scholarly journals Case report on the importance of longitudinal analysis of left ventricular end-systolic volume, rather than ejection fraction, in a heart transplant patient

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Peter L M Kerkhof ◽  
Guy R Heyndrickx
Keyword(s):  
Ejection Fraction ◽  
Heart Transplant ◽  
Mechanical Performance ◽  
Left Ventricular ◽  
Comprehensive Analysis ◽  
Chronic Obstructive ◽  
Volumetric Data ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Insight Into

Abstract Background Sequential determinations of left ventricular (LV) volume constitute a cornerstone in the mechanical performance evaluation of any heart transplant (HTX) patient. A comprehensive analysis of volumetric data offers unique insight into adaptation and pathophysiology. Case summary With a focus on eight sequential biplane angiocardiographic LV end-systolic volume (ESV) determinations, we evaluate the clinical course of a male patient following HTX (female donor) at the age of 61 years. This former smoker had a history of chronic obstructive pulmonary disease, hypertension, and hypercholesterolaemia refractory to treatment, and presented with multivessel coronary artery disease. The later course was complicated by pulmonary hypertension, an abdominal aortic aneurysm, and secondary chronic kidney disease. After an additional episode of pulmonary embolism, the patient died at the age of 79. At one point, the ESV was > 700% higher than the starting value, and actually by far exceeded the relative change of any other volume-based metric evaluated, including ejection fraction (EF). Discussion The longitudinal study of LV volumetric data in HTX patients offers a unique window to the pathophysiology of remodelling and sex-specific adaptation processes. The present case documents that proper analysis of serial findings form a rich source of clinically relevant information regarding disease progression. End-systolic volume is the primary indicator, in contrast to the popular metric EF. This finding is supported by population-based studies reported in the literature. We conclude that comprehensive analysis of volumetric data, particularly ESV, contributes to personalized medicine and enhances insight into LV (reverse) remodelling, while also informing about prognosis.

Đánh giá tình trạng suy tim ở bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp động mạch vành

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Left Ventricular Mass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Ventricular Mass ◽  
Percutaneous Coronary ◽  
End Systolic Volume

Mục tiêu: Khảo sát sự biến đổi hình thái và chức năng thất trái của bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp tại thời điểm 48 giờ và 3 tháng bằng siêu âm tim. Đối tượng nghiên cứu: Trong thời gian từ tháng 02/2020 đến 09/2020 chúng tôi đã tiến hành nghiên cứu trên 97 bệnh nhân bệnh nhồi máu cơ tim cấp ST chênh lên được can thiệp động mạch vành qua da. Phương pháp nghiên cứu: nghiên cứu tiến cứu quan sát. Kết quả: khối lượng cơ thất trái giảm từ 195,2 ± 65,8 gr xuống 170,2 ± 51,1 gr, thể tích thất trái cuối tâm trương giảm từ 105,2 ± 37,4 mm xuống 95,5 ± 41,3 mm, thể tích thất trái cuối tâm thu giảm từ 57,3 ± 45,2 mm xuống 49,8 ± 50,3 mm. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da của nhóm EF ≤ 45 % tăng lên đáng kể từ 39,3 ± 11,2 % lên 45,85 ± 7,56 %, (p < 0,05), ngược lại nhóm EF > 45 % cũng có sự biến đổi từ 57,7 ± 14,4% lên 60,1 ± 13,3 %, (p > 0,05). Kết luận: Sau can thiệp động mạch vành qua da ở thời điểm 3 tháng, khối lượng cơ thất trái, thể tích thất trái cuối tâm thu và cuối tâm trương có sự thay đổi đáng kể. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da nhóm EF ≤ 45 % tăng lên có ý nghĩa thống kê. ABSTRACT EVALUATION OF HEART FAILURE IN ST - ELEVATED MYOCADIAL INFARCTION BEFORE AND AFTER PERCUTANEOUS CORONARY INTERVENTION Objectives: Assess the function of left ventricle in ST elevation myocardial infarction before, 48 - hour and 3 - month after primary percutaneous coronary intervention by cardiac ultrasound. Patients: 97 patients who underwent PCI for ST elevated myocardial infarction from 02/2021 to 09/2020. Methods: Prospective observational study. Results: Left ventricular mass index decreased from 195.2 ± 65.8 gr/m2 to 170.2 ± 51.1 gr/m2, end - diastolic left ventricular volume decreased from 105.2 ± 37.4 mm to 95.5 ± 41.3 mm. End systolic volume decreased from 57.3 ± 45.2 mm to 49.8 ± 50.3 mm. Ejection fraction 3 month after the intervention of the EF ≤ 45 % group significantly increased from 39.3 ± 11.2 % to 45.85 ± 7.56 % (p < 0.05). In contrast, there were a rise of the ejection fraction among the EF > 45% group from 57.7 ± 14.4% to 60.1 ± 13.3 % (p > 0.05). Conclusion: 3 month after PCI, left ventricular mass, end - systolic and diastolic volume changed remarkably. The ejection fraction of EF ≤ 45 % group increased with a statical significance. Keywords: PCI, cardiac ultrasonography, ejection fraction, left ventricular mass, end systolic volume end diastolic volume.

scholarly journals The effect of left ventricle ischemia severity on cardiac performance appeared on ejection fraction using radioactive TC 99m MIBI in comparison with echocardiography

2021 ◽  
Vol 2114 (1) ◽  
pp. 012006
Author(s):  
M K Mohammed ◽  
S I Essa
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Mean Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Significant Difference ◽  
End Systolic Volume ◽  
The Mean

Abstract Ischemic heart disease is a major causes of heart failure. Heart failure patients have predominantly left ventricular dysfunction (systolic or diastolic dysfunction, or both). Acute heart failure is most commonly caused by reduced myocardial contractility, and increased LV stiffness. We performed echocardiography and gated SPECT with Tc99m MIBI within 263 patients and 166 normal individuals. Left ventricular end systolic volume (LVESV), left ventricular end diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were measured. For all degrees of ischemia, there was a significant difference between ejection fraction values measured by SPECT and echocardiography, and there were no significant differences among end systolic volume and end diastolic volume value calculated by two methods for all cases. The mean value for EDV (ECHO)/EDV (SPECT) was 1.07 ± 0.31 for degree (1, 2); in the degree 3 the mean value was 1.02 ± 0.08, and 1.005 ± 0.07 for degree 4. The mean value for ESV (ECHO)/ESV (SPECT) was 1.08 ± 0.34 for degree (1, 2); while 1.03 ± 0.12, 1.021 ± 0.128 for degree 3 and 4 respectively. This study was showed a good relation between left ventricular size and ejection fraction measured by SPECT with Tc99m, and echocardiography.

scholarly journals Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Gian Marco Rosa ◽  
Andreina D'Agostino ◽  
Stefano Giovinazzo ◽  
Giovanni La Malfa ◽  
Paolo Fontanive ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ace Inhibitor ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
And Gender ◽  
The Impact

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

scholarly journals Left Ventricular End-Systolic Volume Is a Reliable Predictor of New-Onset Heart Failure with Preserved Left Ventricular Ejection Fraction

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marina Kato ◽  
Shuichi Kitada ◽  
Yu Kawada ◽  
Kosuke Nakasuka ◽  
Shohei Kikuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Prognostic Indicator ◽  
Left Ventricular ◽  
Volume Index ◽  
Univariable Analysis ◽  
Systolic Volume ◽  
End Systolic Volume

Background. Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods. We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results. A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p<0.001), +dP/dt (r = −0.324, p<0.001), −dP/dt (r = 0.391, p<0.001), and tau (r = 0.337, p<0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p<0.001, LVESVI : AUC : 0.729, p<0.001, respectively). Conclusion. In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.

scholarly journals A Comparative Study of Bisoprolol with Carvedilol on LV Systolic Function in Patients with Chronic Heart Failure

2018 ◽  
Vol 14 (1) ◽  
pp. 3-8
Author(s):  
Mohammad Ashraf Hossain ◽  
Khurshed Ahmed ◽  
Md Faisal Ibn Kabir ◽  
Md Fakhrul Islam Khaled ◽  
Rakibul H Rashed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Group I ◽  
End Systolic Volume ◽  
Group Ii

Background: Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Recent data suggest that beta-blockers are beneficial in patients with CHF. Among β-blocker class of drugs, bisoprolol is a highly selective β1-adrenergic receptor blocker whereas Carvedilol is non-selective. Many large-scale trials have confirmed that both these β-blockers are superior to placebo and other β-blockers. This study was designed to compare the effects of carvedilol and bisoprolol in patients with chronic HF in a single center.Methods: It was a quasi experimental study. A total of 288 cases of heart failure were selected by purposive sampling, from January 2017 to June 2017. Each patient was allocated into either of the two groups, and was continued receiving treatment with either bisoprolol (Group-I) or carvedilol (Group-II). Each patient was evaluated clinically and echocardiographically at the beginning of treatment (baseline) and at the end of 3rd month. Echocardiography was performed to find out change in left ventricular systolic function.Result: After 3 months of treatment, ejection fraction was found higher in the bisoprolol group (42.6 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 8.4% in bisoprolol group and 4.1% in carvedilol group. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (3.2±0.1 in group I versus 2.3±0.5 in group II; P<0.05) occurred after 3 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (10.1±3.2 versus 6.1±6.4; P=0.101) and left ventricular diastolic diameter (1.7±0.8 versus 1.3±0.8; P=0.081) between groups. Three months after treatment, heart rate was reduced in the bisoprolol group from 87.7±9 to 74.5±8.1 and carvedilol group from 88.8±9.1 to 80.1±8.7. Differences in heart rate responses between 2 groups were not statistically significant (P=0.113). Assessment of blood pressure three months later of treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both group but difference between two groups were statistically non significant (p>0.05).Conclusion: In this study, bisoprolol was superior to carvedilol in increasing left-ventricular ejection fraction, improving left ventricular end systolic volume and left ventricular end systolic diameter but no significant difference was observed in LV end diastolic volume, LV end diastolic diameter, heart rate and blood pressure.University Heart Journal Vol. 14, No. 1, Jan 2018; 3-8

Measurement of Left Ventricular Function During Arm Ergometry Using the VESTTM Nuclear Probe

1994 ◽  
Vol 19 (4) ◽  
pp. 462-471
Author(s):  
Len S. Goodman ◽  
Jack M. Goodman ◽  
Linda Yang ◽  
Joanna Sloninko ◽  
Terry Hsia ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Lv Function ◽  
Trained Subjects ◽  
Arm Exercise ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Lv Ejection Fraction ◽  
Rest And Exercise

A chest-mounted left ventricular (LV) nuclear probe (VEST™) for use during arm and leg ergometry is presented, with a discussion of the validity and reproducibility of LV function measures at rest and exercise. During both arm and leg ergometry in trained subjects, transient changes in LV function/volumes were observed. LV ejection fraction and relative end-systolic and end-diastolic volumes were 25 to 30% less with the arms versus the legs, agreeing with data from other studies using conventional techniques. At peak exercise with both limbs, LV ejection fraction and relative LV end-systolic volume increased, followed by immediate postexercise normalization. The effect was greatest with the arms and reflects the effect of high intramuscular and arterial pressures generated during arm cranking, leading to increased LV afterloading. The VESTTM permits rapid and noninvasive assessment of LV function during arm exercise, avoiding the limitations of other techniques. Key words: arm exercise, radionuclide, chest-mounted probe

scholarly journals New Insight Into the Evaluation of Abnormal Left Ventricular Wall Motion

2021 ◽  
Author(s):  
Yoichi Nakamura
Keyword(s):  
Left Ventricle ◽  
Wall Motion ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Motion Group ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
Normal Wall ◽  
Motion Groups ◽  
Insight Into

Abstract BackgroundEvaluation of mechanical dyssynchrony using echocardiography has failed to improve refractory heart failure in patients treated with cardiac resynchronization therapy. Previous predictors may not accurately reflect cardiac dyssynchrony. It was hypothesized that the spatially and temporary continuous information of the whole endocardium is required when the mechanical dyssynchrony is assessed using echocardiography. This study aimed to examine differences in the locus of the centroid of the left ventricle between abnormal and normal wall motion. MethodsTwenty-seven patients with dilated cardiomyopathy (left ventricular ejection fraction [LVEF]: 43±7%) and 45 old myocardial infarction patients with aneurysm (LVEF: 38±11%) were compared with 188 individuals with normal wall motions (LVEF: 61±5%). In an off-line system, the border of the endocardium was defined for each coordinate via the two-dimensional speckle tracking method. The centroid of the three-dimensional left ventricle was defined as the central point between both centroids calculated from four- and two-chamber images using an original application. ResultsThe locus of the centroid of the left ventricle in the normal wall motion group showed a horizontally inverted β shape, whereas this shape was absent in the other groups. When corrected by left ventricular end-systolic volume, the total and each directional length of the locus of the centroid of the left ventricle in the abnormal wall motion groups were clearly reduced compared with those recorded in the normal wall motion group. The acceleration of the centroid was also reduced in the abnormal wall motion groups. Multiple regression analysis with a stepwise method revealed a corrected antero-posterior shift of the centroid of left ventricle by left ventricular end-systolic volume and N-terminal pro-brain natriuretic peptide, which strongly correlated with the LVEF (adjusted R2: 0.6818, p≤2.2e-16).ConclusionUse of the locus of the centroid of the left ventricle provides novel insight into the evaluation of abnormal left ventricular contractions. Trial registrationretrospectively registered

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