Left Ventricular Ejection Fraction and Volumes: It Depends on the Imaging Method

Wood, Peter W.; Choy, Jonathan B.; Nanda, Navin C.; Becher, Harald

doi:10.1111/echo.12331

Cited by 215 publications

(188 citation statements)

References 54 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…The significant decrease in EF from the first to the third trimester was not paired with a decreased FS. We believe that these findings should not be emphasized as a true decrease, but as the result of the measurement variability, as previously reported [13].…”

Section: Discussionsupporting

confidence: 68%

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

et al. 2018

View full text Add to dashboard Cite

Objective: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. Methods: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dichorionic (DC) pregnancies. Results: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). Conclusions: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

show abstract

Section: Discussionsupporting

confidence: 68%

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…However, as this definition does not apply to patients with a reduced LVEF (<53%) at baseline, a drop in LVEF of ≥10% (to any value) was considered as a significant change in cardiac function. This is in agreement with defining a significant change by more than 2 times the standard deviation for echocardiography‐based measurements of LVEF 24. In agreement with the ASE consensus statement, reversibility of cardiac dysfunction was defined in relation to baseline LVEF: improvement to within 5 percentage points of baseline was considered reversible, improvement by ≥10 percentage points from the nadir but remaining >5 percentage points below baseline was considered partially reversible, and improvement by <10 percentage points from the nadir and remaining >5 percentage points below baseline was considered irreversible.…”

Section: Methodssupporting

confidence: 89%

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Nowsheen

Aziz

Park

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundTrastuzumab is life‐extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline.Methods and ResultsWe performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre‐ and on‐therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a ≥10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%.ConclusionsWomen undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co‐managed by a cardiologist.

show abstract

“…Echocardiographic measurements in individual patients were made on only two occasions, so we cannot say whether these changes remained consistent in the longer term in their direction or magnitude. In addition, echocardiography is not the best way to assess cardiac function, with a reported ~6% inter-observer variability in the measurement of EF (23). Finally, the study was carried out at the VA Health Care System and was therefore limited to only men.…”

Section: Discussionmentioning

confidence: 99%

Effect of coronary artery bypass graft surgery on left ventricular systolic function

Koene¹,

Kealhofer²,

Adabag³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

consecutive patients underwent isolated CABG at the Minneapolis Veterans Affairs Health Care System. Of these, 375 had echocardiographic assessment of LV function before (within 6 months) and after (3 to 24 months) CABG and were included in this analysis. Results: While the mean LV ejection fraction (LVEF) did not change following CABG [(49±13)% vs.(49±12)%, P=0.51], LVEF decreased in the subgroup with normal (≥50%) pre-operative LVEF [from (59±5)% to (56±9)%, P<0.001] and improved in those with decreased (<50%) pre-operative LVEF [from (36±9)% to (41±12)%, P<0.001]. There was a significant reduction in LV internal diameter during end-diastole (LVIDd) (5.4±0.8 vs. 5.3±0.9, P=0.002) and an increase in left atrial diameter (LAD) (4.4±0.7 vs. 4.6±0.7, P<0.001).There were no perioperative changes in LV internal diameter during end-systole, LV mass, posterior wall thickness, or septal wall thickness. LVEF improved by >5% in 24% of the study population, did not change (+/− 5%) in 55%, and worsened by >5% in 21%. Patients with improved EF were less often diabetic and had lower pre-operative LVEF, and greater LV dimensions at baseline. Conclusions: After CABG, there was a decrease in LVIDd and an increase in LAD. Also, a decrease in LV systolic function with CABG was observed in patients with normal pre-operative LVEF and an improvement in LV systolic function was observed in patients with decreased pre-operative LVEF. The effect of CABG on LV systolic function remains to be elucidated. While the STICH trial evaluated the effect of CABG in patients with severe LV dysfunction (EF ≤35%), to our knowledge, no large studies have assessed the effect of CABG on LV parameters in patients with normal baseline EF. The STICH trial showed a significant decrease in end-systolic volume index (ESVI) in patients with a baseline LV ESVI >90 mL/m 2 (10), while no significant change in LV ESVI was observed in the subgroups of patients with smaller LV cavity size (10). While LVEF significantly improved in patients with a baseline LV ESVI ≥60 mL/m 2 , no significant improvement in LVEF was seen in those with a baseline LV ESVI <60 mL/m 2 . The objectives of this study were to evaluate the effect of CABG on LV systolic function in patients with both normal and abnormal pre-operative systolic function. Methods Data sourceThe cardiac surgery database at the Minneapolis Veterans Affairs (VA) Health Care System is part of an ongoing multicenter database of prospectively collected data on all patients undergoing cardiac surgery at VA Medical Centers in the United States. The database includes information regarding patient demographics, clinical and laboratory variables, surgical details, and post-operative outcomes, including long-term survival (11,12). Additional clinical, pharmacologic, and echocardiographic variables, that were not included in the database, were extracted from electronic medical records (13). This study was approved by the Institutional Review Board at the Minneapolis VA Health Care System (No. 3949-B). Study patientsAdult pa...

show abstract

Left Ventricular Ejection Fraction and Volumes: It Depends on the Imaging Method

Cited by 215 publications

References 54 publications

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Effect of coronary artery bypass graft surgery on left ventricular systolic function

Contact Info

Product

Resources

About