Decrease In End-diastolic Volume Index Research Articles

Left ventricular recovery after total arterial coronary artery bypass grafting versus conventional coronary artery bypass grafting in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction.

We compared total arterial revascularization (TAR) versus conventional revascularization (CR) in terms of left ventricular function recovery in patients with multivessel coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). We conducted a retrospective cohort study of 162 consecutive patients with multivessel CAD and reduced LVEF who underwent isolated coronary artery bypass grafting at our institution between January 2013 and July 2022. We assessed left ventricular function by transthoracic echocardiography at admission, before discharge, and at follow-up of 3, 6, and 12months, using LVEF, global longitudinal peak strain, end-diastolic volume index, and end-systolic volume index. We also evaluated mitral valve regurgitation and graft patency rate at 1 year. The TAR group had a significantly higher increase in LVEF and global longitudinal peak strain, and a significantly lower decrease in end-diastolic volume index and end-systolic volume index than the CR group at 6 and 12months after surgery. The TAR group also had a significantly lower degree of mitral valve regurgitation than the CR group at all-time points within 12months after surgery. The TAR group had a significantly higher graft patency rate than the CR group at 12months. There was no significant difference in hospital mortality or repeat revascularization between the groups. TAR was associated with better recovery of left ventricular function than CR in patients with multivessel CAD and reduced LVEF. Further studies are needed to confirm these findings in this high-risk population.

Dynamic changes of heart structural and functional condition in patients with acute myocarditis

Diagnosis and prognosis of myocarditis course, which is an inflammatory heart muscle disease, has been and remains one of the most urgent, complex and unresolved problem in modern cardiology. The purpose of the study – to investigate the dynamic changes in the structural and functional heart state in patients with acute myocarditis and reduced left ventricular ejection fraction. Materials and methods. In total, 74 patients with clinically suspected acute myocarditis (AM) with reduced left ventricular (LV) ejection fraction (EF) ≤40 % and NYHA heart failure (HF) functional class II or higher were examined three times: in the first month of myocarditis debut, after 6 and 12 months of observation. All the patients underwent echocardiography and speckle-tracking echocardiography, Holter electrocardiogram monitoring and cardiac magnetic resonance imaging (MRI). Results. It was found that the debut of AM was characterized by the presence of active inflammatory process according to the cardiac MRI - edema and hyperemia of the myocardium were detected in 54.0 % and 70.2 % of cases, respectively, followed by LV dilation and systolic dysfunction as well as by a significant decrease in longitudinal and circumferential LV global systolic strain. After 12 months of observation, there was a significant increase in LV EF, decrease in end-diastolic volume index and an improvement in the parameters of longitudinal and circumferntial LV systolic strain by 30.8 % and 36.8 %, respectively, (P < 0.01), the frequency of active inflammatory changes in the myocardium was significantly reduced, herewith in 41.8 % of cases, delayed enhancement was noted, indicating fibrotic changes in the myocardium. The presence of delayed enhancement in cardiac MRI after 12 months since myocarditis onset was correlated with the presence of unstable ventricular tachycardia episodes (r = 0.62; P < 0.02) and with the frequency of ventricular extrasystoles (r = 0.53; P < 0.05). A significant influence of fibrotic changes in the myocardium on the presence of unstable ventricular tachycardia episodes in 12 months after the disease onset was confirmed by determining Fisher's exact test, its value was: P = 0.016 (P < 0.05). Conclusions. It was established that the debut of myocarditis was characterized by a significant violation of the structural and functional heart state: an active inflammatory process in the myocardium causedLV dilatation and contractile dysfunction. After 12 months, a decrease in detection of active inflammatory myocardial changes followed by regression ofLV dilation and its contractile function improvement was observed. It was proved that the presence of fibrotic changes in the myocardium in patients with myocarditis was associated with the persistence of ventricular rhythm disorders.

Stroke volume paradox in heart failure: mathematical validation

In some patients with ischemic cardiomyopathy, despite large increases in ventricular size with decreased cardiac output, the paradox of preserved stroke volume has been observed. Following surgical ventricular restoration, despite marked improvements clinically and in ventricular volumes and ejection fraction, a decrease in stroke volume was observed. 101 consecutive patients with postinfarction left ventricular aneurysms were studied by 2-dimensional echocardiography and contrast ventriculography at baseline, and 57 of these patients at 1.7 to 2.2 years (mean 1.95 ± 0.44 years) after surgical ventricular restoration. Surgical ventricular restoration resulted in a decrease in end-diastolic volume index of 40.2 mL (95% confidence interval: 33.6-46.7) and stroke volume index of 10.0 mL (95% confidence interval: 6.6-13.5), and an increase in ejection fraction of 6.7% (95% confidence interval: 5.5-7.9). The stroke volume index had a significant linear relationship with the end-diastolic volume index at rest in patients with end-diastolic volume index < 150 mL (r = 0.64, p < 0.001). In patients with end-diastolic volume index >150 mL, this linear relationship was not seen. The change in end-diastolic volume index and stroke volume index had a significant linear relationship (r = 0.72, p < 0.001) that persisted at 1.95 years after surgery. In ischemic cardiomyopathy, stroke volume increases linearly with increases in end-diastolic volume up to a certain magnitude of end-diastolic volume, beyond which it decreases. Hence, following surgical ventricular restoration, decreases in stroke volume are not a reflection of impaired cardiac function.

Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy

Left ventricular end-diastolic volume is decreased and ejection fraction is increased after surgical ventricular reconstruction; however, the impact on left ventricular stroke volume is not well established. We analyzed 248 consecutive patients who underwent surgical ventricular reconstruction at a single center. There were 14 perioperative deaths (5.6%). The 234 surviving patients had pre- and postsurgical ventricular reconstruction echocardiographic measurement of end-diastolic volume, end-systolic volume, and stroke volume, each indexed to body size and ejection fraction. A total of 120 patients had echocardiography data at follow-up (median 8 months). Overall, surgical ventricular reconstruction resulted in reductions in end-diastolic volume index (-30% ± 18%) and end-systolic volume index (-37% ± 20%), and increases in ejection fraction (21% ± 18% relative increase). However, stroke volume index decreased from 35 ± 8 mL/m(2) preoperatively to 28 ± 7 mL/m(2) early postoperatively (a 17% ± 24% relative reduction, P < .0001); 165 patients (71%) exhibited a decrease and 69 patients (29%) exhibited an increase or no change in stroke volume index after surgical ventricular reconstruction. Stroke volume index reduction was strictly related to end-diastolic volume reduction. Patients who initially had a stroke volume index decrease showed recovery, so that at the time of chronic follow-up there was no significant difference between the groups. Notably, 4-year survival was approximately 85% and did not differ between patients with an increase or decrease in stroke volume index (P = .383). Although surgical ventricular reconstruction uniformly results in an impressive decrease in end-diastolic volume index and increase in ejection fraction, seemingly indicating beneficial remodeling and improved pump function, systolic volume index, which more directly indexes cardiac pump function, frequently decreases after surgical ventricular reconstruction. Further study is needed to identify baseline characteristics that predict those patients in whom cardiac performance is enhanced by surgical ventricular reconstruction and to clarify whether there is a beneficial impact on exercise tolerance and cardiac output at peak exercise.

Metoprolol Reverses Left Ventricular Remodeling in Patients With Asymptomatic Systolic Dysfunction

There are no randomized, controlled trial data to support the benefit of beta-blockers in patients with asymptomatic left ventricular systolic dysfunction. We investigated whether beta-blocker therapy ameliorates left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction. Patients with left ventricular ejection fraction <40%, mild left ventricular dilation, and no symptoms of heart failure (New York Heart Association class I) were randomly assigned to receive extended-release metoprolol succinate (Toprol-XL, AstraZeneca) 200 mg or 50 mg or placebo for 12 months. Echocardiographic assessments of left ventricular end-systolic volume, end-diastolic volume, mass, and ejection fraction were performed at baseline and at 6 and 12 months. The 149 patients randomized to the 3 treatment groups (200 mg, n=48; 50 mg, n=48; and placebo, n=53) were similar with regard to all baseline characteristics including age (mean, 66 years), gender (74% male), plasma brain natriuretic peptide (79 pg/mL), left ventricular end-diastolic volume index (110 mL/m2), and left ventricular ejection fraction (27%). At 12 months in the 200-mg group, there was a 14+/-3 mL/m2 decrease (least square mean+/-SE) in end-systolic volume index and a 6+/-1% increase in left ventricular ejection fraction (P<0.05 versus baseline and placebo for both). The decrease in end-diastolic volume index (14+/-3) was different from that seen at baseline (P<0.05) but not with placebo. In the 50-mg group, end-systolic and end-diastolic volume indexes decreased relative to baseline but were not different from what was seen with placebo, whereas ejection fraction increased by 4+/-1% (P<0.05 versus baseline and placebo). Beta-blocker therapy can ameliorate left ventricular remodeling in asymptomatic patients with left ventricular systolic dysfunction.

Effects of reduced preload on diastolic filling in essential hypertensive patients with increased left ventricular mass.

Doppler-derived indices of diastolic filling are widely used in the routine evaluation of essential hypertensives. However, these indices are affected by loading conditions and systolic performance. This study aimed at monitoring the transmitral flow pattern and indices of left ventricular systolic function during acute nonpharmacological isolated reduction of preload in essential hypertensives with left ventricular hypertrophy. Nine essential hypertensive patients with left ventricular hypertrophy and nine age- and sex-matched normotensive controls underwent echocardiographic and Doppler evaluation of both systolic function and diastolic filling indices at baseline and during lower body suction at -40 mm Hg. Lower body suction caused a similar decrease in end-diastolic volume index, stroke volume index, and midwall fractional shortening in the normotensives and hypertensives. Circumferential end-systolic stress was unaffected in both groups. Acceleration time of early diastolic filling and isovolumic relaxation time increased in the normotensives but not in the hypertensives. Deceleration time of early diastolic filling increased in both groups. The ratio of peak velocities during early filling and at atrial contraction decreased in the normotensives, whereas it was unchanged in the hypertensives; this was due to the fact that early filling velocity decreased in both groups, whereas peak velocity at atrial contraction decreased only in the hypertensives. We conclude that Doppler-derived diastolic filling indices are not affected by a reduction of preload in essential hypertensives with left ventricular hypertrophy.

Effects of reduced preload on diastolic filling in essential hypertensive patients with increased left ventricular mass

Doppler-derived indices of diastolic filling are widely used in the routine evaluation of essential hypertensives. However, these indices are affected by loading conditions and systolic performance. This study aimed at monitoring the transmitral flow pattern and indices of left ventricular systolic function during acute nonpharmacological isolated reduction of preload in essential hypertensives with left ventricular hypertrophy. Nine essential hypertensive patients with left ventricular hypertrophy and nine age- and sex-matched normotensive controls underwent echocardiographic and Doppler evaluation of both systolic function and diastolic filling indices at baseline and during lower body suction at −40 mm Hg. Lower body suction caused a similar decrease in end-diastolic volume index, stroke volume index, and midwall fractional shortening in the normotensives and hypertensives. Circumferential end-systolic stress was unaffected in both groups. Acceleration time of early diastolic filling and isovolumic relaxation time increased in the normotensives but not in the hypertensives. Deceleration time of early diastolic filling increased in both groups. The ratio of peak velocities during early filling and at atrial contraction decreased in the normotensives, whereas it was unchanged in the hypertensives; this was due to the fact that early filling velocity decreased in both groups, whereas peak velocity at atrial contraction decreased only in the hypertensives. We conclude that Doppler-derived diastolic filling indices are not affected by a reduction of preload in essential hypertensives with left ventricular hypertrophy.

Early hemodynamic results of left ventricular reconstructive surgery for anterior wall left ventricular aneurysm

To assess the efficacy of left ventricular (LV) reconstruction after aneurysmectomy, 35 consecutive patients with anterior LV aneurysm were studied before and after surgery. Surgical technique was performed by applying a circular patch after aneurysmectomy to maintain a “more physiological” LV cavity. Myocardial revascularization was performed in all but 1 patient concurrently. Global perioperative mortality was 4.8%. LV filling pressure and volumes and regional wall motion were assessed before and after surgery. The major indication for surgery was angina; 8 patients were in New York Heart Association class III/IV. The results showed a significant decrease in end-diastolic volume index (from 120 ± 55 ml/m 2 to 76 ± 22 ml/m 2, p < 0.001), end-systolic volume index (from 74 ± 44 ml/m 2 to 40 ± 18 ml/m 2, p < 0.001) and end-diastolic pressure (from 17 ± 7 mm Hg to 13 ± 5 mm Hg, p < 0.05). Ejection fraction significantly increased (from 39 ± 13% to 49 ± 15%, p < 0.001). LV wall motion significantly improved in all but the anterobasal region; the extent of LV asynergy significantly decreased after surgery. Six of the 35 patients had a deterioration of postintervention ejection fraction (from 44 ±14% to 34 ± 9%). They had no reduction in LV volumes and no improvement in wall kinetics. It is concluded that LV reconstruction after aneurysmectomy induces significant early improvement of global and regional LV function in most patients; postoperative functional improvement is mainly related to the increase in inferior LV wall motion.

Effect of prenalterol on contractility, relaxation, and filling phase in coronary artery disease patients with previous myocardial infarction.

Twelve postmyocardial infarction patients, with angiographically proven asynergic areas, but without overt cardiac failure, were treated with prenalterol intravenously, (a new cardioselective inotropic agent) at a dose of 30 micrograms/kg. The aim of this study was to test the usefulness and safety of this new drug in postmyocardial infarction patients, monitoring systolic and diastolic acute hemodynamic changes. Significant improvement in cardiac contractility was demonstrated by the increase of ejection fraction (+23%), stroke volume index (+22%), cardiac output (+41%), positive dp/dt (+82%), and Vmaxd (+39%). Left ventricular systolic, mean aortic, and mean right atrial pressure remained unchanged; a slight decrease in end-diastolic volume index (-2%) occurred. A significant increase in heart rate (from 66 +/- 7 to 85 +/- 14 beats/min), without electrocardiographic changes or subjective complaints of angina pectoris, was observed. Segmental wall motion analysis showed an improved systolic shortening in normal (from 34 to 44%) and in asynergic areas (from 10 to 18%), whereas no changes were observed in dyskinetic areas. The relaxation and filling phase also improved, as tested by negative dp/dt (+39%), time constant of relaxation (-36%), and by indices of ventricular compliance. Side effects consisted of a slight feeling of tension in two patients and a short episode of ventricular tachycardia (5 beats) in another patients. No episode of angina pectoris was observed. These results, with special emphasis on lack of exacerbation of pre-existing ischemia (although obtained in patients without evident heart failure), suggest the potential usefulness of prenalterol in acute cardiac failure, as well as postmyocardial infarction low-output syndrome.

Alterations in left ventricular volumes and ejection fraction during atrial pacing in patients with coronary artery disease: Assessment with radionuclide ventriculography

The present study was performed to determine the utility of radionuclide ventriculography (RNV) in conjunction with atrial pacing in the identification of individuals with coronary artery disease. Accordingly, left ventricular end-diastolic volume index, end-systolic volume index, ejection fraction, and regional wall motion were measured with radionuclide ventriculography before and during atrial pacing in 37 patients: 27 with and 10 without (control subjects) coronary artery disease. In the control subjects, pacing caused a decrease in end-diastolic volume index (77 ± 19 [mean ± SD] ml/M 2 at rest, 50 ± 18 ml/M 2 at peak pacing; p < 0.001), a decrease in end-systolic volume index (34 ± 14 ml/M 2 at rest, 19 ± 9 ml/M 2 at peak pacing; p < 0.001), an increase in ejection fraction (0.61 ± 0.11 at rest, 0.66 ± 0.11 at peak pacing; p = 0.006); and no deterioration in wall motion. In 16 patients with coronary artery disease who developed ECG and/or metabolic evidence of ischemia during pacing, end-diastolic volume index decreased (87 ± 26 ml/M 2 at rest, 69 ± 24 ml/M 2 at peak pacing; p < 0.001), end-systolic volume index was unchanged (43 ± 20 ml/M 2 at rest, 44 ± 21 ml/M 2 at peak pacing; p = NS, ejection fraction decreased (0.55 ± 0.12 at rest, 0.40 ± 0.14 at peak pacing; p < 0.001), and new wall motion abnormalities developed in 14. In 11 patients with coronary artery disease but no ECG or metabolic evidence of ischemia, pacing caused a decrease in end-diastolic volume index (80 ± 26 ml/M 2 to 61 ± 31 ml/M 2; p < 0.001), a decrease in end-systolic volume index (36 ± 17 ml/M 2 to 28 ± 20 ml/M 2; p = 0.002), no change in ejection fraction (0.60 ± 0.11 to 0.60 ± 0.13; p = NS), and new wall motion abnormalities in four. Although the specificity of these scintigraphic measurements for the identification of patients with coronary artery disease was excellent (1.0), the combined sensitivity of all scintigraphic measurements was high only if ECG or metabolic evidence of ischemia was present: 0.94 in patients with evidence of ischemia but only 0.36 in those without ischemia. Thus radionuclide ventriculography during incremental atrial pacing is useful in the identification of patients with coronary artery disease only if ischemia is induced.