20. Comparison of Causes of Death After Heart Transplantation in Patients With Left Ventricular Ejection Fractions ≤35% Versus >35.

    Science.gov (United States)

    Birati, Edo Y; Mathelier, Hansie; Molina, Maria; Hanff, Thomas C; Mazurek, Jeremy A; Atluri, Pavan; Acker, Michael A; Rame, J Eduardo; Margulies, Kenneth B; Goldberg, Lee R; Jessup, Mariell

    2016-04-15

    Sudden cardiac death (SCD) is a common cause of death in the general population, occurring in 300,000 to 350,000 people in the United States alone. Currently, there are no data supporting implantable cardioverter-defibrillator therapy in patients who underwent orthotopic heart transplant (OHT) with low left ventricular ejection fraction (LVEF). In this retrospective study, we included all patients who underwent primary OHT at our institution from 2007 to 2013. We compared the cause of death in patients who underwent OHT and evaluated the correlation of the cause of death and the patients' LVEF. Our objectives were to determine whether patients who underwent OHT with LVEF 6 months after OHT. Surviving patients had higher LVEF compared with deceased patients (64 ± 7% and 50 ± 24%, respectively, p ≤0.001). In all, 10 (25%) of the deceased patients died suddenly, 9 (23%) from sepsis, and 8 (20%) from malignancy. Of the 11 deceased patients with LVEF ≤35%, 2 patients (18%) died suddenly compared with 9 SCDs among the 29 deceased patients (31%) with LVEF >35% (p = 0.54). In conclusion, patients who underwent OHT who died were more likely to have LVEF <35%, and a quarter of the deceased patients who underwent OHT died suddenly. A reduced LVEF was not associated with an increased risk of SCD. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Automated determination of the right ventricular ejection fraction by digital processing of sup(81m)Kr scintigrams

    International Nuclear Information System (INIS)

    Elfner, R.; Vaknine, R.; Knapp, W.H.; Tillmanns, H.; Lorenz, W.J.

    1986-01-01

    A method is presented for the automated determination of the right ventricular ejection fraction (RVEF) by digital image processing of scintigrams obtained by intravenous infusion of Krypton 81m (sup(81m)Kr) dissolved in a glucose solution. End-diastolic and end-systolic sum pictures were computed by the addition of approximately 30-40 frames selected from the time-activity curve of a preliminary, manually drawn, right ventricular region of interest. After processing these two images with an adaptive Wiener filter, the right ventricular contour was determined by a recently developed algorithm using morphological and functional criteria. The RVEF was calculated for a series of 51 patients from the counts in the detected right ventricular regions in the end-diastolic and end-systolic sum images. In 16 patients without evidence of cardiopulmonary disease, the mean RVEF was 50+-6.1%. RVEF was significantly reduced in 18 patients with obstructive pulmonary disease (42+-6.5%) and in 17 patients with congestive cardiomyopathy (36+-7.1%). The correlation coefficient between two determinations of the RVEF was r=0.94. Through digital image processing, the determination of the RVEF by radioventriculography with sup(81m)Kr showed high reliability and reproducibility. (orig.)

  2. Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction

    International Nuclear Information System (INIS)

    Małek, Łukasz A.; Śpiewak, Mateusz; Kłopotowski, Mariusz; Petryka, Joanna; Mazurkiewicz, Łukasz; Kruk, Mariusz; Kępka, Cezary; Miśko, Jolanta; Rużyłło, Witold; Witkowski, Adam

    2012-01-01

    Background: Left ventricular hypertrophy (LVH) predisposes to larger infarct size, which may be underestimated by the left ventricular ejection fraction (LVEF) due to supranormal systolic performance often present in patients with LVH. The aim of the study was to compare infarct size and LVEF in patients with ST-segment elevation myocardial infarction (STEMI) and increased left ventricular mass on cardiac magnetic resonance (CMR). Methods: The study included unselected group of 52 patients (61 ± 11 years, 69% male) with first STEMI who had CMR after median 5 days from the onset of the event. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index exceeding 95th percentile of references values for age and gender. Infarct size was assessed with means of late gadolinium enhancement (LGE). Results: LVH was found in 16 patients (31%). In comparison to the rest of the group, patients with LVH had higher absolute and relative infarct mass (p = 0.002 and p = 0.02, respectively). LVH was related to higher prevalence of microvascular obstruction and myocardial haemorrhage and higher number of LV segments with transmural necrosis (p = 0.02, p = 0.01 and p = 0.01, respectively). Despite marked difference in the infarct size between both studied subgroups there was no difference in LVEF and mean number of dysfunctional LV segments. Conclusions: Patients with LVH undergoing STEMI have larger infarct size underestimated by the LV systolic performance in comparison to patients without LVH.

  3. Diagnostic and Prognostic Value of CMR T1-Mapping in Patients With Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Rommel, Karl-Philipp; Lücke, Christian; Lurz, Philipp

    2017-10-01

    Heart failure with preserved ejection fraction (HFpEF) presents a major challenge in modern cardiology. Although this syndrome is of increasing prevalence and is associated with unfavorable outcomes, treatment trials have failed to establish effective therapies. Currently, solutions to this dilemma are being investigated, including categorizing and characterizing patients more diversely to individualize treatment. In this regard, new imaging techniques might provide important information. Diastolic dysfunction is a diagnostic and pathophysiological cornerstone in HFpEF and is believed to be caused by systemic inflammation with the development of interstitial myocardial fibrosis and myocardial stiffening. Cardiac magnetic resonance (CMR) T 1 -mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. This review provides an overview of the potential of myocardial tissue characterization with CMR T 1 mapping in HFpEF patients, outlining its diagnostic and prognostic implications and discussing future directions. We conclude that CMR T 1 mapping is potentially an effective tool for patient characterization in large-scale epidemiological, diagnostic, and therapeutic HFpEF trials beyond traditional imaging parameters. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. The effect of varying the acquisition angle on processing and ejection fractions in gated blood pool studies

    International Nuclear Information System (INIS)

    Hughes, K.; Schults, C.G.; Trinh, T.

    2002-01-01

    Full text: Suboptimal ventricular definition has been blamed for difficulties in processing and variations in Ejection Fraction (EF). Clinical patients had Gated Blood Pool Studies (GBPS) performed by one of two operators, ensuring good left ventricular separation and definition. With patient consent, another study was acquired with the camera angle altered in the caudal or septal plane. Using GE Entegra GBPS Software, which allows some operator involvement in modifying the automated systolic and diastolic regions, the studies were analysed by eight 'blinded' technologists. Analyses of optimal and suboptimal acquisitions were compared. The mean, standard deviation (SD) and coefficient of variation (CV%) were determined for each patient's set of EFs. There was no significant difference in the means of the optimal and suboptimal groups (61.2% and 61.7%). One third of the suboptimal studies acquired gave a mean EF that differed by more than 5% from the Optimal' mean. The average CV of all analyses was 4.5%. The optima] group CV 4.7% (septal 4.6%/caudal 4.8%) and the suboptimal group CV 4.3% (septal 4.5%/caudal 4.2%). The analysis demonstrates that precision of processing GBPS is not affected when the study is acquired at a suboptimal angle. Although most EF results are reliable when acquired at a suboptimal angle, approximately one third will produce an EF that varies from the optimal result by more than 5%. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  5. Advances in the pharmacotherapy of chronic heart failure with preserved ejection fraction: an ideal opportunity for precision medicine.

    Science.gov (United States)

    Polsinelli, Vincenzo B; Shah, Sanjiv J

    2017-03-01

    Heart failure with preserved ejection fraction (HFpEF), which comprises approximately 50% of all heart failure patients, is a challenging and complex clinical syndrome that is often thought to lack effective treatments. Areas covered: Despite the common mantra that HFpEF has no effective treatments, closer inspection of HFpEF clinical trials reveals that several of the drugs tested are associated with benefits in exercise capacity and quality of life, and reduction in heart failure hospitalization. Here we review major randomized controlled trials in HFpEF, focusing on renin-angiotensin-aldosterone system antagonists, organic nitrates, digoxin, beta-blockers, and phosphodiesterase-5 inhibitors. In addition, we review several classes of drugs currently in development for HFpEF such as neprilysin inhibitors, inorganic nitrates (nitrites), and soluble guanylate cyclase stimulators. Expert opinion: HFpEF should not be viewed as lacking effective treatments. While there have been no breakthrough clinical trials showing a reduction in mortality, several existing medications are likely to benefit specific subgroups of HFpEF patients. HFpEF is now well known to be a heterogeneous syndrome; thus, the clinical management of HFpEF patients and future HFpEF clinical trials will both likely require a nuanced, phenotype-specific approach instead of a one-size-fits-all tactic. Drug development for HFpEF therefore represents an exciting opportunity for personalized medicine.

  6. Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Bosch, Xavier; Théroux, Pierre

    2005-08-01

    Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommended stratifiers. Several predictors of inhospital mortality were prospectively characterized in a registry study of 1104 consecutive patients, for whom an EF was determined, who were admitted for an ACS. Multiple regression models were constructed using currently recommended clinical, electrocardiographic, and blood marker stratifiers, and values of EF were incorporated into the models. Age, ST-segment shifts, elevation of cardiac markers, and the Thrombolysis in Myocardial Infarction (TIMI) risk score all predicted mortality (P model improved the prediction of mortality (C statistic 0.73 vs 0.67). The odds of death increased by a factor of 1.042 for each 1% decrement in EF. By receiver operating curves, an EF cutoff of 48% provided the best predictive value. Mortality rates were 3.3 times higher within each TIMI risk score stratum in patients with an EF of 48% or lower as compared with those with higher. The TIMI risk score predicts inhospital mortality in a broad population of patients with ACS. The further consideration of EF adds significant prognostic information.

  7. Analysis of blood pressure signal in patients with different ventricular ejection fraction using linear and non-linear methods.

    Science.gov (United States)

    Arcentales, Andres; Rivera, Patricio; Caminal, Pere; Voss, Andreas; Bayes-Genis, Antonio; Giraldo, Beatriz F

    2016-08-01

    Changes in the left ventricle function produce alternans in the hemodynamic and electric behavior of the cardiovascular system. A total of 49 cardiomyopathy patients have been studied based on the blood pressure signal (BP), and were classified according to the left ventricular ejection fraction (LVEF) in low risk (LR: LVEF>35%, 17 patients) and high risk (HR: LVEF≤35, 32 patients) groups. We propose to characterize these patients using a linear and a nonlinear methods, based on the spectral estimation and the recurrence plot, respectively. From BP signal, we extracted each systolic time interval (STI), upward systolic slope (BPsl), and the difference between systolic and diastolic BP, defined as pulse pressure (PP). After, the best subset of parameters were obtained through the sequential feature selection (SFS) method. According to the results, the best classification was obtained using a combination of linear and nonlinear features from STI and PP parameters. For STI, the best combination was obtained considering the frequency peak and the diagonal structures of RP, with an area under the curve (AUC) of 79%. The same results were obtained when comparing PP values. Consequently, the use of combined linear and nonlinear parameters could improve the risk stratification of cardiomyopathy patients.

  8. The Benefits of Exercise Training on Aerobic Capacity in Patients with Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    do Prado, Danilo Marcelo Leite; Rocco, Enéas Antônio

    2017-01-01

    Heart failure with preserved ejection fraction (HFpEF) is defined as an inability of the ventricles to optimally accept blood from atria with blunted end- diastolic volume response by limiting the stroke volume and cardiac output. The HEpEF prevalence is higher in elderly and women and may be associated to hypertension, diabetes mellitus and atrial fibrillation. Severe exercise intolerance, manifested by dyspnea and fatigue during physical effort is the important chronic symptom in HFpEF patients, in which is the major determinant of their reduced quality of life. In this sense, several studies demonstrated reduced aerobic capacity in terms of lower peak oxygen consumption (peak VO 2 ) in patients with HFpEF. In addition, the lower aerobic capacity observed in HFpEF may be due to impaired both convective and diffusive O 2 transport (i.e. reduced cardiac output and arteriovenous oxygen difference, respectively).Exercise training program can help restore physiological function in order to increase aerobic capacity and improve the quality of life in HFpEF patients. Therefore, the primary purpose of this chapter was to clarify the physiological mechanisms associated with reduced aerobic capacity in HFpEF patients. Secondly, special focus was devoted to show how aerobic exercise training can improve aerobic capacity and quality of life in HFpEF patients.

  9. Cardiac Involvement in Myotonic Dystrophy Type 2 Patients With Preserved Ejection Fraction: Detection by Cardiovascular Magnetic Resonance.

    Science.gov (United States)

    Schmacht, Luisa; Traber, Julius; Grieben, Ulrike; Utz, Wolfgang; Dieringer, Matthias A; Kellman, Peter; Blaszczyk, Edyta; von Knobelsdorff-Brenkenhoff, Florian; Spuler, Simone; Schulz-Menger, Jeanette

    2016-07-01

    Myotonic dystrophy type 2 (DM2) is a genetic disorder characterized by skeletal muscle symptoms, metabolic changes, and cardiac involvement. Histopathologic alterations of the skeletal muscle include fibrosis and fatty infiltration. The aim of this study was to investigate whether subclinical cardiac involvement in DM2 is already detectable in preserved left ventricular function by cardiovascular magnetic resonance. Twenty-seven patients (mean age, 54±10 years; 20 females) with a genetically confirmed diagnosis of DM2 were compared with 17 healthy age- and sex-matched controls using a 1.5 T magnetic resonance imaging. For myocardial tissue differentiation, T1 and T2 mapping, fat/water-separated imaging, focal fibrosis imaging (late gadolinium enhancement [LGE]), and (1)H magnetic resonance spectroscopy were performed. Extracellular volume fraction was calculated. Conduction abnormalities were diagnosed based on Groh criteria. LGE located subepicardial basal inferolateral was detectable in 22% of the patients. Extracellular volume was increased in this region and in the adjacent medial inferolateral segment (P=0.03 compared with healthy controls). In 21% of patients with DM2, fat deposits were detectable (all women). The control group showed no abnormalities. Myocardial triglycerides were not different in LGE-positive and LGE-negative subjects (P=0.47). Six patients had indicators for conduction disease (60% of LGE-positive patients and 12.5% of LGE-negative patients). In DM2, subclinical myocardial injury was already detectable in preserved left ventricular ejection fraction. Extracellular volume was also increased in regions with no focal fibrosis. Myocardial fibrosis was related to conduction abnormalities. © 2016 American Heart Association, Inc.

  10. [Surgical revascularisation of the heart in patients with chronic ischaemic cardiomyopathy and leftventricular ejection fraction of less than 30%].

    Science.gov (United States)

    Velinović, Milos; Kocica, Mladen; Vranes, Mile; Mikić, Aleksandar; Vukomanović, Vlada; Davidović, Lazar; Obrenović-Krićanski, Biljana; Cvetkovic, Slobodan; Soski, Ljiljana; Ristić, Arsen D

    2005-01-01

    Patients suffering from chronic ischaemic cardiomyopathy and left ventricular ejection fraction (LVEF) lower than 30% represent a difficult and controversial population for surgical treatment. The aim of this study was to evaluate the effects of surgical treatment on the early and long-term outcome of these patients. The patient population comprised 50 patients with LVEF < 30% (78% male, mean age: 58.3 years, range: 42-75 years) who underwent surgical myocardial revascularisation during the period 1995-2000. Patients with left ventricular aneurysms or mitral valve insufficiency were excluded from the study. The following echocardiography parameters were evaluated as possible prognostic indicators: LVEF, fraction of shortening (FS), left ventricular systolic and diastolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESV), as well as their indexed values (LVESVI). Fifteen patients (30%) died during the follow-up, 2/50 intraoperatively (4%). The presence of diabetes mellitus, previous myocardial infarction, main left coronary artery disease, and three-vessel disease, correlated significantly with the surgical outcomes. The patient's age, family history, smoking habits, hypertension, hyperlipidaemia, history of stroke, peripheral vascular disease, and renal failure, did not correlate with the mortality rate. A comparison of preoperative echocardiography parameters between survivors and non-survivors revealed significantly divergent LVEF, LVEDD, LVESD, LVEDV, LVESV, and LVESVI values. Preoperative LVESVI offered the highest predictive value (R = 0.595). Diabetes mellitus, history of myocardial infarction, stenosis of the main branch, and three-vessel disease, significantly affected the perioperative and long-term outcome of surgical revascularisation in patients with ischaemic cardiomyopathy and LVEF < 30%. In survivors, LVEF, FS, and systolic and diastolic echocardiography parameters, as well as their indexed values, significantly improved after surgical

  11. Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Dona, Manjola; Massi, Lucia; Settimo, Leonardo; Bartolini, Matteo; Gianni, Gianluca; Pupi, Alberto; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy)

    2011-03-15

    The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. We prospectively enrolled 57 consecutive patients with post-stress EF drop {>=} 5 EF units and summed difference score (SDS) {<=} 1. They were followed up for more than 1 year and their outcome was compared with a group of sex- and age-matched controls with the same SDS but without EF decrease. During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p < 0.0001) between the event-free survival curves of the two groups. The event rate of patients with post-stress EF decrease {>=} 5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted. (orig.)

  12. A Global Assessment of Circulating Prolysyl Oxidase in Nonischemic Patients With Garden-variety Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Muñoz Calvo, Benjamín; Villa Martínez, Ana; López Orgil, Susana; López Andrés, Natalia; Román García, Feliciano; Víctor Palomares, Virginia; de la Calle de la Villa, Esther; Nadador Patiño, Verónica; Arribas-Gómez, Ignacio

    2018-05-25

    Lysyl oxidase is overexpressed in the myocardium of patients with hypertensive cardiomyopathy. We aimed to explore whether patients with hypertensive-metabolic heart failure with preserved ejection fraction (HM-HFpEF) also have increased concentrations of circulating prolysyl oxidase (cpLOX) and its possible consequences. We quantified cpLOX concentrations in 85 nonischemic patients with stage C, HM-HFpEF, and compared them with those of 51 healthy controls. We also assessed the correlations of cpLOX with myocardial stiffness parameters, collagen turnover products and fibrogenic cytokines, as well as the predictive value of plasma proenzyme levels at 1-year of follow-up. We detected raised cpLOX values and found that they correlated with calculated E/E' ratios and stiffness constants. The subgroup of patients with type I diastolic dysfunction showed a single negative correlation between cpLOX and B-type natriuretic peptide whereas patients with a restrictive diastolic pattern showed a strong correlation between cpLOX and galectin-3. Kaplan-Meier analysis revealed that cpLOX > 52.20 ng/mL slightly increased the risk of a fatal outcome (log-rank = 4.45; P = .034). When Cox regression was used, cpLOX was found to be a significant independent predictor of cardiovascular death or hospitalization due to the decompensation of HM-HFpEF (HR, 1.360; 95%CI, 1.126-1.638; P = .046). Patients with symptomatic HM-HFpEF show high cpLOX serum levels associated with restrictive diastolic filling indices. These levels represent a moderate risk factor for poor clinical outcome. Throughout the natural history of HM-HFpEF, we observed that cpLOX concentrations were initially negatively correlated with B-type natriuretic peptide but positively correlated with galectin-3 as advanced diastolic dysfunction developed. Copyright © 2018. Published by Elsevier España, S.L.U.

  13. Long-term and clinical profile of heart failure with recovered ejection fraction in a non-tertiary hospital.

    Science.gov (United States)

    Martínez-Mateo, Virgilio; Fernández-Anguita, Manuel; Cejudo, Laura; Martín-Barrios, Eugenia; Paule, Antonio J

    2018-06-05

    Heart failure (HF) with recovered ejection fraction (EF) is emerging as a different HF subtype. There is little information about his clinical profile in hospitals that are not a reference. We analysed characteristics and prognosis in patients with recovered HF followed prospectively in the HF Unit of a non-tertiary hospital. A total of 431 patients with HF with reduced EF were followed (median 50 months, 79.3% males, mean age 70.3±12.2years). Of the patients, 26.9% (N 116) recovered EF, mainly in the first year of follow-up (76.7%). Compared with patients that did not recovered EF in the follow-up, they were younger, rate of ischemic origin of cardiomyopathy was less frequent and presented less comorbidity. Mortality was lower in patients with recovered HF (survival median of 85.2±2.1 vs. 74.2±1.9 months [log-rank χ 2 11.5, P=0.001], hazard ratio 0.37, 95% confidence interval [CI]: 0.21-0.67, P=0.002). Aetiology of deaths was not mainly secondary to HF. Younger age of 68 years (odds ratio [OR] 0-98, 95% CI: 0.96-0,99; P=0.025), ischemic origin (OR 1.12, 95% CI: 1.01-1.21; P=0.003) and use of aldosterone antagonists (OR 1.89, 95% CI: 1.09-3.26; P=0.023) were the variables independently associated to normalisation of EF. HF with recovered EF is a frequent phenomenon. It has a more favourable clinical course, prognosis and basal characteristics than HF with persistent reduced EF. Further studies are needed to identify natural history and optimal medications for HF-recovered patients. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  14. Ejection fraction in myocardial perfusion imaging assessed with a dynamic phantom: comparison between IQ-SPECT and LEHR.

    Science.gov (United States)

    Hippeläinen, Eero; Mäkelä, Teemu; Kaasalainen, Touko; Kaleva, Erna

    2017-12-01

    Developments in single photon emission tomography instrumentation and reconstruction methods present a potential for decreasing acquisition times. One of such recent options for myocardial perfusion imaging (MPI) is IQ-SPECT. This study was motivated by the inconsistency in the reported ejection fraction (EF) and left ventricular (LV) volume results between IQ-SPECT and more conventional low-energy high-resolution (LEHR) collimation protocols. IQ-SPECT and LEHR quantitative results were compared while the equivalent number of iterations (EI) was varied. The end-diastolic (EDV) and end-systolic volumes (ESV) and the derived EF values were investigated. A dynamic heart phantom was used to produce repeatable ESVs, EDVs and EFs. Phantom performance was verified by comparing the set EF values to those measured from a gated multi-slice X-ray computed tomography (CT) scan (EF True ). The phantom with an EF setting of 45, 55, 65 and 70% was imaged with both IQ-SPECT and LEHR protocols. The data were reconstructed with different EI, and two commonly used clinical myocardium delineation software were used to evaluate the LV volumes. The CT verification showed that the phantom EF settings were repeatable and accurate with the EF True being within 1% point from the manufacture's nominal value. Depending on EI both MPI protocols can be made to produce correct EF estimates, but IQ-SPECT protocol produced on average 41 and 42% smaller EDV and ESV when compared to the phantom's volumes, while LEHR protocol underestimated volumes by 24 and 21%, respectively. The volume results were largely similar between the delineation methods used. The reconstruction parameters can greatly affect the volume estimates obtained from perfusion studies. IQ-SPECT produces systematically smaller LV volumes than the conventional LEHR MPI protocol. The volume estimates are also software dependent.

  15. Validation of Left Ventricular Ejection Fraction with the IQ•SPECT System in Small-Heart Patients.

    Science.gov (United States)

    Yoneyama, Hiroto; Shibutani, Takayuki; Konishi, Takahiro; Mizutani, Asuka; Hashimoto, Ryosuke; Onoguchi, Masahisa; Okuda, Koichi; Matsuo, Shinro; Nakajima, Kenichi; Kinuya, Seigo

    2017-09-01

    The IQ•SPECT system, which is equipped with multifocal collimators ( SMART ZOOM) and uses ordered-subset conjugate gradient minimization as the reconstruction algorithm, reduces the acquisition time of myocardial perfusion imaging compared with conventional SPECT systems equipped with low-energy high-resolution collimators. We compared the IQ•SPECT system with a conventional SPECT system for estimating left ventricular ejection fraction (LVEF) in patients with a small heart (end-systolic volume IQ•SPECT. End-systolic volume, end-diastolic volume, and LVEF were calculated using quantitative gated SPECT (QGS) and cardioREPO software. We compared the LVEF from gated myocardial perfusion SPECT to that from echocardiographic measurements. Results: End-diastolic volume, end-systolic volume, and LVEF as obtained from conventional SPECT, IQ•SPECT, and echocardiography showed a good to excellent correlation regardless of whether they were calculated using QGS or using cardioREPO. Although LVEF calculated using QGS significantly differed between conventional SPECT and IQ•SPECT (65.4% ± 13.8% vs. 68.4% ± 15.2%) ( P = 0.0002), LVEF calculated using cardioREPO did not (69.5% ± 10.6% vs. 69.5% ± 11.0%). Likewise, although LVEF calculated using QGS significantly differed between conventional SPECT and IQ•SPECT (75.0 ± 9.6 vs. 79.5 ± 8.3) ( P = 0.0005), LVEF calculated using cardioREPO did not (72.3% ± 9.0% vs. 74.3% ± 8.3%). Conclusion: In small-heart patients, the difference in LVEF between IQ•SPECT and conventional SPECT was less when calculated using cardioREPO than when calculated using QGS. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  16. Medicare Expenditures by Race/Ethnicity After Hospitalization for Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Ziaeian, Boback; Heidenreich, Paul A; Xu, Haolin; DeVore, Adam D; Matsouaka, Roland A; Hernandez, Adrian F; Bhatt, Deepak L; Yancy, Clyde W; Fonarow, Gregg C

    2018-05-01

    The purpose of this study was to analyze cumulative Medicare expenditures at index admission and after discharge by race or ethnicity. Heart failure with preserved ejection fraction (HFpEF) is a growing proportion of heart failure (HF) admissions. Research on health care expenditures for patients with HFpEF is limited. Records of patients discharged from the Get With The Guidelines-Heart Failure registry between 2006 and 2014 were linked to Medicare data. The primary outcome was unadjusted payments for acute care services. Comparisons between race/ethnic groups were made using generalized linear mixed models. Cost ratios were reported by race/ethnicity, and adjustments were made sequentially for patient characteristics, hospital factors, and regional socioeconomic status. Median Medicare costs for index hospitalizations were $7,241 for the entire cohort, $7,049 for whites, $8,269 for blacks, $8,808 for Hispanics, $8,477 for Asians, and $8,963 for other races. Median costs at 30 days for readmitted patients were $9,803 and $17,456 for the entire cohort at 1-year. No significant differences were seen in index admission cost ratios by race/ethnicity. At 30 days among readmitted patients, costs were 9% higher (95% confidence interval [CI]: 1% to 17%; p = 0.020) for blacks in the fully adjusted model than whites. At 1 year, costs were 14% higher (95% CI: 9% to 18%; p expenditures were noted. Minority patients with HFpEF have greater acute care service costs. Further research of improving care delivery is needed to reduce acute care use for vulnerable populations. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Sacubitril/valsartan for heart failure with reduced left ventricular ejection fraction : A retrospective cohort study.

    Science.gov (United States)

    De Vecchis, R; Ariano, C; Di Biase, G; Noutsias, M

    2018-01-19

    The combination drug sacubitril/valsartan was reported to be superior to enalapril in reducing all-cause death, cardiovascular mortality, and heart failure (HF) hospitalizations in patients with cardiac insufficiency and reduced left ventricular ejection fraction (HFREF) with NYHA class II-IV. Our retrospective cohort study aimed to assess the effects of sacubitril/valsartan in addition to a beta-blocker and mineral receptor antagonist (MRA) in a group of HFREF patients with NYHA class II-III HF vs. conventional therapy (ACE inhibitor or angiotensin II receptor blocker added to a beta-blocker plus an MRA) administered to a control group of HFREF patients with comparable clinical features. In both groups, treatment was supplemented by a loop diuretic, usually furosemide, at variable doses. The primary outcomes were all-cause death and HF hospitalizations. Safety outcomes were symptomatic hypotension, angioedema, hyperkalemia, and worsening renal function. Mortality at 6 months was 6.8% in patients taking sacubitril/valsartan vs. 34% in those on conventional therapy (odds ratio [OR] = 0.14; 95% CI: 0.04-0.49). Moreover, there was a 4.5% rate of HF hospitalizations in the sacubitril/valsartan group vs. 59% in the control group (OR = 0.03; 95% CI: 0.01-0.14). Safety outcomes were comparable in the two groups, although hypotension (systolic blood pressure sacubitril/valsartan group vs. 5.7% in the control group (OR = 3.14; 95% CI: 0.94-10.55). Sacubitril/valsartan offered strong protection against all-cause death and HF hospitalizations at 6 months without any significant side effects. To validate this efficacious molecule, further postmarketing observational studies, focusing mainly on hypotension and angioedema are warranted.

  18. Cost-effectiveness of sacubitril/valsartan in chronic heart-failure patients with reduced ejection fraction.

    Science.gov (United States)

    Ademi, Zanfina; Pfeil, Alena M; Hancock, Elizabeth; Trueman, David; Haroun, Rola Haroun; Deschaseaux, Celine; Schwenkglenks, Matthias

    2017-11-29

    We aimed to assess the cost effectiveness of sacubitril/valsartan compared to angiotensin-converting enzyme inhibitors (ACEIs) for the treatment of individuals with chronic heart failure and reduced-ejection fraction (HFrEF) from the perspective of the Swiss health care system. The cost-effectiveness analysis was implemented as a lifelong regression-based cohort model. We compared sacubitril/valsartan with enalapril in chronic heart failure patients with HFrEF and New York-Heart Association Functional Classification II-IV symptoms. Regression models based on the randomised clinical phase III PARADIGM-HF trials were used to predict events (all-cause mortality, hospitalisations, adverse events and quality of life) for each treatment strategy modelled over the lifetime horizon, with adjustments for patient characteristics. Unit costs were obtained from Swiss public sources for the year 2014, and costs and effects were discounted by 3%. The main outcome of interest was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life years (QALYs) gained. Deterministic sensitivity analysis (DSA) and scenario and probabilistic sensitivity analysis (PSA) were performed. In the base-case analysis, the sacubitril/valsartan strategy showed a decrease in the number of hospitalisations (6.0% per year absolute reduction) and lifetime hospital costs by 8.0% (discounted) when compared with enalapril. Sacubitril/valsartan was predicted to improve overall and quality-adjusted survival by 0.50 years and 0.42 QALYs, respectively. Additional net-total costs were CHF 10 926. This led to an ICER of CHF 25 684. In PSA, the probability of sacubitril/valsartan being cost-effective at thresholds of CHF 50 000 was 99.0%. The treatment of HFrEF patients with sacubitril/valsartan versus enalapril is cost effective, if a willingness-to-pay threshold of CHF 50 000 per QALY gained ratio is assumed.

  19. Pharmacodynamic and Pharmacokinetic Profiles of Sacubitril/Valsartan (LCZ696) in Patients with Heart Failure and Reduced Ejection Fraction.

    Science.gov (United States)

    Kobalava, Zhanna; Kotovskaya, Yulia; Averkov, Oleg; Pavlikova, Elena; Moiseev, Valentine; Albrecht, Diego; Chandra, Priya; Ayalasomayajula, Surya; Prescott, Margaret F; Pal, Parasar; Langenickel, Thomas H; Jordaan, Pierre; Rajman, Iris

    2016-08-01

    Concomitant renin-angiotensin-aldosterone system blockade and natriuretic peptide system enhancement may provide unique therapeutic benefits to patients with heart failure and reduced ejection fraction (HFrEF). This study assessed the pharmacodynamics and pharmacokinetics of LCZ696 in patients with HFrEF. This was an open-label, noncontrolled single-sequence study. After a 24-h run-in period, patients (n = 30) with HFrEF (EF ≤ 40%; NYHA class II-IV) received LCZ696 100 mg twice daily (bid) for 7 days and 200 mg bid for 14 days, along with standard treatment for heart failure (HF) (except angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs]). On Day 21, significant increases were observed in the plasma biomarkers indicative of neprilysin and RAAS inhibition (ratio-to-baseline: cyclic guanosine monophosphate [cGMP], 1.38; renin concentration and activity, 3.50 and 2.27, respectively; all, P sacubitril (neprilysin inhibitor prodrug), LBQ657 (active neprilysin inhibitor), and valsartan were reached within 0.5, 2.5, and 2 h. Between 100- and 200-mg doses, the Cmax and AUC0-12 h for sacubitril and LBQ657 were approximately dose-proportional while that of valsartan was less than dose-proportional. Treatment with LCZ696 for 21 days was well tolerated and resulted in plasma biomarker changes indicative of neprilysin and RAAS inhibition in patients with HF. The pharmacokinetic exposure of the LCZ696 analytes in patients with HF observed in this study is comparable to that observed in the pivotal Phase III study. © 2016 John Wiley & Sons Ltd.

  20. Cost-effectiveness of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction.

    Science.gov (United States)

    McMurray, John J V; Trueman, David; Hancock, Elizabeth; Cowie, Martin R; Briggs, Andrew; Taylor, Matthew; Mumby-Croft, Juliet; Woodcock, Fionn; Lacey, Michael; Haroun, Rola; Deschaseaux, Celine

    2018-06-01

    Chronic heart failure with reduced ejection fraction (HF-REF) represents a major public health issue and is associated with considerable morbidity and mortality. We evaluated the cost-effectiveness of sacubitril/valsartan (formerly LCZ696) compared with an ACE inhibitor (ACEI) (enalapril) in the treatment of HF-REF from the perspective of healthcare providers in the UK, Denmark and Colombia. A cost-utility analysis was performed based on data from a multinational, Phase III randomised controlled trial. A decision-analytic model was developed based on a series of regression models, which extrapolated health-related quality of life, hospitalisation rates and survival over a lifetime horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). In the UK, the cost per quality-adjusted life-year (QALY) gained for sacubitril/valsartan (using cardiovascular mortality) was £17 100 (€20 400) versus enalapril. In Denmark, the ICER for sacubitril/valsartan was Kr 174 000 (€22 600). In Colombia, the ICER was COP$39.5 million (€11 200) per QALY gained. Deterministic sensitivity analysis showed that results were most sensitive to the extrapolation of mortality, duration of treatment effect and time horizon, but were robust to other structural changes, with most scenarios associated with ICERs below the willingness-to-pay threshold for all three country settings. Probabilistic sensitivity analysis suggested the probability that sacubitril/valsartan was cost-effective at conventional willingness-to-pay thresholds was 68%-94% in the UK, 84% in Denmark and 95% in Colombia. Our analysis suggests that, in all three countries, sacubitril/valsartan is likely to be cost-effective compared with an ACEI (the current standard of care) in patients with HF-REF. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Barriers to Beta-Blocker Use and Up-Titration Among Patients with Heart Failure with Reduced Ejection Fraction.

    Science.gov (United States)

    Levitan, Emily B; Van Dyke, Melissa K; Loop, Matthew Shane; O'Beirne, Ronan; Safford, Monika M

    2017-12-01

    For patients with heart failure with reduced ejection fraction (HFrEF), guidelines recommend use of beta-blockers with gradual up-titration. However, many patients with HFrEF do not use beta-blockers and up-titration is rare. Our purpose was to identify and rank barriers to beta-blocker use and up-titration from the perspective of primary care physicians. We conducted 4 moderated, structured group discussions among 19 primary care physicians using the nominal group technique; 16 participants also completed a survey. Participants generated lists of barriers to beta-blocker use and up-titration among patients with HFrEF. Each participant had six votes with three votes assigned to the item ranked most important, two to the second most important item, and one to the third most important item. Investigators characterized items into themes. The percentage of available votes was calculated for each theme. Fifteen of 16 participating primary care physicians who completed the survey reported that management of beta-blockers was their responsibility. Treatment/side effects, particularly hypotension, were identified as the most important barrier for beta-blocker use (72% of available votes) followed by polypharmacy (11%), healthcare system barriers (10%), and comorbidities (6%). Barriers to up-titration included treatment/side effects (49% of available votes), patient communication/buy-in (21%), polypharmacy (13%), and healthcare system barriers (8%). Many barriers to guideline concordant use of beta-blockers among patients with HFrEF identified by primary care providers are not readily modifiable. Addressing these barriers may require development, testing, and dissemination of protocols for beta-blocker initiation and up-titration that are safe and appropriate in primary care.

  2. 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

    2018-06-01

    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.

  3. Assessment of ejection fraction of the right and left ventricles in patients with acute myocardial infarction by magnetic resonance imaging

    International Nuclear Information System (INIS)

    Zhang, Youyi; Imai, Kamon; Araki, Yasushi; Nishino, Yukari; Saito, Satoshi; Ozawa, Yukio; Yasugi, Tadao

    1993-01-01

    Right and left ventricular function in acute myocardial infarction (AMI) was assessed by ECG-gated magnetic resonance imaging (MRI) in 64 patients and 8 volunteers. Five short axis images for intrinsic cardiac long-axis of the left ventricle were obtained at 9 msec and 309 msec after the R wave as end-diastole and end-systole. Right and left ventricular volumes were measured by Simpson's rule. The intraobserver variabilities in right and left ventricular ejection fraction (RVEF: r=0.94, LVEF: 0.89) were excellent. The interobserver variabilities in RVEF (r=0.61) and LVEF (r=0.77) were fair. LVEF, but not RVEF, was significantly reduced in patients with AMI. Among left ventricular dysfunction (LVEF≤40%) patients, 50% exhibited right ventricular dysfunction (RVEF≤40%). Among patients without left ventricular dysfunction, only 12% exhibited right ventricular dysfunction. In left ventricular and biventricular dysfunction compared with control, the left ventricular end-diastolic volume index increased (65±10 ml/m 2 , 68±12 ml/m 2 vs 54±8 ml/m 2 ), the end-systolic volume index increased (40±16 ml/m 2 , 43±7 ml/m 2 vs 18±1 ml/m 2 ), and the right ventricular end-diastolic volume index decreased (52±13 ml/m 2 , 53±20 ml/m 2 vs 65±8 ml/m 2 ). MRI can thus be used to assess ventricular systolic function. Since patients with left ventricular dysfunction revealed a high incidence of right ventricular dysfunction, an interaction between the left and right ventricles may occur in ventricular dysfunction. (author)

  4. Comparison of 16-frame and 8-frame gated SPET imaging for determination of left ventricular volumes and ejection fraction

    International Nuclear Information System (INIS)

    Navare, Sachin M.; Liu, Yi-Hwa; Wackers, Frans J.T.

    2003-01-01

    Electrocardiographic (ECG) gated single-photon emission tomography (SPET) allows for simultaneous assessment of myocardial perfusion and left ventricular (LV) function. Presently 8-frame per cardiac cycle ECG gating of SPET images is standard. The aim of this study was to compare the effect of 8-frame and 16-frame gated SPET on measurements of LV volumes and to evaluate the effects of the presence of myocardial perfusion defects and of radiotracer dose administered on the calculation of LV volumes. A total of 86 patients underwent technetium-99m SPET myocardial perfusion imaging using 16-frame per cardiac cycle acquisition. Eight-frame gated SPET images were generated by summation of contiguous frames. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated from the 16-frame and 8-frame data sets. The patients were divided into groups according to the administered dose of the radiotracer and the size of the perfusion defect. Results. Sixteen frame per cardiac cycle acquisition resulted in significantly larger EDV (122±72 ml vs 115±68 ml, P<0.0001), smaller ESV (64±58.6 ml vs 67.6±59.5 ml, P<0.0001), and higher LVEF (55.3%±18% vs 49%±17.4%, P<0.0001) as compared to 8-frame SPET imaging. This effect was seen regardless of whether a high or a low dose was administered and whether or not significant perfusion defects were present. This study shows that EDV, ESV and LVEF determined by 16-frame gated SPET are significantly different from those determined by 8-frame gated SPET. The radiotracer dose and perfusion defects do not affect estimation of LV parameters by 16-frame gated SPET. (orig.)

  5. Determination of right ventricular ejection fraction from reprojected gated blood pool SPET: comparison with first-pass ventriculography

    International Nuclear Information System (INIS)

    Bartlett, M.L.; Seaton, D.; McEwan, L.; Fong, W.

    2001-01-01

    Gated blood pool (GBP) studies are widely available and relatively inexpensive. We have previously published a simple and convenient method for measuring left ventricle ejection fraction (EF) with increased accuracy from single-photon emission tomography (SPET) GBP scans. This paper describes an extension of this method by which right ventricular EF may also be measured. Gated SPET images of the blood pool are acquired and re-oriented in short-axis slices. Counts from the left ventricle are excluded from the short-axis slices, which are then reprojected to give horizontal long-axis images. Time-activity curves are generated from each pixel around the right ventricle, and an image is created with non-ventricular pixels ''greyed out''. This image is used as a guide in drawing regions of interest around the right ventricle on the end-diastolic and end-systolic long-axis images. In 28 patients, first-pass ventriculography studies were acquired followed by SPET GBP scans. The first-pass images were analysed a total of four times by two observers and the SPET images were analysed three times each by two observers. The agreement between the two techniques was good, with a correlation coefficient of 0.72 and a mean absolute difference between first-pass and reprojected SPET EFs of 4.8 EF units. Only four of the 28 patients had a difference of greater than 8 EF units. Variability was also excellent for SPET right ventricular EF values. Intra-observer variability was significantly lower for SPET than for first-pass EFs: standard error of the estimate (SEE)=5.1 and 7.3 EF units, respectively (P<0.05). Inter-observer variability was comparable in the two techniques (SEE=5.2 and 6.9 EF units for SPET and first-pass ventriculography, respectively). (orig.)

  6. Predictive potential of macrophage migration inhibitory factor (MIF) in patients with heart failure with preserved ejection fraction (HFpEF).

    Science.gov (United States)

    Luedike, Peter; Alatzides, Georgios; Papathanasiou, Maria; Heisler, Martin; Pohl, Julia; Lehmann, Nils; Rassaf, Tienush

    2018-05-04

    Prognostication in heart failure with preserved ejection fraction (HFpEF) is challenging and novel biomarkers are urgently needed. Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine that plays a crucial role in cardiovascular and various inflammatory diseases. Whether MIF is involved in HFpEF is unknown. Sixty-two patients with HFpEF were enrolled and followed up for 180 days. MIF plasma levels as well as natriuretic peptide (NP) levels were assessed. High MIF levels significantly predicted the combined end-point of all-cause death or hospitalization at 180 days in the univariate analysis (HR 2.41, 95% CI 1.12-5.19, p = 0.025) and after adjustment for relevant covariates in a Cox proportional hazard regression model (HR 2.35, 95% CI 1.05-5.27, p = 0.0374). Furthermore, MIF levels above the median were associated with higher pulmonary artery systolic pressure (PASP) as assessed by echocardiography (PASP 31 mmHg vs 48 mmHg in the low- and high-MIF group, respectively, p = 0.017). NPs significantly correlated with MIF in HFpEF patients (BNP p = 0.011; r = 0.32; NT-proBNP p = 0.027; r = 0.28). MIF was associated with clinical outcomes and might be involved in the pathophysiology of pulmonary hypertension in patients with HFpEF. These first data on MIF in HFpEF should stimulate further research to elucidate the role of this cytokine in heart failure. Trial registration NCT03232671.

  7. Effect of mental stress on left ventricular ejection fraction and its relationship to the severity of coronary artery disease

    International Nuclear Information System (INIS)

    Kuroda, Toru; Kuwabara, Yoichi; Watanabe, Satoshi; Nakaya, Jiro; Hasegawa, R.; Shikama, Takeshi; Matsuno, Kouki; Mikami, Yuji; Fujii, Kiyotaka; Saito, Toshihiro; Masuda, Yoshiaki

    2000-01-01

    To evaluate the relationship between the mental stress-induced decrease in left ventricular ejection fraction (LVEF) and the severity of exercise-induced ischaemia, 20 patients with stable coronary artery disease (CAD) underwent radionuclide ventriculography during mental stress testing and stress myocardial perfusion single-photon emission tomography (SPET). We also examined whether changes in haemodynamic and neurohormonal parameters are related to changes in LVEF during mental stress. The LVEF decreased from 54.8%±17.7% to 49.8%±16.2% with mental stress (P<0.0005). Ten of the 20 patients (50.0%) had a ≥5% decrease in LVEF. The remaining ten patients had no or a <5% decrease in LVEF. There was a significant correlation between the change in LVEF during mental stress and the size of the reversible defect on stress myocardial perfusion SPET (r=-0.80, P<0.0005), with close regional correspondence (75% identical). This correlation was less strong in the 12 patients with a total defect score at rest of <10 (r=-0.69, P=0.014) than in the eight patients with a total defect score at rest of ≥10 (r=-0.94, P=0.001). The changes in blood pressure and heart rate were not significantly correlated with the change in LVEF, but the percent change in adrenaline concentration correlated with the change in LVEF. It is suggested that mental stress impairs systolic function by inducing transient myocardial ischaemia. The effect of neurohormonal responses during mental stress on LV systolic function may also be important in patients with CAD. (orig.)

  8. Therapeutic Approach to Patients with Heart Failure with Reduced Ejection Fraction and End-stage Renal Disease.

    Science.gov (United States)

    Inampudi, Chakradhari; Alvarez, Paulino; Asleh, Rabea; Briasoulis, Alexandros

    2018-03-14

    Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve. Beta-blockers, especially carvedilol which is poorly dialyzed is associated with cardiovascular benefit in this population. Despite paucity of data, Angiotensin-converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) when appropriately adjusted by dose and with close monitoring of serum potassium can also be administered to these patients who tolerate beta-blockers. Mineralocorticoid receptors in patients with HFrEF and ESRD have been shown to reduce mortality in a large randomized controlled trial without any significantly increased risk of hyperkalemia. Implantable Cardiac-defibrillators (ICDs) should be considered for primary prevention of sudden cardiac death in patients with HFrEF and ESRD who meet the implant indications. Furthermore in anemic iron-deficient patients, intravenous iron infusion may improve functional status. Finally, mechanical circulatory support with leftventricular assist devices may be related to increased mortality risk and the presence of ESRD poses a relative contraindication to further evaluation of these devices. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Effect of Switching from Cilnidipine to Azelnidipine on Cardiac Sympathetic Nerve Function in Patients with Heart Failure Preserved Ejection Fraction.

    Science.gov (United States)

    Kiuchi, Shunsuke; Hisatake, Shinji; Kabuki, Takayuki; Oka, Takashi; Dobashi, Shintaro; Fujii, Takahiro; Ikeda, Takanori

    2018-01-27

    Cardiac sympathetic nerve activity is known to play a key role in the development and progression of heart failure (HF). Azelnidipine, an L-type calcium channel blocker (CCB), inhibits the sympathetic nerve activity of the central system. In contrast, cilnidipine, an N-type CCB, inhibits the sympathetic nerve activity of the peripheral system. CCBs are recommended as class IIa in patients with HF preserved ejection fraction (HFpEF); however, there are no comparative data on the difference in effect of cilnidipine and azelnidipine in patients with HFpEF and hypertension. We investigated the difference in effect of azelnidipine compared with cilnidipine in patients with HFpEF. Twenty-four consecutive HF patients who received angiotensin II type1a receptor blocker and beta blocker from April 2013 to January 2015 were enrolled. Cilnidipine was switched to azelnidipine during the follow-up period. Blood pressures, heart rate, blood tests, echocardiography, and 123 I-metaiodobenzylguanidine (MIBG) cardiac-scintigraphy were measured before and after 6 months from azelnidipine administration. B-type natriuretic peptide tended to decrease after switching to azelnidipine; however, there were no significant differences between the pre-state and post-state (pre-state: 118.5 pg/mL and post-state: 78.4 pg/mL, P = 0.137). Other laboratory findings, including catecholamine, also did not change significantly. In echocardiography, there were no significant differences in systolic and diastolic functions at the pre-state and post-state. As for MIBG, there were no significant changes in heart/mediastinum ratio. However, washout rate was significantly reduced (pre-state: 42.9 and post-state: 39.6, P = 0.030). Azelnidipine improved the dysfunction of cardiac sympathetic nerve activity compared with cilnidipine in patients with HFpEF.

  10. Effect of mental stress on left ventricular ejection fraction and its relationship to the severity of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kuroda, Toru; Kuwabara, Yoichi; Watanabe, Satoshi; Nakaya, Jiro; Hasegawa, R.; Shikama, Takeshi; Matsuno, Kouki; Mikami, Yuji; Fujii, Kiyotaka; Saito, Toshihiro; Masuda, Yoshiaki [Dept. of Internal Medicine, Chiba Univ. (Japan)

    2000-12-01

    To evaluate the relationship between the mental stress-induced decrease in left ventricular ejection fraction (LVEF) and the severity of exercise-induced ischaemia, 20 patients with stable coronary artery disease (CAD) underwent radionuclide ventriculography during mental stress testing and stress myocardial perfusion single-photon emission tomography (SPET). We also examined whether changes in haemodynamic and neurohormonal parameters are related to changes in LVEF during mental stress. The LVEF decreased from 54.8%{+-}17.7% to 49.8%{+-}16.2% with mental stress (P<0.0005). Ten of the 20 patients (50.0%) had a {>=}5% decrease in LVEF. The remaining ten patients had no or a <5% decrease in LVEF. There was a significant correlation between the change in LVEF during mental stress and the size of the reversible defect on stress myocardial perfusion SPET (r=-0.80, P<0.0005), with close regional correspondence (75% identical). This correlation was less strong in the 12 patients with a total defect score at rest of <10 (r=-0.69, P=0.014) than in the eight patients with a total defect score at rest of {>=}10 (r=-0.94, P=0.001). The changes in blood pressure and heart rate were not significantly correlated with the change in LVEF, but the percent change in adrenaline concentration correlated with the change in LVEF. It is suggested that mental stress impairs systolic function by inducing transient myocardial ischaemia. The effect of neurohormonal responses during mental stress on LV systolic function may also be important in patients with CAD. (orig.)

  11. Pre-chemotherapy values for left and right ventricular volumes and ejection fraction by gated tomographic radionuclide angiography using a cadmium-zinc-telluride detector gamma camera

    DEFF Research Database (Denmark)

    Haarmark, Christian; Haase, Christine; Jensen, Maria Maj

    2016-01-01

    age and both left and right ventricular volumes in women (r = -0.4, P right end systolic ventricular volume in men (r = -0.3, P = .001). CONCLUSION: A set of reference values for cardiac evaluation prior to chemotherapy in cancer patients without other known cardiopulmonary......BACKGROUND: Estimation of left ventricular ejection fraction (LVEF) using equilibrium radionuclide angiography is an established method for assessment of left ventricular function. The purpose of this study was to establish normative data on left and right ventricular volumes and ejection fraction......, using cadmium-zinc-telluride SPECT camera. METHODS AND RESULTS: From routine assessments of left ventricular function in 1172 patients, we included 463 subjects (194 men and 269 women) without diabetes, previous potentially cardiotoxic chemotherapy, known cardiovascular or pulmonary disease. The lower...

  12. Assessment of vasodilator therapy in patients with severe congestive heart failure: limitations of measurements of left ventricular ejection fraction and volumes

    International Nuclear Information System (INIS)

    Firth, B.G.; Dehmer, G.J.; Markham, R.V. Jr.; Willerson, J.T.; Hillis, L.D.

    1982-01-01

    Although noninvasive techniques are often used to assess the effect of vasodilator therapy in patients with congestive heart failure, it is unknown whether changes in noninvasively determined left ventricular ejection fraction, volume, or dimension reliably reflect alterations in intracardiac pressure and flow. Accordingly, we compared the acute effect of sodium nitroprusside on left ventricular volume and ejection fraction (determined scintigraphically) with its effect on intracardiac pressure and forward cardiac index (determined by thermodilution) in 12 patients with severe, chronic congestive heart failure and a markedly dilated left ventricle. Nitroprusside (infused at 1.3 +/- 1.1 [mean +/- standard deviation] microgram/kg/min) caused a decrease in mean systemic arterial, mean pulmonary arterial, and mean pulmonary capillary wedge pressure as well as a concomitant increase in forward cardiac index. Simultaneously, left ventricular end-diastolic and end-systolic volume indexes decreased, but the scintigraphically determined cardiac index did not change significantly. Left ventricular ejection fraction averaged 0.19 +/- 0.05 before nitroprusside administration and increased by less than 0.05 units in response to nitroprusside in 11 of 12 patients. The only significant correlation between scintigraphically and invasively determined variables was that between the percent change in end-diastolic volume index and the percent change in pulmonary capillary wedge pressure (r . 0.68, p . 0.01). Although nitroprusside produced changes in scintigraphically determined left ventricular ejection fraction, end-systolic volume index, and cardiac index, these alterations bore no predictable relation to changes in intracardiac pressure, forward cardiac index, or vascular resistance. Furthermore, nitroprusside produced a considerably greater percent change in the invasively measured variables than in the scintigraphically determined ones

  13. Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET

    OpenAIRE

    Jonny Nordström; Tanja Kero; Hendrik Johannes Harms; Charles Widström; Frank A. Flachskampf; Jens Sörensen; Mark Lubberink

    2017-01-01

    BACKGROUND: Quantitative measurement of myocardial blood flow (MBF) is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD). (15)O-water positron emission tomography (PET) is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV) volumes and ejection fraction (EF) is not possible from standard (15)O-water uptake images. The purpose of the present work was to investigate the possibility...

  14. Biomarker Profiles of Acute Heart Failure Patients With a Mid-Range Ejection Fraction.

    Science.gov (United States)

    Tromp, Jasper; Khan, Mohsin A F; Mentz, Robert J; O'Connor, Christopher M; Metra, Marco; Dittrich, Howard C; Ponikowski, Piotr; Teerlink, John R; Cotter, Gad; Davison, Beth; Cleland, John G F; Givertz, Michael M; Bloomfield, Daniel M; Van Veldhuisen, Dirk J; Hillege, Hans L; Voors, Adriaan A; van der Meer, Peter

    2017-07-01

    In this study, the authors used biomarker profiles to characterize differences between patients with acute heart failure with a midrange ejection fraction (HFmrEF) and compare them with patients with a reduced (heart failure with a reduced ejection fraction [HFrEF]) and preserved (heart failure with a preserved ejection fraction [HFpEF]) ejection fraction. Limited data are available on biomarker profiles in acute HFmrEF. A panel of 37 biomarkers from different pathophysiological domains (e.g., myocardial stretch, inflammation, angiogenesis, oxidative stress, hematopoiesis) were measured at admission and after 24 h in 843 acute heart failure patients from the PROTECT trial. HFpEF was defined as left ventricular ejection fraction (LVEF) of ≥50% (n = 108), HFrEF as LVEF of <40% (n = 607), and HFmrEF as LVEF of 40% to 49% (n = 128). Hemoglobin and brain natriuretic peptide levels (300 pg/ml [HFpEF]; 397 pg/ml [HFmrEF]; 521 pg/ml [HFrEF]; p trend  <0.001) showed an upward trend with decreasing LVEF. Network analysis showed that in HFrEF interactions between biomarkers were mostly related to cardiac stretch, whereas in HFpEF, biomarker interactions were mostly related to inflammation. In HFmrEF, biomarker interactions were both related to inflammation and cardiac stretch. In HFpEF and HFmrEF (but not in HFrEF), remodeling markers at admission and changes in levels of inflammatory markers across the first 24 h were predictive for all-cause mortality and rehospitalization at 60 days (p interaction  <0.05). Biomarker profiles in patients with acute HFrEF were mainly related to cardiac stretch and in HFpEF related to inflammation. Patients with HFmrEF showed an intermediate biomarker profile with biomarker interactions between both cardiac stretch and inflammation markers. (PROTECT-1: A Study of the Selective A1 Adenosine Receptor Antagonist KW-3902 for Patients Hospitalized With Acute HF and Volume Overload to Assess Treatment Effect on Congestion and Renal

  15. Influence of magnification on the calculated value of left ventricular ejection fraction and volumes using quantitative gated perfusion SPECT

    International Nuclear Information System (INIS)

    Nunez, M.; Beretta, M.; Alonso, O.; Alvarez, B.; Canepa, J.; Mut, F.

    2002-01-01

    Aim: To compare left ventricular ejection fraction (LVEF), end-diastolic volumes (EDV) and end-systolic volumes (ESV) measured by quantitative gated SPECT (QGSPECT) in studies acquired with and without magnification factor (zoom). Material and Methods: We studied 30 consecutive patients (17 men, ages 61±14 years) referred for myocardial perfusion evaluation with a 2-day protocol. Studies were performed after injection of 925 MBq (25 mCi) of 99mTc-MIBI in the resting state. Gated SPECT was first acquired using a x2 zoom factor and immediately repeated with x1 zoom (no magnification), using a 64x64 matrix and 8 frames/cardiac cycle. Patients with arrhythmia were not included in the investigation. According to the median EDV calculated with the x2 zoom acquisition, the population was further divided in two sub-groups regarding the size of the LV cavity. Average LVEF, EDV, ESV and difference between values (delta) were then calculated for the total population and for each sub-group (a and b). Results: For the total population, results are expressed.Pearson correlation showed r=0.954 between LVEF with and without zoom (p<0.0001), but linear regression analysis did not fit a specific model (p=0.18). Median EDV with zoom was 92.5 ml, allowing to separate 15 cases with EDV above (a) and 15 below that value (b). Results for both sub-groups are presented. Conclusion: Calculated LVEF is higher with no zoom, at the expense of decreasing both EDV and ESV. Although differences were very significant for all parameters, ESV changes were specially relevant with no zoom, particularly in patients with smaller hearts. Although good correlation was found between LVEF with and without zoom, no specific correction factor was found to convert one value into the other. Magnification factor should be kept constant in gated SPECT if calculated LVEF values QGSPECT are expected to be reliable, and validation of the method using different zoom factors should be considered

  16. Cost-effectiveness of sacubitril/valsartan versus enalapril in patients with heart failure and reduced ejection fraction.

    Science.gov (United States)

    Liang, Lin; Bin-Chia Wu, David; Aziz, Mohamed Ismail Abdul; Wong, Raymond; Sim, David; Leong, Kui Toh Gerard; Wei, Yong Quek; Tan, Doreen; Ng, Kwong

    2018-02-01

    Sacubitril/valsartan reduces cardiovascular death and hospitalizations for heart failure (HF). However, decision-makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of traditional standard of care. To evaluate the cost-effectiveness of sacubitril/valsartan compared to enalapril in patients with HF and reduced ejection fraction, from the Singapore healthcare payer perspective. A Markov model was developed to project clinical and economic outcomes of sacubitril/valsartan vs enalapril for 66-year-old patients with HF over 10 years. Key health states included New York Heart Association classes I-IV and deaths; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Sacubitril/valsartan benefits were modeled by applying the hazard ratios (HRs) in PARADIGM-HF trial to baseline probabilities. Primary model outcomes were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for sacubitril/valsartan relative to enalapril Results: Compared to enalapril, sacubitril/valsartan was associated with an ICER of SGD 74,592 (USD 55,198) per QALY gained. A major driver of cost-effectiveness was the cardiovascular mortality benefit of sacubitril/valsartan. The uncertainty of this treatment benefit in the Asian sub-group was tested in sensitivity analyses using a HR of 1 as an upper limit, where the ICERs ranged from SGD 41,019 (USD 30,354) to SGD 1,447,103 (USD 1,070,856) per QALY gained. Probabilistic sensitivity analyses showed the probability of sacubitril/valsartan being cost-effective was below 1%, 12%, and 71% at SGD 20,000, SGD 50,000, and SGD 100,000 per QALY gained, respectively. At the current daily price sacubitril/valsartan may not represent good value for limited healthcare dollars compared to enalapril in reducing cardiovascular morbidity and mortality in HF in the Singapore healthcare setting. This study

  17. Comparison of automatic quantification software for the measurement of ventricular volume and ejection fraction in gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Van Staden, J.A.; Herbst, C.P.; Du Raan, H.; Lotter, M.G.; Otto, A.C.

    2004-01-01

    Full text: Introduction: Gated myocardial perfusion SPECT has been used to calculate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) and has correlated well with conventional methods. However, the comparative accuracy of and correlations across various types of gated SPECT software are not well understood. Materials and methods: Twelve patients participated in a radionuclide gated blood-pool (GBP) study in addition to undergoing 99m Tc-sestamibi gated SPECT. Three different software algorithms, Quantitative Gated SPECT (QGS) from Cedars-Sinai, MultiDim from Stanford University Medical School and GQUANT from Alfa Nuclear were used to compute LVEF and LVEDV. These software algorithms operate in 3-dimensional space, two dependent on surface detection and the other on statistical parameters. The LVEF as calculated from gated SPECT myocardial perfusion images were compared with LVEF calculated from the GBP studies in the same patients to assess accuracy of the three software algorithms. Results: The software success-rate was 92% (11/12 pts) for MultiDim and 100% for the QGS and GQUANT. Agreement between LVEF measured with MultiDim and QGS, MultiDim and GQUANT and QGS and GQUANT were excellent (LVEF-MuItidim 0.80 LVEF QGS +5.02, r = 0.93, LVEF GQUANT = 1.10 LVEF MuItidim -1.33, r 0.90 and LVEF GQUANT = 1.02 LVEF QGS -1.40, r = 0.96). The correlation coefficient for LVEF between gated SPECT and the GBP study was 0.95, 0.95 and 0.97, for MultiDim, GQUANT and QGS, respectively. Conclusion: All 3 software programs showed good correlation between LVEF for gated SPECT and the GBP study. Good agreement for LVEF was observed also between the three software algorithms. However, because each method has unique characteristics that depend on its specific algorithm and thus behaves differently in the various patients, the methods should not be used interchangeably. (author)

  18. Effects of organic and inorganic nitrate on aortic and carotid haemodynamics in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Chirinos, Julio A; Londono-Hoyos, Francisco; Zamani, Payman; Beraun, Melissa; Haines, Philip; Vasim, Izzah; Varakantam, Swapna; Phan, Timothy S; Cappola, Thomas P; Margulies, Kenneth B; Townsend, Raymond R; Segers, Patrick

    2017-11-01

    To assess the haemodynamic effects of organic vs. inorganic nitrate administration among patients with heart failure with preserved ejection fraction (HFpEF). We assessed carotid and aortic pressure-flow relations non-invasively before and after the administration of 0.4 mg of sublingual nitroglycerin (n = 26), and in a separate sub-study, in response to 12.9 mmoL of inorganic nitrate (n = 16). Nitroglycerin did not consistently reduce wave reflections arriving at the proximal aorta (change in real part of reflection coefficient, 1st harmonic: -0.09; P = 0.01; 2nd harmonic: -0.045, P = 0.16; 3rd harmonic: +0.087; P = 0.05), but produced profound vasodilatation in the carotid territory, with a significant reduction in systolic blood pressure (133.6 vs. 120.5 mmHg; P = 0.011) and a marked reduction in carotid bed vascular resistance (19 580 vs. 13 078 dynes · s/cm 5 ; P = 0.001) and carotid characteristic impedance (3440 vs. 1923 dynes · s/cm 5 ; P = 0.002). Inorganic nitrate, in contrast, consistently reduced wave reflections across the first three harmonics (change in real part of reflection coefficient, 1st harmonic: -0.12; P = 0.03; 2nd harmonic: -0.11, P = 0.01; 3rd harmonic: -0.087; P = 0.09) and did not reduce blood pressure, carotid bed vascular resistance, or carotid characteristic impedance (P = NS). Nitroglycerin produces marked vasodilatation in the carotid circulation, with a pronounced reduction in blood pressure and inconsistent effects on central wave reflections. Inorganic nitrate, in contrast, produces consistent reductions in wave reflections, and unlike nitroglycerin, it does so without significant hypotension or cerebrovascular dilatation. These haemodynamic differences may underlie the different effects on exercise capacity and side effect profile of inorganic vs. organic nitrate in HFpEF. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  19. Computer-assisted determination of left ventricular endocardial borders reduces variability in the echocardiographic assessment of ejection fraction

    Directory of Open Access Journals (Sweden)

    Lindstrom Lena

    2008-11-01

    Full Text Available Abstract Background Left ventricular size and function are important prognostic factors in heart disease. Their measurement is the most frequent reason for sending patients to the echo lab. These measurements have important implications for therapy but are sensitive to the skill of the operator. Earlier automated echo-based methods have not become widely used. The aim of our study was to evaluate an automatic echocardiographic method (with manual correction if needed for determining left ventricular ejection fraction (LVEF based on an active appearance model of the left ventricle (syngo®AutoEF, Siemens Medical Solutions. Comparisons were made with manual planimetry (manual Simpson, visual assessment and automatically determined LVEF from quantitative myocardial gated single photon emission computed tomography (SPECT. Methods 60 consecutive patients referred for myocardial perfusion imaging (MPI were included in the study. Two-dimensional echocardiography was performed within one hour of MPI at rest. Image quality did not constitute an exclusion criterion. Analysis was performed by five experienced observers and by two novices. Results LVEF (%, end-diastolic and end-systolic volume/BSA (ml/m2 were for uncorrected AutoEF 54 ± 10, 51 ± 16, 24 ± 13, for corrected AutoEF 53 ± 10, 53 ± 18, 26 ± 14, for manual Simpson 51 ± 11, 56 ± 20, 28 ± 15, and for MPI 52 ± 12, 67 ± 26, 35 ± 23. The required time for analysis was significantly different for all four echocardiographic methods and was for uncorrected AutoEF 79 ± 5 s, for corrected AutoEF 159 ± 46 s, for manual Simpson 177 ± 66 s, and for visual assessment 33 ± 14 s. Compared with the expert manual Simpson, limits of agreement for novice corrected AutoEF was lower than for novice manual Simpson (0.8 ± 10.5 vs. -3.2 ± 11.4 LVEF percentage points. Calculated for experts and with LVEF (% categorized into Conclusion Corrected AutoEF reduces the variation in measurements compared with

  20. Diagnosis of heart failure with preserved ejection fraction: improved accuracy with the use of markers of collagen turnover.

    LENUS (Irish Health Repository)

    Martos, Ramon

    2012-02-01

    AIMS: Heart failure with preserved ejection fraction (HF-PEF) can be difficult to diagnose in clinical practice. Myocardial fibrosis is a major determinant of diastolic dysfunction (DD), potentially contributing to the progression of HF-PEF. The aim of this study was to analyse whether serological markers of collagen turnover may predict HF-PEF and DD. METHODS AND RESULTS: We included 85 Caucasian treated hypertensive patients (DD n=65; both DD and HF-PEF n=32). Serum carboxy (PICP), amino (PINP), and carboxytelo (CITP) peptides of procollagen type I, amino (PIIINP) peptide of procollagen type III, matrix metalloproteinases (MMP-1, MMP-2, and MMP-9), and tissue inhibitor of MMP levels were assayed. Using receiver operating characteristic curve analysis, MMP-2 (AUC=0.91; 95% CI: 0.84, 0.98), CITP (0.83; 0.72, 0.92), PICP (0.82; 0.72, 0.92), B-type natriuretic peptide (BNP) (0.82; 0.73, 0.91), MMP-9 (0.79; 0.68, 0.89), and PIIINP (0.78; 0.66, 0.89) levels were significant predictors of HF-PEF (P<0.01 for all). Carboxytelo peptides of procollagen type I (AUC=0.74; 95% CI: 0.62, 0.86), MMP-2 (0.73; 0.62, 0.84), PIIINP (0.73; 0.60, 0.85), BNP (0.69; 0.55, 0.83) and PICP (0.66; 0.54, 0.78) levels were significant predictors of DD (P<0.05 for all). A cutoff of 1585 ng\\/mL for MMP-2 provided 91% sensitivity and 76% specificity for predicting HF-PEF and combinations of biomarkers could be used to adjust either sensitivity or specificity. CONCLUSION: Markers of collagen turnover identify patients with HF-PEF and DD. Matrix metalloproteinase 2 may be more useful than BNP in the identification of HF-PEF. This suggests that these new biochemical tools may assist in identifying patients with these diagnostically challenging conditions.

  1. Spironolactone use and higher hospital readmission for Medicare beneficiaries with heart failure, left ventricular ejection fraction 73 m(2.).

    Science.gov (United States)

    Inampudi, Chakradhari; Parvataneni, Sridivya; Morgan, Charity J; Deedwania, Prakash; Fonarow, Gregg C; Sanders, Paul W; Prabhu, Sumanth D; Butler, Javed; Forman, Daniel E; Aronow, Wilbert S; Allman, Richard M; Ahmed, Ali

    2014-07-01

    Although randomized controlled trials have demonstrated benefits of aldosterone antagonists for patients with heart failure and reduced ejection fraction (HFrEF), they excluded patients with serum creatinine >2.5 mg/dl, and their use is contraindicated in those with advanced chronic kidney disease (CKD). In the present analysis, we examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Of the 1,140 patients with HFrEF (EF 73 m(2)), 207 received discharge prescriptions for spironolactone. Using propensity scores (PSs) for the receipt of discharge prescriptions for spironolactone, we estimated PS-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for spironolactone-associated outcomes. Patients (mean age 76 years, 49% women, 25% African-American) had mean EF 28%, mean eGFR 31 ml/min/1.73 m(2), and mean potassium 4.5 mEq/L. Spironolactone use had significant PS-adjusted association with higher risk of 30-day (HR 1.41, 95% CI 1.04 to 1.90) and 1-year (HR 1.36, 95% CI 1.13 to 1.63) all-cause readmissions. The risk of 1-year all-cause readmission was higher among 106 patients with eGFR 73 m(2) (HR 4.75, 95% CI 1.84 to 12.28) than among those with eGFR 15 to 45 ml/min/1.73 m(2) (HR 1.34, 95% CI 1.11 to 1.61, p for interaction 0.003). Spironolactone use had no association with HF readmission and all-cause mortality. In conclusion, among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all-cause readmission but had no association with all-cause mortality or HF readmission. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. The natural history of new-onset heart failure with a severely depressed left ventricular ejection fraction: implications for timing of implantable cardioverter-defibrillator implantation.

    Science.gov (United States)

    Teeter, William A; Thibodeau, Jennifer T; Rao, Krishnasree; Brickner, M Elizabeth; Toto, Kathleen H; Nelson, Lauren L; Mishkin, Joseph D; Ayers, Colby R; Miller, Justin G; Mammen, Pradeep P A; Patel, Parag C; Markham, David W; Drazner, Mark H

    2012-09-01

    Guidelines recommend that patients with new-onset systolic heart failure (HF) receive a trial of medical therapy before an implantable cardiac defibrillator (ICD). This strategy allows for improvement of left ventricular ejection fraction (LVEF), thereby avoiding an ICD, but exposes patients to risk of potentially preventable sudden cardiac death during the trial of medical therapy. We reviewed a consecutive series of patients with HF of <6 months duration with a severely depressed LVEF (<30%) evaluated in a HF clinic (N = 224). The ICD implantation was delayed with plans to reassess LVEF approximately 6 months after optimization of β-blockers. Mortality was ascertained by the National Death Index. Follow-up echocardiograms were performed in 115 of the 224 subjects. Of these, 50 (43%) had mildly depressed or normal LVEF at follow-up ("LVEF recovery") such that an ICD was no longer indicated. In a conservative sensitivity analysis (using the entire study cohort, whether or not a follow-up echocardiogram was obtained, as the denominator), 22% of subjects had LVEF recovery. Mortality at 6, 12, and 18 months in the entire cohort was 2.3%, 4.5%, and 6.8%, respectively. Of 87 patients who tolerated target doses of β-blockers, only 1 (1.1%) died during the first 18 months. Patients with new-onset systolic HF have both a good chance of LVEF recovery and low 6-month mortality. Achievement of target β-blocker dose identifies a very low-risk population. These data support delaying ICD implantation for a trial of medical therapy. Copyright © 2012 Mosby, Inc. All rights reserved.

  3. Early Adoption of Sacubitril/Valsartan for Patients With Heart Failure With Reduced Ejection Fraction: Insights From Get With the Guidelines-Heart Failure (GWTG-HF).

    Science.gov (United States)

    Luo, Nancy; Fonarow, Gregg C; Lippmann, Steven J; Mi, Xiaojuan; Heidenreich, Paul A; Yancy, Clyde W; Greiner, Melissa A; Hammill, Bradley G; Hardy, N Chantelle; Turner, Stuart J; Laskey, Warren K; Curtis, Lesley H; Hernandez, Adrian F; Mentz, Robert J; O'Brien, Emily C

    2017-04-01

    The aim of this study was to assess the prevalence and variation in angiotensin receptor/neprilysin inhibitor (ARNI) prescription among a real-world population with heart failure with reduced ejection fraction (HFrEF). The U.S. Food and Drug Administration approved sacubitril/valsartan for patients with HFrEF in July 2015. Little is known about the early patterns of use of this novel therapy. The study included patients discharged alive from hospitals in Get With the Guidelines-Heart Failure (GWTG-HF), a registry of hospitalized patients with heart failure, between July 2015 and June 2016 who had documentation of whether ARNIs were prescribed at discharge. Patient and hospital characteristics were compared among patients with HFrEF (ejection fraction ≤40%) with and without ARNI prescription at discharge, excluding those with documented contraindications to ARNIs. To evaluate hospital variation, hospitals with at least 10 eligible hospitalizations during the study period were assessed. Of 21,078 patients hospitalized with HFrEF during the study period, 495 (2.3%) were prescribed ARNIs at discharge. Patients prescribed ARNIs were younger (median age 65 years vs. 70 years; p < 0.001), had lower ejection fractions (median 23% vs. 25%; p < 0.001), and had higher use of aldosterone antagonists (45% vs. 31%; p < 0.001) at discharge. At the 241 participating hospitals with 10 or more eligible admissions, 125 (52%) reported no discharge prescriptions of ARNIs. Approximately 2.3% of patients hospitalized for HFrEF in a national registry were prescribed ARNI therapy in the first 12 months following Food and Drug Administration approval. Further study is needed to identify and overcome barriers to implementing new evidence into practice, such as ARNI use among eligible patients with HFrEF. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction: A Network Meta-Analysis.

    Science.gov (United States)

    Burnett, Heather; Earley, Amy; Voors, Adriaan A; Senni, Michele; McMurray, John J V; Deschaseaux, Celine; Cope, Shannon

    2017-01-01

    Treatments that reduce mortality and morbidity in patients with heart failure with reduced ejection fraction, including angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), β-blockers (BB), mineralocorticoid receptor antagonists (MRA), and angiotensin receptor-neprilysin inhibitors (ARNI), have not been studied in a head-to-head fashion. This network meta-analysis aimed to compare the efficacy of these drugs and their combinations regarding all-cause mortality in patients with heart failure with reduced ejection fraction. A systematic literature review identified 57 randomized controlled trials published between 1987 and 2015, which were compared in terms of study and patient characteristics, baseline risk, outcome definitions, and the observed treatment effects. Despite differences identified in terms of study duration, New York Heart Association class, ejection fraction, and use of background digoxin, a network meta-analysis was considered feasible and all trials were analyzed simultaneously. The random-effects network meta-analysis suggested that the combination of ACEI+BB+MRA was associated with a 56% reduction in mortality versus placebo (hazard ratio 0.44, 95% credible interval 0.26-0.66); ARNI+BB+MRA was associated with the greatest reduction in all-cause mortality versus placebo (hazard ratio 0.37, 95% credible interval 0.19-0.65). A sensitivity analysis that did not account for background therapy suggested that ARNI monotherapy is more efficacious than ACEI or ARB monotherapy. The network meta-analysis showed that treatment with ACEI, ARB, BB, MRA, and ARNI and their combinations were better than the treatment with placebo in reducing all-cause mortality, with the exception of ARB monotherapy and ARB plus ACEI. The combination of ARNI+BB+MRA resulted in the greatest mortality reduction. © 2017 The Authors.

  5. Influence of ST-segment recovery on infarct size and ejection fraction in patients with ST-segment elevation myocardial infarction receiving primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hallén, Jonas; Ripa, Maria Sejersten; Johanson, Per

    2010-01-01

    percutaneous coronary intervention. Three methods for calculating and categorizing ST-segment recovery were used: (1) summed ST-segment deviation (STD) resolution analyzed in 3 categories (> or = 70%, > or = 30% to or = 2 mm). Infarct size and ejection fraction were assessed at 4 months by cardiac magnetic...... resonance imaging. All 3 ST-segment recovery algorithms predicted the final infarct size and cardiac function. Worst-lead residual STD performed the same as, or better than, the more complex methods and identified large subgroups at either end of the risk spectrum (median infarct size from the lowest...

  6. Worsening Renal Function during Management for Chronic Heart Failure with Reduced Ejection Fraction: Results From the Pro-BNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study.

    Science.gov (United States)

    Ibrahim, Nasrien E; Gaggin, Hanna K; Rabideau, Dustin J; Gandhi, Parul U; Mallick, Aditi; Januzzi, James L

    2017-02-01

    To assess prognostic meaning of worsening renal failure (WRF) occurring during management of chronic heart failure (HF) with reduced ejection fraction. When WRF develops during titration of HF medical therapy, it commonly leads to less aggressive care. A total of 151 patients enrolled in a prospective, randomized study of standard of care (SOC) HF therapy versus SOC plus a goal N-terminal pro-B type natriuretic peptide (NT-proBNP) renal function. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Left ventricular markers of global dyssynchrony predict limited exercise capacity in heart failure, but not in patients with preserved ejection fraction

    Directory of Open Access Journals (Sweden)

    Bajraktari Gani

    2012-09-01

    Full Text Available Abstract Background The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT in patients with heart failure (HF, irrespective of ejection fraction (EF. Methods In 147 HF patients (mean age 61 ± 11 years, 50.3% male, a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 – (total ejection time + total filling time], and Tei index (t-IVT/ejection time. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤300 m and Group II: >300 m, and also in two groups according to EF (Group A: LVEF ≥ 45% and Group B: LVEF  Results In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = −0.49, p  Conclusion In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology.

  8. Rationale and design of the Karolinska-Rennes (KaRen) prospective study of dyssynchrony in heart failure with preserved ejection fraction.

    Science.gov (United States)

    Donal, Erwan; Lund, Lars H; Linde, Cecilia; Edner, Magnus; Lafitte, Stéphane; Persson, Hans; Bauer, Fabrice; Ohrvik, John; Ennezat, Pierre-Vladimir; Hage, Camilla; Löfman, Ida; Juilliere, Yves; Logeart, Damien; Derumeaux, Geneviève; Gueret, Pascal; Daubert, Jean-Claude

    2009-02-01

    Heart failure with preserved ejection fraction (HFPEF) is common but not well understood. Electrical dyssynchrony in systolic heart failure is harmful. Little is known about the prevalence and the prognostic impact of dyssynchrony in HFPEF. We have designed a prospective, multicenter, international, observational study to characterize HFPEF and to determine whether electrical or mechanical dyssynchrony affects prognosis. Patients presenting with acute heart failure (HF) will be screened so as to identify 400 patients with HFPEF. Inclusion criteria will be: acute presentation with Framingham criteria for HF, left ventricular ejection fraction>or=45%, brain natriuretic peptide (BNP)>100 pg/mL or NT-proBNP>300 pg/mL. Once stabilized, 4-8 weeks after the index presentation, patients will return and undergo questionnaires, serology, ECG, and Doppler echocardiography. Thereafter, patients will be followed for mortality and HF hospitalization every 6 months for at least 18 months. Sub-studies will focus on echocardiographic changes from the acute presentation to the stable condition and on exercise echocardiography, cardiopulmonary exercise testing, and serological markers. KaRen aims to characterize electrical and mechanical dyssynchrony and to assess its prognostic impact in HFPEF. The results might improve our understanding of HFPEF and generate answers to the question whether dyssynchrony could be a target for therapy in HFPEF.

  9. Prospective assessment of the frequency of low gradient severe aortic stenosis with preserved left ventricular ejection fraction: Critical impact of aortic flow misalignment and pressure recovery phenomenon.

    Science.gov (United States)

    Ringle, Anne; Castel, Anne-Laure; Le Goffic, Caroline; Delelis, François; Binda, Camille; Bohbot, Yohan; Ennezat, Pierre Vladimir; Guerbaai, Raphaëlle A; Levy, Franck; Vincentelli, André; Graux, Pierre; Tribouilloy, Christophe; Maréchaux, Sylvestre

    2018-02-10

    The frequency of paradoxical low-gradient severe aortic stenosis (AS) varies widely across studies. The impact of misalignment of aortic flow and pressure recovery phenomenon on the frequency of low-gradient severe AS with preserved left ventricular ejection fraction (LVEF) has not been evaluated in prospective studies. To investigate prospectively the impact of aortic flow misalignment by Doppler and lack of pressure recovery phenomenon correction on the frequency of low-gradient (LG) severe aortic stenosis (AS) with preserved LVEF. Aortic jet velocities and mean pressure gradient (MPG) were obtained by interrogating all windows in 68 consecutive patients with normal LVEF and severe AS (aortic valve area [AVA] ≤1cm 2 ) on the basis of the apical imaging window alone (two-dimensional [2D] apical approach). Patients were classified as having LG or high-gradient (HG) AS according to MPG 35mL/m 2 or ≤35mL/m 2 , on the basis of the 2D apical approach, the multiview approach (multiple windows evaluation) and AVA corrected for pressure recovery. The proportion of LG severe AS was 57% using the 2D apical approach alone. After the multiview approach and correction for pressure recovery, the proportion of LG severe AS decreased from 57% to 13% (LF-LG severe AS decreased from 23% to 3%; NF-LG severe AS decreased from 34% to 10%). As a result, 25% of patients were reclassified as having HG severe AS (AVA ≤1cm 2 and MPG ≥40mmHg) and 19% as having moderate AS. Hence, 77% of patients initially diagnosed with LG severe AS did not have "true" LG severe AS when the multiview approach and the pressure recovery phenomenon correction were used. Aortic flow misevaluation, resulting from lack of use of multiple windows evaluation and pressure recovery phenomenon correction, accounts for a large proportion of incorrectly graded AS and considerable overestimation of the frequency of LG severe AS with preserved LVEF. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  10. Use of normalized total dose to represent the biological effect of fractionated radiotherapy

    International Nuclear Information System (INIS)

    Flickinger, J.C.; Kalend, A.

    1990-01-01

    There are currently a number of radiobiological models to account for the effects of dose fractionation and time. Normalized total dose (NTD) is not another new model but is a previously reported, clinically useful form in which to represent the biological effect, determined by any specific radiobiological dose-fractionation model, of a course of radiation using a single set of standardized, easily understood terminology. The generalized form of NTD reviewed in this paper describes the effect of a course of radiotherapy administered with nonstandard fractionation as the total dose of radiation in Gy that could be administered with a given reference fractionation such as 2 Gy per fraction, 5 fractions per week that would produce an equivalent biological effect (probability of complications or tumor control) as predicted by a given dose-fractionation formula. The use of normalized total dose with several different exponential and linear-quadratic dose-fraction formulas is presented. (author). 51 refs.; 1 fig.; 1 tab

  11. Use of normalized total dose to represent the biological effect of fractionated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Flickinger, J C; Kalend, A [Pittsburgh University School of Medicine (USA). Department of Radiation Oncology Pittsburg Cancer Institute (USA)

    1990-03-01

    There are currently a number of radiobiological models to account for the effects of dose fractionation and time. Normalized total dose (NTD) is not another new model but is a previously reported, clinically useful form in which to represent the biological effect, determined by any specific radiobiological dose-fractionation model, of a course of radiation using a single set of standardized, easily understood terminology. The generalized form of NTD reviewed in this paper describes the effect of a course of radiotherapy administered with nonstandard fractionation as the total dose of radiation in Gy that could be administered with a given reference fractionation such as 2 Gy per fraction, 5 fractions per week that would produce an equivalent biological effect (probability of complications or tumor control) as predicted by a given dose-fractionation formula. The use of normalized total dose with several different exponential and linear-quadratic dose-fraction formulas is presented. (author). 51 refs.; 1 fig.; 1 tab.

  12. New echocardiographic predictors of clinical outcome in patients presenting with heart failure and a preserved left ventricular ejection fraction: a subanalysis of the Ka (Karolinska) Ren (Rennes) Study.

    Science.gov (United States)

    Donal, Erwan; Lund, Lars H; Oger, Emmanuel; Hage, Camilla; Persson, Hans; Reynaud, Amélie; Ennezat, Pierre-Vladimir; Bauer, Fabrice; Drouet, Elodie; Linde, Cecilia; Daubert, Claude

    2015-07-01

    To identify electrocardiographic and echocardiographic predictors of mortality and hospitalizations for heart failure (HF) in the KaRen study. KaRen is a prospective, observational study of the long-term outcomes of patients presenting with heart failure and a preserved ejection fraction (HFpEF). We identified 538 patients who presented with acute cardiac decompensation, a >100 pg/mL serum b-type natriuretic peptide (BNP) or >300 pg/mL N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration and a left ventricular ejection fraction (LVEF) >45%. After 4-8 weeks of standard treatment, 413 patients (mean age = 76 ± 9 years, 55.9% women) returned for analyses of their clinical status, laboratory screen, and detailed electrocardiographic and Doppler echocardiographic recordings. They were followed for a mean of 28 months thereafter. The primary study endpoint was time to death from all causes or first hospitalization for heart failure. Mean LVEF was 62.4 ± 6.9% and median NT-proBNP 1410 pmol/L. PR interval >200 ms was present in 11.2% of patients and 14.9% had a >120 ms QRS duration, with left bundle branch block in only 6.3%. Over a mean follow-up of 28 months, 177 patients (42.9%) reached a primary study endpoint, including 61 deaths and 116 hospitalizations for heart failure. After adjustment for age, gender, New York Heart Association class, atrial fibrillation history, creatinine, sodium, BNP, ejection fraction, and right ventricular fractional shortening, only E/e' remained as a predictor, with a hazard ratio = 1.49 and P = 0.0012. The incidence of hospitalizations for HF and deaths in KaRen was high and E/e' predicted adverse clinical outcomes. These observations should help in the risk stratification and therapy of HFpEF. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

  13. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

    Science.gov (United States)

    Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillon, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

    2017-01-01

    Importance Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. Objective To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Design, Setting, and Participants Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Interventions Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Main Outcomes and Measures Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Results Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, −7% [95% CI, −17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse

  14. Effect of Levosimendan on Low Cardiac Output Syndrome in Patients With Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting With Cardiopulmonary Bypass: The LICORN Randomized Clinical Trial.

    Science.gov (United States)

    Cholley, Bernard; Caruba, Thibaut; Grosjean, Sandrine; Amour, Julien; Ouattara, Alexandre; Villacorta, Judith; Miguet, Bertrand; Guinet, Patrick; Lévy, François; Squara, Pierre; Aït Hamou, Nora; Carillion, Aude; Boyer, Julie; Boughenou, Marie-Fazia; Rosier, Sebastien; Robin, Emmanuel; Radutoiu, Mihail; Durand, Michel; Guidon, Catherine; Desebbe, Olivier; Charles-Nelson, Anaïs; Menasché, Philippe; Rozec, Bertrand; Girard, Claude; Fellahi, Jean-Luc; Pirracchio, Romain; Chatellier, Gilles

    2017-08-08

    Low cardiac output syndrome after cardiac surgery is associated with high morbidity and mortality in patients with impaired left ventricular function. To assess the ability of preoperative levosimendan to prevent postoperative low cardiac output syndrome. Randomized, double-blind, placebo-controlled trial conducted in 13 French cardiac surgical centers. Patients with a left ventricular ejection fraction less than or equal to 40% and scheduled for isolated or combined coronary artery bypass grafting with cardiopulmonary bypass were enrolled from June 2013 until May 2015 and followed during 6 months (last follow-up, November 30, 2015). Patients were assigned to a 24-hour infusion of levosimendan 0.1 µg/kg/min (n = 167) or placebo (n = 168) initiated after anesthetic induction. Composite end point reflecting low cardiac output syndrome with need for a catecholamine infusion 48 hours after study drug initiation, need for a left ventricular mechanical assist device or failure to wean from it at 96 hours after study drug initiation when the device was inserted preoperatively, or need for renal replacement therapy at any time postoperatively. It was hypothesized that levosimendan would reduce the incidence of this composite end point by 15% in comparison with placebo. Among 336 randomized patients (mean age, 68 years; 16% women), 333 completed the trial. The primary end point occurred in 87 patients (52%) in the levosimendan group and 101 patients (61%) in the placebo group (absolute risk difference taking into account center effect, -7% [95% CI, -17% to 3%]; P = .15). Predefined subgroup analyses found no interaction with ejection fraction less than 30%, type of surgery, and preoperative use of β-blockers, intra-aortic balloon pump, or catecholamines. The prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%), and other adverse events did not significantly differ between levosimendan and placebo. Among patients with low ejection fraction

  15. Determination of differences in the left ventricular ejection fraction (LVEF) by radionuclides and echocardiography pre and post treatment with anthracycline in pediatric patients with oncology diagnostic of the La Raza Medical Center

    International Nuclear Information System (INIS)

    Veras R, H.

    2003-01-01

    The objective of this work was to correlate the left ventricular ejection fraction determine by radionuclide angiocardiography and echocardiography in pediatric patients under anthracycline treatment. Material and methods: 41 patients were studied with range age from 3 to 14 years, with oncology diagnostic that were treated with anthracycline. Radionuclide angiocardiography and echocardiography were performed before an after anthracycline administration to determine the changes in the Ieft ventricular ejection fraction. Results: Anthracycline treatment caused no changes in the electrocardiography, echocardiogram and radionuclide angiocardiography. Conclusions: In our study anthracycline treatment caused no changes in the electrocardiography, echocardiography and both radionuclide angiocardiography techniques, first-pass and equilibrium. A high correlation was obtaining when left ventricular ejection fraction is compared between radionuclide angiocardiography and echocardiogram. (Author)

  16. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Reddy, Vivek; Kaye, David

    2014-01-01

    BACKGROUND: Heart failure with preserved or mildly reduced ejection fraction (HFpEF) is common and, to date, therapeutic options are limited. Increased left atrial pressure is a key contributor to the symptoms associated with HFpEF, particularly during physical activity. We report the 30-day...... outcome of patients treated with a novel device intended to lower left atrial pressure by creating an 8 mm permanent shunt in the atrial septum. METHODS AND RESULTS: Eleven patients were enrolled in the pilot trial. Key inclusion criteria were: EF >45%; baseline PCWP ≥15 mmHg (rest), or ≥ 25 mm...... patients, one class in five patients, and worsened by one class in one patient. No patient developed pulmonary hypertension. Two serious adverse events occurred; heart failure re-hospitalization, and implant malposition successfully treated with a new device. CONCLUSION: Contemporary management of HFp...

  17. Calculation of left ventricular volume and ejection fraction from ECG-gated myocardial SPECT. Automatic detection of endocardial borders by threshold method

    International Nuclear Information System (INIS)

    Fukushi, Shoji; Teraoka, Satomi.

    1997-01-01

    A new method which calculate end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) of the left ventricle from myocardial short axis images of ECG-gated SPECT using 99m Tc myocardial perfusion tracer has been designed. Eight frames per cardiac cycle ECG-gated 180 degrees SPECT was performed. Threshold method was used to detect myocardial borders automatically. The optimal threshold was 45% by myocardial SPECT phantom. To determine if EDV, ESV and LVEF can also be calculated by this method, 12 patients were correlated ventriculography (LVG) for 10 days each. The correlation coefficient with LVG was 0.918 (EDV), 0.935 (ESV) and 0.900 (LVEF). This method is excellent at objectivity and reproductivity because of the automatic detection of myocardial borders. It also provides useful information on heart function in addition to myocardial perfusion. (author)

  18. Dietary Fat, Sugar Consumption, and Cardiorespiratory Fitness in Patients With Heart Failure With Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Salvatore Carbone, MS

    2017-10-01

    Full Text Available Heart failure with preserved ejection fraction (HFpEF is associated with obesity and, indirectly, with unhealthy diet. The role of dietary components in HFpEF is, however, largely unknown. In this study, the authors showed that in obese HFpEF patients, consumption of unsaturated fatty acids (UFA, was associated with better cardiorespiratory fitness, and UFA consumption correlated with better diastolic function and with greater fat-free mass. Similarly, mice fed with a high-fat diet rich in UFA and low in sugars had preserved myocardial function and reduced weight gain. Randomized clinical trials increasing dietary UFA consumption and reducing sugar consumption are warranted to confirm and expand our findings.

  19. Clinical events in coronary heart disease patients with an ejection fraction of 40% or less: 3-year follow-up results.

    Science.gov (United States)

    Pischke, Claudia R; Elliott-Eller, Melanie; Li, Minmin; Mendell, Nancy; Ornish, Dean; Weidner, Gerdi

    2010-01-01

    It is unclear whether lifestyle changes can delay the need for surgical procedures in coronary heart disease (CHD) patients with asymptomatic reduced left ventricular ejection fraction (LVEF). The aim of this pilot study was to examine whether lifestyle changes can delay the need for surgical procedures in this population. We compared 3-year clinical events in 27 CHD patients eligible to receive revascularization (by insurance standards), but underwent lifestyle changes (low-fat diet, exercise, stress management) instead (intervention group [IG], LVEF Lifestyle Demonstration Project, an insurance-sponsored, community-based, secondary prevention study implemented at 8 hospital sites in the United States. At 3 months, there were more cardiac events in the UCG (6 events) than in the IG (1 event; P changes in lifestyle with no increased risk for cardiac events or overt heart failure over 3 years.

  20. Reduced ejection fraction heart failure – new data from multicenter studies and national registries regarding general and elderly populations: hopes and disappointments

    Directory of Open Access Journals (Sweden)

    Crișan S

    2018-04-01

    Full Text Available Simina Crişan,1,2 Lucian Petrescu,1,2 Mihai Andrei Lazăr,1,2 Cristina Văcărescu,1,2 Alina-Ramona Nicola,1 Dragoş Cozma,1,2 Cristian Mornoş,1,2 Constantin Tudor Luca1,2 1Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Institute of Cardiovascular Diseases, Timisoara, Romania Abstract: The evaluation of patients diagnosed with impaired systolic function heart failure represents a great challenge, in both the general and elderly population. We consider that elderly patients are the most severely affected by this disease that represents the final impact of cardiovascular disease continuum. Cardiovascular diseases are associated with serious morbidity and mortality, and considerable health care costs related to diagnosis and treatment. In this report we discuss some controversies regarding methods of heart failure evaluation as well as therapeutic steps and devices, including: reparatory therapeutic steps and initiation of therapy with loop diuretics, inconsistent dose titration for angiotensin-converting enzyme inhibitors/angiotensin receptor blocker and beta blockers, as well as novel therapies, such as angiotensin receptor neprilysin inhibitor and treatments that directly improve cardiomyocyte function. We conclude that, beyond technical progress, which is raising the cost of therapy for patients with heart failure, more careful monitoring of patient progress through clinical and paraclinical control visits, both at medical facilities and at home, would have greater impact and be more cost-effective. Physical therapy and promoting emotional and psychological wellbeing, to maintain a positive state of mind, contribute substantially to the quality of life and life expectancy, and are most important in elderly people who are most affected by dramatic reductions in wellbeing. Unfortunately, for many patients with severe impairment of left ventricular ejection fraction, these goals and therapeutic

  1. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

    International Nuclear Information System (INIS)

    Chan, Sherwin S.; Whitehead, Kevin K.; Kim, Timothy S.; Fu, Gregory L.; Fogel, Mark A.; Harris, Matthew A.; Keller, Marc S.

    2015-01-01

    There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m 2 vs. 118 ± 30 mL/m 2 ), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation. (orig.)

  2. Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome.

    Science.gov (United States)

    Farmakis, Dimitrios; Simitsis, Panagiotis; Bistola, Vasiliki; Triposkiadis, Filippos; Ikonomidis, Ignatios; Katsanos, Spyridon; Bakosis, George; Hatziagelaki, Erifili; Lekakis, John; Mebazaa, Alexandre; Parissis, John

    2017-05-01

    Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.

  3. Causes and Temporal Patterns of 30-Day Readmission Among Older Adults Hospitalized With Heart Failure With Preserved or Reduced Ejection Fraction.

    Science.gov (United States)

    Goyal, Parag; Loop, Matthew; Chen, Ligong; Brown, Todd M; Durant, Raegan W; Safford, Monika M; Levitan, Emily B

    2018-04-23

    It is unknown whether causes and temporal patterns of 30-day readmission vary between heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to address this question by examining a 5% national sample of Medicare beneficiaries. We included individuals who experienced a hospitalization for HFpEF or HFrEF between 2007 and 2013. We identified causes of 30-day readmission based on primary discharge diagnosis and further classified causes of readmission as HF-related, non-HF cardiovascular-related, and non-cardiovascular-related. We calculated the cumulative incidence of these classifications for HFpEF and HFrEF in a competing risks model and calculated subdistribution hazard ratios of these classifications by comparing those with HFpEF and those with HFrEF. Among 60 640 Medicare beneficiaries, we identified 13 785 unique older adults hospitalized with HFpEF and 15 205 who were hospitalized with HFrEF. Noncardiovascular diagnoses represented the most common causes of 30-day readmission (HFpEF: 59%; HFrEF: 47%), a pattern that was observed for each week of the 30-day study period for both HFpEF and HFrEF participants. In comparing readmission diagnoses in an adjusted model, non-cardiovascular-related diagnoses were more common and HF-related diagnoses were less common in HFpEF participants. Non-cardiovascular-related diagnoses represented the most common causes of 30-day readmission following HF hospitalization for each week of the 30-day postdischarge period. HF diagnoses were less common among those with HFpEF compared with HFrEF. Future interventions aimed at reducing 30-day readmissions following an HF hospitalization would benefit from an increased focus on noncardiovascular comorbidity and interventions that target HFpEF and HFrEF separately. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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

    Science.gov (United States)

    Steinberg, Gerrit; Lossnitzer, Nicole; Schellberg, Dieter; Mueller-Tasch, Thomas; Krueger, Carsten; Haass, Markus; Ladwig, Karl Heinz; Herzog, Wolfgang; Juenger, Jana

    2011-01-01

    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. 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 between depressive symptoms and cognitive impairment. Left ventricular ejection fraction was related to subjective cognitive impairment, and peak oxygen uptake was related to objective cognitive impairment. Cognitive functioning was substantially reduced in patients with CHF and should therefore be diagnosed and treated in routine clinical practice. Caution is advised when the MMSE is used to identify cognitive impairment in patients with CHF.

  5. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated {sup 82}rubidium myocardial perfusion PET

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Tracy L.Y.; Merrill, Jennifer; Bengel, Frank M. [Johns Hopkins University, Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Baltimore, MD (United States); Volokh, Lana [GE Healthcare, Haifa (Israel)

    2008-02-15

    Myocardial perfusion imaging with {sup 82}Rb PET allows for ECG-gated studies to be obtained early after radiotracer injection, capturing ventricular function close to peak pharmacologic action of dipyridamole. This is different from gated SPECT and may potentially provide additional diagnostic information. We sought to identify potential correlates of the PET-derived ejection fraction response to vasodilator stress. One hundred ten consecutive patients undergoing {sup 82}Rb PET myocardial perfusion imaging during evaluation for coronary artery disease were included. Using a GE Discovery STRx PET-CT scanner, ECG-gated images (eight bins) were obtained at rest and 4 min after dipyridamole infusion, 90 s after infusion of 1,480-2,220 MBq of {sup 82}Rb. Summed rest, stress, and difference scores (SRS, SSS, and SDS) were determined using a five-point scoring system and 20-segment model. Ejection fraction was calculated using automated QGS software. Significant reversibility (SDS {>=} 4) was found in 23 patients (21%). Mean LVEF in all patients was 47 {+-} 13% at rest and 53 {+-} 13% during dipyridamole. LVEF increased in 89 patients, and decreased in 17 patients during vasodilation. The change in LVEF was inversely correlated with SDS (r = -0.26; p = 0.007). Additionally, it was inversely correlated with resting LVEF (r = -0.20; p = 0.03) and SSS (r = -0.25; p = 0.009). No significant correlations were observed with SRS, heart rate, blood pressure, age, hypertension, hypercholesterolemia, or pretest likelihood of disease. At multivariate regression analysis, SDS was an independent predictor of the change in LVEF. Gated {sup 82}Rb PET during pharmacologic stress allows for assessment of the functional response to vasodilation. The magnitude of LVEF increase is determined by stress perfusion/reversible perfusion defects. Functional response to hyperemia may thus be incorporated in future evaluations of diagnostic and prognostic algorithms based on {sup 82}Rb PET. (orig.)

  6. Regional interaction between myocardial sympathetic denervation, contractile dysfunction, and fibrosis in heart failure with preserved ejection fraction: {sup 11}C-hydroxyephedrine PET study

    Energy Technology Data Exchange (ETDEWEB)

    Aikawa, Tadao; Naya, Masanao; Obara, Masahiko [Hokkaido University, Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo (Japan); Oyama-Manabe, Noriko [Hokkaido University Hospital, Department of Diagnostic and Interventional Radiology, Sapporo (Japan); Manabe, Osamu [Hokkaido University, Department of Nuclear Medicine, Faculty of Medicine and Graduate School of Medicine, Sapporo (Japan); Magota, Keiichi [Hokkaido University Hospital, Division of Medical Imaging and Technology, Sapporo (Japan); Ito, Yoichi M. [Hokkaido University, Department of Biostatistics, Faculty of Medicine and Graduate School of Medicine, Sapporo (Japan); Katoh, Chietsugu [Hokkaido University, Department of Biomedical Science and Engineering, Faculty of Health Sciences, Sapporo (Japan); Tamaki, Nagara [Kyoto Prefectural University of Medicine, Department of Radiology, Kyoto (Japan)

    2017-10-15

    This investigation aimed to identify significant predictors of regional sympathetic denervation quantified by {sup 11}C-hydroxyephedrine (HED) positron emission tomography (PET) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF). Included in the study were 34 patients (age 63 ± 15 years, 23 men) with HFpEF (left ventricular ejection fraction ≥40%) and 11 age-matched volunteers without heart failure. Cardiac magnetic resonance imaging was performed to measure left ventricular size and function, and the extent of myocardial late gadolinium enhancement (LGE). {sup 11}C-HED PET was performed to quantify myocardial sympathetic innervation that was expressed as a {sup 11}C-HED retention index (RI, %/min). To identify predictors of regional {sup 11}C-HED RI in HFpEF patients, we propose a multivariate mixed-effects model for repeated measures over segments with an unstructured covariance matrix. Global {sup 11}C-HED RI was significantly lower and more heterogeneous in HFpEF patients than in volunteers (P < 0.01 for all). Regional {sup 11}C-HED RI was correlated positively with systolic wall thickening (r = 0.42, P < 0.001) and negatively with the extent of LGE (r = -0.43, P < 0.001). Segments in HFpEF patients with a large extent of LGE had the lowest regional {sup 11}C-HED RI among all segments (P < 0.001 in post hoc tests). Multivariate analysis demonstrated that systolic wall thickening and the extent of LGE were significant predictors of regional {sup 11}C-HED RI in HFpEF patients (both P ≤ 0.001). Regional sympathetic denervation was associated with contractile dysfunction and fibrotic burden in HFpEF patients, suggesting that regional sympathetic denervation may provide an integrated measure of myocardial damage in HFpEF. (orig.)

  7. Adaptive servo-ventilation to treat central sleep apnea in heart failure with reduced ejection fraction: the Bad Oeynhausen prospective ASV registry.

    Science.gov (United States)

    Oldenburg, Olaf; Wellmann, Birgit; Bitter, Thomas; Fox, Henrik; Buchholz, Anika; Freiwald, Eric; Horstkotte, Dieter; Wegscheider, Karl

    2018-04-13

    Central sleep apnea (CSA) is highly prevalent in heart failure patients with reduced left ventricular ejection fraction (HF-REF). The Bad Oeynhausen Adaptive Servo-ventilation (ASV) registry (NCT01657188) was designed to investigate whether treatment of CSA with ASV improved survival in HF-REF patients; the effects of ASV on symptoms and cardiopulmonary performance were also investigated. From January 2004 to October 2013, the registry prospectively enrolled HF-REF patients [NYHA class ≥ II, left ventricular ejection fraction (LVEF) ≤ 45%] with moderate to severe predominant CSA [apnea-hypopnea index (AHI) ≥ 15/h]. ASV-treated patients were followed up at 3, 6, 12 and 24 months, including natriuretic peptide concentrations, blood gas analyses, echocardiography, 6-min walk distance (6MWD), and cardiopulmonary exercise (CPX) testing. 550 patients were included [age 67.7 ± 10 years, 90% male, 52% in NYHA class ≥ III, LVEF 29.9 ± 8%, AHI 35.4 ± 13.6/h, and time with nocturnal oxygen saturation concentration, and nocturnal hypoxemia were significant predictors of mortality. Patient reported NYHA functional class improved in the ASV group, but LVEF, CPX, 6MWD, natriuretic peptides and blood gases remained unchanged. Long-term ASV treatment of predominant CSA in HF-REF patients included in our registry had no statistically significant effect on survival. ASV improved HF symptoms, but had no significant effects on exercise capacity, LVEF, natriuretic peptide concentrations or blood gases during follow-up as compared to control patients.

  8. Clinical tolerability of generic versus brand beta blockers in heart failure with reduced left ventricular ejection fraction: a retrospective cohort from heart failure clinic.

    Science.gov (United States)

    Chanchai, Rattanachai; Kanjanavanit, Rungsrit; Leemasawat, Krit; Amarittakomol, Anong; Topaiboon, Paleerat; Phrommintikul, Arintaya

    2018-01-01

    Background: Beta-blockers have been shown to decrease mortality and morbidity in heart failure with reduced ejection fraction (HFrEF) patients. However, the side effects are also dose-related, leading to the underdosing. Cost constraint may be one of the limitations of appropriate beta-blocker use; this can be improved with generic drugs. However, the effects in real life practice have not been investigated. Methods and results: This study aimed to compare the efficacy and safety of generic and brand beta-blockers in HFrEF patients. We performed a retrospective cohort analysis in HFrEF patients who received either generic or brand beta-blocker in Chiang Mai Heart Failure Clinic. The primary endpoint was the proportion of patients who received at least 50% target dose of beta-blocker between generic and brand beta-blockers. Adverse events were secondary endpoints. 217 patients (119 and 98 patients received generic and brand beta-blocker, respectively) were enrolled. There were no differences between groups regarding age, gender, etiology of heart failure, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), rate of receiving angiotensin converting enzyme inhibitor (ACEI), angiotensin recepter blocker (ARB), or spironolactone. Patients receiving brand beta-blockers had lower resting heart rate at baseline (74.9 and 84.2 bpm, p  = .001). Rate of achieved 50% target dose and target daily dose did not differ between groups (40.4 versus 44.5% and 48.0 versus 55.0%, p  > .05, respectively). Rate of side effects was not different between groups (32.3 versus 29.5%, p  > .05) and the most common side effect was hypotension. Conclusion: This study demonstrated that beta-blocker tolerability was comparable between brand and generic formulations. Generic or brand beta-blockers should be prescribed to HFrEF patients who have no contraindications.

  9. Repaired tetralogy of Fallot with coexisting unrepaired partial anomalous pulmonary venous connection is associated with diminished right ventricular ejection fraction and more severe right ventricular dilation

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Sherwin S. [Children' s Mercy Hospital and Clinics, Department of Radiology, Kansas City, MO (United States); Whitehead, Kevin K.; Kim, Timothy S.; Fu, Gregory L.; Fogel, Mark A.; Harris, Matthew A. [Children' s Hospital of Philadelphia, Department of Cardiology, Philadelphia, PA (United States); Keller, Marc S. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2015-09-15

    There is an established association between tetralogy of Fallot and partial anomalous pulmonary venous connections. This association is important because surgically repaired tetralogy patients have increased risk of right heart failure. We hypothesize that partial anomalous venous connections increase right ventricular volumes and worsen right ventricular failure. We reviewed cardiac MRI exams performed at a tertiary pediatric hospital from January 2005 to January 2014. We identified patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection. We used age- and gender-matched repaired tetralogy patients without partial anomalous pulmonary venous connection as controls. We analyzed the MRI results and surgical course and performed comparative statistics to identify group differences. There were eight patients with repaired tetralogy and unrepaired partial anomalous pulmonary venous connection and 16 controls. In all cases, the partial anomalous pulmonary venous connection was not detected on preoperative echocardiography. There were no significant differences in surgical course and body surface area between the two groups. Repaired tetralogy patients with unrepaired partial anomalous pulmonary venous connection showed significantly higher indexed right ventricular end diastolic volume (149 ± 33 mL/m{sup 2} vs. 118 ± 30 mL/m{sup 2}), right ventricle to left ventricle size ratios (3.1 ± 1.3 vs. 1.9 ± 0.5) and a higher incidence of reduced right ventricular ejection fraction compared to controls (3/8 vs. 0/16). Repaired tetralogy of Fallot with unrepaired partial anomalous pulmonary venous connection is associated with reduced right ventricular ejection fraction and more significant right ventricular dilation. (orig.)

  10. COMPOSITION OF CORONAL MASS EJECTIONS

    Energy Technology Data Exchange (ETDEWEB)

    Zurbuchen, T. H.; Weberg, M.; Lepri, S. T. [Department of Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI (United States); Von Steiger, R. [International Space Science Institute, Bern (Switzerland); Mewaldt, R. A. [California Institute of Technology, Pasadena, CA (United States); Antiochos, S. K. [Heliophysics Science Division, NASA Goddard Space Flight Center, Greenbelt, MD (United States)

    2016-07-20

    We analyze the physical origin of plasmas that are ejected from the solar corona. To address this issue, we perform a comprehensive analysis of the elemental composition of interplanetary coronal mass ejections (ICMEs) using recently released elemental composition data for Fe, Mg, Si, S, C, N, Ne, and He as compared to O and H. We find that ICMEs exhibit a systematic abundance increase of elements with first ionization potential (FIP) < 10 eV, as well as a significant increase of Ne as compared to quasi-stationary solar wind. ICME plasmas have a stronger FIP effect than slow wind, which indicates either that an FIP process is active during the ICME ejection or that a different type of solar plasma is injected into ICMEs. The observed FIP fractionation is largest during times when the Fe ionic charge states are elevated above Q {sub Fe} > 12.0. For ICMEs with elevated charge states, the FIP effect is enhanced by 70% over that of the slow wind. We argue that the compositionally hot parts of ICMEs are active region loops that do not normally have access to the heliosphere through the processes that give rise to solar wind. We also discuss the implications of this result for solar energetic particles accelerated during solar eruptions and for the origin of the slow wind itself.

  11. Impact of early, late, and no ST-segment resolution measured by continuous ST Holter monitoring on left ventricular ejection fraction and infarct size as determined by cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    Haeck, Joost D. E.; Verouden, Niels J. W.; Kuijt, Wichert J.; Koch, Karel T.; Majidi, Mohamed; Hirsch, Alexander; Tijssen, Jan G. P.; Krucoff, Mitchell W.; de Winter, Robbert J.

    2011-01-01

    Background: The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at

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

    Directory of Open Access Journals (Sweden)

    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

  13. An Early View of Real-World Patient Response to Sacubitril/Valsartan: A Retrospective Study of Patients with Heart Failure with Reduced Ejection Fraction.

    Science.gov (United States)

    Antol, Dana Drzayich; Casebeer, Adrianne Waldman; DeClue, Richard W; Stemkowski, Stephen; Russo, Patricia A

    2018-06-01

    Sacubitril/valsartan has been established as an effective treatment for heart failure (HF) with reduced ejection fraction based on clinical trial data; however, little is known about its use or impact in real-world practice. This study included data from medical and pharmacy claims and medical records review for patients (n = 200) who initiated sacubitril/valsartan between August 2015 and March 2016 preceding issuance of American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) focused update on new pharmacological therapy for HF (May 2016), which included recommendations for sacubitril/valsartan. A within-subject analysis compared symptoms and healthcare resource utilization before and after treatment initiation. Patients treated with sacubitril/valsartan had multiple comorbidities, and nearly all had previous treatment for HF. Most patients initiated sacubitril/valsartan at the lowest dose of 24/26 mg twice a day (BID), which remained unchanged during the observation period for half of the patients. During the first 6 weeks of treatment, few patients discontinued sacubitril/valsartan treatment (5.5%), and only 17% achieved the target dose of 97/103 mg BID after 4 months of treatment. The proportion of patients with ≥ 1 all-cause inpatient stay decreased significantly between the pre-initiation period (27.5%) and the post-initiation period (17.0%), P = 0.009. Fatigue was noted in 51.8% of patients pre-initiation and 39.5% post-initiation, P = 0.027. Shortness of breath was documented for 66.7% of patients pre-initiation and 51.8% post-initiation, P = 0.008. The findings of this real-world investigation suggest sacubitril/valsartan is associated with symptom improvements and a reduction in hospitalizations within 4 months of treatment for patients with HF and reduced ejection fraction. Novartis Pharmaceuticals Corporation.

  14. Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion.

    Science.gov (United States)

    Bauer, Anna; Khalil, Markus; Lüdemann, Monika; Bauer, Jürgen; Esmaeili, Anoosh; De-Rosa, Roberta; Voelkel, Norbert F; Akintuerk, Hakan; Schranz, Dietmar

    2018-04-16

    Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect. From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach. Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

  15. The influence of dose fractionation and dose rate on normal tissue responses

    International Nuclear Information System (INIS)

    Barendsen, G.W.

    1982-01-01

    An analysis of responses of a variety of normal tissues in animals to fractionated irradiations has been made with the aim of developing a formalism for the prediction of tolerance doses as a function of the dose per fraction and the overall treatment time. An important feature of the formalism is that it is directly based on radiological insights and therefore provides a logical concept to account for the diversity of tissue responses. (Auth.)

  16. Changes in Cardiopulmonary Reserve and Peripheral Arterial Function Concomitantly with Subclinical Inflammation and Oxidative Stress in Patients with Heart Failure with Preserved Ejection Fraction

    Directory of Open Access Journals (Sweden)

    Damien Vitiello

    2014-01-01

    Full Text Available Background. Changes in cardiopulmonary reserve and biomarkers related to wall stress, inflammation, and oxidative stress concomitantly with the evaluation of peripheral arterial blood flow have not been investigated in patients with heart failure with preserved ejection fraction (HFpEF compared with healthy subjects (CTL. Methods and Results. Eighteen HFpEF patients and 14 CTL were recruited. Plasma levels of inflammatory and oxidative stress biomarkers were measured at rest. Brain natriuretic peptide (BNP was measured at rest and peak exercise. Cardiopulmonary reserve was assessed using an exercise protocol with gas exchange analyses. Peripheral arterial blood flow was determined by strain gauge plethysmography. Peak VO2 (12.0±0.4 versus 19.1±1.1 mL/min/kg, P<0.001 and oxygen uptake efficiency slope (1.55±0.12 versus 2.06±0.14, P<0.05 were significantly decreased in HFpEF patients compared with CTL. BNP at rest and following stress, C-reactive-protein, interleukin-6, and TBARS were significantly elevated in HFpEF. Both basal and posthyperemic arterial blood flow were not significantly different between the HFpEF patients and CTL. Conclusions. HFpEF exhibits a severe reduction in cardiopulmonary reserve and oxygen uptake efficiency concomitantly with an elevation in a broad spectrum of biomarkers confirming an inflammatory and prooxidative status in patients with HFpEF.

  17. The Effects of Wenxin Keli on Left Ventricular Ejection Fraction and Brain Natriuretic Peptide in Patients with Heart Failure: A Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Yu Chen

    2014-01-01

    Full Text Available Objective. To evaluate the beneficial and adverse effects of Wenxin Keli (WXKL, either alone or in combination with Western medicine, on the left ventricular ejection fraction (LVEF and plasma brain natriuretic peptide (BNP in the treatment of heart failure (HF. Methods. Seven major electronic databases were searched to retrieve potential randomized controlled trials (RCTs designed to evaluate the clinical effectiveness of WXKL, either alone or in combination with Western medicine, for HF, with the LVEF or BNP after eight weeks of treatment as main outcome measures. The methodological quality of the included studies was assessed using criteria from the Cochrane Handbook for Systematic Review of Interventions, Version 5.1.0, and analyzed using RevMan 5.1.0 software. Results. Eleven RCTs of WXKL were included. The methodological quality of the trials was generally evaluated as low. The risk of bias was high. The results of the meta-analysis showed that WXKL, either alone or in combination with Western medicine, was more effective in LVEF and BNP, compared with no medicine or Western medicine alone, in patients with HF or HF complicated by other diseases. Five of the trials reported adverse events, while the others did not mention them, indicating that the safety of WXKL remains uncertain. Conclusions. WXKL, either alone or in combination with Western medicine, appears to be more effective in improving the LVEF and BNP in patients with HF and HF complications.

  18. Evaluation of left ventricular ejection fraction from radial long-axis tomography. A new reconstruction algorithm for ECG-gated technetium-99m Sestamibi SPECT

    International Nuclear Information System (INIS)

    Tsujimura, Eiichiro; Kusuoka, Hideo; Uehara, Toshiisa

    1997-01-01

    Radial long-axis tomography can provide views similar to contrast left ventriculography (LVG) including the basal and apical areas of the left ventricle, not possible in routine short-axis tomography. We applied this method to ECG-gated Tc-99m Sestamibi (MIBI) myocardial SPECT images to estimate the left ventricular ejection fraction (LVEF). ECG-gated Tc-99m MIBI SPECT was performed with a temporal resolution of 10 frames per R-R interval. LVEF was calculated on the basis of left ventricular volume estimates at end diastole (ED) and end systole (ES) with using an ellipsoid body model. To validate this method, LVEF's derived from ECG-gated Tc-99m MIBI SPECT were compared with those from LVG in 11 patients with coronary artery disease. There was a close linear correlation between LVEF values calculated from Tc-99m MIBI SPECT and those from LVG (r=0.89, p<0.001), although the gated SPECT underestimated LVEF compared to LVG. The technique showed excellent reproducibility (intra-observer variability, r=0.96, p<0.001; inter-observer variability, r=0.71, p<0.005). The radial long-axis tomography technique gives a good estimate of LVEF, in agreement with estimates based on LVG. ECG-gated Tc-99m MIBI SPECT can, therefore, be applicable to assess myocardial perfusion and ventricular function at the same time. (author)

  19. β-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction.

    Science.gov (United States)

    Abi Khalil, Charbel; Zubaid, Mohammad; Asaad, Nidal; Rashed, Wafa A; Hamad, Adel Khalifa; Singh, Rajvir; Al Suwaidi, Jassim

    2018-04-01

    The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on β-blockers. Mortality was lower in those patients compared with the non-β-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the β-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of β-blockers on mortality persisted, at the cost of more hospitalization for AF.

  20. Do sodium-glucose co-transporter-2 inhibitors prevent heart failure with a preserved ejection fraction by counterbalancing the effects of leptin? A novel hypothesis.

    Science.gov (United States)

    Packer, Milton

    2018-06-01

    Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce the risk of serious heart failure events in patients with type 2 diabetes, but little is known about mechanisms that might mediate this benefit. The most common heart failure phenotype in type 2 diabetes is obesity-related heart failure with a preserved ejection fraction (HFpEF). It has been hypothesized that the synthesis of leptin in this disorder leads to sodium retention and plasma volume expansion as well as to cardiac and renal inflammation and fibrosis. Interestingly, leptin-mediated neurohormonal activation appears to enhance the expression of SGLT2 in the renal tubules, and SGLT2 inhibitors exert natriuretic actions at multiple renal tubular sites in a manner that can oppose the sodium retention produced by leptin. In addition, SGLT2 inhibitors reduce the accumulation and inflammation of perivisceral adipose tissue, thus minimizing the secretion of leptin and its paracrine actions on the heart and kidneys to promote fibrosis. Such fibrosis probably contributes to the impairment of cardiac distensibility and glomerular function that characterizes obesity-related HFpEF. Ongoing clinical trials with SGLT2 inhibitors in heart failure are positioned to confirm or refute the hypothesis that these drugs may favourably influence the course of obesity-related HFpEF by their ability to attenuate the secretion and actions of leptin. © 2018 John Wiley & Sons Ltd.

  1. Evaluation of left ventricular ejection fraction from radial long-axis tomography. A new reconstruction algorithm for ECG-gated technetium-99m Sestamibi SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Tsujimura, Eiichiro; Kusuoka, Hideo; Uehara, Toshiisa [Osaka Univ. (Japan). Faculty of Medicine] [and others

    1997-08-01

    Radial long-axis tomography can provide views similar to contrast left ventriculography (LVG) including the basal and apical areas of the left ventricle, not possible in routine short-axis tomography. We applied this method to ECG-gated Tc-99m Sestamibi (MIBI) myocardial SPECT images to estimate the left ventricular ejection fraction (LVEF). ECG-gated Tc-99m MIBI SPECT was performed with a temporal resolution of 10 frames per R-R interval. LVEF was calculated on the basis of left ventricular volume estimates at end diastole (ED) and end systole (ES) with using an ellipsoid body model. To validate this method, LVEF`s derived from ECG-gated Tc-99m MIBI SPECT were compared with those from LVG in 11 patients with coronary artery disease. There was a close linear correlation between LVEF values calculated from Tc-99m MIBI SPECT and those from LVG (r=0.89, p<0.001), although the gated SPECT underestimated LVEF compared to LVG. The technique showed excellent reproducibility (intra-observer variability, r=0.96, p<0.001; inter-observer variability, r=0.71, p<0.005). The radial long-axis tomography technique gives a good estimate of LVEF, in agreement with estimates based on LVG. ECG-gated Tc-99m MIBI SPECT can, therefore, be applicable to assess myocardial perfusion and ventricular function at the same time. (author)

  2. Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis.

    Science.gov (United States)

    Zeng, Rui-Xiang; Chen, Mao-Sheng; Lian, Bao-Tao; Liao, Peng-Da; Zhang, Min-Zhou

    2017-10-06

    New-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI. MEDLINE ® , EMBASE ® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3. We included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was -4.91 units (95% Cl: -5.70 to -4.12), test for overall effect z-score = 12.18 ( p < 0.00001, I 2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 ( p < 0.00001, I 2 = 57%). Our meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

  3. Relationship between angina pectoris and outcomes in patients with heart failure and reduced ejection fraction: an analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA).

    Science.gov (United States)

    Badar, Athar A; Perez-Moreno, Ana Cristina; Jhund, Pardeep S; Wong, Chih M; Hawkins, Nathaniel M; Cleland, John G F; van Veldhuisen, Dirk J; Wikstrand, John; Kjekshus, John; Wedel, Hans; Watkins, Stuart; Gardner, Roy S; Petrie, Mark C; McMurray, John J V

    2014-12-21

    Angina pectoris is common in patients with heart failure and reduced ejection fraction (HF-REF) but its relationship with outcomes has not been well defined. This relationship was investigated further in a retrospective analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Four thousand, eight hundred and seventy-eight patients were divided into three categories: no history of angina and no chest pain at baseline (Group A; n = 1240), past history of angina but no chest pain at baseline (Group B; n = 1353) and both a history of angina and chest pain at baseline (Group C; n = 2285). Outcomes were examined using Kaplan-Meier and Cox regression survival analysis. Compared with Group A, Group C had a higher risk of non-fatal myocardial infarction or unstable angina (HR: 2.36, 1.54-3.61; P angina are at an increased risk of acute coronary syndrome and HF hospitalization. Whether these patients would benefit from more aggressive medical therapy or percutaneous revascularization is not known and merits further investigation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  4. Comparative Assessment of the Preventive Use of Intra-Aortic Baloon Counterpulsation and Levosimendan in Patients with Coronary Heart Disease and Low Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    V. A. Boboshko

    2012-01-01

    Full Text Available The aim of our study was to compare the efficiency of the use of intraaortic balloon counterpulsation (IABP and levosi-mendan in patients with low left ventricular ejection fraction operated on under cardiopulmonary bypass. The study included 90 patients who were randomized into three groups according to the strategy of hemodynamic support. Group A patients received IABP 24 hours before surgery. In group B, preventive IABP was combined with intraoperative levosimendan infusion. Group C patients received intraoperative levosimendan infusion only. Hemodynamics, the markers of myocardial damage and heart failure, postoperative complications and length of hospital stay were observed. The patients treated with lev-osimendan had a more stable hemodynamic profile. Troponin I level was significantly lower in Group C six hours after cardiopulmonary bypass than that in group A. Length of stay in intensive care was significantly lower in Group C. The pre-operative concentration of BNP (>360 pg/ml is a predictor of inotropic support in the postoperative period. The results of our study indicate that the use of levosimendan in high-risk patients is effective and shows the results comparable with those of intra-aortic balloon counterpulsation.

  5. Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET.

    Science.gov (United States)

    Nordström, Jonny; Kero, Tanja; Harms, Hendrik Johannes; Widström, Charles; Flachskampf, Frank A; Sörensen, Jens; Lubberink, Mark

    2017-11-14

    Quantitative measurement of myocardial blood flow (MBF) is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD). 15 O-water positron emission tomography (PET) is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV) volumes and ejection fraction (EF) is not possible from standard 15 O-water uptake images. The purpose of the present work was to investigate the possibility of calculating LV volumes and LVEF from cardiac-gated parametric blood volume (V B ) 15 O-water images and from first pass (FP) images. Sixteen patients with mitral or aortic regurgitation underwent an eight-gate dynamic cardiac-gated 15 O-water PET/CT scan and cardiac MRI. V B and FP images were generated for each gate. Calculations of end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV) and LVEF were performed with automatic segmentation of V B and FP images, using commercially available software. LV volumes and LVEF were calculated with surface-, count-, and volume-based methods, and the results were compared with gold standard MRI. Using V B images, high correlations between PET and MRI ESV (r = 0.89, p  0.86, p dynamic 15 O-water PET is feasible and shows good correlation with MRI. However, the analysis method is laborious, and future work is needed for more automation to make the method more easily applicable in a clinical setting.

  6. Model-Based Normalization of a Fractional-Crystal Collimator for Small-Animal PET Imaging.

    Science.gov (United States)

    Li, Yusheng; Matej, Samuel; Karp, Joel S; Metzler, Scott D

    2017-05-01

    Previously, we proposed to use a coincidence collimator to achieve fractional-crystal resolution in PET imaging. We have designed and fabricated a collimator prototype for a small-animal PET scanner, A-PET. To compensate for imperfections in the fabricated collimator prototype, collimator normalization, as well as scanner normalization, is required to reconstruct quantitative and artifact-free images. In this study, we develop a normalization method for the collimator prototype based on the A-PET normalization using a uniform cylinder phantom. We performed data acquisition without the collimator for scanner normalization first, and then with the collimator from eight different rotation views for collimator normalization. After a reconstruction without correction, we extracted the cylinder parameters from which we generated expected emission sinograms. Single scatter simulation was used to generate the scattered sinograms. We used the least-squares method to generate the normalization coefficient for each LOR based on measured, expected and scattered sinograms. The scanner and collimator normalization coefficients were factorized by performing two normalizations separately. The normalization methods were also verified using experimental data acquired from A-PET with and without the collimator. In summary, we developed a model-base collimator normalization that can significantly reduce variance and produce collimator normalization with adequate statistical quality within feasible scan time.

  7. Accumulation of DNA Double-Strand Breaks in Normal Tissues After Fractionated Irradiation

    International Nuclear Information System (INIS)

    Ruebe, Claudia E.; Fricke, Andreas; Wendorf, Juliane; Stuetzel, Annika; Kuehne, Martin; Ong, Mei Fang; Lipp, Peter; Ruebe, Christian

    2010-01-01

    Purpose: There is increasing evidence that genetic factors regulating the recognition and/or repair of DNA double-strand breaks (DSBs) are responsible for differences in radiosensitivity among patients. Genetically defined DSB repair capacities are supposed to determine patients' individual susceptibility to develop adverse normal tissue reactions after radiotherapy. In a preclinical murine model, we analyzed the impact of different DSB repair capacities on the cumulative DNA damage in normal tissues during the course of fractionated irradiation. Material and Methods: Different strains of mice with defined genetic backgrounds (SCID -/- homozygous, ATM -/- homozygous, ATM +/- heterozygous, and ATM +/+ wild-type mice) were subjected to single (2 Gy) or fractionated irradiation (5 x 2 Gy). By enumerating γH2AX foci, the formation and rejoining of DSBs were analyzed in organs representative of both early-responding (small intestine) and late-responding tissues (lung, kidney, and heart). Results: In repair-deficient SCID -/- and ATM -/- homozygous mice, large proportions of radiation-induced DSBs remained unrepaired after each fraction, leading to the pronounced accumulation of residual DNA damage after fractionated irradiation, similarly visible in early- and late-responding tissues. The slight DSB repair impairment of ATM +/- heterozygous mice was not detectable after single-dose irradiation but resulted in a significant increase in unrepaired DSBs during the fractionated irradiation scheme. Conclusions: Radiation-induced DSBs accumulate similarly in acute- and late-responding tissues during fractionated irradiation, whereas the whole extent of residual DNA damage depends decisively on the underlying genetically defined DSB repair capacity. Moreover, our data indicate that even minor impairments in DSB repair lead to exceeding DNA damage accumulation during fractionated irradiation and thus may have a significant impact on normal tissue responses in clinical

  8. Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.

    Science.gov (United States)

    Felker, G Michael; Anstrom, Kevin J; Adams, Kirkwood F; Ezekowitz, Justin A; Fiuzat, Mona; Houston-Miller, Nancy; Januzzi, James L; Mark, Daniel B; Piña, Ileana L; Passmore, Gayle; Whellan, David J; Yang, Hongqiu; Cooper, Lawton S; Leifer, Eric S; Desvigne-Nickens, Patrice; O'Connor, Christopher M

    2017-08-22

    The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results. To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF). The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study was a randomized multicenter clinical trial conducted between January 16, 2013, and September 20, 2016, at 45 clinical sites in the United States and Canada. This study planned to randomize 1100 patients with HFrEF (ejection fraction ≤40%), elevated natriuretic peptide levels within the prior 30 days, and a history of a prior HF event (HF hospitalization or equivalent) to either an NT-proBNP-guided strategy or usual care. Patients were randomized to either an NT-proBNP-guided strategy or usual care. Patients randomized to the guided strategy (n = 446) had HF therapy titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL. Patients randomized to usual care (n = 448) had HF care in accordance with published guidelines, with emphasis on titration of proven neurohormonal therapies for HF. Serial measurement of NT-proBNP testing was discouraged in the usual care group. The primary end point was the composite of time-to-first HF hospitalization or cardiovascular mortality. Prespecified secondary end points included all-cause mortality, total hospitalizations for HF, days alive and not hospitalized for cardiovascular reasons, the individual components on the primary end point, and adverse events. The data and safety monitoring board recommended stopping the study for futility when 894 (median age, 63 years; 286 [32%] women) of the planned 1100 patients had been enrolled with

  9. Structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction, comorbided with arterial hypertension

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2013-12-01

    Full Text Available Recently, much attention was paid to left ventricular diastolic dysfunction and its role in the occurrence of chronic heart failure. In patients after myocardial infarction, diastolic dysfunction often precedes systolic dysfunction and predicts prognosis. In patients after myocardial infarction, diastolic dysfunction is caused by a violation of early diastolic relaxation in the area of increasing stiffness. Diastolic dysfunction is formed by hypertrophy, fibrosis, myocardial ischemia and arterial hypertension. Given the important role of diastolic dysfunction in the formation of heart failure in postinfarction patients with concomitant arterial hypertension, the mechanisms of its impact on clinical features and structural-functional changes of the heart is an actual problem. Objective: To determine the structural and functional changes in the heart and clinical features of heart failure with preserved left ventricular ejection fraction in patients after myocardial infarction with concomitant arterial hypertension. Materials and methods: In 91 patients with post-infarction cardiosclerosis and preserved left ventricular ejection fraction (EF > 45 % with arterial hypertension were investigated structural and functional changes in the heart and clinical features of heart failure by assessing clinical status and ultrasound of the heart. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 3 groups. The first group included 50 patients with diastolic dysfunction and symptoms of heart failure (mean age 64,1 ± 1,2 years. In the second group were 31 patients with diastolic dysfunction without heart failure symptoms (mean age 59,5 ± 1,6 years. The third group consisted of 10 patients without diastolic dysfunction and manifestations of heart failure (mean age 57 ± 2,8 years. Results and discussion: 10% patients with postinfarction cardiosclerosis and concomitant hypertension with diastolic heart failure had NYHA

  10. Physiological dead space and arterial carbon dioxide contributions to exercise ventilatory inefficiency in patients with reduced or preserved ejection fraction heart failure.

    Science.gov (United States)

    Van Iterson, Erik H; Johnson, Bruce D; Borlaug, Barry A; Olson, Thomas P

    2017-12-01

    Patients with heart failure (HF) with reduced (HFrEF) or preserved (HFpEF) ejection fraction demonstrate an increased ventilatory equivalent for carbon dioxide (V̇ E /V̇CO 2 ) slope. The physiological correlates of the V̇ E /V̇CO 2 slope remain unclear in the two HF phenotypes. We hypothesized that changes in the physiological dead space to tidal volume ratio (V D /V T ) and arterial CO 2 tension (PaCO 2 ) differentially contribute to the V̇ E /V̇CO 2 slope in HFrEF vs. HFpEF. Adults with HFrEF (n = 32) and HFpEF (n = 27) [mean ± standard deviation (SD) left ventricular ejection fraction: 22 ± 7% and 61 ± 9%, respectively; mean ± SD body mass index: 28 ± 4 kg/m 2 and 33 ± 6 kg/m 2 , respectively; P breath-by-breath ventilation and gas exchange measurements. PaCO 2 was measured via radial arterial catheterization. We calculated the V̇ E /V̇CO 2 slope via linear regression, and V D /V T  = 1 - [(863 × V̇CO 2 )/(V̇ E  × PaCO 2 )]. Resting V D /V T (0.48 ± 0.08 vs. 0.41 ± 0.11; P = 0.04), but not PaCO 2 (38 ± 5 mmHg vs. 40 ± 3 mmHg; P = 0.21) differed between HFrEF and HFpEF. Peak exercise V D /V T (0.39 ± 0.08 vs. 0.32 ± 0.12; P = 0.02) and PaCO 2 (33 ± 6 mmHg vs. 38 ± 4 mmHg; P < 0.01) differed between HFrEF and HFpEF. The V̇ E /V̇CO 2 slope was higher in HFrEF compared with HFpEF (44 ± 11 vs. 35 ± 8; P < 0.01). Variance associated with the V̇ E /V̇CO 2 slope in HFrEF and HFpEF was explained by peak exercise V D /V T (R 2  = 0.30 and R 2  = 0.50, respectively) and PaCO 2 (R 2  = 0.64 and R 2  = 0.28, respectively), but the relative contributions of each differed (all P < 0.01). Relationships between the V̇ E /V̇CO 2 slope and both V D /V T and PaCO 2 are robust, but differ between HFpEF and HFrEF. Increasing V̇ E /V̇CO 2 slope appears to be strongly explained by mechanisms influential in

  11. Is 16-frame really superior to 8-frame gated SPECT for the assessment of left ventricular volumes and ejection fraction? Comparison of two simultaneously acquired gated SPECT studies

    International Nuclear Information System (INIS)

    Montelatici, Giulia; Sciagra, Roberto; Passeri, Alessandro; Dona, Manjola; Pupi, Alberto

    2008-01-01

    Conflicting data exist about the difference between 8- and 16-frame gated single-photon emission computed tomography (SPECT) left ventricular volumes and ejection fraction (EF); moreover, the influence of framing on detection of stress-induced functional changes is unknown. In 133 patients, two separate gated SPECT studies, one with 8 and one with 16 frames, were simultaneously acquired during a single gantry orbit using dedicated software. In 33 of 133 patients, two additional studies (with 8 and 16 frames, respectively) were acquired using arrhythmia rejection. Left ventricular EF and volumes were calculated using the QGS software. Stress-induced ischemia was identified on summed perfusion images. Arrhythmia-rejection did not influence volumes and EF independently of framing rate. Using data without arrhythmia-rejection, there was a significant difference in volumes and EF between 8 and 16 frames both in resting and post-stress gated SPECT. However, the difference was small: 2.6% for resting and 2.8% for post-stress EF. Both using 8 and 16 frames, there were significantly larger volumes and lower EF in patients with than without stress-induced ischemia. A stress-induced decrease >5 EF units was observed in 26 of 133 patients using 8 and in 23 of 133 using 16 frames, respectively, with finding agreement in 19 patients. Comparing two simultaneously acquired studies, the use of 16 instead of 8 frames has minor and predictable influence on functional data. Furthermore, there are no differences in the detection of stress-induced functional changes. The advantage of 16 over 8 frames in the daily clinical practice appears questionable. (orig.)

  12. Validation of a novel modified wall motion score for estimation of left ventricular ejection fraction in ischemic and non-ischemic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Scholl, David, E-mail: David.Scholl@utoronto.ca [Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada); Kim, Han W., E-mail: hanwkim@gmail.com [Duke Cardiovascular Magnetic Resonance Center, Division of Cardiology, Duke University, NC (United States); Shah, Dipan, E-mail: djshah@tmhs.org [The Methodist DeBakey Heart Center, Houston, TX (United States); Fine, Nowell M., E-mail: nowellfine@gmail.com [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Tandon, Shruti, E-mail: standon4@uwo.ca [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Thompson, Terry, E-mail: thompson@lawsonimaging.ca [Lawson Health Research Institute, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Drangova, Maria, E-mail: mdrangov@imaging.robarts.ca [Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); White, James A., E-mail: jwhite@imaging.robarts.ca [Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario (Canada); Lawson Health Research Institute, London, Ontario (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario (Canada)

    2012-08-15

    Background: Visual determination of left ventricular ejection fraction (LVEF) by segmental scoring may be a practical alternative to volumetric analysis of cine magnetic resonance imaging (MRI). The accuracy and reproducibility of this approach for has not been described. The purpose of this study was to validate a novel segmental visual scoring method for LVEF estimation using cine MRI. Methods: 362 patients with known or suspected cardiomyopathy were studied. A modified wall motion score (mWMS) was used to blindly score the wall motion of all cardiac segments from cine MRI imaging. The same datasets were subjected to blinded volumetric analysis using endocardial contour tracing. The population was then separated into a model cohort (N = 181) and validation cohort (N = 181), with the former used to derive a regression equation of mWMS versus true volumetric LVEF. The validation cohort was then used to test the accuracy of this regression model to estimate the true LVEF from a visually determined mWMS. Reproducibility testing of mWMS scoring was performed upon a randomly selected sample of 20 cases. Results: The regression equation relating mWMS to true LVEF in the model cohort was: LVEF = 54.23 - 0.5761 Multiplication-Sign mWMS. In the validation cohort this equation produced a strong correlation between mWMS-derived LVEF and true volumetric LVEF (r = 0.89). Bland and Altman analysis showed no systematic bias in the LVEF estimated using the mWMS (-0.3231%, 95% limits of agreement -12.22% to 11.58%). Inter-observer and intra-observer reproducibility was excellent (r = 0.93 and 0.97, respectively). Conclusion: The mWMS is a practical tool for reporting regional wall motion and provides reproducible estimates of LVEF from cine MRI.

  13. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF. One Year of Clinical Follow-up.

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    Fabiana G Marcondes-Braga

    Full Text Available The identification of new biomarkers of heart failure (HF could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis.To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF.After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months.The composite endpoint death and heart transplantation (HT were observed in 35 patients (39.3%: 29 patients (32.6% died and 6 (6.7% were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001. Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56-6.80, p = 0.002 within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels.High EBA levels could be associated to poor prognosis in HFrEF patients.

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

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    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.

  15. Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial.

    Science.gov (United States)

    Palau, Patricia; Domínguez, Eloy; López, Laura; Ramón, José María; Heredia, Raquel; González, Jessika; Santas, Enrique; Bodí, Vicent; Miñana, Gema; Valero, Ernesto; Mollar, Anna; Bertomeu González, Vicente; Chorro, Francisco J; Sanchis, Juan; Lupón, Josep; Bayés-Genís, Antoni; Núñez, Julio

    2018-03-16

    Despite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. A total of 61 stable symptomatic patients (New York Heart Association II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes. Mean age and peak exercise oxygen uptake were 74 ± 9 years and 9.9 ± 2.5mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 6 months (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found. In HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life. This trial was registered at ClinicalTrials.gov (Identifier: NCT02638961).. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Hormone therapy with tamoxifen reduces plasma levels of NT-B-type natriuretic peptide but does not change ventricular ejection fraction after chemotherapy in women with breast cancer

    Directory of Open Access Journals (Sweden)

    F.B. Silva

    2015-02-01

    Full Text Available The objective of this study was to evaluate the effect of tamoxifen on the plasma concentration of NT-pro-B-type natriuretic peptide (NT-proBNP in women undergoing chemotherapy for breast cancer and to correlate changes in NT-proBNP with the left ventricular ejection fraction (LVEF. Over a period of 12 months, we followed 60 women with a diagnosis of breast cancer. The patients were separated into a group that received only chemotherapy (n=23, a group that received chemotherapy + tamoxifen (n=21, and a group that received only tamoxifen (n=16. Plasma levels of NT-proBNP were assessed at 0 (T0, 6 (T6, and 12 (T12 months of treatment, and echocardiography data were assessed at T0 and T12. Plasma NT-proBNP levels were increased in the chemotherapy-only group at T6 and T12, whereas elevated NT-proBNP levels were only found at T6 in the chemotherapy + tamoxifen group. At T12, the chemotherapy + tamoxifen group exhibited a significant reduction in the peptide to levels similar to the group that received tamoxifen alone. The chemotherapy-only group exhibited a significant decrease in LVEF at T12, whereas the chemotherapy + tamoxifen and tamoxifen-only groups maintained levels similar to those at the beginning of treatment. Treatment with tamoxifen for 6 months after chemotherapy significantly reduced the plasma levels of NT-proBNP and did not change LVEF in women with breast cancer.

  17. Effects of catheter-based renal denervation on heart failure with reduced ejection fraction: a systematic review and meta-analysis.

    Science.gov (United States)

    Fukuta, Hidekatsu; Goto, Toshihiko; Wakami, Kazuaki; Ohte, Nobuyuki

    2017-11-01

    Despite the recent advances in the management of heart failure, the mortality of heart failure patients remains high. It is of urgent need to develop new therapy for heart failure. Heart failure is characterized by increased sympathetic activity, and chronic sympathetic activation is involved in the maintenance of the pathological state. Catheter-based renal denervation (RDN) has emerged as an invasive but safe approach that can reduce sympathetic activation. Studies have reported inconsistent results regarding the effect of RDN in heart failure patients due to limited power with small sample sizes. We aimed to conduct a meta-analysis of the effect of RDN on heart failure patients with reduced left ventricular (LV) ejection fraction (EF). An electronic search for studies examining the effect of RDN on LV function in heart failure patients with reduced EF was conducted. Two controlled (80 patients) and 2 uncontrolled studies (21 patients) were included in this meta-analysis. In the pooled analysis, 6 months after RDN, there was a greater increase in EF (weighted mean difference [95% CI] = 8.63 [6.02, 11.24] %) and a greater decrease in LV end-diastolic diameter (-0.58 [-0.83, -0.34] cm) in RDN group than in control group. No serious adverse events such as acute renal artery stenosis and dissection occurred. Our meta-analysis of feasibility studies suggests that RDN may improve LV function in heart failure patients with reduced EF, providing the rationale to conduct next phase trials to confirm the observed potential benefits of RDN.

  18. Detection of infarct size safety threshold for left ventricular ejection fraction impairment in acute myocardial infarction successfully treated with primary percutaneous coronary intervention.

    Science.gov (United States)

    Sciagrà, Roberto; Cipollini, Fabrizio; Berti, Valentina; Migliorini, Angela; Antoniucci, David; Pupi, Alberto

    2013-04-01

    In acute myocardial infarction (AMI) treated by primary percutaneous coronary intervention (PCI), there is a direct relationship between myocardial damage and consequent left ventricular (LV) functional impairment. It is however unclear whether there is a safety threshold below which infarct size does not significantly affect LV ejection fraction (EF). The aim of this study was to evaluate the relationship between infarct size and LVEF in AMI patients treated by successful PCI using a specific statistical approach to identify a possible safety threshold. Among patients with recent AMI submitted to perfusion gated single photon emission computed tomography (SPECT) to define the infarct size, the data of 427 subjects with sizable infarct size were considered. The relationship between infarct size and LVEF was analysed using a simple segmented regression (SSR) model and an iterative algorithm based on robust least squares (RLS) for parameter estimation. The RLS algorithm detected two break points in the SSR model, set at infarct size values of 11.0 and 51.5 %. Because the slope coefficients of the two extreme segments of the regression line were not significant, by constraining such segments to zero slope in the SSR model, the lower break point was identified at infarct size = 8 % and the upper one at 45 %. Using a rigorous statistical approach, it is possible to demonstrate that below a threshold of 8 % the infarct size apparently does not affect the LVEF and therefore a safety threshold could be set at this value. Furthermore, the same analysis suggests that the relationship between infarct size and LVEF impairment is lost for an infarct size > 45 %.

  19. Factors affecting accuracy of ventricular volume and ejection fraction measured by gated Tl-201 myocardial perfusion single photon emission computed tomography

    International Nuclear Information System (INIS)

    Pai, Moon Sun; Yang, You Jung; Im, Ki Chun; Hong, Il Ki; Yun, Sung Cheol; Kang, Duk Hyun; Song, Jae Kwan; Moon, Dae Hyuk

    2005-01-01

    Systemic errors in the gated single photon emission computed tomography (SPECT) measurement of left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) may occur. We evaluated whether patient-related factors affected the accuracy of EDV, ESV, and EF measured by electrocardiogram-gated Tl-201 SPECT. A total of 518 patients without perfusion defects on Tl-201 SPECT or coronary artery disease were studied. EDV, ESV, and EF were measured from echocardiography and adenosine stress/redistribution gated Tl-201 SPECT using commercially available software packages (QGS and 4D-MSPECT). We identified factors affecting the accuracy of gated SPECT via multiple linear regression analysis of the differences between echocardiography and gated SPECT. Gated SPECT analyzed with QGS underestimated EDV and ESV, and overestimated EF, but 4D-MSPECT overestimated all those values (p<0.001). Independent variables that increased the difference in EDV between echocardiography and gated SPECT were decreasing LV end-diastolic wall thickness, decreasing body surface area, female sex and increasing EDV (p< 0.001). Those for ESV were decreasing LV end-systolic wall thickness, female sex, and decreasing ESV (p<0.001). Increasing end-systolic wall thickness, male sex and decreasing age were independent determinants associated with an increased difference in EF (p< 0.001). Adenosine stress SPECT showed significantly higher EDV and ESV values and a lower EF than did redistribution SPECT (p< 0.001). In determination of EF, QGS demonstrated a smaller bias than did 4D-MSPECT. However, in men with LV hypertrophy, 4D-MSPECT was superior to QGS. Systemic error by gated Tl-201 SPECT is determined by individual patient-characteristics

  20. Cost-Effectiveness of Sacubitril-Valsartan Combination Therapy Compared With Enalapril for the Treatment of Heart Failure With Reduced Ejection Fraction.

    Science.gov (United States)

    King, Jordan B; Shah, Rashmee U; Bress, Adam P; Nelson, Richard E; Bellows, Brandon K

    2016-05-01

    The objective of this study was to determine the cost-effectiveness and cost per quality-adjusted life year (QALY) gained of sacubitril-valsartan relative to enalapril for treatment of heart failure with reduced ejection fraction (HFrEF). Compared with enalapril, combination angiotensin receptor-neprilysin inhibition (ARNI), as is found in sacubitril-valsartan, reduces cardiovascular death and heart failure hospitalization rates in patients with HFrEF. Using a Markov model, costs, effects, and cost-effectiveness were estimated for sacubitril-valsartan and enalapril therapies for the treatment of HFrEF. Patients were 60 years of age at model entry and were modeled over a lifetime (40 years) from a third-party payer perspective. Clinical probabilities were derived predominantly from PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). All costs and effects were discounted at a 3% rate annually and are presented in 2015 U.S. dollars. In the base case, sacubitril-valsartan, compared with enalapril, was more costly ($60,391 vs. $21,758) and more effective (6.49 vs. 5.74 QALYs) over a lifetime. The cost-effectiveness of sacubitril-valsartan was highly dependent on duration of treatment, ranging from $249,411 per QALY at 3 years to $50,959 per QALY gained over a lifetime. Sacubitril-valsartan may be a cost-effective treatment option depending on the willingness-to-pay threshold. Future investigations should incorporate real-world evidence with sacubitril-valsartan to further inform decision making. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Circulating miR-126 and miR-499 reflect progression of cardiovascular disease; correlations with uric acid and ejection fraction

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    Masoud Khanaghaei

    2016-04-01

    Full Text Available BackgroundThe aim of this study was to assess plasma levels of endothelium- and heart-associated microRNAs (miRNAs miR-126 and miR-499, respectively, using quantitative reverse transcriptase polymerase chain reaction.MethodsA two-step analysis was conducted on 75 patients undergoing off-pomp coronary artery bypass graft (CABG surgery. Five biomarkers of inflammation and cardiac injury were assessed in addition to the above-mentioned miRNAs.ResultsPlasma concentrations of miRNAs were found to be significantly correlated with plasma levels of cardiac troponin I (cTnI (miR-499, r 0.49, p~0.002; miR-126, r = 0.30, p~0.001, indicating cardiac damage. Data analysis revealed that miR-499 had higher sensitivity and specificity for cardiac injury than miR-126, which reflects more endothelial activation. Interestingly, a strong correlation was observed between both miRNAs and uric acid (UA levels with ventricular contractility measured as ejection fraction (EF (miR-499/EF%, r = 0.58, p~0.004; UA/EF%, r = -0.6, p~0.006; UA/miR-499, r = -0.34; UA/miR-126, r = 0.5, p~0.01.ConclusionsIn patients undergoing CABG, circulating miR-126/499 is associated with presentation of traditional risk factors and reflects post-operative response to injury. Plasma pool of miRNAs likely reflects extracellular miRNAs which are proportional to intracellular miRNA levels. Therefore, circulating levels of these miRNAs have prognostic implications in detection of higher risk of future cardiovascular events.

  2. Gated 99mTc-MIBI single-photon emission computed tomography for the evaluation of left ventricular ejection fraction. Comparison with three-dimensional echocardiography

    International Nuclear Information System (INIS)

    Lipiec, P.; Wejner-Mik, P.; Krzeminska-Pakula, M.; Kapusta, A.; Kasprzak, J.D.; Kusmierek, J.; Plachcinska, A.; Szuminski, R.

    2008-01-01

    Parameters of left ventricular systolic function directly influence the management of patients with suspected coronary artery disease (CAD). Quantitative gated single-photon emission computed tomography (QGS; Cedars-Sinai Medical Center, Los Angeles, CA, USA) allows the computation of left ventricular ejection fraction (LVEF) from myocardial perfusion imaging studies which are frequently performed on patients with suspected CAD. Three-dimensional (3D) echocardiography is considered to be the echocardiographic ''gold standard'' for the quantification of LVEF. We sought to compare QGS with 3D echocardiography in the evaluation of EF in patients with suspected CAD. Ninety-one consecutive patients with suspected CAD, scheduled for coronary angiography, underwent rest electrocardiographic-gated technetium-99m methoxyisobutylisonitrile SPECT (G-SPECT) with measurement of LVEF by QGS and transthoracic 3D echocardiography with off-line measurement of LVEF (Tomtec 4D LV Analysis 1.1). The diagnosis of CAD was based on coronary angiography, performed on every patient. Nine patients were excluded from the analysis owing to unsuitability for 3D echocardiography (8 patients) or G-SPECT (1 patient). In the remaining group of 82 patients, 71 (87%) had significant CAD, 34 (42%) had a history of myocardial infarction, and 50 (61%) had perfusion defects at rest G-SPECT images. The mean LVEF measured by QGS and 3D echocardiography was 53±13% and 53±10%, respectively. The mean difference in LVEF between 3D echocardiography and QGS was 0.1±6.0% (P=0.87), and the correlation between the values obtained by both methods was high (r=0.88, P< 0.001). The largest discrepancies were observed in patients with small ventricular volumes. In patients undergoing diagnostic work-up for CAD, the measurement of LVEF by QGS algorithm provides high correlation and satisfactory agreement with the results of reference ultrasound method- 3D echocardiography. (author)

  3. Comparison of Gated SPECT Myocardial Perfusion Imaging with Echocardiography for the Measurement of Left Ventricular Volumes and Ejection Fraction in Patients With Severe Heart Failure

    Science.gov (United States)

    Shojaeifard, Maryam; Ghaedian, Tahereh; Yaghoobi, Nahid; Malek, Hadi; Firoozabadi, Hasan; Bitarafan-Rajabi, Ahmad; Haghjoo, Majid; Amin, Ahmad; Azizian, Nasrin; Rastgou, Feridoon

    2015-01-01

    Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF ≤ 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated SPECT MPI has a good correlation with echocardiography for the measurement of left ventricular EF, EDV, and ESV in patients with severe heart failure. However, the absolute values of these functional parameters from echocardiography and gated

  4. The effect of filtrating and reconstruction method on the left ventricular ejection fraction derived from GSPET. A statistical comparison of angiography and echocardiography

    International Nuclear Information System (INIS)

    Bitarafan, A.; Rajabi, H.

    2008-01-01

    There are different protocols of reconstruction in myocardial gated imaging that produce different values of left ventricular ejection fraction (EF). We attempted to determine how the parameters of reconstruction affect the calculated EF. The results were statistically compared with the values obtained from angiography and echocardiography. In this retrospective study, the data from 23 patients were used. All the patients had the angiographic and the echocardiographic data within 2 weeks before the test. Imaging was performed using a single-head gamma camera using technetium-99 methoxyisobutylisonitrile. The image data were reconstructed using 50 different combinations of the ramp, Hanning, Butterworth, Wiener, and Metz filters. The ordered subset expectation maximization (OSEM) technique was also examined using 12 combinations of iteration and subset. The calculated EF values were analyzed and compared with the echocardiographic and angiographic results. The backprojection technique produced higher values of EF than those derived from echocardiography and angiography. The OSEM on the other hand produced lower values when compared with echocardiography and angiography. On using the backprojection technique, the maximum correlation between the values derived from gated single-photon emission tomography and echocardiography (r=0.88, P<0.01) and angiography (r=0.81, P<0.01) was observed when using the Metz filter (full width at half maximum=5 mm and order=9) and the Gaussian filter (α=3), respectively. In the case of the OSEM technique, the maximum correlation with both angiography and echocardiography was observed when using the iteration=2 and the subset=12. On the average, the backprojection technique produces higher values, and iteration technique produces lower estimation of the EF when compared with angiography and echocardiography. (author)

  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

    International Nuclear Information System (INIS)

    Ahn, Byeong Cheol; Bae, Sun Keun; Lee, Sang Woo; Jeong, Sin Young; Lee, Jae Tae; Lee, Kyu Bo

    2002-01-01

    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. Calculation of left ventricular volumes and ejection fraction from dynamic cardiac-gated 15O-water PET/CT: 5D-PET

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    Jonny Nordström

    2017-11-01

    Full Text Available Abstract Background Quantitative measurement of myocardial blood flow (MBF is of increasing interest in the clinical assessment of patients with suspected coronary artery disease (CAD. 15O-water positron emission tomography (PET is considered the gold standard for non-invasive MBF measurements. However, calculation of left ventricular (LV volumes and ejection fraction (EF is not possible from standard 15O-water uptake images. The purpose of the present work was to investigate the possibility of calculating LV volumes and LVEF from cardiac-gated parametric blood volume (V B 15O-water images and from first pass (FP images. Sixteen patients with mitral or aortic regurgitation underwent an eight-gate dynamic cardiac-gated 15O-water PET/CT scan and cardiac MRI. V B and FP images were generated for each gate. Calculations of end-systolic volume (ESV, end-diastolic volume (EDV, stroke volume (SV and LVEF were performed with automatic segmentation of V B and FP images, using commercially available software. LV volumes and LVEF were calculated with surface-, count-, and volume-based methods, and the results were compared with gold standard MRI. Results Using V B images, high correlations between PET and MRI ESV (r = 0.89, p  0.86, p < 0.001. Conclusion Calculation of LV volumes and LVEF from dynamic 15O-water PET is feasible and shows good correlation with MRI. However, the analysis method is laborious, and future work is needed for more automation to make the method more easily applicable in a clinical setting.

  7. Reduced variability of visual left ventricular ejection fraction assessment with reference images: The Japanese Association of Young Echocardiography Fellows multicenter study.

    Science.gov (United States)

    Kusunose, Kenya; Shibayama, Kentaro; Iwano, Hiroyuki; Izumo, Masaki; Kagiyama, Nobuyuki; Kurosawa, Koji; Mihara, Hirotsugu; Oe, Hiroki; Onishi, Tetsuari; Onishi, Toshinari; Ota, Mitsuhiko; Sasaki, Shunsuke; Shiina, Yumi; Tsuruta, Hikaru; Tanaka, Hidekazu

    2018-07-01

    Visual estimation of left ventricular ejection fraction (LVEF) is widely applied to confirm quantitative EF. However, visual assessment is subjective, and variability may be influenced by observer experience. We hypothesized that a learning session might reduce the misclassification rate. Protocol 1: Visual LVEFs for 30 cases were measured by 79 readers from 13 cardiovascular tertiary care centers. Readers were divided into 3 groups by their experience: limited (1-5 years, n=28), intermediate (6-11 years, n=26), and highly experienced (12-years, n=25). Protocol 2: All readers were randomized to assess the effect of a learning session with reference images only or feedback plus reference images. After the session, 20 new cases were shown to all readers following the same methodology. To assess the concordance and accuracy pre- and post-intervention, each visual LVEF measurement was compared to overall average values as a reference. Experience affected the concordance in visual EF values among the readers. Groups with intermediate and high experience showed significantly better mean difference (MD), standard deviation (SD), and coefficient of variation (CV) than those with limited experience at baseline. The learning session with reference image reduced the MD, SD, and CV in readers with limited experience. The learning session with reference images plus feedback also reduced proportional bias. Importantly, the misclassification rate for mid-range EF cases was reduced regardless of experience. This large multicenter study suggested that a simple learning session with reference images can successfully reduce the misclassification rate for LVEF assessment. Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  8. Impact of mild patient prosthesis mismatch on quality of life in patients with preserved ejection fraction after isolated aortic valve replacement for aortic stenosis.

    Science.gov (United States)

    Reskovic Luksic, Vlatka; Dosen, D; Pasalic, M; Separovic Hanzevacki, Jadranka

    2017-01-15

    To analyze whether PPM affects QOL and functional status in patients after isolated AVR for aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). Consecutive patients who underwent AVR in University Hospital Center Zagreb for isolated severe symptomatic AS and preserved EF were enrolled. Echo data was obtained from complete transthoracic examinations prior and after surgery by offline analysis. Patients were divided into two groups according to the presence of PPM (effective orifice area (EOA)/body surface area (BSA)<0,85cm 2 /m 2 ). QOL was assessed by telephone interview using Short Form 36-Item Health Survey (SF-36) along with functional NYHA status estimation. A total of 45 pts were included (23 female), and divided in PPM (n=26), and non-PPM group (n=19). Both groups were similar in pts age, LVEF, AVA/BSA prior surgery. After surgery, 57% of pts had PPM categorized as mild PPM. During follow-up of 2,5years, 3 pts had died and 10 were lost from following. There was no difference in NYHA status after surgery between groups (p=0,758). SF36 results showed no difference between groups. However, there was a significant improvement in Physical functioning (47,50% vs 75,47%,p=0,000) and Role limitation due to physical health (41,41% vs 81,25%, p=0,007) scores in the whole study population after AVR. Males had significantly better Energy/fatigue (p=0,034), Social functioning (p=0,004) and Pain (p=0,017) scores. Mild to moderate PPM showed no clinical relevance. All patients revealed improvement in QOL after AVR, while male sex was related to better functioning scores irrespectively of PPM. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Changes in natriuretic peptides after acute hospital presentation for heart failure with preserved ejection fraction: A feasible surrogate trial endpoint? A report from the prospective Karen study.

    Science.gov (United States)

    Savarese, Gianluigi; Donal, Erwan; Hage, Camilla; Oger, Emmanuel; Persson, Hans; Daubert, Jean-Claude; Linde, Cecilia; Lund, Lars H

    2017-01-01

    In acute decompensated heart failure (ADHF) with preserved ejection fraction (HFpEF) there are no surrogate endpoints for early phase trials. The aim of the current study was to evaluate whether a reduction in natriuretic peptides (NP) between acute hospital presentation to stable follow-up is associated with improved mortality and morbidity. Patients presenting acutely to the hospital for ADHF with HFpEF enrolled in the Karolinska Rennes (KaRen) study and reporting N-terminal pro-B-type NP or B-type NP assessment at baseline hospital presentation and at 4-8weeks follow-up were prospectively studied. Logistic regression analyses were performed to detect the predictors of baseline and changes in NPs. Cox regression models were performed to assess the impact of NP reductions on mortality and the composite of mortality and HF hospitalization. Of 361 patients (median follow-up 585days), 267 (74%) reported an improvement in NPs, while 94 (26%) reported worsening. At baseline, the independent predictors of lower NPs were higher glomerular filtration rate (Odds Ratio [OR] per unit: 1.013; 95% Confidence Interval [CI]: 1.005-1.021) and younger age (OR per year: 0.972; CI: 0.947-0.998). Improvement in NPs at follow-up was predicted by higher heart rate at baseline (OR per bpm: 1.014; CI: 1.003-1.025). After adjustments, the hazard ratio for all-cause death was 0.730 (CI: 0.456-1.169) and for the composite outcome 0.814 (CI: 0.582-1.139) for patients who improved vs. worsened in NP levels. In patients presenting acutely to the hospital with HFPEF, an improvement in NP levels did not independently and significantly predict improved mortality and/or morbidity. NPs as surrogate endpoints in acute HFpEF require further study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Myocardial fibrosis burden predicts left ventricular ejection fraction and is associated with age and steroid treatment duration in duchenne muscular dystrophy.

    Science.gov (United States)

    Tandon, Animesh; Villa, Chet R; Hor, Kan N; Jefferies, John L; Gao, Zhiqian; Towbin, Jeffrey A; Wong, Brenda L; Mazur, Wojciech; Fleck, Robert J; Sticka, Joshua J; Benson, D Woodrow; Taylor, Michael D

    2015-03-26

    Patients with Duchenne muscular dystrophy exhibit progressive cardiac and skeletal muscle dysfunction. Based on prior data, cardiac dysfunction in Duchenne muscular dystrophy patients may be influenced by myocardial fibrosis and steroid therapy. We examined the longitudinal relationship of myocardial fibrosis and ventricular dysfunction using cardiac magnetic resonance in a large Duchenne muscular dystrophy cohort. We reviewed 465 serial cardiac magnetic resonance studies (98 Duchenne muscular dystrophy patients with ≥4 cardiac magnetic resonance studies) for left ventricular ejection fraction (LVEF) and presence of late gadolinium enhancement (LGE), a marker for myocardial fibrosis. LVEF was modeled by examining LGE status, myocardial fibrosis burden (as assessed by the number of LGE-positive left ventricular segments), patient age, and steroid treatment duration. An age-only model demonstrated that LVEF declined 0.58 ± 0.10% per year. In patients with both LGE-negative and LGE-positive studies (n=51), LVEF did not decline significantly over time if LGE was absent but declined 2.2 ± 0.31% per year when LGE was present. Univariate modeling showed significant associations between LVEF and steroid treatment duration, presence of LGE, and number of LGE-positive left ventricular segments; multivariate modeling showed that LVEF declined by 0.93 ± 0.09% for each LGE-positive left ventricular segment, whereas age and steroid treatment duration were not significant. The number of LGE-positive left ventricular segments increased with age, and longer steroid treatment duration was associated with lower age-related increases. Progressive myocardial fibrosis, as detected by LGE, was strongly correlated with the LVEF decline in Duchenne muscular dystrophy patients. Longer steroid treatment duration was associated with a lower age-related increase in myocardial fibrosis burden. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley

  11. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up

    Science.gov (United States)

    Saldiva, Paulo H. N.; Mangini, Sandrigo; Issa, Victor S.; Ayub-Ferreira, Silvia M.; Bocchi, Edimar A.

    2016-01-01

    Background The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis. Objectives To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF). Methods After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months. Results The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56–6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels. Conclusions High EBA levels could be associated to poor prognosis in HFrEF patients. PMID:28030609

  12. Multi-slice CT (MSCT) in cardiac function imaging: threshold-value-supported 3D volume reconstructions to determine the left ventricular ejection fraction in comparison to MRI

    International Nuclear Information System (INIS)

    Ehrhard, K.; Oberholzer, K.; Gast, K.; Mildenberger, P.; Kreitner, K.F.; Thelen, M.

    2002-01-01

    Purpose: To assess MSCT of the heart to determining left ventricular ejection fraction (EF) based on threshold-value-supported 3D volume reconstructions compared to MRI. Methods: Cardiac MSCT was performed in 7 patients. Images were reconstructed during end-systolic and end-diastolic phases of the cardiac cycle and transformed to 3D volumes to determine end-systolic (ESV) and end-diastolic volume (EDV) by using different lower threshold values: besides fixed lower threshold values, identical for each image sequence, individual lower threshold values dependent on contrast enhancement of the left ventricle were applied. The latter represent the mean value calculated by combining the average CT-density of the myocardium and the contrast-enhanced blood in the left ventricle. The EF derived from ESV and EDV. Results: The best correlation with MR imaging was obtained for ESV and EDV by using the individual lower threshold values for the respective sequence. The correlation coefficient for ESV was 0.95 and for EDV it was 0.93. On average, the ESV was overestimated by 3.72 ml, while the ESD was underestimated by 2.85 ml. The respective standard deviation for the ESV was 14,87 ml, for the EDV it was 26.83 ml. On average, the EF was underestimated by 3.57% with a standard deviation of 9.43% and a correlation coefficient of 0.83 in comparison to MRI. Conclusion: The threshold-value-supported 3D volume reconstruction of the left ventricle represents a good method to determine the left ventricular function parameters. Due to the differences in the contrast enhancement, the use of an individual lower threshold value for every image sequence is of particular importance. (orig.) [de

  13. The Correlation between Left and Right Ventricular Ejection Fractions in Patients with Ischemic Heart Disease, Documented by Cardiac Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Ali Eshraghi

    2016-03-01

    Full Text Available Introduction: The correlation between right and left ventricular ejection fractions (RVEF and LVEF, respectively has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance (CMR imaging. Materials and Methods: This observational study was done in Ghaem general hospital in 2014.  LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis.   This study was done in Ghaem general hospital in 2014 with simple sapling. Results: Right ventricular end diastolic volume (186.33±58.90 and left ventricular end diastolic volume (121.72±61.64 were significantly correlated (r=0.223, P=0.005. Moreover, there was a significant correlation between right ventricular end systolic volume (88.18±40.90 and left ventricular end systolic volume (140.96±35.33 (r=0.329, P=0.000. The most significant association was observed between RVEF and LVEF (r=0.913, P=0.000. Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown.

  14. Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study).

    Science.gov (United States)

    Margossian, Renee; Schwartz, Marcy L; Prakash, Ashwin; Wruck, Lisa; Colan, Steven D; Atz, Andrew M; Bradley, Timothy J; Fogel, Mark A; Hurwitz, Lynne M; Marcus, Edward; Powell, Andrew J; Printz, Beth F; Puchalski, Michael D; Rychik, Jack; Shirali, Girish; Williams, Richard; Yoo, Shi-Joon; Geva, Tal

    2009-08-01

    Assessment of the size and function of a functional single ventricle (FSV) is a key element in the management of patients after the Fontan procedure. Measurement variability of ventricular mass, volume, and ejection fraction (EF) among observers by echocardiography and cardiac magnetic resonance imaging (CMR) and their reproducibility among readers in these patients have not been described. From the 546 patients enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study (mean age 11.9 +/- 3.4 years), 100 echocardiograms and 50 CMR studies were assessed for measurement reproducibility; 124 subjects with paired studies were selected for comparison between modalities. Interobserver agreement for qualitative grading of ventricular function by echocardiography was modest for left ventricular (LV) morphology (kappa = 0.42) and weak for right ventricular (RV) morphology (kappa = 0.12). For quantitative assessment, high intraclass correlation coefficients were found for echocardiographic interobserver agreement (LV 0.87 to 0.92, RV 0.82 to 0.85) of systolic and diastolic volumes, respectively. In contrast, intraclass correlation coefficients for LV and RV mass were moderate (LV 0.78, RV 0.72). The corresponding intraclass correlation coefficients by CMR were high (LV 0.96, RV 0.85). Volumes by echocardiography averaged 70% of CMR values. Interobserver reproducibility for the EF was similar for the 2 modalities. Although the absolute mean difference between modalities for the EF was small (<2%), 95% limits of agreement were wide. In conclusion, agreement between observers of qualitative FSV function by echocardiography is modest. Measurements of FSV volume by 2-dimensional echocardiography underestimate CMR measurements, but their reproducibility is high. Echocardiographic and CMR measurements of FSV EF demonstrate similar interobserver reproducibility, whereas measurements of FSV mass and LV diastolic volume are more reproducible by CMR.

  15. Prevalence and characteristics of coronary artery disease in heart failure with preserved and mid-range ejection fractions: A systematic angiography approach.

    Science.gov (United States)

    Trevisan, Lory; Cautela, Jennifer; Resseguier, Noemie; Laine, Marc; Arques, Stephane; Pinto, Johan; Orabona, Morgane; Barraud, Jeremie; Peyrol, Michael; Paganelli, Franck; Bonello, Laurent; Thuny, Franck

    2018-02-01

    Guidelines recommend careful screening and treatment of coronary artery disease (CAD) in heart failure with preserved or mid-range ejection fraction (HFpEF/HFmEF). We aimed to determine the prevalence and characteristics of CAD using a prospective systematic coronary angiography approach. A systematic coronary angiography protocol was applied in consecutive patients admitted for HFpEF/HFmEF during a 6-month period in a single centre. History of CAD and results of angiography, including revascularization, were reported. Of the 164 patients with HFpEF/HFmEF who were included, an angiography assessment was applied in 108 (66%) (median age: 79 years [interquartile range: 70-85 years]; 54% were women). In our analysis, 64% (95% confidence interval [CI] 55-73%) of patients had a significant coronary stenosis corresponding to a global CAD prevalence of 80% (95% CI 73-88%). The prevalence of CAD was similar for HFpEF and HFmEF. The left main coronary artery presented a significant stenosis in 6.5% of cases and 39% of patients had a two- or three-vessel disease. The rate of significant coronary stenosis was non-significantly higher in patients with a history of CAD. Patients with HFpEF/HFmEF with and without CAD did not differ in clinically meaningful ways, in terms of symptoms or laboratory and echocardiography results. This strategy led to complete revascularization in 36% of patients with significant stenosis and in 23% of all patients with HFpEF/HFmEF. Our study differs from others in that we used a systematic angiography approach. The results suggest a much higher prevalence of CAD in HFpEF/HFmEF than previously reported and should encourage clinicians to aggressively identify this co-morbidity. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Comparative proteomics of matrix fractions between pimpled and normal chicken eggshells.

    Science.gov (United States)

    Liu, Zhangguo; Song, Lingzi; Lu, Lizhi; Zhang, Xianfu; Zhang, Fuming; Wang, Kehua; Linhardt, Robert J

    2017-09-07

    Eggshell matrix can be dissociated into three matrix fractions: acid-insoluble matrix (M1), water-insoluble matrix (M2) and acid-water facultative-soluble matrix (M3). Matrix fractions from pimpled and normal eggshells were compared using label-free proteomic method to understand the differences among three matrix fractions and the proteins involved with eggshell quality. A total of 738 and 600 proteins were identified in the pimpled and normal calcified eggshells, respectively. Both eggshells showed a combined proteomic inventory of 769 proteins. In the same type of eggshell, a high similarity was present in the proteomes of three matrix fractions. These triply overlapped common proteins formed the predominant contributor to proteomic abundance in the matrix fractions. In each matrix fraction and between both eggshell models, normal and pimpled eggshells, a majority of the proteomes of the fractions were commonly observed. Forty-two common major proteins (iBAQ-derived abundance ≥0.095% of proteomic abundance) were identified throughout the three matrix fractions and these proteins might act as backbone constituents in chicken eggshell matrix. Finally, using 1.75-fold as up-regulated and using 0.57-fold as down-regulated cutoff values, twenty-five differential major proteins were screened and they all negatively influence and none showed any effect on eggshell quality. Overall, we uncovered the characteristics of proteomics of three eggshell matrix fractions and identified candidate proteins influencing eggshell quality. The next research on differential proteins will uncover the potential mechanisms underlying how proteins affect eggshell quality. It was reported that the proteins in an eggshell can be divided into insoluble and soluble proteins. The insoluble proteins are thought to be an inter-mineral matrix and acts as a structural framework, while the soluble proteins are thought as intra-mineral matrix that are embedded within the crystal during

  17. Normal or abnormal isospin-fractionation as a qualitative probe of nuclear symmetry energy at supradensities

    International Nuclear Information System (INIS)

    Guo, Wenmei; Yong, Gaochan; Wang, Yongjia; Li, Qingfeng; Zhang, Hongfei; Zuo, Wei

    2014-01-01

    Within two different frameworks of isospin-dependent transport model, effect of nuclear symmetry energy at supradensities on the isospin-fractionation (IsoF) was investigated. With positive/negative symmetry potential at supradensities (i.e., values of symmetry energy increase/decrease with density above saturation density), for energetic nucleons, the value of neutron to proton ratio of free nucleons is larger/smaller than that of bound nucleon fragments. Compared with extensively studied quantitative observables of nuclear symmetry energy, the normal or abnormal isospin-fractionation of energetic nucleons can be a qualitative probe of nuclear symmetry energy at supradensities

  18. Wound healing properties of ethyl acetate fraction of Moringa oleifera in normal human dermal fibroblasts

    Directory of Open Access Journals (Sweden)

    Sivapragasam Gothai

    2016-03-01

    Full Text Available Background/Aim: Wounds are the outcome of injuries to the skin that interrupt the soft tissue. Healing of a wound is a complex and long-drawn-out process of tissue repair and remodeling in response to injury. A large number of plants are used by folklore traditions for treatment of cuts, wounds and burns. Moringa oleifera is an herb used as traditional folk medicine for the treatment of various skin wounds and associated diseases. The underlying mechanisms of wound healing activity of ethyl acetate fraction of M. oleifera leaves extract are completely unknown. Methods: In the current study, ethyl acetate fraction of Moringa oleifera leaves was investigated for its efficacy on cell viability, proliferation and migration (wound closure rate in human normal dermal fibroblast cells. Results: Results revealed that lower concentration (12.5 µg/ml, 25 µg/ml, and 50 µg/ml of ethyl acetate fraction of M. oleifera leaves showed remarkable proliferative and migratory effect on normal human dermal fibroblasts. Conclusion: The present study suggested that ethyl acetate fraction of M. oleifera leaves might be a potential therapeutic agent for skin wound healing by promoting fibroblast proliferation and migration through increasing the wound closure rate corroborating its traditional use. [J Complement Med Res 2016; 5(1.000: 1-6

  19. Tumor and normal tissue responses to fractioned non-uniform dose delivery

    Energy Technology Data Exchange (ETDEWEB)

    Kaellman, P; Aegren, A; Brahme, A [Karolinska Inst., Stockholm (Sweden). Dept. of Radiation Physics

    1996-08-01

    The volume dependence of the radiation response of a tumor is straight forward to quantify because it depends primarily on the eradication of all its clonogenic cells. A tumor therefore has a parallel organization as any surviving clonogen in principle can repopulate the tumor. The difficulty with the response of the tumor is instead to know the density and sensitivity distribution of the most resistant clonogenic cells. The increase in the 50% tumor control dose and the decrease in the maximum normalized slope of the dose response relation, {gamma}, in presence of small compartments of resistant tumor cells have therefore been quantified to describe their influence on the dose response relation. Injury to normal tissue is a much more complex and gradual process. It depends on earlier effects induced long before depletion of the differentiated and clonogenic cells that in addition may have a complex structural and functional organization. The volume dependence of the dose response relation of normal tissues is therefore described here by the relative seriality, s, of the infrastructure of the organ. The model can also be generalized to describe the response of heterogeneous tissues to non uniform dose distributions. The new model is compared with clinical and experimental data on normal tissue response, and shows good agreement both with regard to the shape of dose response relation and the volume dependence of the isoeffect dose. The response of tumors and normal tissues are quantified for arbitrary dose fractionations using the linear quadratic cell survival parameters {alpha} and {beta}. The parameters of the dose response relation are derived both for a constant dose per fraction and a constant number of dose fractions, thus in the latter case accounting also for non uniform dose delivery. (author). 26 refs, 4 figs.

  20. EFFECTS OF SACUBITRIL/VALSARTAN ON THE ARTERIAL STIFFNESS AND LEFT VENTRICULAR-ARTERIAL COUPLING IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

    Directory of Open Access Journals (Sweden)

    Zh. D. Kobalava

    2018-01-01

    Full Text Available Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC and arterial stiffness in HFrEF patients.Material and methods. Arterial stiffness by applanation tonometry and LVAC – by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69Ѓ}9 years, 89% male, arterial hypertension – 83%, diabetes – 39%, myocardial infarction – 89%, left ventricular ejection fraction 32Ѓ}4% initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance/ Ees (left ventricular elastance ratio. Differences were considered statistically significant at p<0.05.Results. 72% of patients initially had elevated pulse wave velocity (PWV>10 m/s. The decrease in PWV (from 11.5Ѓ}2.9 to 10.2Ѓ}2.9 m/s, p<0.05, of the augmentation pressure (from 15.3Ѓ}8.9 to 10.5Ѓ}5.0 mm Hg, p=0.002, the increase in the reflected wave transit time (from 132Ѓ}9 to 143Ѓ}29 ms, p=0.02 and the subendocardial viability ratio (from 164Ѓ}25 to 177Ѓ}37%, p=0.009 were found after 12 months. Sacubitryl/valsartanbased therapy was associated with a decrease in central systolic blood pressure (from 116Ѓ}19 to 106Ѓ}10 mm Hg, p=0.001 and central pulse blood pressure (from 44Ѓ}15 to 38Ѓ}7 mm Hg, p<0.05. Decrease in Ea (from 2.20Ѓ}0.84 to 1.79Ѓ}0.63 mm Hg/ml/m2, p=0.005 and Ea/Ees ratio (from 2.26Ѓ}0.77 to 1.68Ѓ}0.32, p=0.05 was found after 12 months. Ees did not change statistically significantly (1.00Ѓ}0.34 vs 1.01Ѓ}0.44 mm Hg/ml/m2. The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found.Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave.

  1. Monitoring of left ventricular ejection fraction with a miniature, nonimaging nuclear detector: accuracy and reliability over time with special reference to blood labeling.

    Science.gov (United States)

    Lindhardt, T B; Hesse, B; Gadsbøll, N

    1997-01-01

    The purpose of this study was to determine the accuracy of determinations of left ventricular ejection fraction (LVEF) by a nonimaging miniature nuclear detector system (Cardioscint) and to evaluate the feasibility of long-term LVEF monitoring in patients admitted to the coronary care unit, with special reference to the blood-labeling technique. Cardioscint LVEF values were compared with measurements of LVEF by conventional gamma camera radionuclide ventriculography in 33 patients with a wide range of LVEF values. In 21 of the 33 patients, long-term monitoring was carried out for 1 to 4 hours (mean 186 minutes), with three different kits: one for in vivo and two for in vitro red blood cell labeling. The stability of the labeling was assessed by determination of the activity of blood samples taken during the first 24 hours after blood labeling. The agreement between Cardioscint LVEF and gamma camera LVEF was good with automatic background correction (r = 0.82; regression equation y = 1.04x + 3.88) but poor with manual background correction (r = 0.50; y = 0.88x - 0.55). The agreement was highest in patients without wall motion abnormalities. The long-term monitoring showed no difference between morning and afternoon Cardioscint LVEF values. Short-lasting fluctuations in LVEFs greater than 10 EF units were observed in the majority of the patients. After 24 hours, the mean reduction in the physical decay-corrected count rate of the blood samples was most pronounced for the two in vitro blood-labeling kits (57% +/- 9% and 41% +/- 3%) and less for the in vivo blood-labeling kit (32% +/- 26%). This "biologic decay" had a marked influence on the Cardioscint monitoring results, demanding frequent background correction. A fairly accurate estimate of LVEF can be obtained with the nonimaging Cardioscint system, and continuous bedside LVEF monitoring can proceed for hours with little inconvenience to the patients. Instability of the red blood cell labeling during long

  2. The Significance of the Cardiac Peptide NT-proBNP in the Assessment of Risk for Myocardial Revascularization in Patients with Decreased Left Ventricular Ejection Fraction

    Directory of Open Access Journals (Sweden)

    V. V. Moroz

    2010-01-01

    Full Text Available Objective: to substantiate a procedure for predicting the severity of postperfusion acute heart failure (AHF from the baseline level of NT-proBNP during myocardial revascularization in patients with a left ventricular ejection fraction (LVEF of less than 35%. Subjects and materials. Fifty-six patients with a LVEF of less than 35% were examined. A total of 3.5±0.1 (range 2—4 coronary arteries were shunted under cardio-pulmonary bypass (CPB (71.0±5.5 min. The concentration of NT-proBNP was measured before surgery (Cardiac Reader®, Roche. Mortality rates, sympathomimetic agents’ dosages required after EC, and the frequency of use of intraaortic balloon pumping (IABP were analyzed. Results. A good clinical course was observed in 47 cases (Group 1. AHF was recorded in 9 patients (Group 2. Comparative analysis demonstrated that the preoperative concentration of NT-proBNP (871±111 pg/ml in Group 1 and 1946±236 pg/ml in Group 2 was of the highest prognostic value as compared with the traditional indicators (p=0.0015. Patients with a NT-proBNP concentration of less than 600 pg/ml did not virtually need inotropic therapy after EC. In a group with a biomarker level of 600—1200 mg/ml, the infusion of dopamine and dobutamine achieved the traditional cardiotonic dosages and every three patients needed epinephrine. With NT-proBNP of 1200-2000 pg/ml, mortality from AHF was 15.4%; a need for epinephrine and IABC was 46.4 and 7.7%, respectively. The peptide concentration of more than 2000 pg/ml indicated the extremely high risk of severe AHF. In the postperfusion period, each patient was given epinephrine and an IABC system was installed in half of them. In this group mortality achieved 50%. Conclusion. It is expedient to determine a preoperative NT-proBNP concentration in a LVEF of less than 35% to predict AHF to be occurred after myocardial revascularization. The concentration of less than 1200 pg/ml may be considered to be a safe level of the

  3. Radiotherapy. Non-standard fractionated regimens improving cancer treatment. Part II. Response of normal tissues to fractionated irradiation

    International Nuclear Information System (INIS)

    Villar, A.; Hernandez, M.; Pera, J.; Cambray, M.; Villa, S.; Arnaiz, M.D.

    1988-01-01

    The phenomena participating in the response of tissues to fractionated irradiation are analyzed with special emphasis on the most relevant points influencing the design of non-standard fractionated regimens. (Author)

  4. Normal and Inverse Diffusive Isotope Fractionation of Deuterated Toluene and Benzene in Aqueous Systems

    DEFF Research Database (Denmark)

    Rolle, Massimo; Jin, Biao

    2017-01-01

    Diffusive isotope fractionation of organic contaminants in aqueous solution is difficult to quantify, and only a few experimental data sets are available for compounds of environmental interest. In this study, we investigate diffusive fractionation of perdeuterated and nondeuterated benzene...... and toluene. Multitracer experiments were carried out in 1-D gel dissection tubes and in a quasi-2-D flow-through porous medium. The experiments allowed us to simultaneously and directly compare the diffusive and dispersive behavior of benzene and toluene. We observed an unexpected, opposite behavior...... of the two monoaromatic hydrocarbons. Toluene showed a normal diffusive isotope effect (DC7D8/DC7H8 = 0.96) with enrichment of the nondeuterated isotopologue in the direction of the diffusive and transverse dispersive fluxes. Conversely, the measured trends for benzene indicate inverse diffusive...

  5. Effects of supervised exercise and dietary nitrate in older adults with controlled hypertension and/or heart failure with preserved ejection fraction.

    Science.gov (United States)

    Shaltout, Hossam A; Eggebeen, Joel; Marsh, Anthony P; Brubaker, Peter H; Laurienti, Paul J; Burdette, Jonathan H; Basu, Swati; Morgan, Ashley; Dos Santos, Patricia C; Norris, James L; Morgan, Timothy M; Miller, Gary D; Rejeski, W Jack; Hawfield, Amret T; Diz, Debra I; Becton, J Thomas; Kim-Shapiro, Daniel B; Kitzman, Dalane W

    2017-09-30

    Aerobic exercise training is an effective therapy to improve peak aerobic power (peak VO 2 ) in individuals with hypertension (HTN, AHA/ACC class A) and heart failure patients with preserved ejection fraction (HFpEF). High nitrate containing beetroot juice (BRJ) also improves sub-maximal endurance and decreases blood pressure in both HTN and HFpEF. We hypothesized that combining an aerobic exercise and dietary nitrate intervention would result in additive or even synergistic positive effects on exercise tolerance and blood pressure in HTN or HFpEF. We report results from two pilot studies examining the effects of supervised aerobic exercise combined with dietary nitrate in patients with controlled HTN (n = 26, average age 65 ± 5 years) and in patients with HFpEF (n = 20, average age 69 ± 7 years). All patients underwent an aerobic exercise training regimen; half were randomly assigned to consume a high nitrate-containing beet juice beverage (BRJ containing 6.1 mmol nitrate for the HFpEF study consumed three times a week and 8 mmol nitrate for the HTN study consumed daily) while the other half consumed a beet juice beverage with the nitrate removed (placebo). The main result was that there was no added benefit observed for any outcomes when comparing BRJ to placebo in either HTN or HFpEF patients undergoing exercise training (p ≥ 0.14). There were within-group benefits. In the pilot study in patients with HFpEF, aerobic endurance (primary outcome), defined as the exercise time to volitional exhaustion during submaximal cycling at 75% of maximal power output, improved during exercise training within each group from baseline to end of study, 369 ± 149 s vs 520 ± 257 s (p = 0.04) for the placebo group and 384 ± 129 s vs 483 ± 258 s for the BRJ group (p = 0.15). Resting systolic blood pressure in patients with HFpEF also improved during exercise training in both groups, 136 ± 16 mm Hg vs 122 ± 3 mm Hg for the placebo group (p

  6. Relation of Renal Function with Left Ventricular Systolic Function and NT-proBNP Level and Its Prognostic Implication in Heart Failure with Preserved versus Reduced Ejection Fraction: an analysis from the Korean Heart Failure (KorHF) Registry.

    Science.gov (United States)

    Park, Chan Soon; Park, Jin Joo; Oh, Il-Young; Yoon, Chang-Hwan; Choi, Dong-Ju; Park, Hyun-Ah; Kang, Seok-Min; Yoo, Byung-Su; Jeon, Eun-Seok; Kim, Jae-Joong; Cho, Myeong-Chan; Chae, Shung Chull; Ryu, Kyu-Hyung; Oh, Byung-Hee

    2017-09-01

    The relationship between ejection fraction (EF), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and renal function is unknown as stratified by heart failure (HF) type. We investigated their relation and the prognostic value of renal function in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF). NT-proBNP, glomerular filtration rate (GFR), and EF were obtained in 1,932 acute heart failure (AHF) patients. HFrEF was defined as EFrenal dysfunction as GFRrenal dysfunction: 30≤GFRrenal dysfunction: GFRrenal dysfunction did not differ between HFpEF and HFrEF (49% vs. 52%, p=0.210). Patients with renal dysfunction had higher 12-month mortality in both HFpEF (7.9% vs. 15.2%, log-rank p=0.008) and HFrEF (8.6% vs. 16.8%, log-rank prenal dysfunction was an independent predictor of 12-month mortality (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.40-3.11). When stratified according to EF: the prognostic value of severe renal dysfunction was attenuated in HFpEF patients (HR, 1.46; 95% CI, 0.66-3.21) contrary to HFrEF patients (HR, 2.43; 95% CI, 1.52-3.89). In AHF patients, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF patients. However, the prognostic value of renal dysfunction was attenuated in HFpEF patients.

  7. Rationale, Design, and Methodology of the APOLLON trial: A comPrehensive, ObservationaL registry of heart faiLure with midrange and preserved ejectiON fraction.

    Science.gov (United States)

    Özlek, Bülent; Özlek, Eda; Çelik, Oğuzhan; Çil, Cem; Doğan, Volkan; Tekinalp, Mehmet; Zencirkıran Ağuş, Hicaz; Kahraman, Serkan; Ösken, Altuğ; Rencüzoğulları, İbrahim; Tanık, Veysel Ozan; Bekar, Lütfü; Çakır, Mustafa Ozan; Kaya, Bedri Caner; Tibilli, Hakan; Çelik, Yunus; Başaran, Özcan; Mert, Kadir Uğur; Sevinç, Samet; Demirci, Erkan; Dondurmacı, Engin; Biteker, Murat

    2018-05-01

    Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. A comPrehensive, ObservationaL registry of heart faiLure with mid range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ≥50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ≥40% and will also be the first study to specifically analyze the recently designated HFmrEF category.

  8. Comparison between radioisotopic ventriculography in balance with Tc99-albumine-DTPA and quantitative gated SPECT with Tc-99m-MIBI for determining the eject fraction of left ventricle

    International Nuclear Information System (INIS)

    Noguera, E. C; Jaime, Adelina; Pamellin, Miriam; Veliz, J

    2002-01-01

    Radionuclide ventriculography (RNV) and electrocardiography gated myocardial perfusion single photon emission computed tomography (GSPECT), can be used to assess the ventricular function.The purpose of this study was:1) to compare left ventricular ejection fraction (LVEF(%) using post-stress or rest gated GSPECT with LVEF by resting RNV and 2) to evaluate the 99m-Tc99m human serum albumin (HAS) with diethylenetriaminepenta-acetic acid (DTPA) (99m-TcHSA-DTPA) as a potential use a as blood pool imaging agent (Au)

  9. Influence of Ejection Fraction on Outcomes and Efficacy of Sacubitril/Valsartan (LCZ696) in Heart Failure with Reduced Ejection Fraction: The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) Trial.

    Science.gov (United States)

    Solomon, Scott D; Claggett, Brian; Desai, Akshay S; Packer, Milton; Zile, Michael; Swedberg, Karl; Rouleau, Jean L; Shi, Victor C; Starling, Randall C; Kozan, Ömer; Dukat, Andrej; Lefkowitz, Martin P; McMurray, John J V

    2016-03-01

    The angiotensin receptor neprilysin inhibitor sacubitril/valsartan (LCZ696) reduced cardiovascular morbidity and mortality compared with enalapril in patients with heart failure (HF) and reduced ejection fraction (EF) in the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. We evaluated the influence of EF on clinical outcomes and on the effectiveness of sacubitril/valsartan compared with enalapril. Eight thousand three hundred ninety-nine patients with New York Heart Association class II to IV HF with reduced EF [left ventricular EF (LVEF) ≤40%] were randomized to sacubitril/valsartan 97/103 mg twice daily versus enalapril 10 mg twice daily and followed for a median of 27 months. The primary study end point was cardiovascular death or HF hospitalization. LVEF was assessed at the sites and recorded on case report forms. We related LVEF to study outcomes and assessed the effectiveness of sacubitril/valsartan across the LVEF spectrum. The mean LVEF in PARADIGM-HF, reported by sites, was 29.5 (interquartile range, 25-34). The risk of all outcomes increased with decreasing LVEF. Each 5-point reduction in LVEF was associated with a 9% increased risk of cardiovascular death or HF hospitalization (hazard ratio, 1.09; 95% confidence interval, 1.05-1.13; PSacubitril/valsartan was effective across the LVEF spectrum, with no evidence of heterogeneity, when modeled either in tertiles (P interaction=0.87) or continuously (P interaction=0.95). In patients with HF and reduced EF enrolled in PARADIGM-HF, LVEF was a significant and independent predictor of all outcomes. Sacubitril/valsartan was effective at reducing cardiovascular death and HF hospitalization throughout the LVEF spectrum. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255. © 2016 American Heart Association, Inc.

  10. Comparison of equilibrium radionuclide and contrast angiographic measurements of left ventricular peak ejection and filling rates and their time intervals

    Energy Technology Data Exchange (ETDEWEB)

    Sugrue, D.D.; Dickie, S.; Newman, H.; Myers, M.J.; Lavender, J.P.; McKenna, W.J. (Royal Postgraduate Medical School, London (UK))

    1984-10-01

    A comparison has been made of the equilibrium radionuclide and contrast angiographic estimates of normalized peak rates of ejection (PER) and filling (PFR) and their time intervals in twenty-one patients with cardiac disorders. Contrast angiographic and radionuclide measurements of left ventricular ejection fraction (LVEF), PER and PFR correlated well but time intervals correlated poorly. Mean values for radionuclide LVEF, PER and PFR were significantly lower and radionuclide time intervals were significantly longer compared to contrast angiography measurements.

  11. Comparison of clinical profile and management of outpatients with heart failure with reduced left ventricular ejection fraction treated by general practitioners and cardiologists in contemporary Poland: the results from the DATA-HELP registry.

    Science.gov (United States)

    Jankowska, Ewa A; Kalicinska, Elzbieta; Drozd, Marcin; Kurian, Beata; Banasiak, Waldemar; Ponikowski, Piotr

    2014-10-20

    We sought to determine and compare clinical profile and management of outpatients with heart failure with reduced ejection fraction (HFREF) treated by cardiologists and general practitioners (GPs) in Poland. All the 790 randomly selected cardiologists and GPs in the DATA-HELP registry, which included 5563 patients, filled out questionnaires about 10 consecutive outpatients with HFREF. Outpatients managed by GPs were older (69±10 vs 66±12 years), and the prevalence of men was less marked (58% vs 67%). They also had higher left ventricular ejection fraction (38±6% vs 35±8%) and had more pulmonary congestion (63% vs 49%) and peripheral oedema (66% vs 51%), compared with those treated by cardiologists (all p0.2) and digoxin (20% vs 21%, p>0.2) by GPs and cardiologists was similar. In contemporary Poland, most outpatients with HFREF receive drugs that improve survival and undergo revascularisation procedures, although devices are rare, but the clinical profiles and management of those treated by GPs and cardiologists differ. Outpatients treated by GPs are older and have more co-morbidities. Outpatients treated by cardiologists more commonly receive β-blocker, MRA, ICD, and CRT, and undergo coronary revascularisations. Copyright © 2014. Published by Elsevier Ireland Ltd.

  12. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.

    Science.gov (United States)

    Gorter, Thomas M; van Veldhuisen, Dirk J; Bauersachs, Johann; Borlaug, Barry A; Celutkiene, Jelena; Coats, Andrew J S; Crespo-Leiro, Marisa G; Guazzi, Marco; Harjola, Veli-Pekka; Heymans, Stephane; Hill, Loreena; Lainscak, Mitja; Lam, Carolyn S P; Lund, Lars H; Lyon, Alexander R; Mebazaa, Alexandre; Mueller, Christian; Paulus, Walter J; Pieske, Burkert; Piepoli, Massimo F; Ruschitzka, Frank; Rutten, Frans H; Seferovic, Petar M; Solomon, Scott D; Shah, Sanjiv J; Triposkiadis, Filippos; Wachter, Rolf; Tschöpe, Carsten; de Boer, Rudolf A

    2018-01-01

    There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  13. Radiogenic responses of normal cells induced by fractionated irradiation -a simulation study. Pt. 2. Late responses

    International Nuclear Information System (INIS)

    Duechting, W.; Ulmer, W.; Ginsberg, T.; Kikhounga-N'Got, O.; Saile, C.

    1995-01-01

    Based on controlled theory, a computed simulation model has been constructed which describes the time course of slowly responding normal cells after irradiation exposure. Subsequently, different clinical irradiation schemes are compared in regard to their delayed radiogenic responses referred to as late effects in radiological terminology. A cybernetic model of a paraenchymal tissue consisting of dominantly resting functional cells has been developed and transferred into a computer model. The radiation effects are considered by characteristic cell parameters as well as by the linear-quadratic model. Three kinds of tissue (brain and lung parenchym of the mouse, liver parenchym of rat) have been irradiated in the model according to standard-, super-, hyperfractionation and a single high dose per week. The simulation studies indicate that the late reaction of brain parenchym to hyperfractionation (3 x 1.5 Gy per day) and of lung parenchym tissue with regard to all fractionation schemes applied is particularly severe. The behavior of liver parenchym is not unique. A comparison of the simulation results basing to the survival of cell numbers with clinical experience and practice shows that the clinical reality can qualitatively be represented by the model. This opens the door for connecting side effects to normal tissue with the corresponding tumor efficacy (discussed in previous papers). The model is open to further refinement and to discussions referring to the phenomenon of late effects. (orig.) [de

  14. Efficacy and safety of sacubitril/valsartan (LCZ696) in Japanese patients with chronic heart failure and reduced ejection fraction: Rationale for and design of the randomized, double-blind PARALLEL-HF study.

    Science.gov (United States)

    Tsutsui, Hiroyuki; Momomura, Shinichi; Saito, Yoshihiko; Ito, Hiroshi; Yamamoto, Kazuhiro; Ohishi, Tomomi; Okino, Naoko; Guo, Weinong

    2017-09-01

    The prognosis of heart failure patients with reduced ejection fraction (HFrEF) in Japan remains poor, although there is growing evidence for increasing use of evidence-based pharmacotherapies in Japanese real-world HF registries. Sacubitril/valsartan (LCZ696) is a first-in-class angiotensin receptor neprilysin inhibitor shown to reduce mortality and morbidity in the recently completed largest outcome trial in patients with HFrEF (PARADIGM-HF trial). The prospectively designed phase III PARALLEL-HF (Prospective comparison of ARNI with ACE inhibitor to determine the noveL beneficiaL trEatment vaLue in Japanese Heart Failure patients) study aims to assess the clinical efficacy and safety of LCZ696 in Japanese HFrEF patients, and show similar improvements in clinical outcomes as the PARADIGM-HF study enabling the registration of LCZ696 in Japan. This is a multicenter, randomized, double-blind, parallel-group, active controlled study of 220 Japanese HFrEF patients. Eligibility criteria include a diagnosis of chronic HF (New York Heart Association Class II-IV) and reduced ejection fraction (left ventricular ejection fraction ≤35%) and increased plasma concentrations of natriuretic peptides [N-terminal pro B-type natriuretic peptide (NT-proBNP) ≥600pg/mL, or NT-proBNP ≥400pg/mL for those who had a hospitalization for HF within the last 12 months] at the screening visit. The study consists of three phases: (i) screening, (ii) single-blind active LCZ696 run-in, and (iii) double-blind randomized treatment. Patients tolerating LCZ696 50mg bid during the treatment run-in are randomized (1:1) to receive LCZ696 100mg bid or enalapril 5mg bid for 4 weeks followed by up-titration to target doses of LCZ696 200mg bid or enalapril 10mg bid in a double-blind manner. The primary outcome is the composite of cardiovascular death or HF hospitalization and the study is an event-driven trial. The design of the PARALLEL-HF study is aligned with the PARADIGM-HF study and aims to assess

  15. Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics.

    Science.gov (United States)

    Eriksson, B; Wändell, P; Dahlström, U; Näsman, P; Lund, L H; Edner, M

    2018-06-01

    The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. The prospective Swedish Heart Failure Registry. Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. Comorbidities, risk factors and mortality. Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other

  16. Diffusion tensor imaging of idiopathic normal pressure hydrocephalus. A voxel-based fractional anisotropy study

    International Nuclear Information System (INIS)

    Koyama, Tetsuo; Ohmura, Takehisa; Miyake, Hiroji; Marumoto, Kohei; Domen, Kazuhisa

    2012-01-01

    Diffusion tensor imaging (DTI) using a 3.0 tesla magnetic resonance scanner was used to investigate white matter changes caused by idiopathic normal pressure hydrocephalus (INPH) in 10 patients diagnosed by clinical symptoms (gait disturbance, dementia, and/or urinary incontinence) and Evans index >0.3, and compared with findings for 10 age-matched controls (≥60 years). Then, using a computer-automated method, fractional anisotropy (FA) brain maps were generated and finally transformed into the standard space. Voxel-based FA values within two regions of interests (ROIs), the forceps minor and corticospinal tracts, were then separately evaluated. Within each ROI, statistical comparisons of results from the INPH and control groups were performed. In addition, for INPH patients, grading scores for clinical symptoms and FA values were correlated. The forceps minor mean FA value was much smaller for the INPH group (0.504) than for the control group (0.631). The corticospinal tract mean FA value was slightly smaller for the INPH group (0.588) than for the control group (0.632). Additional analyses indicated that lower FA values within the forceps minor tended to be associated with clinical symptoms such as urinary incontinence and gait disturbance. Our findings indicate FA values decreased in the forceps minor of INPH patients. We also found that lower values were associated with severer clinical symptoms, implying that DTI techniques may be developed for more accurate diagnosis. (author)

  17. High molecular gas fractions in normal massive star-forming galaxies in the young Universe.

    Science.gov (United States)

    Tacconi, L J; Genzel, R; Neri, R; Cox, P; Cooper, M C; Shapiro, K; Bolatto, A; Bouché, N; Bournaud, F; Burkert, A; Combes, F; Comerford, J; Davis, M; Schreiber, N M Förster; Garcia-Burillo, S; Gracia-Carpio, J; Lutz, D; Naab, T; Omont, A; Shapley, A; Sternberg, A; Weiner, B

    2010-02-11

    Stars form from cold molecular interstellar gas. As this is relatively rare in the local Universe, galaxies like the Milky Way form only a few new stars per year. Typical massive galaxies in the distant Universe formed stars an order of magnitude more rapidly. Unless star formation was significantly more efficient, this difference suggests that young galaxies were much more molecular-gas rich. Molecular gas observations in the distant Universe have so far largely been restricted to very luminous, rare objects, including mergers and quasars, and accordingly we do not yet have a clear idea about the gas content of more normal (albeit massive) galaxies. Here we report the results of a survey of molecular gas in samples of typical massive-star-forming galaxies at mean redshifts of about 1.2 and 2.3, when the Universe was respectively 40% and 24% of its current age. Our measurements reveal that distant star forming galaxies were indeed gas rich, and that the star formation efficiency is not strongly dependent on cosmic epoch. The average fraction of cold gas relative to total galaxy baryonic mass at z = 2.3 and z = 1.2 is respectively about 44% and 34%, three to ten times higher than in today's massive spiral galaxies. The slow decrease between z approximately 2 and z approximately 1 probably requires a mechanism of semi-continuous replenishment of fresh gas to the young galaxies.

  18. Fractionation in normal tissues: the (α/β)eff concept can account for dose heterogeneity and volume effects.

    Science.gov (United States)

    Hoffmann, Aswin L; Nahum, Alan E

    2013-10-07

    The simple Linear-Quadratic (LQ)-based Withers iso-effect formula (WIF) is widely used in external-beam radiotherapy to derive a new tumour dose prescription such that there is normal-tissue (NT) iso-effect when changing the fraction size and/or number. However, as conventionally applied, the WIF is invalid unless the normal-tissue response is solely determined by the tumour dose. We propose a generalized WIF (gWIF) which retains the tumour prescription dose, but replaces the intrinsic fractionation sensitivity measure (α/β) by a new concept, the normal-tissue effective fractionation sensitivity, [Formula: see text], which takes into account both the dose heterogeneity in, and the volume effect of, the late-responding normal-tissue in question. Closed-form analytical expressions for [Formula: see text] ensuring exact normal-tissue iso-effect are derived for: (i) uniform dose, and (ii) arbitrary dose distributions with volume-effect parameter n = 1 from the normal-tissue dose-volume histogram. For arbitrary dose distributions and arbitrary n, a numerical solution for [Formula: see text] exhibits a weak dependence on the number of fractions. As n is increased, [Formula: see text] increases from its intrinsic value at n = 0 (100% serial normal-tissue) to values close to or even exceeding the tumour (α/β) at n = 1 (100% parallel normal-tissue), with the highest values of [Formula: see text] corresponding to the most conformal dose distributions. Applications of this new concept to inverse planning and to highly conformal modalities are discussed, as is the effect of possible deviations from LQ behaviour at large fraction sizes.

  19. The application of the linear-quadratic model to fractionated radiotherapy when there is incomplete normal tissue recovery between fractions, and possible implications for treatments involving multiple fractions per day

    International Nuclear Information System (INIS)

    Dale, R.G.

    1986-01-01

    By extending a previously developed mathematical model based on the linear-quadratic dose-effect relationship, it is possible to examine the consequences of performing fractionated treatments for which there is insufficient time between fractions to allow complete damage repair. Equations are derived which give the relative effectiveness of such treatments in terms of tissue-repair constants (μ values) and α/β ratios, and these are then applied to some examples of treatments involving multiple fractions per day. The interplay of the various mechanisms involved (including repopulation effects) and their possible influence on treatments involving closely spaced fractions are examined. If current indications of the differences in recovery rates between early- and late-reacting normal tissues are representative, then it is shown that such differences may limit the clinical potential of accelerated fractionation regimes, where several fractions per day are given in a relatively short overall time. (author)

  20. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial.

    Science.gov (United States)

    Kristensen, Søren L; Preiss, David; Jhund, Pardeep S; Squire, Iain; Cardoso, José Silva; Merkely, Bela; Martinez, Felipe; Starling, Randall C; Desai, Akshay S; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Solomon, Scott D; Swedberg, Karl; Zile, Michael R; McMurray, John J V; Packer, Milton

    2016-01-01

    The prevalence of pre-diabetes mellitus and its consequences in patients with heart failure and reduced ejection fraction are not known. We investigated these in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. We examined clinical outcomes in 8399 patients with heart failure and reduced ejection fraction according to history of diabetes mellitus and glycemic status (baseline hemoglobin A1c [HbA1c]: diabetes mellitus], and ≥ 6.5% [≥ 48 mmol/mol; diabetes mellitus]), in Cox regression models adjusted for known predictors of poor outcome. Patients with a history of diabetes mellitus (n = 2907 [35%]) had a higher risk of the primary composite outcome of heart failure hospitalization or cardiovascular mortality compared with those without a history of diabetes mellitus: adjusted hazard ratio, 1.38; 95% confidence interval, 1.25 to 1.52; P diabetes mellitus and 2103 (25%) had pre-diabetes mellitus. The hazard ratio for patients with undiagnosed diabetes mellitus (HbA1c, > 6.5%) and known diabetes mellitus compared with those with HbA1c diabetes mellitus were also at higher risk (hazard ratio, 1.27 [1.10-1.47]; P diabetes mellitus is associated with a higher risk of adverse cardiovascular outcomes (compared with patients with no diabetes mellitus and HbA1c < 6.0%). LCZ696 was beneficial compared with enalapril, irrespective of glycemic status. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255. © 2016 The Authors.

  1. Effect of early treatment with ivabradine combined with beta-blockers versus beta-blockers alone in patients hospitalised with heart failure and reduced left ventricular ejection fraction (ETHIC-AHF): A randomised study.

    Science.gov (United States)

    Hidalgo, Francisco J; Anguita, Manuel; Castillo, Juan C; Rodríguez, Sara; Pardo, Laura; Durán, Enrique; Sánchez, José J; Ferreiro, Carlos; Pan, Manuel; Mesa, Dolores; Delgado, Mónica; Ruiz, Martín

    2016-08-15

    To analyse the effect of the early coadministration of ivabradine and beta-blockers (intervention group) versus beta-blockers alone (control group) in patients hospitalised with heart failure and reduced left ventricular ejection fraction (HFrEF). A comparative, randomised study was performed to compare the treatment strategies of beta-blockers alone versus ivabradine and beta-blockers starting 24hours after hospital admission, for acute HF in patients with an left ventricular ejection fraction (EF)70bpm. A total of 71 patients were examined, 33 in the intervention group and 38 in the control group. No differences were observed with respect to their baseline characteristics or standard treatment at discharge. HR at 28days (64.3±7.5 vs. 70.3±9.3bpm, p=0.01) and at 4months (60.6±7.5 vs. 67.8±8bpm, p=0.004) after discharge were significantly lower in the intervention group. Significant differences were found with respect to the EF and brain natriuretic peptide levels at 4months. No differences in clinical events (rehospitalisation/death) were reported at 4months. No severe side effects attributable to the early administration of ivabradine were observed. The early coadministration of ivabradine and beta-blockers during hospital admission for acute HFrEF is feasible and safe, and it produces a significant decrease in HR at 28days and at 4months after hospital discharge. It also seemed to improve systolic function and functional and clinical parameters of HF patients at short-term. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Ejection Tower Lab

    Data.gov (United States)

    Federal Laboratory Consortium — The Ejection Tower Facility's mission is to test and evaluate new ejection seat technology being researched and developed for future defense forces. The captive and...

  3. A simple method to calculate the influence of dose inhomogeneity and fractionation in normal tissue complication probability evaluation

    International Nuclear Information System (INIS)

    Begnozzi, L.; Gentile, F.P.; Di Nallo, A.M.; Chiatti, L.; Zicari, C.; Consorti, R.; Benassi, M.

    1994-01-01

    Since volumetric dose distributions are available with 3-dimensional radiotherapy treatment planning they can be used in statistical evaluation of response to radiation. This report presents a method to calculate the influence of dose inhomogeneity and fractionation in normal tissue complication probability evaluation. The mathematical expression for the calculation of normal tissue complication probability has been derived combining the Lyman model with the histogram reduction method of Kutcher et al. and using the normalized total dose (NTD) instead of the total dose. The fitting of published tolerance data, in case of homogeneous or partial brain irradiation, has been considered. For the same total or partial volume homogeneous irradiation of the brain, curves of normal tissue complication probability have been calculated with fraction size of 1.5 Gy and of 3 Gy instead of 2 Gy, to show the influence of fraction size. The influence of dose distribution inhomogeneity and α/β value has also been simulated: Considering α/β=1.6 Gy or α/β=4.1 Gy for kidney clinical nephritis, the calculated curves of normal tissue complication probability are shown. Combining NTD calculations and histogram reduction techniques, normal tissue complication probability can be estimated taking into account the most relevant contributing factors, including the volume effect. (orig.) [de

  4. Comparison of single, fractionated and hyperfractionated irradiation on the development of normal tissue damage in rat lung

    International Nuclear Information System (INIS)

    Giri, P.G.S.; Kimler, B.F.; Giri, U.P.; Cox, G.G.; Reddy, E.K.

    1985-01-01

    The effect of fractionated thoracic irradiation on the development of normal tissue damage in rats was compared to that produced by single doses. Animals received a single dose of 15 Gy, 30 Gy in 10 daily fractions of 3 Gy each (fractionation), or 30 Gy in 30 fractions of 1 Gy each 3 times a day (hyperfractionation). The treatments produced minimal lethality since a total of only 6 animals died between days 273 and 475 after the initiation of treatment, with no difference in survival observed between the control and any of the 3 treated groups. Despite the lack of lethality, evidence of lung damage was obtained by histological examination. Animals that had received either single doses or fractionated doses had more of the pulmonary parenchyma involved than did animals that had received hyperfractionated doses. The authors conclude that, in the rat lung model, a total radiation dose of 30 Gy fractionated over 14 days produces no more lethality nor damage to lung tissue than does 15 Gy delivered as a single dose. However, long-term effects as evidenced by deposits of collagen and development of fibrosis are significantly reduced by hyperfractionation when compared to single doses and daily fractionation

  5. Dynamic contrast-enhanced MR imaging of the water fraction of normal bone marrow and diffuse bone marrow disease

    Energy Technology Data Exchange (ETDEWEB)

    Katsuya, Tomoo; Inoue, Tomio; Ishizaka, Hiroshi; Aoki, Jun; Endo, Keigo [Gunma Univ., Maebashi (Japan). School of Medicine

    2000-10-01

    To clarify the contrast-enhancement pattern of the normal hematopoietic element by isolating the signal of the water fraction in vertebral bone marrow and to investigate whether this approach can be used to characterize bone marrow pathology in several diffuse bone marrow diseases. Two groups were examined: 30 normal healthy volunteers and 19 patients with primary diffuse bone marrow disease (aplastic anemia [n=8], myelodysplastic syndrome (MDS) [n=5], chronic myelogenic leukemia (CML) [n=4], polycythemia vera [n=2]). Isolation of the signal of hematopoietic tissue was done by the chemical-shift misregistration effect. Twenty consecutive T1-weighted midsagittal lumber vertebral images were obtained immediately after the intravenous administration of Gd-DTPA of 0.1 mmol/kg body weight, and the pattern of the time-intensity curve, the peak contrast-enhancement (CE) ratio, and the washout rate (%/min) of bone marrow in normal volunteers were compared with those in patients suffering from primary diffuse bone marrow disease. The pattern of the time-intensity curve of patients with aplastic anemia showed a low peak value followed by a slow washout. However, the pattern of time-intensity curves in patients with MDS, CML, and polycythemia vera was similar to that of normal volunteers. The peak CE ratio of the water fraction in normal marrow ranged from 0.45 to 1.26 (mean {+-}S.D.: 0.87{+-}0.18). Patients with aplastic anemia showed an abnormally lower peak CE ratio of the water fraction (mean {+-}S.D.: 0.34{+-}0.19, p<0.0001). On the other hand, the peak CE ratio of the water fraction in patients with MDS was significantly higher than that of normal volunteers (mean {+-}S.D. 1.35{+-}0.39, p<0.05). In contrast, the peak CE ratio of patients with CML or polycythemia vera did not differ significantly from that of normal volunteers. The mean washout rate of patients with aplastic anemia was significantly lower than that of normal volunteers (mean {+-}S.D.: 3.50{+-}2.51 %/min

  6. Dynamic contrast-enhanced MR imaging of the water fraction of normal bone marrow and diffuse bone marrow disease

    International Nuclear Information System (INIS)

    Katsuya, Tomoo; Inoue, Tomio; Ishizaka, Hiroshi; Aoki, Jun; Endo, Keigo

    2000-01-01

    To clarify the contrast-enhancement pattern of the normal hematopoietic element by isolating the signal of the water fraction in vertebral bone marrow and to investigate whether this approach can be used to characterize bone marrow pathology in several diffuse bone marrow diseases. Two groups were examined: 30 normal healthy volunteers and 19 patients with primary diffuse bone marrow disease (aplastic anemia [n=8], myelodysplastic syndrome (MDS) [n=5], chronic myelogenic leukemia (CML) [n=4], polycythemia vera [n=2]). Isolation of the signal of hematopoietic tissue was done by the chemical-shift misregistration effect. Twenty consecutive T1-weighted midsagittal lumber vertebral images were obtained immediately after the intravenous administration of Gd-DTPA of 0.1 mmol/kg body weight, and the pattern of the time-intensity curve, the peak contrast-enhancement (CE) ratio, and the washout rate (%/min) of bone marrow in normal volunteers were compared with those in patients suffering from primary diffuse bone marrow disease. The pattern of the time-intensity curve of patients with aplastic anemia showed a low peak value followed by a slow washout. However, the pattern of time-intensity curves in patients with MDS, CML, and polycythemia vera was similar to that of normal volunteers. The peak CE ratio of the water fraction in normal marrow ranged from 0.45 to 1.26 (mean ±S.D.: 0.87±0.18). Patients with aplastic anemia showed an abnormally lower peak CE ratio of the water fraction (mean ±S.D.: 0.34±0.19, p<0.0001). On the other hand, the peak CE ratio of the water fraction in patients with MDS was significantly higher than that of normal volunteers (mean ±S.D. 1.35±0.39, p<0.05). In contrast, the peak CE ratio of patients with CML or polycythemia vera did not differ significantly from that of normal volunteers. The mean washout rate of patients with aplastic anemia was significantly lower than that of normal volunteers (mean ±S.D.: 3.50±2.51 %/min vs. 7.13±1

  7. The α-MSH analogue AP214 attenuates rise in pulmonary pressure and fall in ejection fraction in lipopolysaccharide-induced systemic inflammatory response syndrome in pigs.

    Science.gov (United States)

    Kristensen, Jens; Jonassen, Thomas E N; Rehling, Michael; Tønnesen, Else; Sloth, Erik; Nielsen, Søren; Frøkiaer, Jørgen

    2011-01-01

    The effect of an α-melanocyte stimulating hormone (α-MSH) analogue (AP214) on experimentally endotoxin-induced systemic inflammatory response syndrome (SIRS) was studied, because α-MSH in rodent models has shown promise in attenuating inflammatory response markers and associated organ damage in SIRS. SIRS is associated with considerable morbidity and mortality. Consequently, new treatment modalities are still warranted to address the different aspects of the pathophysiological process. SIRS was induced by lipopolysaccharide (LPS) (Escherichia coli endotoxin) infusion in anaesthetized Danish Landrace pigs (20-25 kg). The pigs received an α-MSH analogue (AP214) or saline as a bolus at the initiation of the LPS infusion. The hemodynamic response was registered as well as echocardiographic indices of left ventricular function. The cardiovascular response was recorded together with echocardiographic indices of left ventricular function in control and in intervention animals. AP214 reduced the early peak in pulmonary pressure and pulmonary vascular resistance by approximately 33%. Furthermore, AP214 prevented the decline in left ventricular fractional shortening as observed in the control group. Mean change and standard deviation in fractional shortening (ΔFS) in control group: - 7·3 (4·7), AP214 (low dose): 0·9 (8·2) and AP214 (high dose) 4·1 (6·0), P < 0·05 for both intervention groups versus control. In the porcine model, the peak increase in pulmonary pressure was attenuated, and the LPS-induced decline in left ventricular function was prevented. © 2010 The Authors. Clinical Physiology and Functional Imaging © 2010 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

  8. Histopathological changes in the irradiated normal organs of guinea pigs with conventional fractionation and hyperfractionation

    International Nuclear Information System (INIS)

    Inomata, Taisuke; Itoh, Satoshi; Tsuboi, Nobuaki

    1998-01-01

    Guinea pigs were divided into groups according to four irradiation schedules : 2 Gy/3 Gy x 1/day, five fractions/week, total 80 Gy/81 Gy (A/C group) and 1.0 Gy/1.5 Gy x 2/day, ten fractions/week, total 80 Gy/81 Gy (B/D group). The A group and the C group pathologically caused severe damage in the kidney six and three months after irradiation, respectively. In the B group pathological analysis suggested that only slight-to-moderate changes were occurred in the Bowman's capsule. The D group caused slight damage in the kidney six months after irradiation. Hyperfractionation (B/D group) used in this protocol can clearly reduce radiation damage in the kidney of guinea pigs as compared with conventional fractionation (A/C group). (author)

  9. Dietary therapy in heart failure with preserved ejection fraction and/or left ventricular diastolic dysfunction in patients with metabolic syndrome.

    Science.gov (United States)

    von Bibra, Helene; Ströhle, Alexander; St John Sutton, Martin; Worm, Nicolai

    2017-05-01

    Heart failure is an ongoing epidemic of left ventricular (LV) dilatation and/or dysfunction due to the increasing prevalence of predisposing risk factors such as age, physical inactivity, (abdominal) obesity, and type-2-diabetes. Approximately half of these patients have diastolic heart failure (HFpEF). The prognosis of HFpEF is comparable to that of systolic heart failure, but without any known effective treatment. A biomathematically corrected diagnostic approach is presented that quantifies diastolic dysfunction via the predominant age dependency of LV diastolic function and unmasks (metabolic) risk factors, that are independent of age and, therefore, potential targets for therapy. Patients with HFpEF have reduced cardiac energy reserve that is frequently caused by insulin resistance. Consequently, HFpEF and/or LV diastolic dysfunction may be regarded as a cardiac manifestation of the metabolic syndrome (MetS). Accordingly, a causal therapy for metabolically induced dysfunction aims at normalizing insulin sensitivity by improving postprandial glucose and lipid metabolism. The respective treatments include 1) weight loss induced by dietary energy restriction that is often not sustained long-term and 2) independent of weight loss, focus on carbohydrate modification in exchange for an increase in protein and fat, ideally combined with an aerobic exercise program. Hence, beneficial effects of different macronutrient compositions in the dietary therapy of the underlying MetS are discussed together with the most recently available publications and meta-analyses. Modulation/restriction of carbohydrate intake normalizes postprandial hyperglycemic and insulinemic peaks and has been shown to improve all manifestations of the MetS and also to reduce cardiovascular risk. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Gallbladder ejection fraction (GBEF): after 0.02(G/KG cholecystokinin (CCK) infusion over 30 minutes in patients with a low probability of gallbladder disease

    International Nuclear Information System (INIS)

    Docherty, P.; Micallef, L.; Gruenewald, S.; Larcos, G.

    2003-01-01

    Full text: Recent literature suggests that an infusion of 0.02 (g/Kg of CCK results in a narrower range of normal GBEF than an infusion 0.01(g/Kg of. Our aim was to investigate the effect of a 30-minutes infusion of 0.02 (g/Kg, in patients with a low probability of gallbladder disease. Sixty patients presenting with abdominal symptoms were referred to West mead Medical Imaging over a 9-month period for DISIDA biliary scans. 1-minute dynamic images were collected over 90 minutes. The CCK infusion was commenced when the gallbladder was well filled. GBEF was calculated from background corrected time activity curves over the gallbladder. Sixteen patients were excluded because of previous cholecystectomy or known gallbladder disease. Thirty-three patients were considered to have a low probability of gallbladder disease after final diagnoses were obtained from referring doctors. The mean GBEF for this group was 65.6%, SD 17.2 with a mean range 28-98% compared with mean 56.9%, SD 18.1 with a mean range 21-85% of our previous study using 0.01(gCCK. Females exhibited lower GBEFs than males while females under 50 gave the lowest mean. We concluded that the higher dose infusion causes more complete gallbladder emptying, and that there is a difference in GBEF between males and females of different ages. We question the validity of the same 'Normal' range being applied to both genders and all age groups. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  11. Asymmetrically thickened posterior wall is associated with decline of ejection fraction after stress on adenosine stress/rest thallium-201 gated myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bom Sahn; Lee, Won Woo; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    2004-07-01

    LV parameters (LVEF. ESVI and EDVI) on adenosine stress/rest thallium-201 gated myocardial SPECT (gSPECT) are various from stress to rest. We investigated the reason why they were various in patients without coronary artery disease. Seventy-one patients(M:F=32:39, age 58.1{+-}9.7yrs), who underwent gSPECT and coronary angiography (CAG) due to chest pain or preoperative evaluation were included. CAG results were normal or insignificant. Exclusion criteria were atrial fibrillation, thyroid disease, primary cardiomyopathy, myocardial bridge, LBBB, MI, and valvular heart disease. Patients were calssified into 3 groups by EF difference ({delta}EF=rest-stress EF) on gSPECT : group1 ({delta}EF{>=}10), group2 (0 {<=}{delta}EF<10), and group3 ({delta}EF<0). LV parameters on gSPECT and thicknesses of IVS (interventricular septum) and LVPW (left ventricular posterior wall) on echocardiography were compared among the 3 groups. Myocardial perfusion status were normal or mild reversible/persistent perfusion defect in 76.1% (54/71). LVEFs at stress were not different among all 3 groups : 59.3{+-}8.54% in group 1 (61.3{+-}10.22% in group 2 and 64.8{+-}7.58% in group 3 (p>0.05). But LVEF at rest was smaller in group 3 (58.7{+-}8.38%) than the other groups (72.5{+-}8.77% in group1 and 66.7{+-}10.6% in group2) (p<0.01). EDVIs and ESVI at stress were larger than those at rest in all groups (p<0.05) except ESVI in group 3 (16.2{+-}6.21ml at stress and 17.5{+-}6.41ml at rest, p<0.01), and that was attributed to EF<0 in group 3. In echocardiographical analysis, group 3 had significantly increased wall thickness of LVPW (10.7{+-}1.2mm versus 9.4{+-}1.6mm, p=0.01) and decreased wall thickness ratio of IVS/LVPW (0.963{+-}0.102 versus 1.048{+-}0.104, p=0.035) than group 1. In patients without coronary artery disease, LVEF, EDVI and ESVI on gSPECT were various and decline of LVEF from stress to rest was caused by unnormalized ESVI . Asymmetrically thickened LVPW may play a crucial role and

  12. Histologic alterations of the normal bladder wall following to variably fractionated irradiation - an experimentation on animals

    International Nuclear Information System (INIS)

    Fueller, J.; Fritzsche, V.; Kob, D.; Arndt, J.; Kriester, A.; Friedrich-Schiller-Universitaet, Jena

    1986-01-01

    The histopathologic alterations of the bladder wall were investigated in 180 rabbits irradiated with different fractionations and total focal doses. Animals sacrified one week after the end of irradiation showed alterations of the urothelium (desquamation, increased polymorphism of nuclei vacuolizations) as well as oedematous and hyperemic reactions in submucosa and muscularis. These alterations became stronger when the single and total focal dose and the ret values were increased. Animals sacrified three to six months after the end of irradiation showed dystrophic-sclerotic processes as well as vascular obliterations in the submucosa and muscularis. The alterations were only clearly visible in case of a total focal dose of at least 30 Gy. With regard to a minimization of histopathologic alterations of the bladder wall, a fractionation of 1.5 Gy per day has to be considered as favorable in radiotherapy of the carcinoma of the urinary bladder. (orig.) [de

  13. Nonischemic changes in right ventricular function on exercise. Do normal volunteers differ from patients with normal coronary arteries

    International Nuclear Information System (INIS)

    Caplin, J.L.; Maltz, M.B.; Flatman, W.D.; Dymond, D.S.

    1988-01-01

    Factors other than ischemia may alter right ventricular function both at rest and on exercise. Normal volunteers differ from cardiac patients with normal coronary arteries with regard to their left ventricular response to exercise. This study examined changes in right ventricular function on exercise in 21 normal volunteers and 13 patients with normal coronary arteries, using first-pass radionuclide angiography. There were large ranges of right ventricular ejection fraction in the two groups, both at rest and on exercise. Resting right ventricular ejection fraction was 40.2 +/- 10.6% (mean +/- SD) in the volunteers and 38.6 +/- 9.7% in the patients, p = not significant, and on exercise rose significantly in both groups to 46.1 +/- 9.9% and 45.8 +/- 9.7%, respectively. The difference between the groups was not significant. In both groups some subjects with high resting values showed large decreases in ejection fraction on exercise, and there were significant negative correlations between resting ejection fraction and the change on exercise, r = -0.59 (p less than 0.01) in volunteers, and r = -0.66 (p less than 0.05) in patients. Older volunteers tended to have lower rest and exercise ejection fractions, but there was no difference between normotensive and hypertensive patients in their rest or exercise values. In conclusion, changes in right ventricular function on exercise are similar in normal volunteers and in patients with normal coronary arteries. Some subjects show decreases in right ventricular ejection fraction on exercise which do not appear to be related to ischemia

  14. Impact of diabetes mellitus on worsening of the left ventricular ejection fraction in exercise-gated 201Tl myocardial single photon emission computed tomography in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Yamagishi, Hiroyuki; Yoshiyama, Minoru; Shirai, Naoya; Akioka, Kaname; Takeuchi, Kazuhide; Yoshikawa, Junichi

    2003-01-01

    It remains uncertain whether factors other than the severity of coronary artery disease (CAD) are associated with the worsening of the left ventricular ejection fraction (LVEF) by exercise. In the present study the impact of coronary risk factors on the worsening of LVEF by exercise was investigated in 391 patients with known or suspected CAD using exercise-gated 201 Tl scanning to calculate the LVEF. Significant worsening of the LVEF by exercise was defined as >4.7% (mean plus 1 SD of the value in 116 patients without CAD). Multivariate analysis revealed that diabetes mellitus (DM) was an independent risk factor for the worsening of LVEF by exercise in patients with multivessel (2- or 3-vessel) CAD with an odds ratio (95% confidence interval) of 2.2 (1.1-4.5, p=0.037). In 157 patients with 2- or 3-vessel CAD, 20 (23.5%) of 85 nondiabetic patients and 31 (43.1%, p=0.009 vs nondiabetic patients) of 72 diabetic patients showed significant worsening of LVEF by exercise. In patients with 2- or 3-vessel CAD, there was no significant difference in Gensini score or reversibility of perfusion defects between nondiabetic and diabetic patients. Thus, DM is a risk factor for worsening LVEF by exercise in addition to the severity of CAD. (author)

  15. The Effect of Right Ventricular Apical and Nonapical Pacing on the Short- and Long-Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials.

    Science.gov (United States)

    Hussain, Mohammad Akhtar; Furuya-Kanamori, Luis; Kaye, Gerald; Clark, Justin; Doi, Suhail A R

    2015-09-01

    The right ventricular apex (RVA) is the traditional lead site for chronic pacing but in some patients may cause impaired left ventricular (LV) systolic function over time. Comparisons with right ventricular nonapical (RVNA) pacing sites have generated inconsistent results and recent meta-analyses have demonstrated unclear benefit due to heterogeneity across studies. A systematic search for randomized controlled trials that compared LV ejection fraction (LVEF) outcomes between RVNA and RVA pacing was performed up to October 2014. Twenty-four studies (n = 1,628 patients) met the inclusion criteria. To avoid between study heterogeneity two homogenous groups were created; group 1 where studies reported a difference (in favor of RVNA pacing) and group 2 where studies reported no difference between pacing sites. For group 1, weighted mean difference between RVNA and RVA pacing in terms of LVEF at follow-up was 5.40% (95% confidence interval [CI]: 3.94-6.87), related in part to group one's RVA arm demonstrating a significant reduction (mean loss -3.31%; 95% CI: -6.19 to -0.43) in LVEF between study baseline and end of follow-up. Neither of these finding were seen in group 2. Weighted regression modeling demonstrated that inclusion of poor baseline LVEF (right ventricular pacing where there is inclusion of impaired baseline LVEF (<40%), RVA pacing is associated with deterioration in LV function relative to RVNA pacing. © 2015 Wiley Periodicals, Inc.

  16. The impact of left ventricular deformation and dyssynchrony on improvement of left ventricular ejection fraction following radiofrequency catheter ablation in Wolff-Parkinson-White syndrome: A comprehensive study by speckle tracking echocardiography.

    Science.gov (United States)

    Nagai, Tomoo; Hamabe, Akira; Arakawa, Junko; Tabata, Hirotsugu; Nishioka, Toshihiko

    2017-11-01

    The purpose of this study was to evaluate left ventricular (LV) deformation and LV dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome and to identify the factors that affect the efficacy of radiofrequency catheter ablation (RFCA). Thirty patients (26 men, mean age 40 ± 12 years) with WPW syndrome were prospectively recruited for this study. They underwent 2-dimensional transthoracic echocardiography with speckle tracking analysis before RFCA and again within 48 hours after RFCA. Control group consisted of 15 age and sex-matched healthy volunteers. The patients had significantly lower LV ejection fraction (LVEF), global longitudinal strain (S l ), and global circumferential strain (S c ) compared with healthy controls (64% ± 8% vs 68% ± 5%, P = .049; -17.6% ± 3.2% vs -19.9% ± 3.3%, P = .037, -15.2% ± 2.5% vs -19.4% ± 2.5%, P syndrome, impaired LV circumferential deformation can be restored by RFCA with concomitant improvement in LV dyssynchrony and LVEF. © 2017, Wiley Periodicals, Inc.

  17. Left ventricle ejection fraction obtained by radioisotopic angiocardiography. Correlation between the values of the conventional ventriclegraphy. Fracao de ejecao do ventriculo esquerdo obtida por angiocardiografia radioisotopica. Correlacao com os valores fornecidos pela ventriculografia convencional

    Energy Technology Data Exchange (ETDEWEB)

    Ascer, E; Pimentel Filho, W A; Martins, L R.F.; Marioni Filho, H; Queiroga Filho, A F; Alonso, G; Germek, O A; Thom, A F; Souza, J E.M.R. [Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP (Brazil)

    1983-02-01

    Forty-two patients with clinical signs of coronary insuficiency underwent cineangiographic and radioisotopic examinations with the purpose of analysing the correlation between the values of left ventricle ejection fraction (LVEF) obtained by both methods. The values of EF obtained by the hemodynamic method (HEMO) ranged from 0.14 to 0.85 (x-bar = 0.566) and by radioisotopic method (RM) from 0.22 to 0.89 (x-bar = 0.573). The Student T test did not demonstrate statistically significant differences between the two methods (mean of differences = 0.007; t = 0.38 and p {ge} 0.353). A regression equation was obtained in order to estimate the EF by HEMO deriving from results obtained by RM (y = 0.11 + 0.80x) and to estimate the EF through RN from the results obtained by HEMO (x = 0.08 + 0.86y), where y = hemodynamic method and x = radioisotopic method. The authors conclude that the calculation of the EF by the methods used showed a good correlation and that this fact is evidenced by the elevated Pearson's correlation coefficient (r = 0.833). (author).

  18. Relative Importance of History of Heart Failure Hospitalization and N-Terminal Pro-B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Jhund, Pardeep S; Køber, Lars

    2015-01-01

    of NT-proBNP (n = 1468) (HR: 3.19; 95% CI: 2.68 to 3.80). In patients with no recent HF hospitalization and NT-proBNP ≤360 pg/ml (n = 1,187), the event rate was 2.43 (95% CI: 2.03 to 2.90) compared with 17.79 (95% CI: 15.77 to 20.07) per 100 person-years when both risk predictors were present (n = 523......; HR: 6.18; 95% CI: 4.96 to 7.69). CONCLUSIONS: Recent hospitalization for HF or an elevated level of NT-proBNP identified patients at higher risk for cardiovascular events, and this risk was increased further when both factors were present.......OBJECTIVES: The aim of this study was to investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and recent heart failure (HF) hospitalization as predictors of future events in heart failure - preserved ejection fraction (HF-PEF). BACKGROUND: Recently, doubt has been expressed...

  19. The magnitude and course of exercise-induced stroke volume changes determine the exercise tolerance in heart transplant recipients with heart failure and normal ejection fraction

    Czech Academy of Sciences Publication Activity Database

    Meluzín, J.; Hude, P.; Leinveber, P.; Jurák, Pavel; Soukup, L.; Viščor, Ivo; Špinarová, L.; Štěpánová, R.; Podroužková, H.; Vondra, Vlastimil; Langer, P.; Němec, P.

    2014-01-01

    Roč. 20, č. 1 (2014), s. 674-687 ISSN 1205-6626 R&D Projects: GA MŠk(CZ) LO1212 Keywords : heart failure * stroke volume index * exercise tolerance * bioimpedance Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.758, year: 2013

  20. The use of biological isodoses ''IsobioGy 2'' for evaluation of tumour and normal tissues response for fractionated irradiation

    International Nuclear Information System (INIS)

    Maciejewski, B.; Skolyszewski, J.; Majewski, S.; Lobodziec, W.; Jedynak, T.; Slosarek, K.

    1988-01-01

    Divergences between physical and biological dose distributions were analysed using linear quadratic model. It was found that small variations in physical dose distribution and differences in normal tissue sensitivity for change in dose per fraction, expressed by a α/β value, can cause a high difference between physical and biological doses. This difference significantly increases when one field instead of two fields is daily treated. If there is no enough separation between treated fields, the biological dose may dramatically increase. The use of biological ''isobioGy 2'' isodoses, instead of physical isodoses, can provide an important information on biological effect in tumour or normal tissue and may diminish the risk of giving too high dose to normal tissue and too low dose to the tumour. 6 figs., 13 refs. (author)

  1. Modification of the biologic dose to normal tissue by daily fraction

    Energy Technology Data Exchange (ETDEWEB)

    Wollin, M; Kagan, A R [Southern California Permanente Medical Group, Los Angeles Calif. (USA). Dep. of Radiation Therapy

    1976-12-01

    A method to predict normal tissue injury is proposed that includes high daily doses and unusual times successfully by calculating a new value called BIR (Biologic Index of Reaction). BIR and NSD were calculated for various normal tissue reactions. With the aid of statistical correlation techniques it is found that the BIR model is better than the NSD model in predicting radiation myelopathy and vocal edema and as good as NSD IN PREDICTING RIB FRACTURE/ Neither model predicts pericardial effusion. In no case were the results of BIR inferior to those of NSD.

  2. Normal and Inverse Diffusive Isotope Fractionation of Deuterated Toluene and Benzene in Aqueous Systems

    DEFF Research Database (Denmark)

    Rolle, Massimo; Jin, Biao

    2017-01-01

    and toluene. Multitracer experiments were carried out in 1-D gel dissection tubes and in a quasi-2-D flow-through porous medium. The experiments allowed us to simultaneously and directly compare the diffusive and dispersive behavior of benzene and toluene. We observed an unexpected, opposite behavior...... of the two monoaromatic hydrocarbons. Toluene showed a normal diffusive isotope effect (DC7D8/DC7H8 = 0.96) with enrichment of the nondeuterated isotopologue in the direction of the diffusive and transverse dispersive fluxes. Conversely, the measured trends for benzene indicate inverse diffusive...

  3. Characteristics of Endotoxin-Altering Fractions Derived from Normal Serum III. Isolation and Properties of Horse Serum alpha(2)-Macroglobulin.

    Science.gov (United States)

    Yoshioka, M; Konno, S

    1970-05-01

    The endotoxin-altering activity of fractions isolated from normal horse serum was examined by incubation of Salmonella typhosa strain 0-901 endotoxin (Boivin) in a solution of the fraction, and subsequent quantitation of any diminution in the capacity of endotoxin to be precipitated by specific anti-endotoxin antiserum. The horse serum fraction isolated by precipitation with ammonium sulfate at a concentration between 1.6 and 2.7 m was incubated with Pronase PA and then with trypsin. When this partly digested fraction was passed twice through a Sephadex G-200 column and eluted with 0.2 m tris(hydroxymethyl)aminomethane buffer, most of the endotoxinaltering activity was found in the first protein peak designated F-1a. F-1a was found to be homogeneous and corresponded to an alpha(2)-macroglobulin by the techniques of electrophoresis, immunodiffusion, and ultracentrifugation. Approximately 100-fold more F-1a than endotoxin was needed to reduce the antigenicity of the endotoxin by one-half. Alteration was increased when F-1a was incubated with the endotoxin at acid pH or at 45 C rather than at 37 C and was lost after heating F-1a at 56 C for 30 min. N-ethylmaleimide increased the endotoxin-altering activity of horse serum, F-1a, and human plasma fraction III(0), whereas p-chloromercuribenzoate did not. On the other hand, diazonium-1-H-tetrazole, iodoacetic acid, and benzylchloride suppressed the activity of F-1a. When the interaction of endotoxin and F-1a was examined by immunodiffusion techniques, depolymerization of the endotoxin molecule was indicated. The endotoxin-altering factor of horse serum is discussed in relation to the mechanisms of other known reagents, such as deoxycholate and sodium lauryl sulfate.

  4. Characteristics of Endotoxin-Altering Fractions Derived from Normal Serum III. Isolation and Properties of Horse Serum α2-Macroglobulin

    Science.gov (United States)

    Yoshioka, Morimasa; Konno, Seishi

    1970-01-01

    The endotoxin-altering activity of fractions isolated from normal horse serum was examined by incubation of Salmonella typhosa strain 0-901 endotoxin (Boivin) in a solution of the fraction, and subsequent quantitation of any diminution in the capacity of endotoxin to be precipitated by specific anti-endotoxin antiserum. The horse serum fraction isolated by precipitation with ammonium sulfate at a concentration between 1.6 and 2.7 m was incubated with Pronase PA and then with trypsin. When this partly digested fraction was passed twice through a Sephadex G-200 column and eluted with 0.2 m tris(hydroxymethyl)aminomethane buffer, most of the endotoxinaltering activity was found in the first protein peak designated F-1a. F-1a was found to be homogeneous and corresponded to an α2-macroglobulin by the techniques of electrophoresis, immunodiffusion, and ultracentrifugation. Approximately 100-fold more F-1a than endotoxin was needed to reduce the antigenicity of the endotoxin by one-half. Alteration was increased when F-1a was incubated with the endotoxin at acid pH or at 45 C rather than at 37 C and was lost after heating F-1a at 56 C for 30 min. N-ethylmaleimide increased the endotoxin-altering activity of horse serum, F-1a, and human plasma fraction III0, whereas p-chloromercuribenzoate did not. On the other hand, diazonium-1-H-tetrazole, iodoacetic acid, and benzylchloride suppressed the activity of F-1a. When the interaction of endotoxin and F-1a was examined by immunodiffusion techniques, depolymerization of the endotoxin molecule was indicated. The endotoxin-altering factor of horse serum is discussed in relation to the mechanisms of other known reagents, such as deoxycholate and sodium lauryl sulfate. Images PMID:16557754

  5. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients with Heart Failure and Preserved Ejection Fraction A Randomized, Controlled Trial

    Science.gov (United States)

    Kitzman, Dalane W.; Brubaker, Peter; Morgan, Timothy; Haykowsky, Mark; Hundley, Gregory; Kraus, William E.; Eggebeen, Joel; Nicklas, Barbara J.

    2016-01-01

    Importance More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of HF among older persons, are overweight/obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality-of-life (QOL). Objective To determine whether caloric restriction (Diet), or aerobic exercise training (Exercise), improves exercise capacity and QOL in obese older HFPEF patients. Design Randomized, attention-controlled, 2x2 factorial trial conducted from February 2009 November 2014. Setting Urban academic medical center. Participants 100 older (67±5 years) obese (BMI=39.3±5.6kg/m2) women (n=81) and men (n=19) with chronic, stable HFPEF enrolled from 577 patients initially screened (366 excluded by inclusion / exclusion criteria, 31 for other reasons, 80 declined participation). Twenty-six participants were randomized to Exercise alone, 24 to Diet alone, 25 to Diet+Exercise, and 25 to Control; 92 completed the trial. Interventions 20 weeks of Diet and/or Exercise; Attention Control consisted of telephone calls every 2 weeks. Main Outcomes and Measures Exercise capacity measured as peak oxygen consumption (VO2, ml/kg/min; primary outcome) and QOL measured by the Minnesota Living with HF Questionnaire (MLHF) total score (co-primary outcome; score range: 0–105, higher scores indicate worse HF-related QOL). Results By main effects analysis, peak VO2 was increased significantly by both interventions: Exercise main effect 1.2 ml/kg/min (95%CI: 0.7,1.7; pDiet main effect 1.3 ml/kg/min (95%CI: 0.8,1.8; pExercise+Diet was additive (complementary) for peak VO2 (joint effect 2.5 ml/kg/min). The change in MLHF total score was non-significant with Exercise (main effect −1 unit; 95%CI: −8,5; p=0.70) and with Diet (main effect −6 units; 95%CI: −12,1; p=0.078). The change in peak VO2 was positively correlated with the change in percent lean body mass (r=0.32; p=0.003) and the change in thigh muscle

  6. Substituição isolada da valva aórtica em pacientes com função ventricular deprimida Aortic valve replacement in patients with depressed left ventricular ejection fraction

    Directory of Open Access Journals (Sweden)

    Gilberto Venossi Barbosa

    1989-12-01

    Full Text Available Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall, foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos: o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA = 2,8; o GE = FE To evaluate the prognostic value of resting left ventricular ejection fraction (LVEF a series of 210 consecutive patients with aortic valve disease operated upon between May 1981 and October 1988 was studied retrospectively. All patients had their aortic valve replaced by Omniscience or Meditronic prosthesis; 112 formed the study group because they have complete follow up and cineangiocardiographic data. Based on pre-operatory left ventricular ejection fraction the patients were divided in two groups: Group 1 = 52 patients with LVEF > 40%, 39 ± 12 years, NYHA functional class 2.8, and EF 58 ± 10%. Group 2 = 60 patients with LVEF < 40, 48 ± 17 years, NYHA functional class 3.6, and LVEF of 27 ± 12%. During surgery moderate hypothermia and hemodilution were utilized, with dubble oxygenator and cardioplegia With St. Thomas cardioplegic solution. Mean extracorporeal circulation and cardiac arrest time were respectively 82 ± 18 and 49 ± 7 minutes in Group 1 and 96 ± 11 and 55 ± 6 minutes in Group 2. The size of the prosthesis were 25.2 ± 1.8 mm in Group 1. The short term mortality was 3.8% in Group 1 and 5.8 in Group 2. The long-term mortality was 4.0% in Group 1 and 8.7% in Group 2. In Group 1 there was a significant association between mortality and left ventricular systolic function. In the follow-up evaluation, among patients in Group 1, 65% were in class I, 28% were in functional class II, 5% in class III, and 2% in class IV. Among patients

  7. Initial clinical experience with the first drug (sacubitril/valsartan) in a new class - angiotensin receptor neprilysin inhibitors in patients with heart failure with reduced left ventricular ejection fraction in Poland.

    Science.gov (United States)

    Kałużna-Oleksy, Marta; Kolasa, Jolanta; Migaj, Jacek; Pawlak, Agnieszka; Lelonek, Małgorzata; Nessler, Jadwiga; Straburzyńska-Migaj, Ewa

    2018-01-01

    Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilysin inhibitors (ARNIs) recommended in the new European Society of Cardiology guidelines instead of angiotensin converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARB) that are used if ACEI are not tolerated. Sacubitril/valsartan is recommended for further reduction in the risk of hospitalisation or death in outpatients with heart failure with reduced ejection fraction (HFrEF) if symptoms continue despite optimal treatment with ACEI/ARB, beta-blockers, and mineralocorticoid antagonists. The aim of this study is to present the initial experience with regard to the effectiveness, tolerance, and safety of sacubitril/valsartan in the outpatient cardiology practice in Poland. The study is a retrospective analysis of data obtained through a questionnaire filled in by the physicians who initiated the sacubitril/valsartan treatment in patients with HFrEF between 1 June 2016 and 30 September 2016. Patients were followed-up for three months. The analysis included data on 28 patients aged 61 ± 16 years, of whom 85.7% were males. The drug was used in patients in New York Heart Association (NYHA) class I-III. In 25 (89.2%) patients sacubitril/valsartan was started at the lowest dose (24/26 mg BID). During follow-up the sacubitril/valsartan-treated patients had a reduction in HF symptoms assessed using the NYHA functional class (p = 0.001), a significant drop in N-terminal-pro B-type natriuretic peptide levels (mean, from 2900 to 2270 pg/mL; p = 0.008), and improved exercise tolerance, which occurred shortly after treatment initiation - after a mean of 28 days. It was demonstrated that the use of sacubitril/valsartan in outpatients with HFrEF is safe and is associated with a significant clinical improvement.

  8. Technetium-99m sestamibi imaging to predict left ventricular ejection fraction outcome after revascularisation in patients with chronic coronary artery disease and left ventricular dysfunction: comparison between baseline and nitrate-enhanced imaging

    International Nuclear Information System (INIS)

    Sciagra, R.; Pupi, A.; Leoncini, M.; Dabizzi, R.P.; Marcucci, G.

    2001-01-01

    Acceptance of technetium-99m sestamibi as a tracer of myocardial viability is growing, particularly when nitrate-enhanced imaging is used. However, few data are available on the ability of 99m Tc-sestamibi to predict the evolution of global left ventricular ejection fraction (EF). The aim of this study was to examine the ability of resting and nitrate 99m Tc-sestamibi single-photon emission tomography (SPET) to predict EF changes after revascularisation in patients who have chronic coronary artery disease with left ventricular dysfunction. Using baseline resting and nitrate 99m Tc-sestamibi SPET, we studied 61 patients scheduled for revascularisation because of left ventricular dysfunction. EF was estimated using two-dimensional echocardiography before and after the intervention. A post-revascularisation improvement of ≥5 EF units was defined as significant. Using a 13-segment model, 99m Tc-sestamibi activity was quantified and the nitrate-induced activity changes calculated. Three different criteria for detecting viability (defined as post-revascularisation reversible dysfunction) in asynergic segments were compared: (1) resting 99m Tc-sestamibi activity ≥60%; (2) nitrate 99m Tc-sestamibi activity ≥65%; and (3) nitrate-induced increase >+10% or nitrate-induced increase ≤+10% and nitrate activity ≥65%. EF increased significantly in 32 patients. The number of viable asynergic segments was significantly higher in these patients than in the remaining 29 subjects, and the difference was greater (P 99m Tc-sestamibi SPET appears able to predict the evolution of global left ventricular EF after revascularisation, thereby confirming the value of 99m Tc-sestamibi as a tracer of myocardial viability. The combination of baseline resting and nitrate imaging seems to significantly improve the diagnostic accuracy of 99m Tc-sestamibi SPET for this particular purpose. (orig.)

  9. Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions.

    Science.gov (United States)

    O'Keefe, James H; Abuissa, Hussam; Sastre, Antonio; Steinhaus, David M; Harris, William S

    2006-04-15

    We explored possible mechanisms by which recommended intakes of omega-3 fatty acids may decrease the risk for sudden cardiac death in patients with documented coronary heart disease. The cardioprotective effects of omega-3 fatty acids have been documented in epidemiologic and randomized controlled trials. These fatty acids are presumed to decrease susceptibility to fatal arrhythmias, but whether this is mediated by classic risk factors or direct cardiac mechanisms is not known. Eighteen white men with a history of myocardial infarction and ejection fractions <40% were randomized to placebo or omega-3 fatty acids (585 mg of docosahexaenoic acid and 225 mg of eicosapentaenoic acid) for two 4-month periods in a crossover design. At the end of each period, heart rate (HR), HR variability, and rate of HR recovery after exercise were determined, as were effects on arterial compliance, blood pressure, cardiac function, and fasting serum levels of lipids and inflammatory markers. Omega-3 fatty acids decreased HR at rest from 73 +/- 13 to 68 +/- 13 beats/min (p <0.0001) and improved 1-minute HR recovery after exercise (-27 +/- 10 to -32 +/- 12 beats/min, p <0.01). HR variability in the high-frequency band increased (p <0.02), but no change was noted in overall HR variability. There were no significant effects on blood pressure, arterial compliance, lipids, or inflammatory markers. These changes are consistent with an increase in vagal activity and may in part explain the observed decrease in risk for sudden cardiac death seen with omega-3 fatty acid supplementation.

  10. Correlation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: a systematic review and meta-analysis.

    Science.gov (United States)

    Sevilla Berrios, Ronaldo A; O'Horo, John C; Velagapudi, Venu; Pulido, Juan N

    2014-08-01

    The prognostic implications of myocardial dysfunction in patients with sepsis and its association with mortality are controversial. Several tools have been proposed to evaluate cardiac function in these patients, but their usefulness beyond guiding therapy is unclear. We review the value of echocardiographic estimate of left ventricular ejection fraction (LVEF) in the setting of severe sepsis and/or septic shock and its correlation with 30-day mortality. We conducted a systematic review and meta-analysis to evaluate the prognostic functionality of newly diagnosed LV systolic dysfunction by transthoracic echocardiography on critical ill patients admitted to the intensive care unit with severe sepsis or septic shock. A search of EMBASE and PubMed, Ovide MEDLINE, and Cochrane CENTRAL medical databases yielded 7 studies meeting inclusion criteria reporting on a total of 585 patients. The pooled sensitivity of depressed LVEF for mortality was 52% (95% confidence interval [CI], 29%-73%), and pooled specificity was 63% (95% CI, 53%-71%). Summary receiver operating characteristic curve showed an area under the curve of 0.62 (95% CI, 0.58-0.67). The overall mortality diagnostic odd ratio for septic patients with LV systolic dysfunction was 1.92 (95% CI, 1.27-2.899). Statistical heterogeneity of studies was moderate. The presence of new LV systolic dysfunction associated with sepsis and defined as low LVEF is neither a sensitive nor a specific predictor of mortality. These findings are limited because of the heterogeneity and underpower of the studies. Further research into this method is warranted. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Cost Effectiveness of the Angiotensin Receptor Neprilysin Inhibitor Sacubitril/Valsartan for Patients with Chronic Heart Failure and Reduced Ejection Fraction in the Netherlands: A Country Adaptation Analysis Under the Former and Current Dutch Pharmacoeconomic Guidelines.

    Science.gov (United States)

    Ramos, Isaac Corro; Versteegh, Matthijs M; de Boer, Rudolf A; Koenders, Jolanda M A; Linssen, Gerard C M; Meeder, Joan G; Rutten-van Mölken, Maureen P M H

    2017-12-01

    To describe the adaptation of a global health economic model to determine whether treatment with the angiotensin receptor neprilysin inhibitor LCZ696 is cost effective compared with the angiotensin-converting enzyme inhibitor enalapril in adult patients with chronic heart failure with reduced left ventricular ejection fraction in the Netherlands; and to explore the effect of performing the cost-effectiveness analyses according to the new pharmacoeconomic Dutch guidelines (updated during the submission process of LCZ696), which require a value-of-information analysis and the inclusion of indirect medical costs of life-years gained. We adapted a UK model to reflect the societal perspective in the Netherlands by including travel expenses, productivity loss, informal care costs, and indirect medical costs during the life-years gained and performed a preliminary value-of-information analysis. The incremental cost-effectiveness ratio obtained was €17,600 per quality-adjusted life-year (QALY) gained. This was robust to changes in most structural assumptions and across different subgroups of patients. Probability sensitivity analysis results showed that the probability that LCZ696 is cost-effective at a €50,000 per QALY threshold is 99.8%, with a population expected value of perfect information of €297,128. On including indirect medical costs of life-years gained, the incremental cost-effectiveness ratio was €26,491 per QALY gained, and LCZ696 was 99.46% cost effective at €50,000 per QALY, with a population expected value of perfect information of €2,849,647. LCZ696 is cost effective compared with enalapril under the former and current Dutch guidelines. However, the (monetary) consequences of making a wrong decision were considerably different in both scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Additive prognostic value of left ventricular ejection fraction to the TIMI risk score for in-hospital and long-term mortality in patients with ST segment elevation myocardial infarction.

    Science.gov (United States)

    Wei, Xue-Biao; Liu, Yuan-Hui; He, Peng-Cheng; Jiang, Lei; Zhou, Ying-Ling; Chen, Ji-Yan; Tan, Ning; Yu, Dan-Qing

    2017-01-01

    To investigate whether the addition of left ventricular ejection fraction (LVEF) to the TIMI risk score enhances the prediction of in-hospital and long-term death in ST segment elevation myocardial infarction (STEMI) patients. 673 patients with STEMI were divided into three groups based on TIMI risk score for STEMI: low-risk group (TIMI ≤3, n = 213), moderate-risk group (TIMI 4-6, n = 285), and high-risk group (TIMI ≥7, n = 175). The predictive value was evaluated using the receiver operating characteristic. Multivariate logistic regression was used to determine risk predictors. The rates of in-hospital death (0.5 vs 3.2 vs 10.3 %, p risk group. Multivariate analysis showed that TIMI risk score (OR 1.24, 95 % CI 1.04-1.48, P = 0.015) and LVEF (OR 3.85, 95 % CI 1.58-10.43, P = 0.004) were independent predictors of in-hospital death. LVEF had good predictive value for in-hospital death (AUC: 0.838 vs 0.803, p = 0.571) or 1-year death (AUC: 0.743 vs 0.728, p = 0.775), which was similar to TIMI risk score. When compared with the TIMI risk score alone, the addition of LVEF was associated with significant improvements in predicting in-hospital (AUC: 0.854 vs 0.803, p = 0.033) or 1-year death (AUC: 0.763 vs 0.728, p = 0.016). The addition of LVEF to TIMI risk score enhanced net reclassification improvement (0.864 for in-hospital death, p value to TIMI risk score.

  13. Patterns of left ventricular geometry and the transition to congestive heart failure with preserved versus depressed ejection fraction (Patrones de geometría ventricular izquierda y la transición a la insuficiencia cardíaca congestiva con fracción de eyección conservada versus deprimida

    Directory of Open Access Journals (Sweden)

    José H. Donis Hernández

    2014-12-01

    Full Text Available Abstract (english Analysis of cross-sectional and follow up clinical studies, of hypertensive patients with the different left ventricular geometric patterns, provide plausible explanations for the transition from hypertensive heart disease to the two distinct phenotypes of systolic and diastolic congestive heart failure. According to the LIFE study treated-uncomplicated patients, with normal ventricular geometry (12%, concentric remodeling (11 % and concentric hypertrophy (34 %, may evolve to the eccentric hypertrophy pattern. Patients with the eccentric hypertrophy pattern have selective sympathetic activation and progressive enlargement of the left ventricular cavity with thinning of its walls. This pattern goes on to a stage of systolic dysfunction with diminished ejection fraction and enhanced degradation of the collagen matrix. On the other hand, patients with the concentric hypertrophy pattern have predominant activation of the renin-angiotensin-aldosterone system and progressive shrinking of the left ventricular cavity with thickening of its walls. This pattern usually precedes the stage of diastolic heart failure with preserved ejection fraction, impairment of relaxation and increased deposition of collagen in the myocardial interstitium. Thus, ventricular remodeling preceding diastolic heart failure is opposite to that of hypertensive patients who go on to develop systolic heart failure. Resumen (español El análisis de los estudios transversales y longitudinales, de pacientes hipertensos con diferentes patrones de geometría ventricular izquierda, permite postular posibles mecanismos fisiopatológicos para explicar la transición de la cardiopatía hipertensiva hacia los dos fenotipos conocidos de insuficiencia cardiaca. De acuerdo con el estudio LIFE, los pacientes hipertensos no complicados, con patrones de geometría ventricular normal (12 %, remodelado concéntrico (11 % e hipertrofia concéntrica (34 %, pueden evolucionar hacia

  14. Sterilization of Normal Human Plasma and Some of its Fractions by Means of Gamma Rays

    International Nuclear Information System (INIS)

    López Martínez de Alva, L.; Crespo, Y M.

    1967-01-01

    Owing to the frequency with which normal human plasma transmits hepatitis, various methods of sterilization have been tried. The method most used, but which has been shown to be ineffective, is sterilization of the liquid plasma with ultraviolet rays. The other method is the use of ß-propiolactone, but this has also been discontinued because of the changes it produces in the structure of plasma proteins. The object of the present study, which should be regarded as a preliminary report, is to present the results obtained by sterilizing, by means of gamma rays ( 60 Co, 1.3316 MeV) at doses of 2, 2. 5 and 3 Mrad, a substance which, like plasma, contains highly labile proteins easily able to undergo structural changes under irradiation. Pure fibrinogen, pure gamma globulin, and albumin of human origin were subjected to the same doses; the results were very satisfactory, in that no appreciable change could be demonstrated as regards the structure, solubility or chemical characteristics of the substances concerned. It was shown by means of simple coagulation tests that some of the proteins involved in this mechanism, such as prothrombin, die Power-Stuart factor and the Hageman factor, were practically unchanged. All the plasma samples and the various proteins were previously lyophilized to give a maximum moisture content of 0.034%, in order to avoid ionizing the water content into oxygenated water, which would modify and oxidize the proteins. It was shown that lyophilized plasmas initially contaminated with different strains and viruses remained sterile with doses as low as 2 Mrad. Finally, it was shown that this method is simple and practical, since sterilization can be checked in the final packaging. (author) [es

  15. Mass ejections from the solar corona into interplanetary space

    International Nuclear Information System (INIS)

    Hildner, E.

    1977-01-01

    Mass ejections from the corona are common occurrances, as observations with the High Altitude Observatory's white light coronagraph aboard Skylab showed. During 227 days of operation in 1973 and 1974 at least 77 mass ejections were observed and as many more probably occurred unobserved. It is suggested that the frequency of ejections varies with the solar cycle and that ejections may contribute 10 percent or more of the total solar mass efflux to the interplanetary medium at solar maximum. Since ejections are confined to relatively low latitudes, their fractional mass flux contribution is greater near the ecliptic than far from it. From the behavior of ejecta, we can estimate the magnitude of the force driving them through the corona. It is also suggested that loop-shaped ejection - the largest fraction of ejections - are driven, primarily, by magnetic forces. By comparison, gas pressure forces are negligible, and forces due to wave pressure are completely inadequate. That magnetic forces are important is consistent with observation that ejections seem to come, primarily, from regions where the magnetic field is more intense and more complex than elsewhere. Indeed, ejections are associated with phenomena (flares and eruptive prominences) which occur over lines separating regions of opposite polarities. (Auth.)

  16. Impact of systolic blood pressure on the safety and tolerability of initiating and up-titrating sacubitril/valsartan in patients with heart failure and reduced ejection fraction: insights from the TITRATION study.

    Science.gov (United States)

    Senni, Michele; McMurray, John J V; Wachter, Rolf; McIntyre, Hugh F; Anand, Inder S; Duino, Vincenzo; Sarkar, Arnab; Shi, Victor; Charney, Alan

    2018-03-01

    The TITRATION trial investigated two strategies to initiate and up-titrate sacubitril/valsartan (LCZ696) to the same target dose, over a condensed (3-week) or conservative (6-week) period, in patients with heart failure with reduced ejection fraction (HFrEF) and systolic blood pressure (SBP) of ≥100 mmHg. This post hoc analysis examined the relationship between baseline SBP at screening and achievement of the target dose of sacubitril/valsartan of 97 mg/103 mg (also termed 'LCZ696 200 mg') twice per day during the study. Patients (n = 498) were categorized in four groups based on SBP at screening: 100-110 mmHg (n = 70); 111-120 mmHg (n = 93); 121-139 mmHg (n = 168) and ≥140 mmHg (n = 167). Overall, 72.7%, 76.1%, 85.6% and 82.9%, respectively, of patients in these SBP categories achieved and maintained the target dose of sacubitril/valsartan without down-titration/dose interruption over 12 weeks ('treatment success'). Compared with patients with SBP of 100-110 mmHg, rates of treatment success among patients in the higher SBP groups [111-120 mmHg (P = 0.96); 121-139 mmHg (P = 0.06) and ≥140 mmHg (P = 0.25)] did not differ significantly. A higher percentage of patients with lower SBP (100-110 mmHg) achieved treatment success with gradual up-titration (6 weeks) (∼80%) than with rapid up-titration (∼69%). Similar findings were observed with regard to 'tolerability success' (maintenance of the target dose for at least the final 2 weeks prior to study completion). Hypotension occurred more frequently in patients with lower SBP. The majority of patients (>80%) with SBP of ≥100 mmHg achieved and maintained the target dose of sacubitril/valsartan if the treatment was titrated gradually. These findings suggest that low SBP should not prevent clinicians from considering the initiation of sacubitril/valsartan. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of

  17. Relative Importance of History of Heart Failure Hospitalization and N-Terminal Pro-B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Kristensen, Søren L; Jhund, Pardeep S; Køber, Lars; McKelvie, Robert S; Zile, Michael R; Anand, Inder S; Komajda, Michel; Cleland, John G F; Carson, Peter E; McMurray, John J V

    2015-06-01

    The aim of this study was to investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and recent heart failure (HF) hospitalization as predictors of future events in heart failure - preserved ejection fraction (HF-PEF). Recently, doubt has been expressed about the value of a history of HF hospitalization as a predictor of adverse cardiovascular outcomes in patients with HF and HF-PEF. We estimated rates and adjusted hazard ratios (HRs) for the composite endpoint of cardiovascular death or HF hospitalization, according to history of recent HF hospitalization and baseline NT-proBNP level in the I-PRESERVE (Irbesartan in Heart Failure with Preserved systolic function) trial. Rates of composite endpoints in patients with (n = 804) and without (n = 1,963) a recent HF hospitalization were 12.78 (95% confidence interval [CI]: 11.47 to 14.24) and 4.49 (95% CI: 4.04 to 4.99) per 100 person-years, respectively (HR: 2.71; 95% CI: 2.33 to 3.16). For patients with NT-proBNP concentrations >360 pg/ml (n = 1,299), the event rate was 11.51 (95% CI: 10.54 to 12.58) compared to 3.04 (95% CI: 2.63 to 3.52) per 100 person-years in those with a lower level of NT-proBNP (n = 1468) (HR: 3.19; 95% CI: 2.68 to 3.80). In patients with no recent HF hospitalization and NT-proBNP ≤360 pg/ml (n = 1,187), the event rate was 2.43 (95% CI: 2.03 to 2.90) compared with 17.79 (95% CI: 15.77 to 20.07) per 100 person-years when both risk predictors were present (n = 523; HR: 6.18; 95% CI: 4.96 to 7.69). Recent hospitalization for HF or an elevated level of NT-proBNP identified patients at higher risk for cardiovascular events, and this risk was increased further when both factors were present. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Normal left ventricular emptying in coronary artery disease at rest: analysis by radiographic and equilibrium radionuclide ventriculography

    International Nuclear Information System (INIS)

    Denenberg, B.S.; Makler, P.T.; Bove, A.A.; Spann, J.F.

    1981-01-01

    The volume ejected early in systole has been proposed as an indicator of abnormal left ventricular function that is present at rest in patients with coronary artery disease with a normal ejection fraction and normal wall motion. The volume ejected in systole was examined by calculating the percent change in ventricular volume using both computer-assisted analysis of biplane radiographic ventriculograms at 60 frames/s and equilibrium gated radionuclide ventriculograms. Ventricular emptying was examined with radiographic ventriculography in 33 normal patients and 23 patients with coronary artery disease and normal ejection fraction. Eight normal subjects and six patients with coronary artery disease had both radiographic ventriculography and equilibrium gated radionuclide ventriculography. In all patients, there was excellent correlation between the radiographic and radionuclide ventricular emptying curves (r . 0.971). There were no difference in the ventricular emptying curves of normal subjects and patients with coronary artery disease whether volumes were measured by radiographic or equilibrium gated radionuclide ventriculography. It is concluded that the resting ventricular emptying curves are identical in normal subjects and patients with coronary artery disease who have a normal ejection fraction and normal wall motion

  19. Coronal Mass Ejections

    CERN Document Server

    Kunow, H; Linker, J. A; Schwenn, R; Steiger, R

    2006-01-01

    It is well known that the Sun gravitationally controls the orbits of planets and minor bodies. Much less known, however, is the domain of plasma fields and charged particles in which the Sun governs a heliosphere out to a distance of about 15 billion kilometers. What forces activates the Sun to maintain this power? Coronal Mass Ejections (CMEs) and their descendants are the troops serving the Sun during high solar activity periods. This volume offers a comprehensive and integrated overview of our present knowledge and understanding of Coronal Mass Ejections (CMEs) and their descendants, Interplanetary CMEs (ICMEs). It results from a series of workshops held between 2000 and 2004. An international team of about sixty experimenters involved e.g. in the SOHO, ULYSSES, VOYAGER, PIONEER, HELIOS, WIND, IMP, and ACE missions, ground observers, and theoreticians worked jointly on interpreting the observations and developing new models for CME initiations, development, and interplanetary propagation. The book provides...

  20. Real-time three-dimensional echocardiographic left ventricular ejection fraction and volumes assessment: comparison with cardiac computed tomography; Comparacao entre a afericao da fracao de ejecao e dos volumes do ventriculo esquerdo, medidos com ecocardiografia tridimensional em tempo real e com tomografia computadorizada ultra-rapida

    Energy Technology Data Exchange (ETDEWEB)

    Vieira, Marcelo L.C.; Nomura, Cesar H.; Tranchesi Junior, Bernardino; Oliveira, Wercules A. de; Naccarato, Gustavo; Serpa, Bruna S.; Cury, Alexandre; Passos, Rodrigo B.D.; Nobrega, Marcel V. da; Funari, Marcelo B.G.; Pfefermam, Abhaham; Makdisse, Marcia; Fischer, Claudio H.; Morhy, Samira S., E-mail: luiz766@terra.com.br [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil)

    2008-10-15

    Background and objective: Few studies addressed the comparison between real-time 3D echocardiography (RT3DE) and cardiac computed tomography (CCT) concerning left ventricular ejection fraction and volumes assessment. We sought to compare both techniques regarding left ventricle (LV) ejection fraction function and volumes analysis. Methods: we studied by RT3DE (Philips IE 33, And, MA, USA) and by CCT (Toshiba, 64-slice, Otawara, Japan) 41 consecutive patients (29 males, 58 ± 11 yrs). We analysed by both techniques LVEF, LVEDV, LVESV. RT3DE and CCT data were compared by coefficients of determination (r: Pearson), Bland and Altman test and linear regression, 95% CI. Results: RT3DE data: LVEF ranged from 56.7 to 78.9 % (65.3 + 5.7 ); LVEDV ranged from 49.6 to 178.2 (88 + 27.5) mL; LVESV from 11.4 to 78 ( 33.9 + 13.7) mL. CCT data: LVEF ranged from 53 to 86 % (67.3 + 7.9 ); LVEDV ranged from 51 to 186 (106.4 + 30.7) mL; LVESV from 7 to 72 ( 35.1 + 13.8) mL. Correlations relative to RT3DE and CCT were: LVEF (r: 0. 7877, p<0.0001, 95 % CI 0.6327 to 0.8853 ); LVEDV (r:0.7671, p<0.0001, 95 % CI 0.5974 to 0.8745); LVESV (r: 0.8121, p<0.0001, 95 % CI 0.6659 to 0.8957). Conclusions: it was observed adequate correlation between real-time 3D echocardiography and cardiac computed tomography concerning ejection fraction and volumes assessment. (author)

  1. Normal range of hepatic fat fraction on dual- and triple-echo fat quantification MR in children.

    Science.gov (United States)

    Shin, Hyun Joo; Kim, Hyun Gi; Kim, Myung-Joon; Koh, Hong; Kim, Ha Yan; Roh, Yun Ho; Lee, Mi-Jung

    2015-01-01

    To evaluate hepatic fat fraction on dual- and triple-echo gradient-recalled echo MRI sequences in healthy children. We retrospectively reviewed the records of children in a medical check-up clinic from May 2012 to November 2013. We excluded children with abnormal laboratory findings or those who were overweight. Hepatic fat fraction was measured on dual- and triple-echo sequences using 3T MRI. We compared fat fractions using the Wilcoxon signed rank test and the Bland-Altman 95% limits of agreement. The correlation between fat fractions and clinical and laboratory findings was evaluated using Spearman's correlation test, and the cut-off values of fat fractions for diagnosing fatty liver were obtained from reference intervals. In 54 children (M:F = 26:28; 5-15 years; mean 9 years), the dual fat fraction (0.1-8.0%; median 1.6%) was not different from the triple fat fraction (0.4-6.5%; median 2.7%) (p = 0.010). The dual- and triple-echo fat fractions showed good agreement using a Bland-Altman plot (-0.6 ± 2.8%). Eight children (14.8%) on dual-echo sequences and six (11.1%) on triple-echo sequences had greater than 5% fat fraction. From these children, six out of eight children on dual-echo sequences and four out of six children on triple-echo sequences had a 5-6% hepatic fat fraction. When using a cut-off value of a 6% fat fraction derived from a reference interval, only 3.7% of children were diagnosed with fatty liver. There was no significant correlation between clinical and laboratory findings with dual and triple-echo fat fractions. Dual fat fraction was not different from triple fat fraction. We suggest a cut-off value of a 6% fat fraction is more appropriate for diagnosing fatty liver on both dual- and triple-echo sequences in children.

  2. Results of radionuclide ventriculography in normal children and adolescents

    International Nuclear Information System (INIS)

    Reich, O.; Krejcir, M.; Ruth, C.

    1989-01-01

    In order to assess the range of normal values in radionuclide ventriculography, 53 normal children and adolescents were selected in retrospect. All were exdamined by radionuclide angiocardiography on account of clinical and echocardiographical suspicion of congenital heart disease with a left-to-right shunt; a significant shunt was, however, excluded. In all patients, after equilibration of the radiopharmaceutical the ventricular function was examined by radionuclide ventriculography. The usual volume, time and rate characteristics were evaluated. The normal range was defined as the mean ±2 standard deviations which is 47 to 72% for the ejection fraction of the left ventricle and 31 to 56% for the ejection fraction of the right ventricle. (author). 2 tabs., 18 refs

  3. Proton ejection project for Saturne

    International Nuclear Information System (INIS)

    Bronca, G.; Gendreau, G.

    1959-01-01

    The reasons for choosing the ejection system are given. The characteristics required for the ejected beam are followed by a description of the ejection process, in chronological order from the viewpoint of the protons: movement of the particles, taking into account the various elements which make up the system (internal magnet, external magnet, quadrupoles, ejection correction coils, thin and thick cables,...) and specification of these elements. Then follows an estimation of the delay in manufacture and the cost of the project. Finally, the characteristics of the magnets and quadrupoles are listed in an appendix. (author) [fr

  4. Supernova mass ejection and core hydrodynamics

    International Nuclear Information System (INIS)

    Colgate, S.A.

    1978-01-01

    Simplifications that have emerged in the descriptions of stellar unstable collapse to a neutron star are discussed. The neutral current weak interaction leads to almost complete neutrino trapping in the collapse and to an electron fraction Y/sub e/ congruent to 0.35 in equilibrium with trapped electron neutrinos and ''iron'' nuclei. A soft equation of state (γ congruent to 1.30) leads to collapse, and bounce occurs on a hard core, γ = 2.5, at nuclear densities. Neutrino emission is predicted from a photosphere at r congruent to 2 x 10 7 cm and E/sub ν/ congruent to 10 MeV. The ejection of matter by an elastic core bounce and a subsequent escaping shock is marginal and may not be predicted for accurate values of the equation of state. A new concept of Rayleigh-Taylor driven core instabilities is invoked to predict an increased mass ejection either due to an increased flux and energy of neutrinos at second bounce time and, or, the rapid 0.1 to 0.4 second formation of a more energetically bound neutron star. The instability is caused by highly neutronized external matter from which neutrinos have escaped being supported by lighter matter of the lepton trapped core. An initial anisotropy of 10 -2 to 10 -3 should lead to adequately rapid (several milliseconds) overturn following several (2 to 4) bounces. Subsequent to the overturnwith or without a strong ejection shock, a weak ejection shock will allow an accretion shock to form on the ''cold'' neutron star core due to the reimplosion or rarefaction wave in the weakly ejected matter. The accretion shock forms at low enough mass accumulation rate, 1 / 2 M/sub solar/ sec -1 , such that a black body neutrino flux can escape from the shock front (kT congruent to 10 MeV, [E/sub ν/] congruent to 30 MeV). This strongly augments the weaker bounce ejection shock by heating the external matter in the mantle by electron neutrino scattering (congruent to 10 52 ergs) causing adequate mass ejection

  5. Aggregatory behaviour of platelets incubated with subcellular fractions of normal and chagasic human syncytiotrophoblast Comportamento agregatório das plaquetas incubadas com frações subcelulares de sinciciotrofoblasto humano normal e chagásico

    Directory of Open Access Journals (Sweden)

    A.R. Eynard

    1993-06-01

    Full Text Available The surface of human syncytiotrophoblast does not induce maternal blood platelet aggregation even though it is not an endothelium. It can be surmised that as occurs in endothelial injury the subcellular components of the syncytiotrophoblast may have pro-or antiaggregatory activity. During congenital Chagas' disease which is associated to trophoblast lesions, platelets may play a role in the development of T. cruzi-induced placentitis. In the present work the aggregatory behaviour of normal human blood platelets was recorded after their challenging with subcellular fractions of syncytiotrophoblast isolated from normal and chagasic women. Nuclear, Mitochondrial, Microsomal and Supernatant fractions isolated from normal and chagasic syncytiotrophoblast failed to induce per se any aggregatory reaction on platelets. When samples of platelet-rich plasma (PRP were preincubated with normal and chagasic nuclear fractions and then stimulated with collagen at threshold level (CT-PRP an inhibition of the aggregatory response was observed. Treatment of CT-PRP with normal and chagasic mitochondrial fractions induced inhibition of platelet aggregation whereas only chagasic fraction reduced latency time. Microsornal fraction from normal placentas showed no significant effects on platelet aggregation. It is concluded that subcellular fractions of normal human syncytiotrophoblast do not exhibit any effect on platelet aggregation, whereas those subcellular fractions enriched in intracellular membrane components isolated from chagasic placentas inhibit platelet aggregation.A superficie do sinciciotrofoblasto humano não induz agregação das plaquetas maternas apesar de não ser um endotélio. Lesões endoteliais propiciam o aparecimento de agregados plaquetários, o que nos leva a questionar se os componentes subcelulares do sinciciotrofoblasto também poderiam propiciar eventos semelhantes. Na doença de Chagas congênita, que está associada a lesões a nivel de

  6. The relative biological effectiveness of fractionated doses of fast neutrons (42 MeVd→Be) for normal tissues. Pt. 3

    International Nuclear Information System (INIS)

    Rezvani, M.; Hopewell, J.W.; Robbins, M.E.C.; Hamlet, R.; Barnes, D.W.H.; Sansom, J.M.; Adams, P.J.V.

    1990-01-01

    The effect of single and fractionated doses of fast neutrons (42 MeV d→Bc ) on the early and late radiation responses of the pig lung have been assessed by the measurement of changes in lung function using a 133 Xe washout technique. The results obtained for irradiation schedules with fast neutrons have been compared with those after photon irradiation. There was no statistically significant difference between the values for the relative biological effectiveness (RBE) for the early and late radiation response of the lung. The RBE of the neutron beam increased with decreasing size of dose/fraction with an upper limit value of 4.39 ± 0.94 for infinitely small X-ray doses per fraction. (author)

  7. Beat-to-beat evaluation of left ventricular ejection in cardiac arrhythmias

    International Nuclear Information System (INIS)

    Itti, R.; Philippe, L.; Lorgeron, J.M.

    1982-01-01

    Conventional multi-gated cardiac blood pool studies suffer from two kinds of superimpositions: the spatial overlapping of various heart chambers and the temporal superimposition of a large number of cardiac cycles. The first problem can be partially solved by first pass techniques or by emission tomography. For the second one, which is specially critical arrhythmias, the single probe device (''nuclear stethoscope'') represents an original solution. Patients with normal cardiac rythm and patients presenting various kinds of cardiac rythm alterations were examined using a commercial ''nuclear stethoscope''. Some characteristic results achieved in these cases, were presented. For blood pool labeling, 20 mCi of 99mTc albumin was injected. The single probe detector was then positioned over the left ventricular area. The beat-to-beat left ventricular activity curve was then recorded for several minutes on paper in the same time as the E.C.G. signal. In cases with irregular cardiac rythm, the multigated techniques yield an average value of left ventricular ejection. Due to the relatively constant duration of systole, the superimposition of cycles may be valid during contration: differences mainly appear during diastole. But, as it could be demonstrated using the ''nuclear stethoscope'', individual cycles can show a large variability of ejection and average ejection fraction is only a very partial aspect of the real cardiac function

  8. Sample handling and contamination encountered when coupling offline normal phase high performance liquid chromatography fraction collection of petroleum samples to Fourier transform ion cyclotron resonance mass spectrometry.

    Science.gov (United States)

    Oro, Nicole E; Whittal, Randy M; Lucy, Charles A

    2012-09-05

    Normal phase high performance liquid chromatography (HPLC) is used to separate a gas oil petroleum sample, and the fractions are collected offline and analyzed on a high resolution Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FT-ICR MS). The separation prior to MS analysis dilutes the sample significantly; therefore the fractions need to be prepared properly to achieve the best signal possible. The methods used to prepare the HPLC fractions for MS analysis are described, with emphasis placed on increasing the concentration of analyte species. The dilution effect also means that contamination in the MS spectra needs to be minimized. The contamination from molecular sieves, plastics, soap, etc. and interferences encountered during the offline fraction collection process are described and eliminated. A previously unreported MS contamination of iron formate clusters with a 0.8 mass defect in positive mode electrospray is also described. This interference resulted from the stainless steel tubing in the HPLC system. Contamination resulting from what has tentatively been assigned as palmitoylglycerol and stearoylglycerol was also observed; these compounds have not previously been reported as contaminant peaks. Copyright © 2012 Elsevier B.V. All rights reserved.

  9. Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC: comparação entre fetos masculinos e femininos Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC: comparison between male and female fetuses

    Directory of Open Access Journals (Sweden)

    Christiane Simioni

    2012-06-01

    Full Text Available OBJETIVO: Comparar do débito cardíaco (DC e a fração de ejeção (FE do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC. MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino e a FE (masculina e feminina foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05. CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC não apresentaram diferença significativa em relação ao gênero.OBJECTIVE: To compare the cardiac output (CO and ejection fraction (EF of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC. METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL rotated 30º. To calculate the DC used the formula

  10. An Evaluation of a New Format for Presenting Ejection Information in a NATOPS Manual.

    Science.gov (United States)

    1979-11-01

    Assessment-the subject’s awareness of ejection system limits and knowledge of the specific principles and relationships involved in the ejection decision...percti & le pilot ejecting cannern tintiong onfigursesan at~ 71 knete arrtaeei.l From" th front cockpit. c. Normal aircraft pitc For conditions shown it...40) Arlington, VA 22209 700 Robbins Avenue * 1 CDR P.R. Chatelier Philadelphia, PA 19111 Office of the Undersecretary of Defense for Research

  11. Fractional excretion of beta-2-microglobulin in the urine of patients with normal or reduced renal function and hepatic coma

    DEFF Research Database (Denmark)

    Hansen, P B; Dalhoff, K; Joffe, P

    1991-01-01

    The purpose of this prospective study was to evaluate beta-2-microglobulin (beta 2m) as a differential diagnostic indicator between hepatic nephropathy (HN) and acute tubulointerstitial nephropathy (ATIN) in patients with reduced renal function and hepatic coma, and to determine whether beta 2m...... excretion could be used as a marker of renal impairment before increased serum creatinine (S-Cr) concentration or decreased creatinine clearance (Cr-Cl). Finally, the use of beta 2m as a prognostic indicator was investigated. Eighteen patients in hepatic coma grade III-IV were entered in the study and were...... to the small number of patients. FE-beta 2m could not predict the development of renal failure earlier than the increase in S-Cr or decrease in Cr-Cl. However, a few patients who survived paracetamol intoxication had increased FE-beta 2M in the beginning of the coma and normal S-Cr and Cr-Cl. Patients who died...

  12. Coronal Mass Ejections An Introduction

    CERN Document Server

    Howard, Timothy

    2011-01-01

    In times of growing technological sophistication and of our dependence on electronic technology, we are all affected by space weather. In its most extreme form, space weather can disrupt communications, damage and destroy spacecraft and power stations, and increase radiation exposure to astronauts and airline passengers. Major space weather events, called geomagnetic storms, are large disruptions in the Earth’s magnetic field brought about by the arrival of enormous magnetized plasma clouds from the Sun. Coronal mass ejections (CMEs) contain billions of tons of plasma and hurtle through space at speeds of several million miles per hour. Understanding coronal mass ejections and their impact on the Earth is of great interest to both the scientific and technological communities. This book provides an introduction to coronal mass ejections, including a history of their observation and scientific revelations, instruments and theory behind their detection and measurement, and the status quo of theories describing...

  13. Quantitative analysis of cardiac function: Comparison of electrocardiogram dual gated single photon emission tomography, planar radionuclide ventriculogram and contrast ventriculography in the determination of LV volume and ejection fraction

    Energy Technology Data Exchange (ETDEWEB)

    Ziada, G.; Abdel-Dayem, H.M.; Higazy, E.; Mohamed, M.M.; Bahar, R.; Hayat, N.; Yousof, A.M.

    1987-03-01

    A dual gated tomography (DGT) program for end systolic and end diastolic acquisition and subsequent processing for calculation of LVEF, end diastolic and end systolic volumes (EDV, ESV) has been evaluated in 20 healthy volunteers (25 years-40 years) and 45 patients (25 years-60 years): 20 with ischaemic heart disease and 25 with valvular heart disease (VHD). All had biplane multigated blood pool (MUGA) studies in the 40/sup 0/ LAO projection using in vivo /sup 99m/Tc-R BCs, immediately followed by DG. The results in the patients group were correlated with contrast ventriculography (CV). In the volunteer group, the normal values for LVEF, EDV and ESV measured with DGT were found to be 63%+10%, 91 ml + 6 ml and 30 ml + 6ml and r value for the LVEF=0.91 compared with MUGA. In the IHD group, r values compared with CV were 0.915 and 0.97 for the EDV and ESV and 0.934 for the LVEF. Compared with the MUGA, the r value for LVEF was 0.883. In the VHD group, r values were 0.98 for both the EDV and ESV and 0.948 for the LVEF (P<0.002) compared with CV and 0.789 for the LVEF compared with the MUGA. We feel that DGT is an accurate and reproducible technique for LV function measurements.

  14. suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

    DEFF Research Database (Denmark)

    Theilade, Simone; Rossing, Peter; Eugen-Olsen, Jesper

    2016-01-01

    AIM: Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if su...

  15. EJECTION AND CAPTURE DYNAMICS IN RESTRICTED THREE-BODY ENCOUNTERS

    International Nuclear Information System (INIS)

    Kobayashi, Shiho; Hainick, Yanir; Sari, Re'em; Rossi, Elena M.

    2012-01-01

    We study the tidal disruption of binaries by a massive point mass (e.g., the black hole at the Galactic center), and we discuss how the ejection and capture preference between unequal-mass binary members depends on which orbit they approach the massive object. We show that the restricted three-body approximation provides a simple and clear description of the dynamics. The orbit of a binary with mass m around a massive object M should be almost parabolic with an eccentricity of |1 – e| ∼ 1/3 1/3 times the binary rotation velocity, it would be abruptly disrupted, and the energy change at the encounter can be evaluated in a simple disruption model. We evaluate the probability distributions for the ejection and capture of circular binary members and for the final energies. In principle, for any hyperbolic (elliptic) orbit, the heavier member has more chance to be ejected (captured), because it carries a larger fraction of the orbital energy. However, if the orbital energy is close to zero, the difference between the two members becomes small, and there is practically no ejection and capture preferences. The preference becomes significant when the orbital energy is comparable to the typical energy change at the encounter. We discuss its implications to hypervelocity stars and irregular satellites around giant planets.

  16. Ejection of Uranium Atoms from UO{sub 2} by Fission Fragments

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, Goesta

    1964-02-15

    The numbers of uranium atoms ejected from the surface of sintered plates of UO{sub 2} by fission fragments have been measured over the fission density range 5x10{sup 15} to 7x10{sup 16} fissions/cm{sup 3}. The number of uranium atoms ejected per escaping fragment was about 9. The measurements were performed by irradiating the plates in vacuum and collecting a fraction of the uranium atoms ejected on catcher foils. The amount collected was determined by fission counting. Saturation of the amount collected, as reported by Rogers and Adam, was not observed. The numbers of uranium atoms ejected as knock-ons under the same experimental conditions have been calculated. The reasonably close agreement between the experimental and theoretical values indicates that, under the prevailing experimental conditions, mainly knock-ons are ejected. Other ejection mechanisms, e. g. evaporation of material in thermal spikes, are probably insignificant; this is in contrast to the usual interpretation of the ejection process. The mean range in UO{sub 2}, of fission products of mass number 140 was found to be 7.37 {+-} 0. 05 mg/cm{sup 2} by direct gamma spectrometric, determination of the fraction of {sup 140}La escaping from the surface of the plates.

  17. Left atrial ejection force predicts the outcome after catheter ablation for paroxysmal atrial fibrillation.

    Science.gov (United States)

    Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

    2018-02-01

    Left atrium (LA) systolic dysfunction is observed in the early stages of atrial fibrillation (AF) prior to LA anatomical change. We investigated whether LA systolic dysfunction predicts recurrent AF after catheter ablation (CA) in patients with paroxysmal AF. We studied 106 patients who underwent CA for paroxysmal AF. LA systolic function was assessed with the LA emptying volume = Maximum LA volume (LAV max ) - Minimum LA volume (LAV min ), LA emptying fraction = [(LAV max - LAV min )/LAV max ] × 100, and LA ejection force calculated with Manning's method [LA ejection force = (0.5 × ρ × mitral valve area × A 2 )], where ρ is the blood density and A is the late-diastolic mitral inflow velocity. Recurrent AF was detected in 35/106 (33%) during 14.6 ± 9.1 months. Univariate analysis revealed reduced LA ejection force, decreased LA emptying fraction, larger LA diameter, and elevated brain natriuretic peptide as significant variables. On multivariate analysis, reduced LA ejection force and larger LA diameter were independently associated with recurrent AF. Moreover, patients with reduced LA ejection force and larger LA diameter had a higher risk of recurrent AF than preserved LA ejection force (log-rank P = 0.0004). Reduced LA ejection force and larger LA diameter were associated with poor outcome after CA for paroxysmal AF, and could be a new index to predict recurrent AF. © 2017 Wiley Periodicals, Inc.

  18. Effect of treatment in fractionated schedules with the combination of x-irradiation and six cytotoxic drugs on the RIF-1 tumor and normal mouse skin

    International Nuclear Information System (INIS)

    Lelieveld, P.; Scoles, M.A.; Brown, J.M.; Phil, D.; Kallman, R.F.

    1985-01-01

    RIF-1 tumors, implanted syngeneically in the gastrocnemius muscles of the right hind legs of C3H/Km mice, were treated either with X ray alone, drug alone, or drug and X ray combined. The drugs tested were bleomycin, BCNU, cis-diamminedichloro platinum, adriamycin, cyclophosphamide, and actinomycin-D. All drugs were administered either in the maximum tolerated dose or a dose that causes minimal tumor growth delay. Both drugs and X rays were administered either as a single dose or in five daily fractions. In addition to the single modality controls, seven different schedules of combined modalities were tested. Tumors were measured periodically after treatment in order that the day at which each tumor reached 4 times its initial cross-sectional area, i.e., its size at the time of treatment, could be determined. The effect of treatment on tumors was based upon excess growth delay (GD), i.e., T400% (treated)-T400% (untreated control). Treatment effects for the same combined modality schedules were also determined for normal skin, using the early skin reaction as an endpoint. Dose effect factors (DEF) were computed for all combined modality schedules and were based upon calculated radiation dose equivalents. We also calculated supra-additivity ratios, SR/sub I/ and SR/sub II/, therapeutic gain factors and adjusted therapeutic gain factors. The only drugs to produce significant supra-additivity with X rays were cis-Pt and cyclo

  19. The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review.

    Science.gov (United States)

    Siasios, Ioannis; Kapsalaki, Eftychia Z; Fountas, Kostas N; Fotiadou, Aggeliki; Dorsch, Alexander; Vakharia, Kunal; Pollina, John; Dimopoulos, Vassilios

    2016-09-01

    OBJECTIVE Diffusion tensor imaging (DTI) for the assessment of fractional anisotropy (FA) and involving measurements of mean diffusivity (MD) and apparent diffusion coefficient (ADC) represents a novel, MRI-based, noninvasive technique that may delineate microstructural changes in cerebral white matter (WM). For example, DTI may be used for the diagnosis and differentiation of idiopathic normal pressure hydrocephalus (iNPH) from other neurodegenerative diseases with similar imaging findings and clinical symptoms and signs. The goal of the current study was to identify and analyze recently published series on the use of DTI as a diagnostic tool. Moreover, the authors also explored the utility of DTI in identifying patients with iNPH who could be managed by surgical intervention. METHODS The authors performed a literature search of the PubMed database by using any possible combinations of the following terms: "Alzheimer's disease," "brain," "cerebrospinal fluid," "CSF," "diffusion tensor imaging," "DTI," "hydrocephalus," "idiopathic," "magnetic resonance imaging," "normal pressure," "Parkinson's disease," and "shunting." Moreover, all reference lists from the retrieved articles were reviewed to identify any additional pertinent articles. RESULTS The literature search retrieved 19 studies in which DTI was used for the identification and differentiation of iNPH from other neurodegenerative diseases. The DTI protocols involved different approaches, such as region of interest (ROI) methods, tract-based spatial statistics, voxel-based analysis, and delta-ADC analysis. The most studied anatomical regions were the periventricular WM areas, such as the internal capsule (IC), the corticospinal tract (CST), and the corpus callosum (CC). Patients with iNPH had significantly higher MD in the periventricular WM areas of the CST and the CC than had healthy controls. In addition, FA and ADCs were significantly higher in the CST of iNPH patients than in any other patients with other

  20. Sex-related differences in the normal cardiac response to upright exercise

    International Nuclear Information System (INIS)

    Higginbotham, M.B.; Morris, K.G.; Coleman, R.E.; Cobb, F.R.

    1984-01-01

    In previous studies from this laboratory, it was found that approximately 30% of women with chest pain and normal coronary arteries demonstrated either a decrease in or a failure to increase radionuclide ejection fraction during exercise. To examine the hypothesis that this apparent abnormality in left ventricular function represents a physiologic difference between men and women, a prospective study was made of central and peripheral cardiovascular responses to exercise in 31 age-matched healthy volunteers (16 women and 15 men). A combination of quantitative radionuclide (technetium) angiography and expired-gas analysis was used to measure ejection fraction and relative changes in end-diastolic counts, stroke counts, count output, and arteriovenous oxygen difference during symptom-limited upright bicycle exercise. Normal male and female volunteers demonstrated comparable baseline left ventricular function and similar aerobic capacity, as determined by weight-adjusted peak oxygen consumption. However, their cardiac responses to exercise were significantly different. The ejection fraction increased by 5 points or more in 14 of 15 men, but in only seven of the 16 women. End-diastolic counts increased by 30% in women, but was unchanged in men. Because decreases in ejection fraction were matched by increases in end-diastolic counts, relative increases in stroke counts and count output were the same for men and women. These data demonstrate a basic difference between men and women with respect to the mechanism by which they achieve a normal response of stroke volume to exercise; these differences must be taken into account when measurements of cardiac function during exercise stress are used for diagnostic purposes

  1. Cobalt irradiation box ejection accident of ETRR-2

    International Nuclear Information System (INIS)

    El-Messiry, A.M.

    2000-01-01

    The new Egyptian test and research reactor number 2 ETRR-2, MTR type, is now under operational tests. It has a main central irradiation channel for the purpose of Co 60 isotope production with an intended rated capacity of 50000 Ci per year. The reactivity introduced in the reactor due to accidental ejection of the Co 60 irradiation box (CIB) should be discussed. This reactivity insertion accident (RIA) may be fast or slow with maximum reactivity worth 2.9428 $. The CIB may move with constant speed or variable acceleration according to its initial speed and the applied forces. This results in a linear, parabolic or sinusoidal motion, which in turn affects the reactivity insertion rate (RIR). The present work analyzes this type of perturbation during normal operating conditions: 22 MW full power and 1900 kg s -1 forced core cooling flow. The work serves as a part of the safety evaluation process applicable to similar MTR cores. The RIA code TRANSP20 is developed for this study. It simulates various types of RIR, fast or slow resulting from different CIB ejections. Scram signal due to power, period, inlet and outlet temperatures, or temperature difference is expected to activate the shutdown system. The work presents five case studies, two for fast ejection and three for slow. The transient behavior of the reactor during this is illustrated. The results show that the reactor can withstand slow ejection if the scram is available. However, for fast ejection the scram system does not prevent the clad temperature from exceeding safety limits. Recommendations to prevent or mitigate this accident are highlighted. (orig.)

  2. Ultrasound - Aided ejection in micro injection molding

    Science.gov (United States)

    Masato, D.; Sorgato, M.; Lucchetta, G.

    2018-05-01

    In this work, an ultrasound-aided ejection system was designed and tested for different polymers (PS, COC and POM) and mold topographies. The proposed solution aims at reducing the ejection friction by decreasing the adhesion component of the frictional force, which is controlled by the contact area developed during the filling stage of the injection molding process. The experimental results indicate a positive effect of ultrasound vibration on the friction force values, with a maximum reduction of 16. Moreover, it is demonstrated that the ultrasound effect is strictly related to both polymer selection and mold roughness. The combined effect on the ejection force of mold surface roughness, melt viscosity during filling and polymer elastic modulus at ejection was modeled to the experimental data, in order to demonstrate that the effect of ultrasound vibration on the ejection friction reduction is due to the heating of the contact interface and the consequent reduction of the polymer elastic modulus.

  3. Space weather and coronal mass ejections

    CERN Document Server

    Howard, Tim

    2013-01-01

    Space weather has attracted a lot of attention in recent times. Severe space weather can disrupt spacecraft, and on Earth can be the cause of power outages and power station failure. It also presents a radiation hazard for airline passengers and astronauts. These ""magnetic storms"" are most commonly caused by coronal mass ejections, or CMES, which are large eruptions of plasma and magnetic field from the Sun that can reach speeds of several thousand km/s. In this SpringerBrief, Space Weather and Coronal Mass Ejections, author Timothy Howard briefly introduces the coronal mass ejection, its sc

  4. The relative biological effectiveness of fractionated doses of fast neutrons (42 MeV sub d yields Be ) for normal tissues. Pt. 3; Effects on lung function

    Energy Technology Data Exchange (ETDEWEB)

    Rezvani, M.; Hopewell, J.W.; Robbins, M.E.C.; Hamlet, R. (Churchill Hospital, Oxford (UK)); Barnes, D.W.H.; Sansom, J.M.; Adams, P.J.V. (Medical Research Council, Harwell (UK). Radiobiological Research Unit)

    1990-11-01

    The effect of single and fractionated doses of fast neutrons (42 MeV{sub d{yields}Bc}) on the early and late radiation responses of the pig lung have been assessed by the measurement of changes in lung function using a {sup 133}Xe washout technique. The results obtained for irradiation schedules with fast neutrons have been compared with those after photon irradiation. There was no statistically significant difference between the values for the relative biological effectiveness (RBE) for the early and late radiation response of the lung. The RBE of the neutron beam increased with decreasing size of dose/fraction with an upper limit value of 4.39 {plus minus} 0.94 for infinitely small X-ray doses per fraction. (author).

  5. Validation of noninvasive indices of global systolic function in patients with normal and abnormal loading conditions: a simultaneous echocardiography pressure-volume catheterization study.

    Science.gov (United States)

    Yotti, Raquel; Bermejo, Javier; Benito, Yolanda; Sanz-Ruiz, Ricardo; Ripoll, Cristina; Martínez-Legazpi, Pablo; del Villar, Candelas Pérez; Elízaga, Jaime; González-Mansilla, Ana; Barrio, Alicia; Bañares, Rafael; Fernández-Avilés, Francisco

    2014-01-01

    Noninvasive indices based on Doppler echocardiography are increasingly used in clinical cardiovascular research to evaluate left ventricular global systolic chamber function. Our objectives were to clinically validate ultrasound-based methods of global systolic chamber function to account for differences between patients in conditions of abnormal load, and to assess their sensitivity to load confounders. Twenty-seven patients (8 dilated cardiomyopathy, 10 normal ejection fraction, and 9 end-stage liver disease) underwent simultaneous echocardiography and left heart catheterization with pressure-conductance instrumentation. The reference index, maximal elastance (Emax), was calculated from pressure-volume loop data obtained during acute inferior vena cava occlusion. A wide range of values were observed for left ventricular systolic chamber function (Emax: 2.8±1.0 mm Hg/mL), preload, and afterload. Among the noninvasive indices tested, the peak ejection intraventricular pressure difference showed the best correlation with Emax (R=0.75). A significant but weaker correlation with Emax was observed for ejection fraction (R=0.41), midwall fractional shortening (R=0.51), global circumferential strain (R=-0.53), and strain rate (R=-0.46). Longitudinal strain and strain rate failed to correlate with Emax, as did noninvasive single-beat estimations of this index. Principal component and multiple regression analyses demonstrated that peak ejection intraventricular pressure difference was less sensitive to load, whereas ejection fraction and longitudinal strain and strain rate were heavily influenced by afterload. Current ultrasound methods have limited accuracy to characterize global left ventricular systolic chamber function in a given patient. The Doppler-derived peak ejection intraventricular pressure difference should be preferred for this purpose because it best correlates with the reference index and is more robust in conditions of abnormal load.

  6. Comparison of stroke work between repaired tetralogy of Fallot and normal right ventricular physiologies.

    Science.gov (United States)

    Lee, Namheon; Das, Ashish; Banerjee, Rupak K; Gottliebson, William M

    2013-01-01

    Adult patients who underwent tetralogy of Fallot repair surgery (rTOF) confront life-threatening ailments due to right ventricular (RV) myocardial dysfunction. Pulmonary valve replacement (PVR) needs to be performed to restore the deteriorating RV function. Determination of correct timing to perform PVR in an rTOF patient remains subjective, due to the unavailability of quantifiable clinical diagnostic parameters. The objective of this study is to evaluate the possibility of using RV body surface area (BSA)-indexed stroke work (SW(I)) to quantify RV inefficiency in TOF patients. We hypothesized that RV SW(I) required to push blood to the lungs in rTOF patients is significantly higher than that of normal subjects. Seven patients with rTOF pathophysiology and eight controls with normal RV physiology were registered for this study. Right ventricular volume and pressure were measured using cardiac magnetic resonance imaging and catheterization, respectively. Statistical analysis was performed to quantify the difference in SW(I) between the RV of the rTOF and control groups. Right ventricular SW(I) in rTOF patients (0.176 ± 0.055 J/m(2)) was significantly higher by 93.4% (P = 0.0026) than that of controls (0.091 ± 0.030 J/m(2)). Further, rTOF patients were found to have significantly higher (P < 0.05) BSA normalized RV end-systolic volume, end-systolic pressure, and regurgitation fraction than control subjects. Ejection fraction and peak ejection rate of rTOF patients were significantly lower (P < 0.05) than those of controls. Patients with rTOF pathophysiology had significantly higher RV SW(I) compared with subjects with normal RV physiology. Therefore, RV SW(I) may be useful to quantify RV inefficiency in rTOF patients along with currently used clinical end points such as RV volume, pressure, regurgitation fraction, and ejection fraction.

  7. How can journal impact factors be normalized across fields of science? An assessment in terms of percentile ranks and fractional counts

    NARCIS (Netherlands)

    Leydesdorff, L.; Zhou, P.; Bornmann, L.

    2013-01-01

    Using the CD-ROM version of the Science Citation Index 2010 (N = 3,705 journals), we study the (combined) effects of (a) fractional counting on the impact factor (IF) and (b) transformation of the skewed citation distributions into a distribution of 100 percentiles and six percentile rank classes

  8. Capacidade funcional máxima, fração de ejeção e classe funcional na cardiomiopatia chagásica: existe relação entre estes índices? Maximal functional capacity, ejection fraction, and functional class in Chagas cardiomyopathy: are these indices related?

    Directory of Open Access Journals (Sweden)

    Charles Mady

    2005-02-01

    Full Text Available OBJETIVO: Avaliar a potencial associação entre a capacidade funcional máxima (VO2max, fração de ejeção do ventrículo esquerdo (FEVE e a classe funcional (CF pela NYHA em pacientes com cardiomiopatia chagásica. MÉTODOS: Foram estudados 104 homens, com idade média de 40.3± 9.0 anos (variação: de 18 a 65, com diagnóstico estabelecido de cardiomiopatia chagásica. A FEVE e VO2max foram classificadas em três categorias: FEVE 0.50 e VO2max 20 ml.kg-1.min-1, respectivamente. RESULTADOS: Do total, 31 (29.8% pacientes estavam em CF II, 41 (39.4% em classe funcional III, e 32 (30.8% em CF IV. Os valores correspondentes do VO2max e da FEVE para CF II, III e IV foram 21.5±4.0 ml.kg-1.min-1, 18.3±5.8 ml.kg-1.min-1 e 14.7±4.9 ml.kg-1.min-1 e 0.50±0.6, 0.35±0.9 e 0.29±0.7, respectivamente. FEVE 0.50 como também VO2max >20 ml.kg-1.min-1. CONCLUSÃO: Existe uma boa associação entre a classe funcional, a capacidade funcional máxima e a fração de ejeção do ventrículo esquerdo em pacientes com cardiomiopatia chagásica. Dados que podem ser úteis no manuseio da insuficiência cardíaca, em chagásicos.OBJECTIVE: Left ventricular ejection fraction (LVEF and maximal functional capacity (VO2max have both been shown to be related to a poor long-term survival in Chagas' disease patients. The aim of this study was to estimate the potential association of VO2max, LVEF, and NYHA functional class in patients with Chagas' disease cardiomyopathy. METHODS: One hundred four male patients, aged 40.3±9.0 years (range, 18 to 65, with a definite diagnosis of Chagas disease cardiomyopathy were studied. LVEF and VO2max were both classified into 3 degrees: LVEF 0.50 and VO2max 20 ml.kg-1.min-1, respectively. RESULTS: Thirty-one patients (29.8% were in NYHA functional class II, 41 (39.4% in functional class III, and 32 (30.8% in functional class IV. The corresponding values of VO2max and LVEF for functional classes II, III, and IV were 21.5±4.0 ml.kg-1

  9. [Correlation between the inspired fraction of oxygen, maternal partial oxygen pressure, and fetal partial oxygen pressure during cesarean section of normal pregnancies].

    Science.gov (United States)

    Castro, Carlos Henrique Viana de; Cruvinel, Marcos Guilherme Cunha; Carneiro, Fabiano Soares; Silva, Yerkes Pereira; Cabral, Antônio Carlos Vieira; Bessa, Roberto Cardoso

    2009-01-01

    Despite changes in pulmonary function, maternal oxygenation is maintained during obstetric regional blocks. But in those situations, the administration of supplementary oxygen to parturients is a common practice. Good fetal oxygenation is the main justification; however, this has not been proven. The objective of this randomized, prospective study was to test the hypothesis of whether maternal hyperoxia is correlated with an increase in fetal gasometric parameters in elective cesarean sections. Arterial blood gases of 20 parturients undergoing spinal block with different inspired fractions of oxygen were evaluated and correlated with fetal arterial blood gases. An increase in maternal inspired fraction of oxygen did not show any correlation with an increase of fetal partial oxygen pressure. Induction of maternal hyperoxia by the administration of supplementary oxygen did not increase fetal partial oxygen pressure. Fetal gasometric parameters did not change even when maternal parameters changed, induced by hyperoxia, during cesarean section under spinal block.

  10. Determinants of global left ventricular peak diastolic filling rate during rest and exercise in normal volunteers

    International Nuclear Information System (INIS)

    Filiberti, A.W.; Bianco, J.A.; Baker, S.P.; Doherty; Nalivaika, L.A.; King, M.A.; Alpert, J.S.

    1984-01-01

    Early peak diastolic filling rate (PFR) of the left ventricle (LV) is said to be a sensitive index of LV dysfunction in patients with coronary disease, hypertension and hypertrophic cardiomyopathy. Radionuclide (RN0 multigated PFR was measured in 20 normal volunteers (13 males, 7 females, mean age 31 yrs., range 20-43) at rest and during supine bicycle exercise conducted to a symptomatic end-point. At rest, RN PFR was 3.4 +- SD 0.4 end-diastolic vols./sec (range 3.1 - 3.6). During exercise all normal volunteers had a progressive and numerically and statistically significant increase in PFR. Stepwise multiple linear regression (BMPD2R) was applied to the rest and exercise PFR data to develop a linear model describing the main determinants of the RN PFR. The potential independent variables which were included in the model were heart rate (HR), ejection fraction (EF), systolic arterial pressure, systolic ejection rate and exercise stage. Ranking of variables for prediction of RN PFR, and exclusion of less important variables, was done by F value criteria. The final multivariate equation was: LVPFR = -3.84437 + 0.03834 HR + 0.07537 LVEF. The model fit was highly significant (p<0.001), and accounted for 89 per cent of variability in the PFR. The authors conclude that the left ventricular peak filling rate is critically determined by heart rate and by ejection fraction at rest and during exercise

  11. Analysis of a control rod ejection transient in a mox-fuelled PWR

    International Nuclear Information System (INIS)

    Lenain, R.; Mathonniere, G.; Perrutel, J.P.; Schaeffer, H.; Stelletta, S.; Lam Hime, M.

    1988-09-01

    The decision to use mixed-oxide (MOX) fuel in PWR's involved re-investigation of a certain number of accidents and notably control rod ejection transients. It has thus been shown that this accident would be no more severe than in the case of all-uranium cores, since the positive effects on the ejected rod worth would counterbalance the negative effects on the delayed neutron fraction. A new approach to the kinetics aspect of the calculation method for this accident is also presented, involving a 3-D kinetic calculation with only a few axial meshes

  12. Proton ejection project for Saturne; Projet d'ejection des protons de saturne

    Energy Technology Data Exchange (ETDEWEB)

    Bronca, G; Gendreau, G

    1959-07-01

    The reasons for choosing the ejection system are given. The characteristics required for the ejected beam are followed by a description of the ejection process, in chronological order from the viewpoint of the protons: movement of the particles, taking into account the various elements which make up the system (internal magnet, external magnet, quadrupoles, ejection correction coils, thin and thick cables,...) and specification of these elements. Then follows an estimation of the delay in manufacture and the cost of the project. Finally, the characteristics of the magnets and quadrupoles are listed in an appendix. (author) [French] On donne d'abord les raisons du choix du systeme d'ejection, puis le principe. Apres les caracteristiques requises pour le faisceau ejecte, on decrit le processus d'ejection selon l'ordre chronologique vu par les protons: mouvement des particules compte tenu des divers elements composant le systeme (aimant interne, aimant externe, quadrupoles, enroulements correcteurs ejection, cibles mince et epaisse,. ..) et cahier de charge de ces elements. On estime, ensuite les delais de realisation et le cout du projet. Enfin, un resume des caracteristiques des aimants et quadrupoles est donne en appendice. (auteur)

  13. On the mass ejected by supernova explosions

    International Nuclear Information System (INIS)

    Bohigas, J.

    1984-01-01

    A simple model is developed in order to calculate the mass ejected by superonovae. We find that the 185, 1006, 1572 and 1604 AD events, all of them classified as either probable or possible type I supernovae, ejected between 0.1 and 0.4 solar masses with an expansion velocity of roughly 10,000 km s -1 . This range of masses suggests that a collapsed object is at the center of the remnants produced by these supernovae if the precursor was a white dwarf whose mass was closed to the Chandrasekhar limit. For the Crab we obtain an ejected mass of 0.45 Msub(sun) and point out that this value is not in contradiction with a proposal in which the moderate helium stars are good candidates for producing this kind of supernovae. Finally we obtain an ejected mass of 3.1 Msub(sun) for Cas A, indicating that a type II event produced this remnant. This ejected mass is closed to what would be expected for a progenitor like an OBN star. (author)

  14. Polarized DNA Ejection from the Herpesvirus Capsid

    Science.gov (United States)

    Newcomb, William W.; Cockrell, Shelley K.; Homa, Fred L.; Brown, Jay C.

    2009-01-01

    Ejection of DNA from the capsid is an early step in infection by all herpesviruses. Ejection or DNA uncoating occurs after a parental capsid has entered the host cell cytoplasm, migrated to the nucleus and bound to a nuclear pore. DNA exits the capsid through the portal vertex and proceeds by way of the nuclear pore complex into the nucleoplasm where it is transcribed and replicated. Here we describe use of an in vitro uncoating system to determine which genome end exits first from the herpes simplex virus (HSV-1) capsid. Purified DNA-containing capsids were bound to a solid surface and warmed under conditions in which some, but not all, of the DNA was ejected. Restriction endonuclease digestion was then used to identify the genomic origin of the ejected DNA. The results support the view that the S segment end exits the capsid first. Preferential release at the S end demonstrates that herpesvirus DNA uncoating conforms to the paradigm in dsDNA bacteriophage where the last end packaged is the first to be ejected. Release of HSV-1 DNA beginning at the S end causes the first gene to enter the host cell nucleus to be α4, a transcription factor required for expression of early genes. PMID:19631662

  15. Fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for single vertebral body metastases: acceptable local control and normal tissue tolerance with 5 fraction approach

    Energy Technology Data Exchange (ETDEWEB)

    Gill, Beant; Oermann, Eric; Ju, Andrew; Suy, Simeng; Yu, Xia; Rabin, Jennifer [Department of Radiation Medicine, Georgetown University Hospital,, Washington, DC (United States); Kalhorn, Christopher; Nair, Mani N.; Voyadzis, Jean-Marc [Department of Neurosurgery, Georgetown University Hospital,, Washington, DC (United States); Unger, Keith; Collins, Sean P.; Harter, K. W.; Collins, Brian T., E-mail: collinsb@gunet.georgetown.edu [Department of Radiation Medicine, Georgetown University Hospital,, Washington, DC (United States)

    2012-04-26

    This retrospective analysis examines the local control and toxicity of five-fraction fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for single vertebral body (VB) metastases. All patients had favorable performance status (ECOG 0–1), oligometastatic disease, and no prior spine irradiation. A prescribed dose of 30–35 Gy was delivered in five fractions to the planning target volume (PTV) using the CyberKnife with X-sight spine tracking. Suggested maximum spinal cord and esophagus point doses were 30 and 40 Gy, respectively. A median 30 Gy (IQR, 30–35 Gy) dose was delivered to a median prescription isodose line of 70% (IQR, 65–77%) to 20 patients. At 34 months median follow-up (IQR, 25–40 months) for surviving patients, the 1- and 2-year Kaplan–Meier local control estimates were 80 and 73%, respectively. Two of the five local failures were infield in patients who had received irradiation to the gross tumor volume and three were paravertebral failures just outside the PTV in patients with prior corpectomy. No local failures occurred in patients who completed VB radiation alone. The 1- and 2-year Kaplan–Meier overall survival estimates were 80 and 57%, respectively. Most deaths were attributed to metastatic disease; one death was attributed to local recurrence. The mean maximum point doses were 26.4 Gy (SD, 5.1 Gy) to the spinal cord and 29.1 Gy (SD, 8.9 Gy) to the esophagus. Patients receiving maximum esophagus point doses greater than 35 Gy experienced acute dysphagia (Grade I/II). No spinal cord toxicity was documented. Five-fraction fiducial-free CyberKnife SBRT is an acceptable treatment option for newly diagnosed VB metastases with promising local control rates and minimal toxicity despite the close proximity of such tumors to the spinal cord and esophagus. A prospective study aimed at further enhancing local control by targeting the intact VB and escalating the total dose is planned.

  16. Studies on inorganic polyphosphate metabolism in Mycobacterium phlei. Pt. 1. The incorporation of 32P into various phosphorus fractions of M. phlei grown on normal and modified Loewenstein media

    International Nuclear Information System (INIS)

    Szymona, O.

    1974-01-01

    Mycobacterium phlei was grown on various media with radioactive orthophosphate added. At timed intervals the bacteria were fractionated and in particular fractions both total and 32 P was determined. The content of acid-insoluble polyphosphate was measured enzymatically by the use of specific glucokinase. The organism grown on normal Loewenstein medium proved to accumulate high amounts of polyphosphate which was formed in more than 50% at the expense of organic egg yolk phosphorus. In contrast, the nuclei acid phosphorus was derived to a greater extent from labeled orthophosphate. Concentration of polyphosphate was lower in the presence of either purified phosvitin or lecithin substituted for egg yolk, although lecithin ensured good growth of the bacteria. (author)

  17. Studies on inorganic polyphosphate metabolism in Mycobacterium phlei. I. The incorporation of /sup 32/P into various phosphorus fractions of M. phlei grown on normal and modified Loewenstein media

    Energy Technology Data Exchange (ETDEWEB)

    Szymona, O [Akademia Medyczna, Lublin (Poland)

    1974-01-01

    Mycobacterium phlei was grown on various media with radioactive orthophosphate added. At timed intervals the bacteria were fractionated and in particular fractions both total and /sup 32/P was determined. The content of acid-insoluble polyphosphate was measured enzymatically by the use of specific glucokinase. The organism grown on normal Loewenstein medium proved to accumulate high amounts of polyphosphate which was formed in more than 50% at the expense of organic egg yolk phosphorus. In contrast, the nuclei acid phosphorus was derived to a greater extent from labeled orthophosphate. Concentration of polyphosphate was lower in the presence of either purified phosvitin or lecithin substituted for egg yolk, although lecithin ensured good growth of the bacteria.

  18. Coronal mass ejections and coronal structures

    International Nuclear Information System (INIS)

    Hildner, E.; Bassi, J.; Bougeret, J.L.

    1986-01-01

    Research on coronal mass ejections (CMF) took a variety of forms, both observational and theoretical. On the observational side there were: case studies of individual events, in which it was attempted to provide the most complete descriptions possible, using correlative observations in diverse wavelengths; statistical studies of the properties of CMEs and their associated activity; observations which may tell us about the initiation of mass ejections; interplanetary observations of associated shocks and energetic particles; observations of CMEs traversing interplanetary space; and the beautiful synoptic charts which show to what degree mass ejections affect the background corona and how rapidly (if at all) the corona recovers its pre-disturbance form. These efforts are described in capsule form with an emphasis on presenting pictures, graphs, and tables so that the reader can form a personal appreciation of the work and its results

  19. Ionizing radiation and autoimmunity: Induction of autoimmune disease in mice by high dose fractionated total lymphoid irradiation and its prevention by inoculating normal T cells

    International Nuclear Information System (INIS)

    Sakaguchi, N.; Sakaguchi, S.; Miyai, K.

    1992-01-01

    Ionizing radiation can functionally alter the immune system and break self-tolerance. High dose (42.5 Gy), fractionated (2.5 Gy 17 times) total lymphoid irradiation (TLI) on mice caused various organ-specific autoimmune diseases, such as gastritis, thyroiditis, and orchitis, depending on the radiation dosages, the extent of lymphoid irradiation, and the genetic background of the mouse strains. Radiation-induced tissue damage is not the primary cause of the autoimmune disease because irradiation of the target organs alone failed to elicit the autoimmunity and shielding of the organs from irradiation was unable to prevent it. In contrast, irradiation of both the thymus and the peripheral lymphoid organs/tissues was required for efficient induction of autoimmune disease by TLI. TLI eliminated the majority of mature thymocytes and the peripheral T cells for 1 mo, and inoculation of spleen cell, thymocyte, or bone marrow cell suspensions (prepared from syngeneic nonirradiated mice) within 2 wk after TLI effectively prevented the autoimmune development. Depletion of T cells from the inocula abrogated the preventive activity. CD4 + T cells mediated the autoimmune prevention but CD8 + T cells did not. CD4 + T cells also appeared to mediate the TLI-induced autoimmune disease because CD4 + T cells from disease-bearing TLI mice adoptively transferred the autoimmune disease to syngeneic naive mice. Taken together, these results indicate that high dose, fractionated ionizing radiation on the lymphoid organs/tissues can cause autoimmune disease by affecting the T cell immune system, rather than the target self-Ags, presumably by altering T cell-dependent control of self-reactive T cells. 62 refs., 9 figs., 2 tabs

  20. Beat-to-beat assessment of left ventricular ejection in atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Benjelloun, H; Brochier, M; Itti, R; Philippe, L; Lorgeron, J M

    1983-05-01

    Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with artrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and syst