Impaired Ventricular Systolic Function Research Articles

Pulmonary Pressure and Cardiac Function in Chronic Mountain Sickness Patients

Chronic mountain sickness (CMS) is characterized by a loss of adaptation to hypoxia in high-altitude (HA) dwellers. Chronic hypoxemia, excessive erythrocytosis and frequently pulmonary hypertension (PH), which may lead to cardiac failure, develop in patients. We sought to assess the determinants of cardiac function in CMS patients with hypoxia-induced PH. Fifteen healthy men living at sea level (SL) were compared to 15 healthy men living at HA and 55 patients with CMS from Cerro de Pasco, Peru (altitude, 4,300 m). Pulmonary pressures and cardiac function were estimated by echocardiography. None of the subjects had overt cardiac failure symptoms. CMS patients exhibited elevated mean pulmonary pressures as assessed by high-tricuspid pressure gradients (CMS patients, 34 +/- 10 mm Hg; HA subjects, 25 +/- 4 mm Hg [p = 0.002]; and SL subjects, 19 +/- 3 mm Hg [p < 0.001]). They also showed right ventricular (RV) dilation (mean end-diastolic RV area: CMS patients, 17 +/- 2 cm(2); HA subjects, 13 +/- 2 cm(2); SL subjects, 12 +/- 2 cm(2); p < 0.001) but did not display impaired systolic ventricular function. However, the RV Tei index was increased in CMS and HA subjects (CMS patients, 0.56 +/- 0.15; HA subjects, 0.52 +/- 0.12; SL subjects, 0.21 +/- 0.12; p < 0.001). Despite obvious pulmonary arterial hypertension and right heart dilation, CMS patients did not show any symptom or echocardiographic parameter of heart failure. ClinicalTrials.gov. Identifier: NCT00424970.

Cardiopulmonary response to exercise in patients with the Fontan circulation

The Fontan circuit is characterized by a pulmonary circulation dependent on central venous pressure in the absence of a subpulmonary ventricle. Patients with this circulation usually exhibit a low cardiac output. In addition to their abnormal cardiac state, recent studies have demonstrated impaired cardiac autonomic nervous activity, elevated neurohormonal factors, and impaired endothelial function, findings also encountered in adults with chronic heart failure. One major component of these impairments is the abnormal cardiorespiratory response during exercise. Despite some pathophysiologic similarities to adults with cardiac disease, those with the Fontan circulation usually have a congenitally malformed heart underscoring abnormal haemodynamics, with further compromise from multiple surgical procedures. It differs in many aspects from the situation in the adults with impaired systolic ventricular function in the setting of chronic cardiac failure. In this review, I will focus on the cardiorespiratory response during exercise, seeking to clarify the characteristics in these particular patients with the Fontan circulation.

Aortic Valve Replacement: A Safe and Durable Option in Patients with Impaired Ventricular Systolic Function

Aortic Valve Replacement: A Safe and Durable Option in Patients with Impaired Ventricular Systolic Function

Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries

Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks–40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years). Results Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4% ± 3.1% at 1 year and 89.7% ± 4.4% at 9 years. Survivals at 7 years were 84.9% ± 7.1% in the double-switch group and 95.5% ± 4.4% in the Rastelli-Senning group ( P = .32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% ± 3.3% and 77.5% ± 9.0%, with no significant difference between the groups ( P = .60). Conclusions Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.

Características clínicas y pronóstico a medio plazo de la insuficiencia cardíaca con función sistólica conservada. ¿Es diferente de la insuficiencia cardíaca sistólica?

To assess the prevalence, clinical profile and medium-term prognosis in patients with heart failure and preserved systolic ventricular function compared to those with systolic dysfunction. 153 patients were included, 62 with preserved systolic ventricular function (left ventricular ejection fraction > or = 45%) and 91 with impaired systolic ventricular function (left ventricular ejection fraction < 45%). The mean follow-up period was 25 10 months. Mean age was similar (66 10 vs. 65 10; p = 0.54). There was a higher proportion of women among patients with preserved systolic function (53% vs. 28%; p < 0.01). Ischemic and idiopathic cardiomyopathy were the most common causes of heart failure in patients with systolic dysfunction, whereas valvular disease and hypertensive cardiopathy were the most common in patients with preserved systolic function. Angiotensin-converting enzyme inhibitors and beta-blockers were more often prescribed in patients with impaired systolic ventricular function (86% vs. 52%; p < 0.01 and 33% vs. 11%; p < 0.01, respectively). There were no differences between the groups in terms of mortality rate (37% vs. 29%), readmission rate for other causes (29% vs. 23%), readmission rate for heart failure (45% vs. 45%), cumulative survival (51% vs. 62%) and the likelihood of not being readmitted for heart failure (50% vs. 52%). In the multivariate analysis, left ventricular ejection fraction was not a predictor of death or readmission because of heart failure. In a large proportion of patients with heart failure, systolic ventricular function is preserved. Despite the clinical differences between patients with preserved and impaired systolic ventricular function, the medium-term prognosis was similar in both groups.

In the elderly the impact on disability and quality of life is similar in heart failure with preserved versus impaired systolic ventricular function

In the elderly the impact on disability and quality of life is similar in heart failure with preserved versus impaired systolic ventricular function