Ejection Fraction Levels Research Articles

Role of endothelin-1 in the development of a special type of cardiomyopathy.

The role of endothelin-1 (ET-1) in certain pathological states is still unclear. We have investigated the effect of anthracyclines (maximum dose, 450 mg/m(2) of body surface) on left ventricular systolic and diastolic function and how it influences the level of plasma ET-1 in 21 patients (12 female and nine male) with Hodgkin and non-Hodgkin lymphoma. We also studied the association between plasma ET-1 concentration and echocardiographic parameters. Serum ET-1 was measured by ELISA. Left ventricular function was analysed by echocardiography: ejection fraction (EF), velocity-time integral, E- and A-waves, E:A ratio, deceleration time (DT) and Doppler index were all measured. Statistical analysis was made by the Wilcoxon rank test. EF and serum ET-1 level decreased significantly (EF, 56.29+/-5.0% to 48.57+/-5.9%, P<0.0001; ET-1, 6.45+/-4.0 pg/ml to 2.9+/-1.0 pg/ml, P<0.0001). DT increased significantly (179.8+/-47.8 ms to 215.5+/-66.7 ms, P<0.01) after anthracycline therapy. There was no difference in other echocardiographic parameters before and after therapy. The decrease in serum ET-1 concentration might be a result of anthracycline's direct cytotoxic effect and the decreasing level of ET-1 can play a role in the reduction of EF. However, more studies are needed to evaluate the presence and severity of endothelial damage.

Clinical significance of systolic time intervals for the evaluation of left ventricular function in patients with coronary artery disease.

Systolic time intervals and cardiac output were measured in 10 normal subjects (group I), 25 patients with angina pectoris (group II) and 32 patients with old myocardial infarction who were subdivided into 3 groups (group III : ejection fraction (EF) &ges;50% without congestive heart failure (CHF), group IV : EF < 50% without CHF and group V with CHF irrespective of the level of EF). Because the number of the patients of group V was too small and only this group was undergoing treatment during the study, the results obtained from this group were used for comparison only. The ET/PEP ratio was 2.41 ± 0.28 in group I, 2.70 ± 0.34 in group II (p < 0.02 as compared with group I), 2.35 ± 0.30 in group III and 2.11 ± 0.18 in group IV (p < 0.01 as compared with group I). The ejection time (ET) showed no significant difference between group I and group III or IV. The pre-ejection period (PEP) showed no significant difference between groups I and II. In groups III and IV, the PEP was prolonged as the EF decreased. These results indicate that the increase of the ET/PEP ratio in group II was mainly due to the prolongation of the ET, and the decrease of the ET/PEP ratio in group IV was not directly related to the ET but to the PEP prolongation. Both the stroke index (SI) and the mean systolic ejection rate (MSER) in groups III and IV were significantly low as compared with those in group I, but those in group II showed no significant difference as compared with those in group I. These findings suggest that the prolongation of ET in groups II, III and IV indicates a compensatory mechanism to maintain the SI.

Angiographic estimation of right ventricular volume in man.

Although the feasibility of angiographic estimation of right ventricular (RV) volume (V) has been demonstrated, no method has been validated by comparison with independent measurements of volume, and none has been applied to the systematic analysis of RVV characteristics in man. In the present study, postmortem casts of the human RV were used to determine a regression analysis for RVV for biplane frontal and lateral films by the Simpson's rule technique (true volume = 0.749 calculated volume, r = 0.99, see 3.7 ml, for casts ranging in volume from 20 to 115 ml). This method was then employed to estimate RVV from biplane cineangiograms of 32 patients. The validity of RVV measurements in vivo was corroborated by close correlation of stroke volumes estimated independently by angiographic and indicator dilution methods ( r = 0.98, see 4.1 ml). In nine patients with normal RV hemodynamics RV end-diastolic volume (EDV) averaged 81 ml/m 2 (range 63 to 101 ml/m 2 ); ejection fraction (EF) averaged 0.51 (range 0.40 to 0.66), values generally lower than the normal left ventricular EF. Of 14 patients with elevated RV systolic pressure (&gt; 45 mm Hg), normal RV function was evidenced in eight by normal levels of EF and EDV; in the remaining six patients, EF was reduced and EDV was elevated, suggesting that dilatation occurred in these patients as a function of depressed RV myocardial performance. In six patients with left-to-right shunts RV EDV was also increased; however, in these patients normal levels of EF were observed, indicating that the accommodation to volume overload was accomplished through the Starling mechanism. Finally, in six of 13 patients with reduced levels of cardiac output, RV EDV was increased and EF reduced, signifying that impaired RV myocardial function contributed to depression of over-all cardiac performance. It is concluded that the biplane angiographic method provides a practical, accurate means of quantitating RVV characteristics, including the magnitude of volume overload as well as the level of RV myocardial performance.

Case of the spring season

Rates of cholecystectomy for biliary dyskinesia are rising. Our objective was to identify clinical determinants of symptom improvement in children undergoing cholecystectomy for biliary dyskinesia.This retrospective cohort study included patients undergoing cholecystectomy for biliary dyskinesia from 2006–2013 who had their gallbladder ejection fraction (EF) measured by either cholecystokinin-stimulated hepatobiliary iminodiacetic acid scan and/or fatty meal ultrasound. Patients presenting from 2010–2013 were interviewed >1 y after cholecystectomy to determine symptom improvement, complete symptom resolution, and any postoperative clinical interventions related to biliary dyskinesia. Sensitivity and positive predictive values for the diagnostic tests for symptom improvement were calculated. Multivariable logistic regression models were used to identify preoperative characteristics associated with symptom improvement.Of the 153 included patients, 76% were female, 89% were Caucasian, and 39% were obese. At postoperative evaluation, symptom improvement was reported by 82% of the patients and complete symptom resolution in 56%. For both the hepatobiliary iminodiacetic acid and fatty meal ultrasound, the sensitivity of the test to predict symptom improvement increased with higher EF, whereas the positive predictive values remained around 80%. Of the 41 patients who participated in phone interview for long-term follow-up, 85% reported symptom improvement and 44% reported complete symptom resolution. Factors associated with symptom improvement included a shorter duration of pain, a history of vomiting, and a history of epigastric pain.Despite not identifying an EF level that predicted symptom improvement, over 80% of patients undergoing cholecystectomy for biliary dyskinesia reported symptom improvement. These results support continuing to offer cholecystectomy to treat biliary dyskinesia in children.