Optimising Direct Access Echo Referral in Suspected Heart Failure

2000 ◽  
Vol 45 (2) ◽  
pp. 43-44 ◽  
Author(s):  
M. M. Lindsay ◽  
N.E.R. Goodfield ◽  
K.J. Hogg ◽  
F.G. Dunn
Keyword(s):  
Ventricular Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Direct Access ◽  
Lv Function ◽  
Ventricular Systolic Dysfunction ◽  
Normal Left Ventricular Function ◽  
Normal Left Ventricular ◽  
History Of

The objective was to prospectively validate a method of increasing the sensitivity, specificity and negative predictive value of a normal ECG in the exclusion of left ventricular systolic dysfunction by the addition of clinical history. We performed a prospective three year study of all referrals to our direct access ECHO service for assessment of LV function. The ECG was reported blind of the result of the ECHO, history of MI or not was noted, and result of the ECHO predicted. Over three years 416 patients were assessed for the presence or absence of left ventricular systolic dysfunction and consequent changes in clinical management. A total of 320(77%) of patients referred with suspected left ventricular dysfunction were found to have normal left ventricular function. Of the 250(60%) patients treated prior to referral for assessment, 183(73%) were treated inappropriately. The combination of a normal ECG and a negative history of myocardial infarction had a sensitivity of 98% and a negative predictive value of 99% in the assessment of LV function. This was an improvement over a normal ECG alone. Our study shows that diagnosis and treatment of heart failure in the community remains sub-optimal. The combination of a normal ECG and no previous history of myocardial infarction is shown to be a sensitive and accurate predictor of normal left ventricular function. If adopted by general practitioners this would be a valuable method of optimising the use of ECHOCARDIOGRAPHIC in patients with suspected left ventricular dysfunction.

scholarly journals Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community

Circulation ◽  
2003 ◽  
Vol 108 (8) ◽  
pp. 977-982 ◽  
Author(s):  
Thomas J. Wang ◽  
Jane C. Evans ◽  
Emelia J. Benjamin ◽  
Daniel Levy ◽  
Elizabeth C. LeRoy ◽  
...  
Keyword(s):  
Natural History ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
History Of

scholarly journals Ross procedure in patients with severe left ventricular systolic dysfunction

2015 ◽  
Vol 17 (1) ◽  
pp. 5
Author(s):  
A. M. Karaskov ◽  
I. I. Demin ◽  
S. I. Zheleznev ◽  
A. V. Bogachev-prokofev ◽  
R. M. Sharifulin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ross Procedure ◽  
Ventricular Systolic Dysfunction

The Ross procedure outcomes in patients with left ventricular dysfunction are presented. 20 Ross procedures were performed in patients with aortic disease complicated by severe left ventricular dysfunction. The average left ventricular ejection fraction before surgery was 31,56,57%. Aortic stenosis was found in 60% of cases. Hospital mortality rate was 5%. Heart failure prevailed among complications. It was already in the early postoperative period that significant left ventricular remodeling was observed. The patients with aortic stenosis demonstrated a 56,9 % increase in ejection fraction, while their end-systolic diameter and end-systolic volume decreased by 34,5% and 13,3% respectively. In the group with aortic insufficiency there was a statistically significant reduction in the left ventricular volume indices: left ventricular end-diastolic diameter by 20%, left ventricular end-diastolic volume by 36,5%. No reoperation due to dysfunction of the autograft and conduits in the pulmonary artery area was required. At 12 months after surgery the processes of left ventricular cavity remodeling and normalization of contractility in both groups continued. The results of this study show that the Ross procedure can be used successfully in patients with severe left ventricular systolic dysfunction.

scholarly journals AB0182 HEMOGLOBIN RATE AS A PREDICTOR OF SUBCLINICAL LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1116.2-1116
Author(s):  
Y. Ben Abderrazek ◽  
R. Dhahri ◽  
W. Lahmar ◽  
M. Slouma ◽  
B. Louzir ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Roc Curve ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Curve Analysis ◽  
Myocardial Deformation ◽  
Ventricular Systolic Dysfunction ◽  
Roc Curve Analysis ◽  
History Of

Background:The role of rheumatoid arthritis as an ischemic heart disease and heart failure risk factor is well acknowledged even if the physiopathological pathways are still debated. The effect of anemia on myocardial deformation has already been established and a hemoglobin level below 9g/dL was associated with a significantly lower global longitudinal strain (GLS) patients with no history of CVD or chronic inflammatory diseases.[1]Objectives:In the present study, we looked into the effect of anemia and hemoglobin on the myocardial impairement in RA patients.Methods:We conducted a monocentric cross-sectional study between march 2019 and september 2019 on 36 RA patients without any history of cardiovascular disease and non-altered left ventricular ejection fraction in the outpatient population of the rheumatology department of the military hospital of Tunis matched with 36 healthy control subjects. Both groups underwent conventional echocardiography and STE to measure GLS; subclinical left ventricular systolic dysfunction was defined as a GLS > −18%, and a complete blood cell count; anemia was defined as Hemoglobin levels < 12 g/dL for women and < 13 g/dL for men.Results:Myocardial deformation study revealed that rheumatoid arthritis patients had a significantly worse GLS than healthy controls (18.99±2.81% vs 20.42±1.33%; P=.015). We also observed that third of the RA patients had subclinical left ventricular systolic dysfunction.In our report 36% of RA patients were anemic. In our univariate analysis anemia was found to be significantly correlated with GLS (r=−0.368, P=.027) and hemoglobin was found to be the best predictor of subclinical LVSD in our ROC curve analysis (AUC=0.752, 95% CI: 0.577-0.927, P=.02). In our multivariate analysis anemia was the only factor that was independently related to subclinical LVSD (OR: 11.39, 95% CI: 1.57-82.89, P=.016).Figure 1.ROC curve analysis for Hemoglobin as a predictor of subclinical left ventricular systolic dysfunctionConclusion:To our knowledge, this is the first study to look into the relationship between GLS and anemia among RA patients, and now it is safe to say that anemia is yet another added burden on the myocardial function in RA patients that needs to be taken into account when discussing therapeutic action.References:[1]Zhou Q, Shen J, Liu Y, Luo R, Tan B, Li G. Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography. Anatol J Cardiol. 2017;18(3):194–9.Disclosure of Interests:None declared

Abstract 17132: Risk Factors for Anthracycline And/or Herceptin-induced Left Ventricular Systolic Dysfunction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yasmin S Hamirani ◽  
Ali El Sayed ◽  
Patrick Dillon ◽  
Andrew Wong ◽  
Pooja Mehra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lv Function ◽  
Fisher Exact Test ◽  
Ventricular Systolic Dysfunction ◽  
Exact Test ◽  
The Difference

Introduction: Anthracyclines (ANT) and Herceptin (HER) are known to cause left ventricular (LV) systolic dysfunction and congestive heart failure (CHF). We aimed to identify the clinical risk factors associated with reduced LV function caused by one or both agents. Methods: We retrospectively examined our electronic records for patients that received ANT and/or HER from 2000-2013 and identified 3253 patients. 2704 were excluded for lack of a follow-up EF assessment (2699) or development of CAD (5) after the start of chemotherapy. Of the remaining 216 patients, 27 (12.5%) had a drop in EF after chemotherapy of >10% to below 50% and 185 (86.6%) did not. Kruskal Wallis test and Fisher exact test were utilized to estimate the difference between groups, and logistic regression model was used to predict a fall in EF. Results: More patients with a fall in EF had hypertension (HTN), hyperlipidemia (HL) and CAD (Table). A higher % of patients with a fall in EF received both HER and ANT as compared to ANT alone (36% vs 9.5% p=0.001). Higher use of liposomal doxorubicin was seen in the group with no reduction in EF. The median (IQR) time difference (days) between start of chemotherapy and reduced EF was 213 (76-761) and the doxorubicin dose in this group was 240 (128.5-254) mg/m2. On multivariate analysis hypertension and use of Herceptin remained independent predictors of EF fall. Conclusion: HTN, HL, CAD and concomitant HER use were univariate predictors of EF decline, while only HTN and HER were independent multivariate predictors. Given the prevalence of reduced EF at follow-up, late assessment of EF is indicated to avoid missing chemotherapy-induced cardiotoxicity.

Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage

2006 ◽  
Vol 105 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Nader Banki ◽  
Alexander Kopelnik ◽  
Poyee Tung ◽  
Michael T. Lawton ◽  
Daryl Gress ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Recovery Rate ◽  
Time Course ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Cardiac Injury ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Systolic Dysfunction ◽  
Lv Dysfunction

Object Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH. Methods Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected. Conclusions Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.

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