Detection Of Left Ventricular Dysfunction Research Articles

Aortic regurgitation. Detection of left ventricular dysfunction by exercise echocardiography.

Left ventricular performance was assessed in 20 symptom free patients and 10 with symptoms, all with isolated aortic regurgitation, by measuring the echocardiographic peak velocity of circumferential fibre shortening (echo peak Vcf) at rest and during graded bicycle ergometer exercise in the supine position. The normal left ventricular response during such exercise was first determined in 20 healthy controls. On the basis of their resting and exercise echo peak Vcf, the 30 patients with aortic regurgitation could be separated into three groups: Group 1 comprised 11 symptom free patients with a normal resting echo peak Vcf which increased normally with exercise; group 2 comprised nine symptom free patients with a normal resting echo peak Vcf but with a subnormal response to exercise; group 3 consisted of 10 patients with symptoms with a depressed resting echo peak Vcf which remained subnormal with exercise. Subsequent cardiac catheterisation disclosed normal ejection fractions in patients in group 1, borderline ejection fractions in those in group 2, and reduced ejection fractions in those in group 3. Echocardiographic assessment of left ventricular performance during supine isotonic exercise may provide a simple noninvasive method for the early detection of left ventricular dysfunction in symptom free patients with aortic regurgitation.

Noninvasive detection of left ventricular dysfunction with a portable electrocardiographic gated scintillation probe device

A comparison of left ventricular function data derived from a low cost, portable electrocardiographic gated scintillation probe (nuclear stethoscope) with conventional scintiangiographic data was performed in 68 patients. Ejection fraction correlation (r = 0.86, p < 0.005) was better in patients with uniform wall motion than in those with regional asynergy (r = 0.68 p < 0.01). Probe variables reflecting systolic emptying rates, diastolic filling rates and timing intervals, and relative volumes analyzed in combination provided 100 percent sensitivity, specificity, and predictive value in detecting abnormal left ventricular performance. The results suggest that radionuclide angiography with an electrocardiographic gated scintillation probe is a sensitive, rapid and relatively inexpensive portable method of screening for cardiac dysfunction with a yield similar to that from the more costly gamma camera derived scintiangiogram.

Left ventricular dysfunction--bedside Valsalva manoeuvre.

Thirty-seven patients were evaluated before cardiac catheterisation by bedside physical examination, including Valsalva manoeuvre, to assess the value of the sphygmomanometrically determined arterial pressure responses during the Valsalva manoeuvre and to compare its sensitivity, specificity, and predictive accuracy in the detection of left ventricular dysfunction with that of the commonly used diagnostic signs including the chest x-ray. Patients not on beta-blockade treatment could be separated into three distinct arterial pressure responses detectable at the bedside which corresponded well to three statistically different groups with regard to left ventricular ejection fraction (0.29 +/0 0.11, 0.48 +/0 0.15, 0.69 +/0 0.11) and left ventricular end-diastolic pressure (38 +/- 5 mmHg, 24 +/- 10 mmHg, 14 +/- 5 mmHg) at subsequent cardiac catheterisation. In patients not on beta-blockade it was shown for the first time that (1) the height of the systolic arterial pressure overshoot was directly related to left ventricular ejection fraction and inversely related to left ventricular end-diastolic pressure, and that (2) the bedside sphygmomanometrically determined arterial pressure response during Valsalva manoeuvre provided a semiquantitative estimate of left ventricular function and was unsurpassed in its ability to do so by any of the standard diagnostic signs including the chest x-ray film.

Assessment of early ventricular systole by first pass radionuclide angiography: Useful method for detection of left ventricular dysfunction at rest in patients with coronary artery disease

To identify abnormal left ventricular function without exercise stress in patients with coronary artery disease first-pass radionuclide angiograms were analyzed in 32 normal subjects (Group I); 31 patients with coronary disease and normal contrast ventriculograms (Group II); and 17 patients with coronary disease and depressed left ventricular function (Group III). Total ejection fraction (EF) was computed with standard angiographic methods and from each time-activity curve. During the first third of systole, ejection fraction was determined manually by averaging three to five beats and the value compared with that obtained with contrast ventriculography: ∗ Group Total EF 1 3 EF Total EF 1 3 EF I 0.62 ± 0.04 0.29 ± 0.04 II 0.64 ± 0.08 0.23 ± 0.04 0.59 ± 0.05 0.18 ± 0.04 † III 0.42 ± 0.09 ∗ 0.18 ± 0.04 0.34 ± 0.09 † 0.13 ± 0.04 ‡ ∗ P < 0.01 versus II . † P < 0.01 versus I and II . ‡ P < 0.01 versus I ). Both total radionuclide ejection fraction ( r = 0.95) and first-third ejection fraction ( r = 0.91) correlated well with angiography. Intraobserver and interobserver variation was small, averaging 0.02 ± 0.02 (range 0 to 0.05). The radionuclide first-third ejection fraction was 0.25 or greater in normal subjects and less than 0.25 in 29 of 31 patients (94 percent) in Group II and in all patients in Group III. It is concluded that the first-third ejection fraction obtained with first pass angiography identifies subtle abnormalities of left ventricular function at rest in more than 90 percent of patients with coronary disease that may not be recognized by total ejection fraction alone.

Effects of decreased aortic compliance on performance of the left ventricle.

Effects of decreased aortic compliance on performance of the left ventricle.