Ventricular Volume Index Research Articles

Pressure-derived collateral flow index: a strong predictor of late left ventricular remodeling after thrombolysis for acute myocardial infarction

Despite proved efficacy of pressure-derived collateral flow index in determining microvascular dysfunction in patients with acute myocardial infarction, its role in prediction of left ventricular remodeling at long term has yet to be demonstrated. In this study, we investigated the relationship between quantitatively assessed microvascular dysfunction by using intracoronary pressure wire and late left ventricular remodeling. The study population consisted of 28 patients with first acute myocardial infarction. They were treated with fibrinolytic therapy. The inclusion criteria were thrombolysis in myocardial infarction grade II-III flow in infarct-related artery and all destined for stent implantation. Cardiac catheterization and stent implantation were performed in mean of 3.3 days after acute myocardial infarction. During the stent implantation procedure, the pressure-derived collateral flow index was measured by using intracoronary pressure wire. Control angiograms were performed at 6+/-2 months. Echocardiographic left ventricular volume indexes were measured at discharge, at 6 months and at 1 year. Changes in left ventricular volumes from baseline to 1 year were followed. Left ventricular end-diastolic volume index at 1 year correlated significantly with the pressure-derived collateral flow index (r=0.69, P<0.01). A significant correlation was also observed between the change in left ventricular end-diastolic volume index from baseline to 1 year and the pressure-derived collateral flow index (r=0.65, P<0.01). The most important predictor of 1-year left ventricular remodeling was the pressure-derived collateral flow index (P<0.0001), and collateral circulation (P=0.03). The pressure-derived collateral flow index is a powerful independent predictor of 1-year left ventricular dilatation. Given its simplicity of measurement, and correlation with microvascular obstruction and left ventricular outcome at long term, the pressure-derived collateral flow index may provide useful and valuable estimates of clinical outcomes after acute myocardial infarction.

Normalized Left Ventricular Volumes and Function in Thalassemia Major Patients with Normal Myocardial Iron.

Repeated blood transfusions in Thalassemia Major (TM) may lead to myocardial iron accumulation and death. Left ventricular (LV) function is commonly used to assess for iron overload, however, the reference range in TM for these variables in the absence of myocardial iron loading is not known. We used cardiovascular magnetic resonance (CMR) in 205 TM patients and studied those (N=81) with normal myocardial T2* measurements (T2*>20ms) and by inference without excess myocardial iron. Resting LV volumes and function normalized to body surface area were compared with 40 age and gender matched healthy controls. All LV parameters were significantly different (p<0.05) in TM patients (see tables 1 and 2). The lower limit for ejection fraction was higher in TM (males 59 vs 55%, females 63 vs 59%, both P<0.001). The upper limit for end-diastolic volume index was higher in TM (males 152 vs 105 mL/m2, females 121 vs 99 mL/m2, both P<0.05). In TM the cardiac output index (P<0.001) was increased. In conclusion, at rest TM patients with normal myocardial T2* values and no excess myocardial iron loading have a hyperdynamic circulation and substantially different values for LV parameters compared with controls. Significant misdiagnosis of cardiomyopathy will result from comparison of TM patients with normal ranges.LV Parameters Normalized to Body Surface Area in Males.TM Patients (Mean±SD)Controls (Mean±SD)LVEDVI (mL/m2)97.2±27.284.1±10.5LVESVI (mL/m2)23.1±5.229.6±6.1LVSVI (mL/m2)70.8±15.854.4±7.1LVEF71.0±6.164.9±5.0LVMI (g/m2)84.6±20.375.0±8.4CO (L/min)9.8±3.26.8±1.5COI (L/min/m2)5.7±1.93.5±0.7LV parameters normalized to body surface area for males with mean and standard deviations divided into TM patients with no myocardial iron loading and non-anemic age matched controls. The ejection fraction is not indexed to body surface area as it does not vary significantly with body habitus. LVEDVI - left ventricular end-diastolic volume index, LVESVI - left ventricular end-systolic volume index, LVSVI - left ventricular stroke volume index, LVEF - left ventricular ejection fraction, LVMI - left ventricular mass index, CO - cardiac output, COI cardiac output index.LV Parameters Normailzed to Body Surface Area in FemalesTM Patients (Mean±SD)Controls (Mean±SD)LVEDVI (mL/m2)87.4±16.679.4±9.8LVESVI (mL/m2)20.8±7.326.1±4.7LVSVI (mL/m2)66.5±12.453.3±7.3LVEF75.1±5.967.1±4.3LVMI (g/m2)69.9±17.361.9±7.9CO (L/min)8.2±2.05.8±1.6COI (L/min/m2)5.2±1.33.4±0.8LV parameters normalized to body surface area for females with mean and standard deviations divided into TM patients with no myocardial iron loading and non-anemic age matched controls. The ejection fraction is not indexed to body surface area as it does not vary significantly with body habitus. LVEDVI - left ventricular end-diastolic volume index, LVESVI - left ventricular end-systolic volume index, LVSVI - left ventricular stroke volume index, LVEF - left ventricular ejection fraction, LVMI - left ventricular mass index, CO - cardiac output, COI cardiac output index.

Double-Blind Comparison of Full and Partial Anemia Correction in Incident Hemodialysis Patients without Symptomatic Heart Disease

It is unclear whether physiologic hemoglobin targets lead to cardiac benefit in incident hemodialysis patients without symptomatic heart disease and left ventricular dilation. In this randomized, double-blind study, lower (9.5 to 11.5 g/dl) and higher (13.5 to 14.5 g/dl) hemoglobin targets were generated with epoetin alpha over 24 wk and maintained for an additional 72 wk. Major eligibility criteria included recent hemodialysis initiation and absence of symptomatic cardiac disease and left ventricular dilation. The primary outcome measure was left ventricular volume index (LVVI). The study enrolled 596 patients. Mean age, duration of dialysis therapy, baseline predialysis hemoglobin, and LVVI were 50.8 yr, 0.8 yr, 11.0 g/dl, and 69 ml/m2, respectively; 18% had diabetic nephropathy. Mean hemoglobin levels in the higher and lower target groups were 13.3 and 10.9 g/dl, respectively, at 24 wk. Percentage changes in LVVI between baseline and last value were similar (7.6% in the higher and 8.3% in the lower target group) as were the changes in left ventricular mass index (16.8 versus 14.2%). For the secondary outcomes, the only between-group difference was an improved SF-36 Vitality score in the higher versus the lower target group (1.21 versus -2.31; P = 0.036). Overall adverse event rates were similar in both target groups; higher (P < 0.05) rates of skeletal pain, surgery, and dizziness were seen in the lower target group, and headache and cerebrovascular events were seen in the higher target group. Normalization of hemoglobin in incident hemodialysis patients does not have a beneficial effect on cardiac structure, compared with partial correction.

Technique and outcome of mitral valve replacement in dogs

Eight dogs with naturally occurring severe mitral regurgitation underwent mitral valve replacement with a mechanical valve prosthesis during cardiopulmonary bypass. Dogs received warfarin orally after surgery to maintain a prothrombin time-based international normalized ratio from 2.5 to 3.5. Seven dogs survived surgery. Left ventricular diastolic volume index decreased significantly from 206 +/- 91 mL/m2 before surgery to 121 +/- 47 mL/m2 after surgery. Left atrium-to-aorta ratio decreased significantly from 2.66 +/- 0.4 before surgery to 1.73 +/- 0.65 after surgery. Left ventricular systolic volume index was not significantly different after surgery (56 +/- 36 mL/m2), compared with before surgery (40 +/- 32 mL/m2). Median survival after surgery was 4.5 months (range, 0.75 months to 5.25 years). Six dogs died of confirmed or suspected thrombosis of the valve prosthesis. Dogs with severe mitral regurgitation tolerated mitral valve replacement well, but a high incidence of prosthetic valve thrombosis limited long-term outcome.

Differentiation of Athlete's Heart from Pathological Forms of Cardiac Hypertrophy by Means of Geometric Indices Derived from Cardiovascular Magnetic Resonance

Determination of the underlying etiology of left ventricular hypertrophy (LVH) is a common, challenging, and critical clinical problem. The authors aimed to test whether pathological LVH, such as occurs in hypertrophic cardiomyopathy (HCM), hypertensive heart disease, or aortic stenosis, and physiological LVH in athletes, can be distinguished by means of left ventricular volume and geometric indices, derived from cardiovascular magnetic resonance imaging. A total of 120 subjects were studied on a 1.5 Tesla MR (Sonata, Siemens Medical Solutions, Erlangen, Germany) scanner, comprising healthy volunteers (18), competitive athletes (25), patients with HCM (35), aortic stenosis (24), and hypertensive heart disease (18). Left ventricular mass index, ejection fraction, end-diastolic, end-systolic and stroke volume index, diastolic wall thickness, wall thickness ratio and diastolic and systolic wall-to-volume ratios were determined. Left ventricular (LV) mass indices were similar for all forms of LVH (p > 0.05), which were at least 35% higher than those obtained in healthy volunteers (p < 0.05). Multiple logistic regression showed that the percentage of correctly predicted diagnoses was 100% for athlete's heart, 80% for hypertrophic cardiomyopathy, 54% for aortic stenosis, and 22% for hypertensive heart disease. Using a receiver operating curve-determined cut-off value for diastolic wall-to-volume ratio of less than 0.15 mm x m2 x ml(-1), athletes' hearts could be differentiated from all forms of pathological cardiac hypertrophy with 99% specificity. Athlete's heart can be reliably distinguished from all forms of pathological cardiac hypertrophy using CMR-derived LV volume and geometric indices, but pathological forms of LVH present with overlapping cardiac hypertrophy phenotypes. This capability of CMR should be of high clinical value.

DYNAMIC OF LEFT VENTRICULAR VOLUME AFTER ACUTE MYOCARDIAL INFARCTION UNDER THERAPY WITH ACE INHIBITORS

&amp;lt;p&amp;gt;Change in left ventricular volumes, particularly end-systolic volume index is a major representative of left ventri cular dilatation, and is a predictor of mortality after acute myocardial infarction of anterior localization. Several large-scale trials have demonstrated beneficial effectiveness of ACE inhibitors on the process of left ventricular remodeling after myo cardial infarction, not only in patients with compromised systolic function. Aim of the study was to evaluate the influence of therapy for ACE inhibitors in the early faze of anterior myocardial infarction, trough dynamics of left ventricular volume in dexes. During six months 30 patients were evaluated with echocardiography in admission, before leaving the hospital, after&amp;lt;br /&amp;gt;three and six months after myocardial infarction. In evaluated group there was increased end-diastolic and end-systolic vo lume index, but without statistically significant value. There were no new cardiac decompensations. We concluded that ACE inhibitors given in the early stage of acute myocardial infarction anterior localization have beneficial effect on the process of left ventricular remodeling and that is recommended to bee given to this patients, after excluded contraindications&amp;lt;/p&amp;gt;

Regulation of Arginine Vasopressin in the Human Heart

The role of arginine vasopressin (AVP) in the heart has yet to be determined. The present study was designed to examine whether AVP is regulated in the human heart. The subjects were 93 patients who underwent coronary angiography and left ventriculography. Blood samples were collected at the aortic root (AO) and the coronary sinus (CS) to measure the plasma levels of AVP. The patients who showed increases in AVP levels at the CS and AO were assigned to the increased AVP group and those who showed no change or a decrease were assigned to the non-increased AVP group. Cardiac function was compared between these 2 groups. There was a significant difference (p<0.0234) in left ventricular end-diastolic volume index between the increased AVP group (125.5 +/-53.4 ml/m2) and the non-increased AVP group (102.2+/-30.6 ml/m2). There was also a significant difference (p<0.0137) in left ventricular stroke volume index between the increased AVP group (66.6+/-23.2 ml/m2) and the non-increased AVP group (54.4+/-18.6 ml/m2). These results suggest that both the production of AVP and synthesis with its receptors may be enhanced at regional sites of the human heart in the volume load.

Cardiac alterations in cirrhosis: reversibility after liver transplantation

Liver cirrhosis induces cardiac alterations. We aimed to define these alterations and assess their reversibility after transplantation. Cirrhotic patients (n = 40) and controls (n = 15) underwent echocardiography and stress ventriculography. Fifteen cirrhotics were reevaluated 6-12 months after transplantation. Cirrhotics had higher left ventricular wall thickness (9.6+/-1.2 vs. 8.8+/-1.2 mm; P < 0.05) and ejection fraction (73+/-6 vs. 65+/-4%, P < 0.001) than controls. Basal diastolic function was similar. During stress, cirrhotics presented lower increases of heart rate, left ventricular ejection fraction, stroke volume and cardiac index (P < 0.05 for all), and diastolic dysfunction with lower ventricular peak filling rate (P = 0.001). Exercise capacity was reduced (48+/-21 vs. 76+/-24 W; P < 0.001). Ascitic patients exhibited more diastolic dysfunction at rest and during stress compared to non-ascitic patients. Liver transplantation caused regression of ventricular wall thickness (10.2+/-1.3 vs. 9.5+/-1.2 mm; P < 0.05), improvement of diastolic function, and normalization of systolic response and exercise capacity during stress (significant increases in heart rate, ventricular ejection fraction, stroke volume and cardiac index; P < 0.05 for all). Cardiac alterations in cirrhosis present with mild increases in ventricular wall thickness, diastolic dysfunction that worsens with ascites and physical stress, and abnormal systolic response to stress limiting exercise capacity. Liver transplantation reverses these alterations.

QT–DISPERSION AND ALTERATIONS IN LEFT VENTRICULAR MASS INDICES IN KIDNEY FAILURE

A112 Aims: A prolonged QT-Dispersion is associated with an increased risk of cardiovascular mortality and can be observed in patients after a myocardial infarction. In patients with kidney failure, the incidence of a myocardial infarction is highly increased. Moreover, dialysis treatment also modulates QT dispersion. In this study, a possible relation between QT-dispersion and left ventricular volume and mass indices should be investigated. Methods: 40 hemodialysis patients (20 with and 20 without coronary heart disease) were investigated. Echocardiography as well as ECG were performed before and after hemodialysis. Results: In patients with CHD, QT-Dispersion increased from 65.45 + 16.2 (SD) ms to 84.90 + 22.25 (SD) ms (p<0.002). In patients without CHD, no significant change in QT dispersion was detected. Echocardiography examination revealed a significant change in LVED from 5.81 + 1.08 (SD) cm to 5.09 + 1.2 (SD) cm (p<0,036) as well as LVVOL (p<0,047) and LVM (p<0,007) in patients with CHD. Correlation analysis showed no significant relation between QT-Dispersion and left ventricular mass and volume indices. Conclusions: This study shows, that changes in QT-Dispersion in hemodialysis patients are independent from alterations in left ventricular mass- and volume indices. Alterations in QT dispersion, however, are associated with CHD.

Dyslipidemia, Oxidative Stress and Cardiac Dysfunction in Children with Chronic Renal Failure: Effects of L-Carnitine Supplementation

Secondary carnitine deficiency may develop in chronic renal failure (CRF) patients undergoing long-term hemodialysis (HD), with a resulting higher incidence of cardiovascular diseases, dyslipidemia and oxidative stress. We studied the efficacy of 12 months of L-carnitine supplementation on the amelioration of dyslipidemia, oxidative stress and cardiac dysfunction in 24 CRF children undergoing long-term HD compared with 24 age- and sex-matched controls. Plasma samples were analyzed spectrophotometerically before and after dialysis sessions and after 2-month supplementation with oral L-carnitine (50 mg/kg/day) for free carnitine (FC), the lipid profile, and oxidative stress markers. Echocardiography the day following dialysis measured cardiac diameters, wall thicknesses, left ventricular mass index (MI), end diastole and systole volume indices and functions. The pre-dialysis FC concentration was substantially lower than controls and decreased significantly at the end of the dialysis session. Pre- and post-dialysis plasma levels of free fatty acids (FFAs), trigyleride (TG), total cholesterol (TC) and oxidative stress markers significantly increased while high-density lipoprotein cholesterol (HDL-C) and phospholipids significantly decreased compared to controls. Echocardiography detected a significant increase in cardiac diameters and thickness, and systolic and diastolic cardiac dysfunction. After L-carnitine supplementation, plasma levels of FC increased to normal levels. FFAs, TC and HDL-C returned to control levels while TG, phospholipids, and the oxidative stress markers decreased but remained significantly higher than controls. There was a significant decrease in cardiac diameters and an increase in left ventricular diastolic function (E/A ratio), but no correlation between FC levels and echocardiographic parameters. Pre-dialysis, post-dialysis and after treatment, plasma FC level showed a significant positive correlation with HDL-C and phospholipids and a significant negative correlation with each of oxidative stress markers, FFAs, TG and TC. On the other hand, FFAs showed a significant positive correlation with TG, TC, DC, NO and a significant negative correlation with HDL-C and phospholipids. This study demonstrates that CRF children under regular HD suffer from a decrease in the level of plasma FC, dyslipidemia, oxidative stress, and an increase in cardiac diameters and thickness with impairment of cardiac functions. Oral L-carnitine supplementation at a dose of 50 mg/kg for 2 months can increase plasma FC level, improve dyslipidemia, decrease oxidative stress with reduction of cardiac diameters and increase in diastolic function.

Inducible nitric oxide synthase dimerization inhibitor prevents cardiovascular and renal morbidity in sheep with combined burn and smoke inhalation injury.

Inducible nitric oxide synthase (iNOS) is implicated in the pathogenesis of acute respiratory distress syndrome (ARDS). ARDS treatment is frequently complicated by significant extrapulmonary comorbidity. This study was designed to clarify the role of iNOS in mediating extrapulmonary comorbidity in sheep after combined burn and smoke inhalation injuries using a potent and highly selective iNOS dimerization inhibitor, BBS-2. Twenty-two female sheep were operatively prepared. After 5 days of recovery, tracheostomy was performed under ketamine-halothane anesthesia. Sheep were given a 40% total body surface third-degree burns and insufflated with cotton smoke (48 breaths, <40 degrees C). Sheep were divided into four groups: noninjured and nontreated (sham group; n = 6), noninjured but treated with BBS-2 (sham/BBS-2 group; n = 4), injured but nontreated (control group, n = 6), and injured but treated with 100 microg.kg-1.h-1 BBS-2 (BBS-2 group; n = 6). Evaluation was in a laboratory intensive care unit setting for 48 h. The sham group had stable cardiopulmonary and systemic hemodynamics. Control animals showed multiple signs of morbidity. Decreased left ventricular stroke work index and stroke volume index with elevated left atrial pressure indicated myocardial depression. Systemic vascular leak was evidenced by robust hemoconcentration, decreased plasma oncotic pressure, and increased transvascular fluid flux into the lymphatic system. Finally, severely impaired renal function (urinary output) was associated with adverse net fluid balance. Treatment with BBS-2 prevented all these morbidities without adversely effecting cardiovascular hemodynamics such as cardiac index and mean arterial pressure. The results identify a major role for iNOS in mediating extrapulmonary comorbidity in a clinically relevant and severe trauma model and support the use of highly selective iNOS inhibitors as novel treatments in critical care medicine.

Disminución de la reserva de flujo coronario en pacientes con insuficiencia cardíaca no isquémica

Coronary flow reserve (CFR) is impaired not only in ischemic heart disease, but also in cardiac diseases that may or may not course with heart failure. The aim of the present study was to determine if the severity of heart failure can influence CFR impairment. Forty patients with non-ischemic heart disease and heart failure were studied 41 times. Four groups were established: 1. 10 patients in functional class III-IV; 2. 10 patients in functional class II not taking beta-blockers; 3. 11 patients in class II treated with carvedilol, and 4. 10 patients in class I. These patients had a history of heart failure and systolic dysfunction. Myocardial blood flow (MBF) was measured with positron emission tomography (PET) and N-13 ammonia at rest (r) and during adenosine triphosphate (ATP) infusion. MBF and CFR were significantly higher in group 4 (1.95 0.58 and 2.40 0.95 ml/min/g) than in group 1 (1.02 0.52 and 1.46 0.48 ml/min/g). CFR tended to be higher in groups 2 (1.73 0.72), and 3 (1.89 0.75) vs group 1. No significant correlation was found between CFR and the following variables: age, systolic blood pressure, ventricular mass index, ventricular volume indexes, and ejection fraction. Coronary microvascular function is impaired in non-ischemic heart failure, and the impairment is related to functional class, regardless of the underlying responsible heart disease.

Effect of thrombolytic therapy on occurrence of complex ventricular arrhythmias in the late hospitalization period in acute myocardial infarct: relation with long-term remodeling of the left ventricle

The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients), underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolyzed and non-thrombolyzed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occurred that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.

Right ventricular function in patients with acute anterior myocardial infarction: tissue Doppler echocardiographic approach

Objective — Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall.Methods and results — The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.018 and 0.012) and E of RV free wall (p = 0.011) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.015) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI.TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r = -0.46, p = 0.01 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p = 0.02).Conclusion — PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.

Prediction of 6 months left ventricular dilatation after myocardial infarction in relation to cardiac morbidity and mortality. Application of a new dilatation model to GISSI-3 data.

To predict the long-term left ventricular volume index early after myocardial infarction and to investigate the relationship between long-term left ventricular dilatation risk and clinical outcome. By applying a previously developed dilatation model, we predicted the 6-month left ventricular volume index early after myocardial infarction (median 9 days) in 13,679 GISSI-3 patients, to identify patients at high risk of long-term left ventricular dilatation. The left ventricular systolic and diastolic volume indexes at 6 months were predicted with r=0.72 and r=0.68, respectively, in the subgroup of patients in whom a pre-discharge echo was available (n=7842). Patients predicted to be at risk for long-term left ventricular dilatation had an increased risk of mortality (RR 1.87, 95% CI: 1.48 to 2.36) and heart failure at 6 months (RR 2.59, 95% CI:2.04 to 3.28), but no increased risk of reinfarction at 6 months (RR 1.12, 95% CI: 0.87 to 1.45) or of angina pectoris (RR 1.07, 95% CI: 0.95 to 1.20). Our prediction of long-term left ventricular dilatation, obtained by applying our new dilatation model in over 13,000 GISSI-3 patients, correlated well with mortality and heart failure after myocardial infarction. Therefore, our new dilatation model may contribute to more efficient risk stratification early after myocardial infarction.

Right ventricular doppler myocardial performance index in adults with repaired tetralogy of fallot: correlations with ventricular volume indices assessed by cardiac magnetic resonance

Right ventricular doppler myocardial performance index in adults with repaired tetralogy of fallot: correlations with ventricular volume indices assessed by cardiac magnetic resonance

Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol

Objective: To compare the efficacy of milrinone and dobutamine in patients chronically treated with carvedilol. Background: Milrinone and dobutamine are used to manage decompensated heart failure, but their efficacy in patients on beta-blocker therapy was unknown. Methods: Twenty patients with decompensated heart failure were prospectively enrolled. Inotropic responses to milrinone (12.5, 25 or 50 μg/kg bolus infusions) or dobutamine (5, 10, 15 or 20 μg/kg/min infusions) were evaluated by right-heart catheterization. Results: Milrinone increased cardiac index (2.0–2.6 l/min/m 2, P=0.0001) without significantly altering heart rate (70–75 bpm, P=0.19). Milrinone decreased mean pulmonary artery pressure (36–29 mm Hg, P=0.0001), pulmonary capillary wedge pressure (24–18 mm Hg, P=0.0001) and mean arterial blood pressure (78–75 mm Hg, P=0.0002). Left ventricular stroke volume index increased in the milrinone group (31–35 ml/beat/m 2, P=0.0001). Dobutamine produced an increase in cardiac index (2.4–3.3 l/min/m 2, P=0.0001) only at doses that are not typically used to treat heart failure (15–20 μg/kg/min). At these doses, dobutamine increased heart rate (68–82 bpm, P=0.008), mean systemic pressure (90–117 mm Hg, P=0.0001) and mean pulmonary artery pressure (21–30 mm Hg, P=0.001). Dobutamine did not alter left ventricular stroke volume index or pulmonary capillary wedge pressure. Conclusions: Dobutamine and milrinone have different hemodynamic effects in patients treated chronically with carvedilol. These differences should be considered when selecting inotropic therapy for decompensated heart failure.

Assessment of left ventricular volume by an ambulatory radionuclide monitoring system during head-up tilt in patients with unexplained syncope: Relation to autonomic activity assessed by heart rate variability

Background. Decreased left ventricular volume during head-up tilt plays an important role in triggering syncope in patients with neurally mediated syncope. However, precise changes in left ventricular volume during head-up tilt have not been well investigated. This study was conducted to test the hypothesis that the decline in left ventricular volume during tilt could trigger ventricular mechanoreceptor activation. Methods and Results. To investigate the mechanisms of tilt-induced syncope, we measured the temporal changes in left ventricular volume, ejection fraction, cardiac output, and heart rate variability indices during head-up tilt in 25 patients with syncope of undetermined etiology. Eleven patients had a cardioinhibitory response (CI group), 7 patients showed a vasodepressor response (VD group), and 7 patients demonstrated a negative response (NG group). Before syncope, ejection fraction increased most in the CI group, the left ventricular end-diastolic volume declined most in the VD group (VD group, −11.0% ± 3.3%; CI group, −2.8% ± 4.8%; NG group, −3.4% ± 2.2%; P < .005), and the high-frequency spectra increased most in the CI group (CI group, 25.0% ± 21.0%; VD group, −4.1% ± 11.7%; NG group, −5.3% ± 12.7%; P < .01). The vasodepressor response was dependent on left ventricular volume, whereas the cardioinhibitory response was related to the vagal activity reflected by high-frequency spectra. Conclusions. The precise evaluation of left ventricular volume by an ambulatory radionuclide monitoring system combined with a heart rate variability analysis is considered useful for clarifying the pathophysiology of neurally mediated syncope. (J Nucl Cardiol 2001;8:660-8.)

Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure

OBJECTIVESWe sought to evaluate the effects of spironolactone on neurohumoral factors and left ventricular remodeling in patients with congestive heart failure (CHF).BACKGROUNDAldosterone (ALD) promotes collagen synthesis and structural remodeling of the heart. Spironolactone, an ALD receptor antagonist, is reported to reduce mortality in patients with CHF, but its influence on left ventricular remodeling has not been clarified.METHODSThirty-seven patients with mild-to-moderate nonischemic CHF were randomly divided into two groups that received treatment with spironolactone (n = 20) or placebo (n = 17). We measured left ventricular volume and mass before treatment and after four months of treatment. We also measured the plasma levels of neurohumoral factors, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), as well as plasma procollagen type III aminoterminal peptide (PIIINP), a marker of myocardial fibrosis.RESULTSLeft ventricular volume and mass were significantly decreased and ejection fraction was significantly increased in the spironolactone group, while there were no changes in the placebo group. Plasma levels of ANP, BNP and PIIINP were significantly decreased after spironolactone treatment, but were unchanged in the placebo group. There was a significant positive correlation between the changes of PIIINP and changes of the left ventricular volume index (r = 0.45, p = 0.045) as well as the left ventricular mass index (r = 0.65, p = 0.0019) with spironolactone treatment.CONCLUSIONSThese findings indicate that four months of treatment with spironolactone improved the left ventricular volume and mass, as well as decreased plasma level of BNP, a biochemical marker of prognosis and/or ventricular hypertrophy, suggesting that endogenous aldosterone has an important role in the process of left ventricular remodeling in nonischemic patients with CHF.

Rescue use of abciximab improves regional left ventricular function after early incomplete reperfusion in acute myocardial infarction.

Abciximab was shown to have important beneficial effects beyond the maintenance of epicardial coronary artery patency. However, it remains uncertain whether abciximab may lead to a better functional outcome in patients with acute myocardial infarction (AMI) and with incomplete reperfusion after primary angioplasty (PA). The study aimed to evaluate whether rescue use of abciximab may lead to a better functional outcome in such patients. The study included 25 patients with first AMI who met the following criteria: (1) total occlusion of the infarct-related artery, (2) PA within 12 h of symptom onset, (3) postprocedural diameter stenosis < 30%, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2. Echocardiographic examination was performed before and on Days 7 and 30 after PA. The study population was divided into two groups: Group 1 (usual care, n = 13) and Group 2 (rescue use of abciximab, n = 12). Baseline characteristics were similar between the two groups. Peak level of creatine kinase was higher in Group 1 than in Group 2 (5,800+/-2,700 vs. 3,800+/-2,000 U/I, p < 0.05). At 1 month follow-up, infarct zone wall motion score index (2.71+/-0.26 vs. 2.05+/-0.63, p < 0.01) and left ventricular (LV) volume indices were smaller in Group 2 than in Group 1, whereas LV ejection fraction was higher in Group 2 than in Group 1 (52.1+/-7.8 vs. 42.1+/-6.4, p < 0.01). At 1-month, abciximab was the only independent predictor of wall motion recovery index by multiple regression analysis. Rescue use of abciximab may reduce the infarct size in patients with AMI and TIMI grade 2 flow after PA, which may improve the recovery of regional LV function.