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

Dimensional analysis of the left ventricle: effects of acute aortic regurgitation

1975 ◽  
Vol 228 (2) ◽  
pp. 536-542 ◽  
Author(s):  
SJ Leshin ◽  
LD Horwitz ◽  
JH Mitchell
Keyword(s):  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Catheter Technique ◽  
End Systolic Volume

The effects of acute severe aortic regurgitation on the left ventricle were investigated in conscious, chronically instrumented dogs. Left ventricular dimensions and volumes were measured from biplane cineradiographs of beads positioned near the endocardium. Data were collected before and after the production of aortic regurgitation by a catheter technique. The aortic regurgitation resulted in increases in mean aortic pulse pressure from 44 to 73 mmHg (P smaller than 0.001), heart rate from 87 to 122 beats/min (P smaller than 0.02), and left ventricular end-diastolic pressure from 11 to 25 mmHg (P smaller than 0.05). Mean end-diastolic volume rose from 61 to 69 cc (P smaller than 0.001), while end-systolic volume remained unchanged at 37 cc. The end-diastolic dilatation following regurgitation was asymmetrical in that the increase in size was due principally to an increase in the septal-lateral axis. The acute volume load of aortic regurgitation was accomplished by an increase in end-diastolic volume, i.e., the Frank-Starling mechanism. The tachycardia probably reflects augmented cardiac sympathetic activity, but the constant end-systolic volume at a similar mean systolic pressure suggests that the net contractile state was unchanged.

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.

P4985Blunted heart rate reserve as an imaging-independent predictor of abnormal left ventricular contractile reserve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
T Bombardini ◽  
A Djordjevic-Dikic ◽  
H Rodriguez-Zanella ◽  
Q Ciampi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Confidence Intervals ◽  
Odds Ratio ◽  
Wall Motion ◽  
Left Ventricular ◽  
Contractile Reserve ◽  
Heart Rate Reserve ◽  
Systolic Volume ◽  
Specific Analysis ◽  
End Systolic Volume

Abstract Background Stress echocardiography (SE) relies on regional wall motion and left ventricular contractile reserve (LVCR) based on force (systolic blood pressure/end-systolic volume). An additional non-imaging parameter based on EKG is the blunted heart rate reserve (HRR) which is a simple marker of altered autonomic balance and is associated with worse prognosis independently of ischemia. Aim To assess the relationship between HRR and LVCR in patients undergoing SE. Methods We enrolled 4707 patients (age 63.6±11.3 yrs, 2800 males) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. The employed stress was exercise (n=2062), dipyridamole (n=2007) or dobutamine (n=638). We assessed LVCR (stress/rest ratio of force=systolic blood pressure/end-systolic volume, ESV). Stress-specific abnormal cutoff value of LVCR were <2.0 for exercise and dobutamine and <1.1 for dipyridamole. All readers had passed the upstream quality control reading for wall motion abnormalities and ESV. HR (with 12-lead ECG) was obtained each minute and recorded at rest and peak stress. HR reserve (HRR) was calculated as the peak/rest HR ratio. Results HRR was related to LVCR at cumulative (n=4707; r=0.351; p<0.001: see figure) and stress-specific analysis for exercise (r=0.351; p<0.001), dipyridamole (r=0.241; p<0.001) and dobutamine (r=0.214; p<0.001). At multivariate logistic regression analysis, blunted HRR (optimal cutoff: 1.73 for exercise, 1.306 for dipyridamole, 1.932 for dobutamine) was a significant predictor of abnormal LVCR at stress-specific analysis for exercise (Odds ratio = 0.285, 95% Confidence Intervals: 0.149–0.546, p=0.0001), dobutamine (Odds ratio = 0.187, 95% Confidence Intervals: 0.057–0.617, p=0.0001) and dipyridamole (Odds ratio = 0.263, 95% Confidence Intervals: 0.115–0.602, p=0.002). Conclusion A blunted HRR is a useful non-imaging predictor of abnormal LVCR response during exercise or pharmacological SE. HRR is a simple biomarker of autonomic unbalance of physiologic and potentially prognostic meaning. A “slow heart” during stress (with blunted HRR) is more often a “weak heart”, with blunted increase in force.

scholarly journals Significance of the left ventricular ejection fraction in diagnosis of heart failure

2018 ◽  
Vol 20 (1) ◽  
pp. 68-74
Author(s):  
Yu S Malov ◽  
I I Yarovenko
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume ◽  
End Systolic Volume

Left ventricular ejection fraction, not being an indicator of contractility, is widely used in practice for the diagnosis of heart failure. It reflects only a change in volume of the left ventricle. It was found that the ejection fraction is not so much dependent on the shock and final diastolic volume as on the final systolic volume. An inverse relationship was found between the left ventricular ejection fraction and the end systolic volume. The larger the end systolic volume, the lower the ejection fraction. High final ejection fraction corresponds to a small terminal systolic volume of the left ventricle. The ejection fraction, representing the ratio of the impact volume to the final diastolic, reflects structural changes in the left ventricle. The more these disorders, the lower the fraction of the ejection of the left ventricle. Its connection with heart failure is realized indirectly through structural restructuring of the myocardium. Low ejection fraction indicates severe damage to the myocardium and unfavorable prognosis for the patient. The empirically established emission fraction did not receive a scientific justification for the regulatory framework. According to the symmetrical approach to the study of a heart, the volume ratio of the left ventricle represents a golden proportion (0,618). Hence, the ideal left ventricular ejection fraction is 62 %, but not 50-80 %, as is customary. An increase or decrease in the ejection fraction indicates a change in the volume of the left ventricle. The clinical morphological similarity of patients with heart failure, classified according to functional classes and size of the ejection fraction, was revealed, which casted doubt on the introduction of the classification of heart failure by the size of the ejection fraction into practice.

scholarly journals Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

2009 ◽  
Vol 66 (5) ◽  
pp. 399-402
Author(s):  
Branislav Baskot ◽  
Miodrag Zivkovic ◽  
Sandra Tepic ◽  
Slobodan Obradovic
Keyword(s):  
Myocardial Perfusion ◽  
Wall Motion ◽  
Hyperbaric Oxygenation ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Perfusion Scintigraphy ◽  
Systolic Volume ◽  
Heart Insufficiency ◽  
End Diastolic Volume ◽  
End Systolic Volume

Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV) volume, ejection fraction (LVEF) and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC) in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. Case report. We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia). He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO) and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche) was applied deeply subcutaneously, every second day from 2 000 IU to totally 16 000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity abnormal motion and wall thickening for all segments. Left ventricle end-diastolic volume was 393 ml (normal < 142 ml), and LV end-systolic volume was 334 ml (normal < 65 ml). Four months after the therapy G-SPECT showed improvement in any parameters; LVEF 25%, with improvement in wall motion (normalized wall motion in the anterior, lateral area, and proximal septum) and wall thickening, LV end-diastolic volume was 390 ml, LV end-systolic volume was 289 ml. Conclusion. Using G-SPECT method before and after the therapy with hyperbaric oxygenation and erythopoietine we obtained objective improvement and good therapy effects in the treatment of chronic heart insufficiency.

Mechanical discoordination rather than dyssynchrony predicts reverse remodeling upon cardiac resynchronization

2008 ◽  
Vol 295 (2) ◽  
pp. H640-H646 ◽  
Author(s):  
Borut Kirn ◽  
Annemieke Jansen ◽  
Frank Bracke ◽  
Berry van Gelder ◽  
Theo Arts ◽  
...  
Keyword(s):  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Systolic Volume ◽  
Time To Peak ◽  
End Diastolic Volume ◽  
Before And After ◽  
End Systolic Volume ◽  
Time To Onset

By current guidelines a considerable part of the patients selected for cardiac resynchronization therapy (CRT) do not respond to the therapy. We hypothesized that mechanical discoordination [opposite strain within the left ventricular (LV) wall] predicts reversal of LV remodeling upon CRT better than mechanical dyssynchrony. MRI tagging images were acquired in CRT candidates ( n = 19) and in healthy control subjects ( n = 9). Circumferential strain (εcc) was determined in 160 regions. From εcc signals we derived 1) an index of mechanical discoordination [internal stretch fraction (ISF), defined as the ratio of stretch to shortening during ejection] and 2) indexes of mechanical dyssynchrony: the 10–90% width of time to onset of shortening, time to peak shortening, and end-systolic strain. LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF) were determined before and after 3 mo of CRT. Responders were defined as those patients in whom LVESV decreased by >15%. In responders ( n = 10), CRT increased LVEF and decreased LVEDV and LVESV (11 ± 6%, 21 ± 16%, and 30 ± 16%, respectively) significantly more ( P < 0.05) than in nonresponders (1 ± 6%, 3 ± 4%, and 5 ± 10%, respectively). Among mechanical indexes, only ISF was different between responders and nonresponders (0.53 ± 0.25 vs. 0.31 ± 0.16; P < 0.05). In patients with ISF >0.4 ( n = 10), LVESV decreased by 31 ± 18% vs. 5 ± 11% in patients with ISF <0.4 ( P < 0.05). We conclude that mechanical discoordination, as estimated from ISF, is a better predictor of reverse remodeling after CRT than differences in time to onset and time to peak shortening. Therefore, discoordination rather than dyssynchrony appears to reflect the reserve contractile capacity that can be recruited by CRT.

A Systematic Review and Meta-analysis : Safety and Efficacy of Mesenchymal stem Cells Therapy for Heart Failure

2020 ◽  
Vol 15 ◽  
Author(s):  
Tiantian Shen ◽  
Lin Xia ◽  
Wenliang Dong ◽  
Jiaxue Wang ◽  
Feng Su ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Safety And Efficacy ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume

Background: Preclinical and clinical evidence suggests that mesenchymal stem cells (MSCs) may be beneficial in treating heart failure (HF). However, the effects of stem cell therapy in patients with heart failure is an ongoing debate and the safety and efficacy of MSCs therapy is not well-known. We conducted a systematic review of clinical trials that evaluated the safety and efficacy of MSCs for HF. This study aimed to assess the safety and efficacy of MSCs therapy compared to the placebo in heart failure patients. Methods: We searched PubMed, Embase, Cochrane library systematically, with no language restrictions. Randomized controlled trials(RCTs) assessing the influence of MSCs treatment function controlled with placebo in heart failure were included in this analysis. We included RCTs with data on safety and efficacy in patients with heart failure after mesenchymal stem cell transplantation. Two investigators independently searched the articles, extracted data, and assessed the quality of the included studies. Pooled data was performed using the fixed-effect model or random-effect model when it appropriate by use of Review Manager 5.3. The Cochrane risk of bias tool was used to assess bias of included studies. The primary outcome was safety assessed by death and rehospitalization and the secondary outcome was efficacy which was assessed by six-minute walk distance and left ventricular ejection fraction (LVEF)，left ventricular end-systolic volume（LVESV），left ventricular end-diastolic volume（LVEDV） and brain natriuretic peptide（BNP） Results: A total of twelve studies were included, involving 823 patients who underwent MSCs or placebo treatment. The overall rate of death showed a trend of reduction of 27% (RR [CI]=0.73 [0.49, 1.09], p=0.12) in the MSCs treatment group. The incidence of rehospitalization was reduced by 47% (RR [CI]=0.53[0.38, 0.75], p=0.0004). The patients in the MSCs treatment group realised an average of 117.01m (MD [95% CI]=117.01m [94.87, 139.14], p<0.00001) improvement in 6MWT.MSCs transplantation significantly improved left ventricular ejection fraction (LVEF) by 5.66 % (MD [95% CI]=5.66 [4.39, 6.92], p<0.00001), decreased left ventricular end-systolic volume (LVESV) by 14.75 ml (MD [95% CI]=-14.75 [-16.18, -12.83], p<0.00001 ) and left ventricular end-diastolic volume (LVEDV) by 5.78 ml (MD [95% CI]=-5.78[-12.00, 0.43], p=0.07 ) ,in the MSCs group , BNP was decreased by 133.51 pg/ml MD [95% CI]= -133.51 [-228.17,-38.85], p=0.54, I2= 0.0%) than did in the placebo group. Conclusions: Our results suggested that mesenchymal stem cells as a regenerative therapeutic approach for heart failure is safe and effective by virtue of their self-renewal potential, vast differentiation capacity and immune modulating properties. Allogenic MSCs have superior therapeutic effects and intracoronary injection is the optimum delivery approach. In the tissue origin, patients who received treatment with umbilical cord MSCs seem more effective than bone marrow MSCs. As to dosage injected, (1-10)*10^8 cells were of better effect.

scholarly journals Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria

2016 ◽  
Vol 10 ◽  
pp. CMC.S38447
Author(s):  
Valentine N. Amadi ◽  
Olufemi E. Ajayi ◽  
Anthony O. Akintomide ◽  
Olugbenga O. Abiodun ◽  
Olaniyi J. Bamikole ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Heart Failure Patients ◽  
Mean Pulmonary Arterial Pressure ◽  
Diastolic Velocity ◽  
End Systolic Volume ◽  
Pulmonary Arterial ◽  
Systolic And Diastolic Function

Background Pulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH. Methods A total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile. Results PH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity ( E′), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E′ ratio. Conclusion PH is very common in heart failure and has significant relationship with left ventricular function.

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