Decline In Left Ventricular Function Research Articles

Effects on ventricular function of disopyramide, procainamide and quinidine as determined by radionuclide angiography

To evaluate the effects of the 3 commonly used antiarrhythmic agents—disopyramide, procainamide and quinidine—on left ventricular (LV) function, these 3 agents were administered in random sequence after control radionuclide angiography performed at rest and during exercise in 17 patients. Drug dosages were tailored to achieve therapeutic blood levels 5 minutes before and 2 to 3 hours after drug administration. The mean dose of disopyramide was 141 ± 26 mg every 6 hours, procainamide, 441 ± 100 mg every 4 hours, and quinidine, 401 ± 101 mg of the gluconate preparation every 6 hours. The patients received the appropriate dosage for 7 or more days before repeat radionuclide angiography was performed. The ejection fraction at rest was: control 60 ± 13%, disopyramide 55 ± 11%, procainamide 58 ± 11%, and quinidine 59 ± 12%. The exercise ejection fraction was: control 61 ± 14%, disopyramide 58 ±13%, procainamide 58 ±12% and quinidine 61 ± 13%. In neither case, at rest nor during exercise was there any significant difference observed between any of the agents or between any individual agent and control. However, at rest 8 subjects had a 5% or more decrease from the control value with disopyramide, 5 had a 5 % or more decrease with procainamide and 6 had a 5 % or more decrease with quinidine, whereas during exercise the decreases were 8, 6 and 5%, respectively. These values were not statistically different but suggest that caution should be taken in administering all 3 agents, particularly to patients with impaired LV function, because individual sensitivity to a given agent may precipitate a significant decline in LV function.

Effects of coronary artery disease on the aging heart: observations from cardiac catheterization.

We evaluated catheterization laboratory data from 691 individuals (219 normals and 472 coronary patients) using a computerized data file that provided several measures of cardiovascular performance in 10-year age increments. The expected increase in arterial pressure with age was noted in normals and coronary patients. Left ventricular end diastolic pressure, end diastolic volume, and end systolic volume remained constant with age but were higher in all age groups in the coronary patients. Ejection fraction showed no change with age but was lower in all age groups in patients with coronary disease. Left ventricular mass increased with age in normals and coronary patients. Cardiac index declined with age, whereas arteriovenous oxygen difference and oxygen consumption were unchanged. Age-related changes in the circulation were for the most part unaffected by the presence of coronary disease. Resting left ventricular function was not altered by age but coronary disease produced a decline in left ventricular function in all ages.

Severe preeclampsia: I. Peripartum hemodynamic observations

With the use of peripheral and pulmonary arterial catheters, the peripartum hemodynamic patterns of 10 patients with severe preeclampsia were studied. At the time of line placement, our results demonstrated elevated cardiac outputs (9.3 + 1.3 L/min), high systemic vascular resistances (1,042 + 160 dynes · sec · cm−5), and hyperdynamic ventricular function. Immediately post partum (<30 minutes), a transient decline in left ventricular function in association with a rise in central venous and wedge pressures was observed. By 1 hour after delivery, ventricular function had returned to its hyperdynamic state. Swan-Ganz catheterization and cardiac output data were most helpful in the monitoring of patients with severe preeclampsia. Ventricular function in these patients appears to operate in the hyperdynamic zone or a “normal” ventricular function zone that is different from that in the nonpregnant patient. At the same time, as shown by our data and a review of the literature, severe preeclampsia appears to be a continuum, as determined by cardiac output and systemic vascular resistance measurements, which range from a high-output-low-resistance system to a low-output-high-resistance one. Therefore, in the evaluation of the patient with severe preeclampsia, a complete hemodynamic profile would be helpful in determining the “phase” of the disease and the status of ventricular function. This would be useful information with which one could theoretically direct therapy in a more precise fashion.

Recovery of Left Ventricular Function Following Discontinuation of Anthracycline Chemotherapy in Children

Echocardiographic evaluation of left ventricular (LV) performance was performed in 41 children during and following anthracycline chemotherapy. Prior to treatment LV function was normal in all patients; LV shortening fraction was 35.2 +/- 0.7% and percent of predicted velocity of circumferential fiber shortening was 110 +/- 20%. However, the indices measured concurrent with the final anthracycline dose (mean = 308 +/- 16 mg/sq m) demonstrated a significant decline in LV function. The LV shortening fraction had decreased to 29.5 +/- 0.8% and percent of predicted velocity of circumferential fiber shortening decreased to 94 +/- 4% (P less than .01). Four of the eight patients with evidence of significant LV dysfunction had received thoracic or upper abdominal irradiation. Following cessation of anthracycline therapy, LV function improved within one to six months and had returned to normal in all but two patients, both of whom received irradiation. Echocardiography is useful for the identification of anthracycline-induced LV dysfunction. With discontinuation of further anthracycline administration the functional decline in LV performance appears to be reversible.

Coronary Flow Supplementation in Experimental Myocardial Infarction with Shock

Cardiogenic shock was induced in 12 anesthetized sheep by ligating branches of the left coronary artery. Coronary blood flow (CBF) did not decrease until shock was produced by the serial coronary artery branch ligations. Perfusion of the left coronary artery with arterial blood was performed using a special nonocclusive catheter. Perfusion flow rate (PFR) increments up to an optimal level resulted in improvement of left ventricular (LV) function as expressed by rise in cardiac output, fall in left atrial pressure and increase of systemic blood pressure up to a level approximating the control. Higher PFR resulted in deterioration of these variables. The improvement of LV function was related to the increased CBF. It is concluded that in experimental myocardial infarction with shock, supplementation of the CBF deficit, which resulted from decreased systemic blood pressure and increased CBF requirements, can improve the LV function up to the preligation levels. Beyond an optimal perfusion flow rate, autoregulatory phenomena result in decreased CBF and decline of LV function.