Left Ventricular Ejection Fraction In Patients Research Articles

7.19 Utility of trimetazidine in detection of myocardial viability and improvement of left-ventricular ejection fraction in patients with coronary artery disease and poor left-ventricular function

7.19 Utility of trimetazidine in detection of myocardial viability and improvement of left-ventricular ejection fraction in patients with coronary artery disease and poor left-ventricular function

Long-term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation.

This study sought to determine the long-term follow-up, safety, and efficacy of radiofrequency catheter ablation of patients with the permanent form of junctional reciprocating tachycardia (PJRT). We assessed the reversibility of tachycardia induced LV dysfunction and we detailed the location and electrophysiological characteristics of these retrograde atrioventricular decremental pathways. PJRT is an infrequent form of reciprocating tachycardia, commonly incessant, and usually drug refractory. The ECG hallmarks include an RP interval > PR with inverted P waves in leads II, III, a VF, and V3-V6. During tachycardia, retrograde VA conduction occurs over an accessory pathway with slow and decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long-lasting and incessant tachycardia may result in tachycardia induced severe ventricular dysfunction. We included 36 patients (13 men, 23 women, mean +/- SD, aged 44 +/- 22 years) with the diagnosis of PJRT. Seven patients had tachycardia induced left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during ventricular pacing or during reciprocating tachycardia. All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented with depressed LV function. Radiofrequency ablation was performed in 36 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 32 patients (88%), right mid-septal in 2 (6%), right posterolateral in 1 (3%), and left anterolateral in 1 (3%). Thirty-five accessory pathways were successfully ablated with a mean of 5 +/- 3 applications. A mid-septal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (range 1-64) 34 patients are asymptomatic. There were recurrences in 8 patients after the initial successful ablation (mean of 1.2 months), 5 were ablated in a second ablation procedure, 2 patients required a third procedure, and 1 patient required four ablation sessions. All patients with LV dysfunction experienced a remarkable improvement after ablation. Mean preablation LV ejection fraction in patients with tachycardiomyopathy was 28% +/- 6% and rose to 51% +/- 16% after ablation (P < 0.02). Our study supports the concept that radiofrequency catheter ablation is a safe and effective treatment for patients with PJRT. Radiofrequency ablation should be the treatment of choice in these patients because this arrhythmia is usually drug refractory. The majority of accessory pathways are located in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of LV dysfunction.

Normal Left Ventricular Ejection Fraction in Older Persons With Congestive Heart Failure

To investigate in older patients with congestive heart failure (CHF) associated with prior myocardial infarction or hypertension the relationship between normal left ventricular (LV) ejection fraction and age, gender, hypertension, prior myocardial infarction, and atrial fibrillation. A prospective study was performed in 572 older patients (age >60 years) with CHF associated with prior myocardial infarction or hypertension and technically adequate two-dimensional echocardiograms for measuring LV ejection fraction. A long-term health-care facility. One hundred seventy-seven men and 395 women, mean age 82+/-8 years, with CHF associated with prior myocardial infarction or hypertension. Normal LV ejection fraction (> or = 50%) occurred in 66 of 177 men (37%) and in 221 of 395 women (56%) (p<0.0001). Multiple logistic regression analysis showed that independent risk factors for normal LV ejection fraction in patients with CHF were no prior myocardial infarction (p=0.0001; odds ratio=3.048), female gender (p=0.0004; odds ratio=1.978), and age (p=0.016; odds ratio=1.029). Normal LV ejection fraction occurred in 50% of 572 older patients with CHF associated with prior myocardial infarction or hypertension. Independent risk factors for normal LV ejection fraction in patients with CHF were no prior myocardial infarction, female gender, and age.

Abnormal left ventricular ejection fraction response to mental stress and exercise in cardiomyopathy

A decline in left ventricular (LV) ejection fraction in response to mental stress and exercise is regarded as an indicator of myocardial ischemia. In patients with LV dysfunction, the ejection fraction is sensitive to afterload, which increases during stress. Thus, the effects of mental stress and exercise on LV systolic function in patients with cardiomyopathy were examined. The ambulatory nuclear VEST (Capintec, Inc., Ramsey, N.J.) was used to monitor LV ejection fraction in patients with cardiomyopathy (10 idiopathic and 9 ischemic). Patients underwent a series of mental stress tests (serial 7s, Stroop color, and Paced auditory addition) and treadmill exercise. Heart rate, systolic blood pressure, and LV ejection fraction were measured. Mental stress and exercise increased heart rate and systolic blood pressure. For idiopathic cardiomyopathy, LV ejection fraction decreased during serial 7s, Stroop color, Paced auditory addition and exercise by -8% +/- 6%, -7% +/- 5%, -7% +/- 3%, -9% +/- 10%, respectively. For ischemic cardiomyopathy, LV ejection fraction declined by -4% +/- 3%, -7% +/- 5%, -6% +/- 3%, -2% +/- 6% during the same stress tests. There was no difference between the idiopathic and ischemic groups. Each patient showed a 5% or greater decline in LV ejection fraction during one mental stress test. There was an inverse relation between changes in LV ejection fraction and systolic blood pressure during all mental stress tests and exercise (r = -0.47, p < 0.0001). In patients with depressed baseline systolic function, the decline in systolic function during mental stress and exercise could be related in part to increases in LV afterload.