Left Ventricular Systolic Index Research Articles

Addressing Functional Mitral Regurgitation in Dilated Cardiomyopathy: A Focus on Myocardial Segment Resynchronization Through Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) has emerged as a pivotal intervention in reducing functional mitral regurgitation (FMR), not only by enhancing global left ventricular (LV) systolic function but also by refining local myocardial synchronization. This studyhypothesized that CRT-mediated synchronization of myocardial segments, particularly between papillary muscles, reduces FMR further, independent of the improvement of the LV systolic indices. Eighteen patients with dilated cardiomyopathy and biventricular pacing were evaluated. Measurements included the rate of rise in LV systolic pressure (LV dP/dt), asynchrony indices, transmitral pressure differences, mitral regurgitation quantification and diastolic filling times during pacing and with pacemaker interruption. As LV dP/dt decreased while the pacemaker was interrupted, dobutamine infusion was administered to restore LV dP/dt to pacing levels.All parameters were reassessed to evaluate the impact of myocardial resynchronization on FMR, independent of LV systolic performance. Results: LV dP/dt significantly decreased in 10 patients after pacemaker interruption (838±190 vs 444±72, p<0.01), with no significant change in eight patients (603±134 vs 592±156, p=0.679). Despite similar LV performance indices, biventricular pacing led to a statistically significant reduction in both effective regurgitant orifice area and regurgitant volume across all patients (p<0.001 and p=0.003, respectively). CRT significantly reduces FMR in dilated cardiomyopathy patients with intraventricular delay independent of improvements in LV systolic performance indicators by resynchronization of the LV segments underlying the papillary muscles. Moreover, it may be the main determinant of the reduction in FMR in CRT, underscoring the need for further research into its mechanisms and therapeutic implications.

Cardiac Dysfunction Indices and Their Prognostic Value in Acute Exacerbation COPD Patients

Introduction: The aims of this study were to characterize the left ventricular dysfunction in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the role of the echocardiographic and biochemical cardiac dysfunction indices in predicting clinical outcome. Materials and Methods: This prospective cohort study was carried out on 37 AECOPD patients. Demographic and routine laboratory data were recorded. Clinical data; arterial blood gases; brain natriuretic peptide (BNP); echocardiographic examination including left ventricular (LV) systolic function, mitral valve E wave, mitral valve septal e′, E/e′ ratio (E/e′ ratio as the study LV diastolic dysfunction Index), and tricuspid annular plane systolic excursion were measured on admission and on discharge. Patients’ standard spirometric reports were cited. The patients were followed up in the intensive care unit till discharge. Results: There were high E velocities and E/e′ ratios (>14) on admission with significant improvement on discharge, whereas there were insignificant changes in LV systolic function and internal dimensions. About 51.4% of participant had BNP level between 100 and 500 pg/mL. Multivariate analysis showed that both admission BNP and E/e′ ratio were independent predictor of length of stay (R2 = 88.4% and P = .000, R2 = 98.1% and P = .000), and E/é ratio and tricuspid annular plane systolic excursion were independent predictors of elevated BNP (R2 = 0.930, P = .000, P = .009, respectively). None of the COPD obstructive values, admission hemodynamic parameters, and LV systolic indices had a significant impact. Reciever operating characteristic curve (ROC) analysis showed that BNP level >311 pg/mL and E/e′ ratio >15.3 were the significant predictive values for length of stay. Discussion: Most of the AECOPD patients had impaired LV diastolic function and elevated BNP levels that improved after control of the exacerbation. We recommend the use of BNP and E/e′ ratio to risk stratify the AECOPD patients.

Effects of HIV Infection on Pulmonary Artery Pressure in Children

Pulmonary hypertension may complicate human immunodeficiency virus (HIV) infection and result in right ventricular (RV) failure and premature death. There are limited data of the effects of childhood HIV infection or antiretroviral therapy (ART) on pulmonary artery pressure (PAP). To establish if there is an association between childhood HIV infection or its treatment and pulmonary artery pressure. The study conducted a cross-sectional study of 102 HIV-infected (48 ART-naïve, 54 ART-exposed) and 51 HIV-uninfected children in Jakarta, Indonesia, to estimate PAP using echocardiography parameters: tricuspid regurgitation peak velocity (TRV), left ventricular systolic index and diastolic eccentricity index (EI), and RV systolic function, assessed by tricuspid annulus plane systolic excursion. The association between either ART-naive or ART-exposed HIV and PAP was explored using general linear modelling adjusted for potential confounders. ART-exposed HIV-infected children had higher TRV (adjusted difference: 0.36 m/s; 95% confidence interval [CI]: 0.12 to 0.60; p= 0.003) and diastolic EI (adjusted difference 0.06; 95% CI: 0.01 to 0.11; p= 0.02) than did uninfected children. The EI in ART-exposed children was significantly higher than normal. ART-naive HIV-infected children had a lower tricuspid annulus plane systolic excursion (adjusted difference: -2.2 mm; 95% CI: -3.73 to -0.71; p= 0.004), despite no difference in TRV (adjusted difference: 0.18 m/s; 95% CI: -0.06 to 0.43 m/s; p= 0.14). Seven (13%) ART-exposed and 4 (8.3%) ART-naïve HIV-infected children had pulmonary hypertension. Within-HIV group comparisons showed that accounting for lower respiratory tract infections attenuated the lower RV systolic function in ART-naïve children but not in ART-exposed children (difference: -1.1 mm; 95% CI:-2.8 to 0.7 mm; p= 0.22), but not the higher left ventricular eccentricity indexes in the ART-exposed children (systolic difference: 0.07; 95% CI: 0.02 to 0.12; p= 0.007; diastolic difference: 0.08; 95% CI: 0.02 to 0.14; p= 0.006). ART-exposed HIV infection is associated with higher estimated PAP. Reduced RV systolic function is seen in ART-naïve HIV infection. Lower respiratory tract infection partly explains lower systolic RV function in ART-naïve relative to ART-exposed HIV infection.

Quantifying longitudinal right ventricular dysfunction in patients with old myocardial infarction by using speckle-tracking strain echocardiography

BackgroundWe investigated longitudinal right ventricular (RV) function assessed using speckle-tracking strain echocardiography in patient with myocardial infarction (MI), and identified the contributing factors for RV dysfunction.MethodsWe retrospectively studied 71 patients with old MI (the OMI group) and 45 normal subjects (the Control group) who underwent a transthoracic echocardiography. Global and free wall RV peak systolic strains (PSSs) in the longitudinal direction were measured by using speckle-tracking strain echocardiography. Left ventricular (LV) PSSs were measured in the longitudinal, radial and circumferential directions. Cardiac hemodynamics including peak systolic pulmonary artery pressure was also assessed non-invasively. Plasma brain natriuretic peptide (BNP) levels were measured in all patients.ResultsIn the OMI group, 73% of the patients had a normal estimated peak systolic pulmonary artery pressure of less than 35 mmHg. Global and free wall RV PSS were impaired in the OMI group compared with the Control group, and these RV systolic indices were significantly associated with heart rate, logarithmic transformed plasma BNP, greater than 1 year after onset of MI, Doppler-derived estimated pulmonary vascular resistance, LV systolic indices, LV mass index, infarcted segments within a territory of the left circumflex artery and residual total occlusion in the culprit right coronary artery. Multivariable linear regression analysis indicated that reduced longitudinal LV PSS in the 4-chamber view and BNP levels ≥500 pg/ml were independently associated with reduced global and free wall RV PSS. Moreover, when patients were divided into 3 groups according to plasma BNP levels (BNP <100 pg/ml; n = 31, 100 ≤BNP <500 pg/ml; n = 24, and BNP ≥500 pg/ml; n = 16), only patients with BNP ≥500 pg/ml had a strong correlation between RV PSS and longitudinal LV PSS in the 4-chamber view (r = 0.78 for global RV PSS and r = 0.71 for free wall RV PSS, p <0.05).ConclusionLongitudinal RV systolic strain depends significantly on longitudinal LV systolic strain especially in patients with high plasma BNP levels, but not on estimated peak systolic pulmonary artery pressure. These results indicate that process of RV myocardial dysfunction following MI may be governed by neurohormonal activation which causing ventricular remodeling rather than increased RV afterload.

Evaluation of Systolic Properties in Hypertensive Patients With Different Degrees of Diastolic Dysfunction and Normal Ejection Fraction

Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD. We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease. A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DD (DR, PN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P < 0.0001) and stroke work (SW) (P < 0.0001), EF (P < 0.01), midwall shortening (MFS) (P < 0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P < 0.001), and tissue Doppler (TD) systolic velocity (P < 0.0001) as compared to the N group, particularly the PN group.After adjustments, the reductions of LV systolic indexes were still significantly related to DD, particularly to PN. Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DD, which is related to the degree of dysfunction.

The Insulin Gradient Phenomenon: A Manifestation of the Effects of Body Weight on Blood Pressure and Insulin Resistance

The relationship between hyperinsulinemia and hypertension is frequently observed in overweight patients; however, population studies have not confirmed an independent association. A population study was conducted to assess whether differences in body mass index and levels of insulinemia modify cardiovascular hemodynamics and arterial pressure. In all, 322 healthy adults underwent a medical evaluation including insulin sensitivity and cardiac performance assessment with echocardiography. A direct relationship between body mass index and blood pressure (r=0.36; P<.01) was shown along with increments in fasting insulin levels. The underlying and progressive rise in insulin levels during blood pressure increase is named the insulin gradient. Left ventricular systolic indexes were significantly greater in the higher-insulin quartile. These findings suggest that body weight increases accompany a rise in systolic pressure and a drop in insulin sensitivity related to the insulin gradient. Increments in ejection fraction and cardiac output with normal total peripheral resistance are related to the blood pressure shift in these persons.

Correlation of echocardiography parameters with cardiac magnetic resonance imaging in transfusion‐dependent thalassaemia major

Heart iron load (cardiac Fe) can be indirectly quantified by cardiac magnetic resonance (CMR) T2*. CMR accessibility is limited, whereas echocardiography (Echo) is relatively inexpensive and readily available. The objective was to find Echo parameters that may be useful for predicting cardiac Fe. We compared a number of parameters derived from Echo to cardiac Fe in 142 thalassaemia major patients who had undergone a CMR study. All patients with decreased left ventricular (LV) function had cardiac Fe. After removing those patients from the analysis, the total diameter index (Tdi) >5.57 cms/m2, left atrial diameter index >2.41 cm/m2, and the diastolic parameter E/A > 1.96 were highly specific (91.4%, 97.1% and 96.9% respectively) but had low sensitivity (31.8%, 20.45% and 21.8%) in predicting iron load. A right ventricular index >1.47 cm/m2, LV systolic index >2.26 cm/m2 or Tdi >6.26 cm/m2 discriminated between patients with no, or mild to moderate cardiac Fe from those with heavy load, with specificity of 91%, 98.5%, and 98.5%, respectively, but with low sensitivity. Echo parameters for cardiac Fe prediction have restricted value, whereas CMR is essential to assess cardiac Fe. However, patients with decreased LV systolic function should be considered a priori as having cardiac Fe, and chelation therapy should be intensified. This also applies to patients who have the above-described Echo criterion values, even if CMR is not available. Once a patient is found by CMR to have cardiac Fe, then the above Echo criterion values may be useful for ongoing monitoring.

Prognostic Importance of Wall Motion Abnormalities in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter-Defibrillator

Patients with extensive regional wall motion abnormalities are predisposed to development of ventricular tachyarrhythmia. The prognostic effect of this in patients with an implantable cardioverter-defibrillator (ICD) and coronary artery disease (CAD) is not known. Echocardiographic left ventricular systolic indexes, wall motion score index (WMSI), and extent of regional akinesia in 140 patients (65 +/- 10 years old; 92% men) with an ICD and CAD were studied. Arrhythmic events requiring ICD therapy and causing death (n = 41, 29%) were recorded over a mean follow-up of 1.4 +/- 0.8 years. Left ventricular basal fractional shortening, ejection fraction, global WMSI, and extent of akinesia, especially in the inferoposterior regions of a right coronary artery territory, were univariate predictors (all p values <0.05). Global WMSI (hazard ratio 2.18, 95% confidence interval 1.03 to 4.65, p = 0.04) and fractional shortening (hazard ratio 0.93, 95% confidence interval 0.88 to 1.00, p = 0.04) were multivariate predictors. Global WMSI (p = 0.04) and > or =2 right coronary region akinetic segments (p = 0.05) provided incremental risk prediction to left ventricular ejection fraction in a global risk-assessment model (chi-square p = 0.001). Presence of right coronary region akinesia better identified those at increased risk of events (p = 0.02) compared with the presence of left anterior descending region akinesia (p = 0.2), independent of systolic function. In conclusion, global WMSI and left ventricular basal fractional shortening were important additional risk predictors of ICD events in CAD. Global WMSI and right coronary region inferoposterior akinesia provided independent and incremental risk assessment to left ventricular ejection fraction and improved identification of those at increased risk of ICD-related events in patients with ischemic cardiomyopathy.

Impact of Doppler-derived left ventricular diastolic performance on exercise capacity in normal individuals

Doppler-derived left ventricular (LV) diastolic indexes have been shown to correlate with exercise capacity in patients with heart diseases as well as healthy individuals. However, it is uncertain whether they predict exercise capacity independent of noncardiac factors. To clarify the impact of the LV diastolic index on exercise capacity, 160 healthy individuals were investigated. All underwent Bruce protocol treadmill stress testing and 2-dimensional and Doppler echocardiography. Estimated metabolic equivalent was calculated from exercise time (metabolic equivalent = 1.11 + 0.016 x exercise time). Diastolic performance was assessed by Doppler transmitral flow velocity pattern. Pulmonary function tests and complete blood cell count were also performed. LV diastolic indexes correlated well with metabolic equivalent (peak transmitral filling velocity (A): r = -0.51, P <.0001; ratio of early and late transmitral filling velocities (E/A): r = 0.58, P <. 0001). However, there was no significant correlation between LV systolic indexes and metabolic equivalent. Independent predictors for a higher metabolic equivalent by multivariate analysis were higher E/A (P <.0001), higher vital capacity (P =.001), smaller body mass index (P =.0003), younger age (P =.0050), and higher hemoglobin concentration (P =.0026). Doppler-derived LV diastolic index may help in predicting exercise capacity in normal individuals independent of other cardiac and extracardiac factors.

The effects of cardioversion and defibrillation on left ventricular systolic function.

The purpose of this research was to evaluate the left ventricular systolic function behavior after cardioversion and defibrillation. The study included 18 adult patients who had direct current cardioversion or defibrillation performed for conversion of spontaneous or induced arrhythmias. All patients were submitted to a careful medical evaluation and an M-mode echocardiogram before cardioversion or defibrillation. The clinical and echocardiographic evaluations were repeated immediately after, and 6 and 12 h following the countershock. Six hours after cardioversion or defibrillation a statistically significant (p = .04) decrease in contractility (circumferential fiber shortening and ejection fraction) was observed without significant changes in preload (end diastolic volume), heart rate or afterload (end systolic stress and diastolic arterial pressure). Within 12 h, the left ventricular systolic dysfunction disappeared. The impairment of systolic function was independent of the amount of energy used, the type of arrhythmia, the rhythm after cardioversion or defibrillation and the etiologic cardiac diagnoses. There was a significant (p = .03) direct, negative and linear correlation between left ventricular systolic indices (ejection fraction and circumferential fiber shortening) before the countershock and the amount of decrease in systolic function after the countershock. In spite of the fact that most patients had a low ejection fraction, none of them presented clinical signs of heart failure. Defibrillation and cardioversion produce a transient decrease in cardiac contractility which is independent of the amount of energy used and does not produce clinical signs of heart failure.

Left ventricular volume characteristics in children with tricuspid atresia before and after surgery

Left ventricular volume variables (left ventricular end-diastolic volume, ejection fraction, mass and systolic output) were quantified in (1) 13 patients with tricuspid atresia preoperatively (type Ia, 3 patients; type Ib, 9 patients; type IIb, 1 patient), (2) 4 patients after a shunt procedure (Blalock-Taussig, 3; Glenn, 1), and (3) 1 patient after corrective surgery. Cardiac catheterization and angiography were performed at age 1 month to 5.8 years (mean 1.4 years). All patients had decreased pulmonary blood flow. The results were compared with data in 15 patients with no significantly greater than normal in 12 of the 13 patients. Left ventricular mass was significantly greater than normal, but ejection fraction was significantly less than normal. There was a positive correlation between ejection fraction and systemic oxygen saturation. Left ventricular systolic index was normal in 9 of the 13 patients preoperatively. After a shunt procedure, left ventricular end-diastolic volume and systolic index increased significantly in all four patients, and ejection fraction improved greatly in three of the four. After corrective surgery, left ventricular end-diastolic volume and left ventricular systolic index returned to the normal range and left ventricular ejection fraction improved. These findings suggest that patients with tricuspid atresia have impaired left ventricular function.

Left heart volume and mass quantification in children with left ventricular pressure overload.

This investigation was designed to quantify left ventricular and left atrial volume, volume change, systolic output, and ventricular mass in 31 patients with isolated left ventricular pressure overload secondary to aortic stenosis (AS, n = 14) or coarctation of the aorta (n = 17). These parameters were compared with normal standards and with data from a group of nine patients with a combined pressure and volume overload due to aortic stenosis plus aortic or mitral insufficiency (AS + AI or MI). Volumes were calculated from biplane cineangiocardiograms exposed at 60 frames/sec. Left ventricular end-diastolic volume (LVEDV) was significantly lower than normal in patients with AS (57 ± 11 cc/m 2 ), but was normal (73 ± 12 cc/m 2 ) in patients with coarctation. An increase in the ejection fraction (LVEF) was found in both groups averaging 0.73 ± 0.12 in AS patients and 0.69 ± 0.09 in coarctation patients. Patients with AS + aortic or mitral insufficiency (AI or MI) showed elevated LVEDV (103 ± 29 cc/m 2 ), but had a normal ejection fraction. The LV mass was significantly increased in all groups: normal, 82 ± 10 g/m 2 ; AS, 126 ± 41 g/m 2 ; coarctation, 130 ± 44 g/m 2 ; and AS + AI or MI, 168 ± 42 g/m 2 . The left ventricular systolic index and left atrial maximal volume were both normal in patients with pure pressure overload but were significantly increased in patients with combined pressure and volume overload. The low LVEDV in patients with AS as well as the normal volume in patients with coarctation occurred in the presence of elevated LV end-diastolic pressure and indicates a decrease in LV diastolic distensibility in patients responding to an isolated LV pressure overload by significant muscular hypertrophy without dilatation.