Decrease In End-systolic Volume Index Research Articles

Surgical ventricular restoration-meta-analysis of observational studies.

Technique of surgical ventricular restoration (SVR) may impact its outcomes. Therefore, we conducted a meta-analysis of studies on SVR performed by using different techniques and studied outcomes. Scientific databases were searched for studies on SVR. End points assessed were NYHA class, left ventricular ejection fraction (LVEF), end-systolic volume index (ESVI), sphericity index, apical rotations, mortality, and re-admissions for heart failure. Circular patch use showed significant increases in LVEF by 9.53% (7.62, 11.45), decreases in ESVI by - 35.16 ml (- 44.97, - 25.34), improvements in NYHA class by - 1.29 (- 1.45, - 1.13), and decreases in sphericity index by - 0.04 (- 0.08, 0.00) . In studies using rectangular patch, the LVEF showed an increase by 5.75% (3.52, 7.98,), the NYHA class improved by - 2.45 (- 2.59, - 2.32). The decrease in ESVI was - 40.36 ml (- 62.2, - 18.52). The apical rotation increased by 3.45 0 (0.62, 6.29,). Re-admission for heart failure and mortality was less.When the magnitude of ESVI decrease were compared within studies using rectangular patch, the greatest decrease in ESVI was notedwith use of a rectangular patch. (- 59 ml versus - 40 ml a very narrow patch and - 22 ml use of oval patch) The improvements in sphericity index at 2 years in use of rectangular patch study was - 0.78 ± 0.11 versus 0.00 ± 0.03 in use of oval patch study. Rectangular patch use resulted in maximal decreases in ESVI and sphericity index. Mortality and re-admissions for heart failure were also significantly less at mid-term after SVR.

Effect of Diabetes Mellitus on Cardiac Resynchronization Therapy and to Prognosis in Heart Failure (from the Prospective Evaluation of Asian With Cardiac Resynchronization Therapy for Heart Failure Study)

The association of diabetes mellitus (DM) with cardiac resynchronization therapy (CRT) response and cardiovascular outcomes in Asian patients with heart failure (HF) is unclear. This study aims to investigate the effects of DM on CRT response and cardiovascular outcomes in Asian HF patients. Consecutive Asian HF patients receiving CRT were enrolled in the Prospective Evaluation of Asian with CRT for Heart Failure (PEACH) study from 2011 to 2017. CRT response and super-response were defined as decrease in end-systolic volume index ≥15% and ≥30%, respectively. Primary endpoint was time to composite of HF-hospitalization and all-cause mortality. Among 161 patients followed for 3.3 ± 1.5 years (age 66.7 ± 11.2 years, 22% females, mean QRS duration 154.3 ± 22.4 ms, 83% left bundle branch block), 84 (52%) were CRT responders and 57 (35%) were super-responders. Of 82 (51%) patients with DM (100% type 2, mean HbA1c 7.3 ± 1.9%), 35 (43%) were responders. DM attenuated reverse remodeling (CRT response: AOR 0.44, 95% confidence interval [CI] 0.20 to 0.98, p < 0.05; super-response: AOR 0.42, 95% CI 0.18 to 0.97, p <0.05), and DM increased HF-hospitalization and all-cause mortality (AHR 1.68, 95% CI 1.00 to 2.82, p = 0.05). The extent of CRT-response correlates with higher event-free survival (CRT response: AHR 0.5, 95% CI 0.30 to 0.81, p = 0.005; super-response: AHR 0.27, 95% CI 0.14 to 0.52, p < 0.001). In conclusion, the extent of reverse remodeling post-CRT is the strongest predictor of event free survival. However, DM is detrimental to the CRT recipient by attenuating reverse remodeling, inducing end organ dysfunction and is independently associated with worsened clinical outcomes among Asian HF patients.

The systolic paradox in hypertrophic cardiomyopathy

ObjectiveWe explored cardiac volumes and the effects on systolic function in hypertrophic cardiomyopathy (HCM) patients with left ventricular hypertrophy (HCM LVH+) and genotype-positive patients without left ventricular hypertrophy (HCM LVH−).MethodsWe...

Low-dose dobutamine responsiveness in idiopathic dilated cardiomyopathy: relation to exercise capacity and clinical outcome.

To evaluate myocardial contractile reserve using low-dose dobutamine echocardiography in patients with chronic heart failure secondary to idiopathic dilated cardiomyopathy stratified by peak exercise oxygen consumption (VO(2)). Sixty clinically stable patients (56+/-11 years; 45 males) with idiopathic cardiomyopathy and NYHA class I to III symptoms of heart failure were studied and followed-up for 13+/-3 months. All patients underwent cardiopulmonary exercise testing and low-dose dobutamine. The dobutamine infusion protocol consisted of an initial dose of 2.5 micro. kg(-1)per 3 min, increasing by 2.5 micro. kg(-1)per min every 3 min; the maximal dose was 10 micro. kg(-1)per min. The end-systolic volume index, left ventricular ejection fraction and cardiac output were measured at baseline and peak dobutamine dose and their change calculated as ((peak dose value-baseline value)/baseline value]x100. Ten normal subjects with normal left ventricular function and no coronary artery lesions served as a control group to compare low-dose dobutamine results. All analysed echocardiographic variables either at baseline or following dobutamine infusion were significantly lower in patients with chronic heart failure as a whole compared to the control group. When the patients were grouped according to Weber's classification, a statistically significant decrease in percentange changes in end-systolic volume index (rho=-0.77;P<0.0001), left ventricular ejection fraction (rho=-0.72;P<0.0001) and cardiac output (rho=-0. 82;P<0.0001) from class A to class C was observed. The mean percentage decrease in end-systolic volume index following the dobutamine infusion was 28.7+/-9% in class A (peak VO(2)>20 ml. kg(-1). min(-1)), 18.6+/-8% in class B (peak VO(2)between 16 and 20 ml. kg. min(-1)), and only 6.4+/-6% in class C (peak VO(2)between 10 and 16 ml. kg(-1). min(-1)) patient groups. At multivariate analysis, only the percentage change in end-systolic volume index was significantly associated with a peak VO(2)<15 ml. kg(-1). min(-1)(P=0.006). During the follow-up, 17 patients had events (15 readmissions for worsening heart failure and two deaths). At multivariate analysis, only the percentage change in end-systolic volume index was significantly associated with the occurrence of events (P=0.003). The area under the receiver operating characteristic curve for percentage change in end-systolic volume index was not significantly different from that for peak VO(2)(0. 86+/-0.04 vs 0.80+/-0.06;P:ns). This study indicates that in patients with chronic heart failure secondary to idiopathic cardiomyopathy, the cardiac response to low-dose dobutamine, as assessed by echocardiography, is correlated with peak VO(2), an objective and accurate measure of the severity of the disease and clinical outcome.

Regulation of stroke volume during submaximal and maximal upright exercise in normal man.

To characterize the hemodynamic factors that regulate stroke volume during upright exercise in normal man, 24 asymptomatic male volunteers were evaluated by simultaneous right heart catheterization, radionuclide angiography, and expired gas analysis during staged upright bicycle exercise to exhaustion. From rest to peak exercise, oxygen consumption increased from 0.33 to 2.55 liters/min (7.7-fold), cardiac index increased from 3.0 to 9.7 liters/min per m2 (3.2-fold), and arteriovenous oxygen difference increased from 5.8 to 14.1 vol% (2.5-fold). The increase in cardiac index resulted from an increase in heart rate from 73 to 167 beats/min (2.5-fold), and an increase in left ventricular stroke volume index from 41 to 58 ml/m2 (1.4-fold). During low levels of exercise, there was a linear increase in cardiac index due to an increase in both heart rate and stroke volume index; stroke volume index increased as a result of an increase in left ventricular filling pressure and end-diastolic volume index and, to a much smaller extent, a decrease in end-systolic volume index. During high levels of exercise, further increases in cardiac index resulted entirely from an increase in heart rate, since stroke volume index increased no further. Left ventricular end-diastolic volume index decreased despite a linear increase in pulmonary artery wedge pressure; stroke volume index was maintained by a further decrease in end-systolic volume index. The degree to which stroke volume index increased during exercise in individuals correlated with the change in end-diastolic volume index (r = 0.66) but not with the change in end-systolic volume index (r = 0.07). Thus, the mechanism by which left ventricular stroke volume increases during upright exercise in man is dependent upon the changing relationship between heart rate, left ventricular filling, and left ventricular contractility. At low levels of exertion, an increase in left ventricular filling pressure and end-diastolic volume are important determinants of the stroke volume response through the Starling mechanism. At high levels of exertion, the exercise tachycardia is accompanied by a decrease in end-diastolic volume despite a progressive increase in filling pressure, so that stroke volume must be maintained by a decrease in end-systolic volume.

Noninvasive measurement of the rest and exercise peak systolic pressure/end-systolic volume ratio: A sensitive two-dimensional echocardiographic indicator of left ventricular function

Thirty-five patients with previous myocardial infarction and 25 normal subjects underwent subcostal view two-dimensional echocardiography at rest and at peak up-right bicycle exercise. The purpose was to assess changes in left ventricular volume with maximal upright bicycle exercise and to compare the utility of the peak systolic pressure/end-systolic volume index ratio and ejection fraction as indicators of left ventricular function. With exercise, normal subjects had a decrease in end-systolic volume index (22 +/- 8 to 11 +/- 3 ml/m2) (p less than 0.001); the normal ejection fraction (59 +/- 9 to 72 +/- 8%, p less than 0.001) and the pressure/volume ratio (6 +/- 3 to 18 +/- 6, p less than 0.001) increased. In patients with prior myocardial infarction there was no change in end-systolic volume index, ejection fraction or pressure/volume ratio with exercise. Although at peak exercise significant differences between normal subjects and patients with prior infarction were demonstrated in end-systolic volume index (p less than 0.001), ejection fraction (p less than 0.001) and pressure/volume ratio (p less than 0.001), the pressure/volume ratio provided sharper delineation between the two groups than did ejection fraction. The exponential relation of the pressure/volume ratio and ejection fraction at peak exercise demonstrates that the pressure/volume ratio is more sensitive as an indicator of normal or borderline left ventricular function and that ejection fraction is more sensitive in quantifying the degree of left ventricular dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations in left ventricular function during therapy of unstable angina pectoris: Relationship to clinical outcome

We studied 30 consecutive patients with unstable angina during pain-free intervals with gated blood pool scintigraphy. The initial study was performed within 18 hours of admission to the coronary care unit. A second study was performed near the time of hospital discharge, after stabilization with medical therapy. Three months thereafter patients were categorized according to their worst anginal status following hospital discharge. Fifteen patients were New York Heart Association functional class I or II (group A); 15 patients were in functional class III or IV (group B). Left ventricular ejection fraction was similar at the time of initial study (55.9 ± 2.18% and 56.0 ± 3.55% for groups A and B respectively). At the time of hospital discharge the ejection fraction had risen to 60.3 ± 1.85% ( p < 0.01) in group A and in group B it had fallen to 48.1 ± 3.4% ( p < 0.005). End-systolic volume index in group B rose from 37 ml/m 2 ± 6.1 to 43 ± 6.2 ml/m 2 ( p < 0.005) at the time of the follow-up study. There were no significant intergroup differences in the amount of nitrates or beta blockers received by the patients during the two scintigraphic examinations. Eleven group B patients subsequently underwent coronary artery bypass surgery. A significant increase in ejection fraction and a significant decrease in end-systolic volume index were noted when these patients were restudied an average of 3.2 months after surgery. This study suggests that changes in left ventricular function during the course of unstable angina pectoris are common and may be detected by serial gated blood pool scintigraphy. The direction of the change in ejection fraction was associated with the severity of angina in the follow-up period. A fall in ejection fraction and a rise in end-systolic volume index from admission to the time of the follow-up study were associated with an unfavorable clinical outcome and may represent clinically silent ischemic depression of left ventricular function.

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.