Left Ventricular Ejection Fraction In Group Research Articles

Athletic Remodeling in Female College Athletes: The "Morganroth Hypothesis" Revisited.

There is limited data regarding ventricular remodeling in college female athletes, especially when appropriate scaling of cardiac dimensions to lean body mass (LBM) is considered. Moreover, it is not well established whether cardiac remodeling in female athletes is a balanced process with proportional increase in left ventricular (LV) mass and volume or the right and LV size. During the preparticipation competitive screening, 72 female college athletes volunteered to undergo dual energy x-ray absorptiometry scan for quantification of LBM and comprehensive 2D echocardiography including assessment of longitudinal myocardial strain. The athletes were divided in 2 groups according to the intensity of the dynamic and static components of their sport categories, ie, a higher intensity dynamic and resistive group (n = 37 participating in rowing, water polo and lacrosse) and a lower intensity group (n = 35, participating in short distance running, sailing, synchronized swimming, and softball). In addition, we recruited a group of 31 age-matched nonathlete controls. The mean age of the study population was 18.7 ± 1.0 years. When scaled to body surface area, the higher intensity group had 17.1 ± 3.6% (P < 0.001) greater LV mass when compared with the lower intensity group and 21.7 ± 4.0% (P < 0.001) greater LV mass than the control group. The differences persisted after scaling to LBM with 14.2 ± 3.2% (P < 0.001) greater LV mass in the higher intensity group. By contrast, there was no difference in any of the relative remodeling indices including the LV mass to volume ratio, right to LV area ratio, or left atrial to LV volume ratio (P > 0.50 for all). In addition, no significant difference was noted among the 3 groups in LV ejection fraction (P = 0.22), LV global longitudinal strain (P = 0.55), LV systolic strain rate (P = 0.62), or right ventricular global longitudinal strain (P = 0.61). Female collegiate athletes participating in higher intensity dynamic and resistive sports have higher indexed LV mass even when scaled to LBM. The remodeling process does however appear to be a balanced process not only at the intraventricular level but also at the interventricular and atrioventricular levels.

Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease.

Background and ObjectivesIt is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD).MethodsTransthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants.ResultsThe mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF (<55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36–0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39–0.97, p=0.037) for all-cause mortality.ConclusionsLVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.

Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis

ObjectivesThe aim of this study was to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) in patients with severe aortic stenosis (AS). BackgroundThe prognostic impact of LVEF in severe AS remains controversial. MethodsAmong 3,815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study population consisted of 3,794 patients after excluding 21 patients without LVEF data. Patients were divided into 4 groups according to LVEF at index echocardiography (<50%, 50% to 59%, 60% to 69%, and ≥70%; conservative strategy: n = 388, n = 390, n = 1,025, and n = 800; initial aortic valve replacement strategy: n = 206, n = 170, n = 375, and n = 440). Echocardiographic data were site reported, and there was no echocardiography core laboratory. ResultsIn the conservative group, the cumulative 5-year incidence of the primary outcome measure (a composite of aortic valve–related death or heart failure hospitalization) was significantly higher in patients with LVEFs <50% and 50% to 59% than in those with LVEFs 60% to 69% and ≥70% (72.3%, 58.4%, 38.7%, and 35.0%, respectively, p < 0.001), whereas in the initial aortic valve replacement group, the negative effect of low LVEF was markedly attenuated (20.2%, 20.3%, 17.7%, and 12.4%, respectively, p = 0.03). After adjusting for confounders, LVEF <50% (hazard ratio: 1.82; 95% confidence interval: 1.44 to 2.28; p < 0.001) and 50% to 59% (hazard ratio: 1.77; 95% confidence interval: 1.42 to 2.20; p < 0.001) but not 60% to 69% (hazard ratio: 1.14; 95% confidence interval: 0.94 to 1.39; p = 0.17) were independently associated with poorer outcomes compared with LVEF ≥70% (reference) in the conservative group. In the initial aortic valve replacement group, the adjusted risk for the primary outcome measure was not significantly different across the 4 LVEF groups. ConclusionsThis study demonstrates that survival in patients with severe AS is impaired when LVEF is <60%, and these findings have implications for decision making with regard to the timing of surgical intervention.

Long-term outcomes of implanting drug-eluting stents for unprotected left main coronary artery disease patients with left ventricular systolic dysfunction

Objective: To analyze the clinical characteristics and prognosis of implanting drug-eluting stents (DES) for unprotected left main (ULM) coronary artery disease patients with left ventricular systolic dysfunction (LVSD). Methods: A total of 511 ULM coronary artery disease patients who underwent DES implantation from January 2005 to January 2012 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. Based on left ventricular ejection fraction (LVEF), the patients were divided into three groups: LVEF≤40% (n=104), 41%≤LVEF≤49% (n=137), and LVEF≥50% (n=270). The clinical characteristics of patients undergoing DES implantation were retrospectively compared, and the effects of LVSD on ULM coronary artery disease were analyzed. Results: After comparison of clinical baseline data among three different LVEF groups, the incidence of peripheral vascular diseases, old myocardial infarction (OMI), multi-vessel lesions, complete revascularization and chronic total occlusion (CTO) was statistically different (P=0.002, P<0.001, P<0.001, P=0.049, P=0.001, respectively). However, there was no significant difference in the incidence of other clinical characteristics (all P>0.05). In terms of survival analysis, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (both P<0.001). There was no statistical difference of total mortality between 41%≤LVEF≤49% group and LVEF≥50% group (P>0.05), while cardiac mortality was higher in LVEF≥50% group (P=0.027) . Besides, there was no significant difference among three groups in major adverse cardiac and cerebral events (MACCE), myocardial infarction(MI), cerebral infarction and target vessel revascularization (TVR) (all P>0.05). After adjusting for multiple clinical factors, total mortality and cardiac mortality were both remarkably higher in LVEF≤40% group than those in LVEF≥50% group (P=0.002, P<0.001), while there were no statistical differences of total mortality and cardiac mortality between 41%≤LVEF≤49% group and LVEF≥50% group (both P>0.05). In terms of MACCE, MI, cerebral infarction and TVR, there were also no significant differences among three groups (all P>0.05). Conclusion: For ULM coronary artery disease patients with LVSD, implanting DES is safe and effective, but for those with severe LVSD (LVEF≤40%), DES implantation showed an increased risk of long-term death and therefore should be selected with great care.

Associations between left ventricular diastolic function and right ventricular function in patients with and without preserved left ventricular ejection fraction.

The purpose of this study was to investigate associations between right ventricular (RV) function and left ventricular (LV) diastolic function in patients with reduced LV ejection fraction (LVEF) and preserved LVEF. A total of 139 patients who had undergone echocardiography were recruited. LV diastolic function was determined as the ratio of mitral inflow E to mitral e' lateral annular velocities (E/e'). RV function was determined as the RV index of myocardial performance (RIMP). Patients were divided into two groups: the preserved LVEF group (n=100, LVEF≥50%) and the reduced LVEF group (n=39, LVEF<50%). Associations between RV function and LV diastolic function in patients with reduced LVEF and preserved LVEF differed significantly. RIMP correlated significantly with E/e' in patients with reduced LVEF (r=0.47, p=0.003), but not in those with preserved LVEF (r=0.04, p=0.68). An important finding of the multivariate regression analysis showed that RIMP was the only independent determinant of E/e' in patients with reduced LVEF, whereas age and gender (not RIMP) was the independent determinant of E/e' in patients with preserved LVEF. Associations between RV function and LV diastolic function in patients with reduced LVEF and preserved LVEF differed significantly, and RV function showed a close correlation with LV diastolic function in patients with reduced LVEF, but not in those with preserved LVEF. Thus, these findings may well have clinical implications for better management of patients with reduced LVEF.

Association of serum total cholesterol and left ventricular ejection fraction in patients with heart failure caused by coronary heart disease.

IntroductionThe aim was to evaluate the association of serum total cholesterol (TC) level and left ventricular ejection fraction (LVEF) in patients with heart failure (HF) caused by coronary heart disease (CHD).Material and methodsA total of 236 participants were enrolled. Participants were divided into severely reduced (≤ 35%) and moderately reduced (> 35%) LVEF groups and the between-group difference was evaluated. Multivariate regression analysis was used to evaluate the association between LVEF and parameters of interest. Linear regression analysis was applied to analyze the odds ratio of per 1-SD increase in serum TC level for LVEF change.ResultsMean age was 57.3 years and males accounted for 58.1%. Mean serum TC level was 4.6 mmol/l, albumin (ALB) 33.6 g/l, and C-reactive protein (CRP) 11.4 mg/l. Mean LVEF was 38.3%. Compared to high-reduced LVEF group, participants in moderate-reduced LVEF group had significantly higher TC (4.8 ±0.9 mmol/l vs. 4.4 ± 0.7 mmol/l) and ALB (35.8 ±6.7 g/l vs. 31.4 ±6.0 g/l) but lower CRP (9.6 ±4.7 mg/l vs. 14.2 ±7.0 mg/l) levels (p < 0.05 for all comparisons). Increased TC and ALB levels were associated with higher LVEF, and increased CRP level was associated with lower LVEF. After adjusted for CRP, although per 1-SD increase in TC level was still associated with an increment in 4 % in LVEF, it did not achieve achieve statistic significance.ConclusionsIn patients with HF caused by CHD, higher serum TC level appeared to be associated with higher LVEF, which might be associated with systemic inflammation improvement.

Effects of oxygen therapy on wall‐motion score index in patients with ST elevation myocardial infarction—the randomized SOCCER trial

Although oxygen (O2 ) is routinely used in patients with acute myocardial infarction (AMI), it may have negative effects. In this substudy of the SOCCER trial, we aimed to evaluate the effects of O2 -treatment on myocardial function in patients with ST elevation myocardial infarction (STEMI). Normoxic (≥94%) STEMI patients were randomized in the ambulance to either supplemental O2 or room air until the end of the percutaneous coronary intervention (PCI). The patients underwent echocardiography on day 2-3 after the PCI and once again after 6months. The study endpoints were wall-motion score index (WMSI) and left ventricular ejection fraction (LVEF). Forty-six patients in the O2 group and 41 in the air group were included in the analysis. The index echocardiography showed no significant differences between the groups in WMSI (1.32±0.27 for O2 group vs 1.28±0.28 for air group) or LVEF (47.0±8.5% vs 49.2±8.1%). Nor were there differences at 6months in WMSI (1.16±0.25 vs 1.14±0.24) or LVEF (53.5±5.8% vs 53.5±6.9%). The present findings indicate no harm or benefit of supplemental O2 on myocardial function in STEMI patients. Our results support that it is safe to withhold supplemental O2 in normoxic STEMI patients.

105 Differences in myocardial mechanics between ischaemic and non-ischaemic cardiomyopathy assessed by cmr: a sub-group analysis of the vindicate trial

BackgroundPrognosis and treatment of patients with chronic heart failure (CHF) differs according to whether it is ischaemic (ICM) or non-ischaemic cardiomyopathy (NICM). Multi-parametric cardiovascular magnetic resonance (CMR) can distinguish these...

Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators.

Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using random-effects modeling. Sixteen studies with 3,959 patients were included in our analysis. Study arms were defined by LVEF improvement at follow-up (improved LVEF [>35%]: 1,622; low LVEF [≤35%] 2,337). Mean age (64.8 vs 64.9years, p= 0.97) was similar, whereas men were overrepresented in the persistent low LVEF group (79% vs 72%, p <0.001). Appropriate ICD therapy rate was 9.7% (improved LVEF) versus 21.8% (low LVEF) over a median follow-up period of 2.9years. In the meta-analysis, improved LVEF group had significantly lower (3.3% vs 7.2% per year IRR 0.52; CI 0.38 to 0.70; p <0.001) appropriate ICD therapies which was uniformly seen across all subgroups (ICD-only studies: IRR 0.59; p= 0.004) (cardiac resynchronization therapy-defibrillator-only studies: IRR 0.31; p= 0.002) (super-responder studies [mean LVEF > 45%]: IRR 0.53; p= 0.002). Inappropriate ICD therapy rates were, however, similar in both groups (3.01% vs 2.56% per year IRR 0.76; CI 0.43 to 1.36; p= 0.35). All-cause mortality rates in our meta-analysis favored (3.63% vs 8.23% per year IRR 0.49; CI 0.35 to 0.69; p <0.001) the improved LVEF group. In conclusion, our meta-analysis demonstrates that an improvement in LVEF is associated with a significantly reduced risk of ventricular arrhythmia and mortality. However, inappropriate ICD therapy rates remain similar.

Epidemiology and one‐year outcomes in patients with chronic heart failure and preserved, mid‐range and reduced ejection fraction: an analysis of the ESC Heart Failure Long‐Term Registry

The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients. Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.

Gender Differences in Left Ventricular Ejection Fraction and Outcomes Among Patients Hospitalized for Acute Decompensated Heart Failure

In patients with acute decompensated heart failure (HF), the association of gender and left ventricular ejection fraction (LVEF) with clinical outcomes has not been fully investigated. The aim of this study was to evaluate gender differences in LVEF and adverse outcomes across the full spectrum of LVEF in patients hospitalized for acute decompensated HF. Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 4,231 patients (2,461 men and 1,770 women) discharged alive after hospitalization for acute decompensated HF were investigated to assess the association of gender and LVEF with the primary end point (all-cause death and readmission for HF). Men or women were divided into 5 groups based on the LVEF at hospital discharge (<30%, 30% to <40%, 40% to <50%, 50% to <60%, and ≥60%). The median follow-up period after discharge was 523 (384 to 791) days. The frequency of the primary end point did not differ between men and women (36.5% vs 38.1%, p= 0.291). After adjustment for multiple comorbidities, male patients with an LVEF <30%, 30% to <40%, 40% to <50%, or 50% to <60% had a significantly higher risk of the primary end point than those with an LVEF ≥60%, indicating an inverse association between LVEF and adverse outcomes. In contrast, the adjusted risk of the primary end point was similar for all 5 LVEF groups of female patients. In conclusions, the association between LVEF and outcomes differs markedly between men and women hospitalized for acute decompensated HF, although event-free survival is similar for both genders.

BNP and obesity in acute decompensated heart failure with preserved vs. reduced ejection fraction: The Atherosclerosis Risk in Communities Surveillance Study

BackgroundLevels of B-type natriuretic peptide (BNP), a prognostic marker in patients with heart failure (HF), are lower among HF patients with obesity or preserved Left Ventricular Ejection Fraction (LVEF). We examined the distribution and prognostic value of BNP across BMI categories in acute decompensated heart failure (ADHF) patients with preserved vs. reduced LVEF. MethodsWe analyzed data from the Atherosclerosis Risk in Communities (ARIC) HF surveillance study which sampled and adjudicated ADHF hospitalizations in patients aged ≥55years from 4 US communities (2005–2009). We examined 5 BMI categories: underweight (<18.5kg/m2), normal weight (18.5–<25), overweight (25–<30), obese (30–<40) and morbidly obese (≥40) in HF with preserved LVEF (HFpEF) and reduced LVEF (HFrEF). The outcome was 1-year mortality from admission. We used ANCOVA to model log BNP and logistic regression for 1-year mortality, both adjusted for demographics and clinical characteristics. ResultsThe cohort included 9820 weighted ADHF hospitalizations (58% HFrEF; 42% HFpEF). BNP levels were lower in HFpEF compared to HFrEF (p<0.001) and decreased as BMI increased within the LVEF groups (p<0.001). After adjustment for covariates, log10 BNP independently predicted 1-year mortality (adjusted OR 1.62 (95% CI 1.17–2.24)) with no significant interaction by BMI or LVEF groups. ConclusionsBNP levels correlated inversely with BMI, and were higher in HFrEF compared to HFpEF. Obese patients with HFpEF and ADHF had a significant proportion with BNP levels below clinically accepted thresholds. Nevertheless, BNP was a predictor of mortality in ADHF across groups of BMI in HFpEF and HFrEF.

The role of Inflammatory Processes in Occurrence of Left Ventricular Failure in Patients with Chronic Kidney Disease

Background:Recently, the relationship between increased level of inflammatory mediators and occurrence of left ventricular failure in patients with kidney disease has been suggested. The present study attempted to assess relationship between inflammatory mediators and occurrence of left ventricular failure in patients with chronic kidney disease.Materials and Methods:This cross-sectional study was performed at Noor and Hazrat Aliasghar hospital in Isfahan between September 2012 to September 2013 on patients aged >19 years that referred for following their chronic kidney disease. Serum level of inflammatory parameters including C-reactive protein (CRP) and Interleukin-6 (IL-6) was measured using spectrophotometer. All patients were also assessed using M-mode echocardiography to determine left ventricular ejection fraction (LVEF).Results:The group with significant reduced LVEF showed lower GFR when compared to the normal LVEF group (40.73 ± 20.61% versus 44.43 ± 17.98%, P = 0.032). Comparing GFR across the three groups with normal LVEF (>55%), with mild LV dysfunction (LVEF: 45 – 55) those with significant LV dysfunction (LVEF < 45%) showed significantly lower GFR level in latter group compared with normal LVEF and mild LV dysfunction group (P = 0.026). Although the level of serum CRP was significantly higher in patients with significant left ventricular failure than other groups (P = 0.018).Conclusion:Inflammatory processes can potentially affect left ventricular function in patients with chronic kidney disease. In this regard, increased level of CRP may be a main factor for predicting severity of left ventricular failure in these patients.

Long-term Effect of Enlargement of a Ventricular Septal Defect in the Rastelli Procedure

We investigated the effect of ventricular septal defect (VSD) enlargement on long-term surgical results, late arrhythmia, and left ventricular (LV) function in the Rastelli procedure for D-transposition of the great arteries with LV outflow tract obstruction (LVOTO). From 1979 to 2001, 74 patients (D-transposition of the great arteries, n = 56; double outlet right ventricle, n = 18) underwent the Rastelli procedure. In group A, 46 patients underwent the Rastelli procedure with VSD enlargement, and in group B, 28 patients underwent the Rastelli procedure without enlargement. There were no hospital deaths. Actuarial survival at 20 years was 80% in group A and 91% in group B (P = 0.50). Freedom from reoperations at 20 years was 40.1% in group A and 52.0% in group B. Reoperations for LVOTO were performed in 2 patients in both groups. In postoperative catheterization, LV ejection fraction in group A was 57.1% ± 8.7% vs 57.2% ± 8.1% in group B (P = 0.97); LV end-diastolic volume, 150.0% ± 47.2% vs 142.0% ± 36.9% of the normal volume (P = 0.97). In long-term postoperative echocardiography, the pressure gradient of the LV to the aorta was 12.0 ± 12.8 vs 17.7 ± 26.0 mm Hg in groups A and B (P = 0.31). There were no differences between the groups regarding basal rhythms, anti-arrhythmic agents, and pacemaker implantation rate. VSD enlargement in the Rastelli procedure can be safely performed without early mortality and with long-term low mortality and morbidity regarding arrhythmia, LV function, and reoperation for late LVOTO. VSD enlargement should be considered as an option for avoiding long-term LVOTO.

Elevation of arginine vasopressin levels following loop diuretic therapy as a prognostic indicator in heart failure.

ObjectiveTo investigate the association between arginine vasopressin (AVP) levels and loop diuretic (LD) therapy in patients with heart failure and to determine if AVP levels are a prognostic indicator of treatment failure.MethodsPatients with stable heart failure and reduced (< 40%) left ventricular ejection fraction (LVEF) were divided into those treated with (LD) or without LD (NLD). The LD group was separated into subgroups of high (> 6.5 pg/dl) and low (≤ 6.5 pg/dl) AVP levels. The clinical and biochemical characteristics of the two groups were compared and the prognostic value of AVP levels in heart failure evaluated.ResultsOf the 63 patients enrolled into the study, 41 (65.1%) were in the LD group and 22 (34.9%) were in the NLD group. Despite no differences between groups in LVEF, creatinine clearance, or brain natriuretic peptide, the LD group had significantly higher AVP levels compared with the NLD group. A Cox proportional-hazards model showed that AVP was an independent predictor of adverse events. In addition, the elevation in AVP in the LD group was inversely correlated with an increase in free water clearance but not serum osmolality and was related to poor outcome.ConclusionsElevated AVP levels in patients with heart failure who received LD therapy were associated with a poor prognosis. Loop diuretics may induce non-osmolar AVP release, which can worsen heart failure.

Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with coronary artery disease.

The prognosis of hypertensive patients with reduced left ventricular ejection fraction (LVEF) is poorer than that with normal LVEF. The influence of LVEF on blood pressure (BP)-lowering therapy remains unclear. The aim of this study was to clarify the impact of LVEF on clinical outcomes of BP-lowering therapy in hypertensive patients with coronary artery disease (CAD). This study was a post hoc analysis from Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease trial, a total of 2049 hypertensive patients with CAD were included. We analyzed 1849 patients with available LVEF data on enrollment. They were divided into three groups based on LVEF; reduced (<45%, n = 386), intermediate (45-55%, n = 524), and preserved (>55%, n = 999). The 'achieved SBP' was defined as the mean value of SBP in patients who did not experience major adverse cardiac events (MACE) and the mean value of SBP prior to MACE in those who experienced MACE. During a median follow-up period of 4.2 years, MACE rates were 30.6, 27.6, and 24.0% in the reduced, intermediate, and preserved LVEF groups, respectively. A J-shaped association between achieved SBP and MACE was observed only in the preserved LVEF group [hazard ratio of MACE in patients with lower SBP (achieved SBP < 120 mmHg) was 1.81 (1.13-2.90) compared to reference SBP patients (120 < achieved BP < 130 mmHg)], but not in the reduced or intermediate LVEF groups. In hypertensive patients with CAD, the goal of BP-lowering therapy should consider LVEF status.

Dynamic changes in left ventricular function after a percutaneous coronary intervention

To estimate the prevalence, identify predictors, and assess the prognostic implications of left ventricular ejection fraction (LVEF) changes after an elective percutaneous coronary intervention (PCI). We included all consecutive patients who underwent elective PCI in our institution and were evaluated with echocardiography before and within 1 year of the procedure. Patients were grouped in terms of baseline LVEF. Hazard ratios (HRs) for all-cause mortality and acute myocardial infarction were calculated for baseline LVEF groups and in terms of LVEF normalization or decline. A total of 974 patients were included. Patients with moderately impaired (HR 1.41, P=0.01) and poor LVEF (HR 2.44, P<0.001) had significantly worse survival in comparison with patients with good LVEF. Decline from preserved to impaired LVEF following PCI was associated with an increased 1-year risk (HR 3.48, P<0.001) and 5-year risk (HR 2.79, P<0.001) for the composite outcome of all-cause mortality and acute myocardial infarction. LVEF recovery from impaired to preserved was associated with a decreased 5-year risk for the composite outcome (HR 0.5, P<0.001). Changes in LVEF after elective PCI occur often. Both higher baseline LVEF and post-PCI LVEF normalization are associated with improved outcomes.

Long-term Clinical Outcomes in Acute Myocardial Infarction Patients with Left Ventricular Dysfunction

Objective: The purpose of this study was to define the effect of the changes of left ventricular ejection fraction (LVEF) on long-term major adverse cardiac events (MACEs) in patients with acute myocardial infarction (AMI). Methods: Clinical analysis was performed on 1,188 AMI patients who completed follow- up 2-dimensional (2D) echocardiography after one year and clinical follow-up for 5 years. These patients were divided into three groups according to the LVEF change ratio: group A [increased LVEF change ratio, N=626], group B [decreased LVEF change ratio<20%, N=414], group C [decreased LVEF change ratio≥20%, N=148]. Results: Initial low LVEF group and normal LVEF group showed no differences in MACEs. The mean initial and follow-up LVEF were 54.4±12.2% and 60.4±12.3% in the group A, 54.6±13.0% and 47.9±12.1% in the group B, and 56.5±12.6% and 39.9±11.6% in the group C (p=0.71). Total MACEs occurred in 62 (9.9%) patients in the group A, 83 (20.0%) patients in the group B, 44 (29.7%) patients in the group C during 5-year clinical follow-up (p=0.01). Initial low EF (<45%) was not a risk factor for long-term MACEs (Odd ratio (OR), 1.686; 95% confidence index (CI), 0.861-2.862, p=0.065), but the LVEF change ratio was a strong risk factor for long-term MACEs (OR, 3.731; 95% CI, 2.039-6.828, p=0.001). MACE-free survivals of patients with initial low LVEF and patients with low LVEF during follow-up period showed no significant differences (p=0.731). Conclusion: Initial low LVEF is not a predictor of long-term MACEs, but the decreased LVEF ratio during follow-up period is a strong predictor of long-term MACEs. (J Lipid Atheroscler 2016 June;5(1):37-47)

Analysis of left ventricular systolic function in patients with isolated ventricular noncompaction by cardiac MRI

Objective To compare cardiac magnetic resonance imaging (MRI) features between patients with normal and decreased left ventricular (LV) systolic function in isolated ventricular noncompaction (IVNC) and to analyze the related factors of LV systolic function. Methods In a retrospective blinded study, 62 IVNC patients were divided into two subgroups: those with normal LV systolic function [LV ejection fraction (LVEF) ≥55%) ] and those with decreased LV systolic function (LVEF< 55%). A total of 30 healthy volunteers were enrolled as controls. The LVEF, LV volume, number of non-compacted segments, ratio of non-compacted to compacted myocardium (NC/C ratio) , and delayed enhancement were assessed using cardiac MRI. One-way analysis of variance, independent t test and χ2 test were used. The correlation between LVEF and the number of non-compacted segments or NC/C ratio were calculated with Spearman and Pearson correlation analysis. Results The LVEF of patients with normal LVEF [ (58.8±3.8) %] and patients with decreased LVEF [ (31.1±11.1) %] were less than that of control group [ (66.1±6.0) %], which demonstrated significant differences (F=140.789, P 0.05). The patients with decreased LVEF had significantly greater LV volume compared with patients with normal LVEF and control group (P<0.05). The number of non-compacted segments in patients with decreased LVEF (7.5±1.0) was more than that of the patients with normal LVEF (5.6± 1.0) , and the NC/C ratio in patients with decreased LVEF (4.4±0.9) was higher than that of patients with normal LVEF (3.4±0.7) , which demonstrated significant differences (t=7.248, 4.472, P<0.01). There was significant difference in the rate of delayed enhancement between patients with decreased LVEF (18/42) and patients with normal LVEF (1/20) (χ2=9.136, P<0.01). The non-compacted segments were more common in apex, apical and mid lateral segments in two IVNC groups, and there were no involvement of basal septal, mid septal and mid inferior segments. Some basal segments were involved in patients with decreased LVEF, while there were no basal segments involved in patients with normal LVEF. The number of non-compacted segments and NC/C ratio were correlated negatively with LVEF (r=- 0.690, - 0.591, respectively,P<0.01). Conclusions The dilation, remodeling and myocardial delayed enhancement of LV in IVNC patients can lead to decreased LV systolic function. In addition, the extent and severity of non-compacted myocardium in IVNC patients are correlated negatively with LVEF. Key words: Cardiomypathies; Ventricular dysfunction, left; Magnetic resonance imaging

Which can predict left ventricular size and systolic function: cardiothoracic ratio or transverse cardiac diameter.

The aim of this study is to investigate the association between the cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), and left ventricular (LV) size and systolic function in patients with or without preserved LV ejection fraction (LVEF). A total of 181 subjects suspected with coronary artery disease underwent chest radiography (CR) and dual source computed tomography coronary angiography (DSCT-CA). TCD and CTR were derived from CR. The LV size and systolic function parameters, such as LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LVEF were measured from DSCT-CA. The association between TCD, CTR and LV size and systolic function parameters were analyzed according to LVEF value (< 55%, depressed LVEF group; versus ≥ 55%, preserved LVEF group). Both TCD and CTR were higher in the depressed LVEF group compared with the preserved LVEF group. Significant correlations were found between TCD, CTR and LVEDV, LVESV, LVEF in depressed LVEF group. However, there was no significant association detected between CTR and LV size and systolic function parameters in preserved LVEF group. Both the LVEDV and LVESV showed a positive correlation with TCD in preserved LVEF group. Although CTR was not a reliable indicator of LV size and systolic function in patients with preserved LVEF, it was correlated with LV size and LVEF in depressed LVEF patients. Furthermore, TCD showed stronger correlations with LV size and systolic function even in patients with preserved LVEF.