Prognosis in medically-treated coronary artery disease: influence of ejection fraction compared to other parameters.

Nelson, Gregory; Cohn, Peter F.; Gorlin, Richard

doi:10.1161/01.cir.52.3.408

Cited by 201 publications

(43 citation statements)

References 17 publications

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“…However, the left ventricular ejection fraction is a powerful predictor of shortand long-term survival.8' 14, 16 Nelson et al 8 found that ejection fraction was a more discriminant prognosticator than the severity of angiocardiographic coronary disease or the clinical functional class. Schulze et al 22 found that survivors of acute myocardial infarction with a predischarge radionuclide ejection fraction > 0.40 had an overall good prognosis.…”

Section: Ejection Fractionsmentioning

confidence: 99%

Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction.

Warnowicz¹,

Parker

Cheitlin

1983

Circulation

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SUMMARY To assess the prognostic importance of resting left ventricular function in survivors of acute myocardial infarction with pulmonary edema, we retrospectively identified 39 consecutive patients who presented with acute pulmonary edema and myocardial infarction. Sixteen patients had radionuclide ejection fractions 10 2 days postinfarction of > 0.45 (group A, mean 0.55 0.06), and 23 patients had ejection fractions S 0.45 (group B, 0.32 + 0.06). There were no significant differences between the two groups for age or sex, but group A patients had a significantly greater incidence of first myocardial infarction predominantly inferior in location. The calculated stroke work index during the acute event was significantly greater in group A than in group B (33.4 + 2.4 vs 23.4 + 2.0) (p < 0.05). During a follow-up of 9 3 months, mortality was not significantly different between the two groups: Four (25%) died in group A and seven (30%) died in group B. In addition, eight patients (50%) in group A were hospitalized for recurrent angina, new myocardial infarction or recurrent pulmonary edema, compared with 11 (48%) in group B (NS). Three deaths in group A were preceded by infarction of the anterior wall of the left ventricle, confirmed at autopsy, and two nonfatal infarctions were anterior by electrocardiography. Four patients in group A had coronary arteriography performed during the follow-up period because of unstable angina, and all had significant (Dr 70% stenosis) three-vessel disease and two had left main coronary artery disease. Therefore, the predischarge ejection fraction did not predict prognosis for this group of patients.Patients with acute pulmonary edema in the course of myocardial infarction form a high-risk group despite good resting left ventricular function at discharge. They have a significant incidence of recurrent myocardial infarction and death and, because they have good residual left ventricular function, are excellent candidates for surgical intervention.THE EARLY and late prognoses for acute myocardial infarction are adversely affected by the occurrence of left ventricular failure. 1-3 The manifestation of acute pulmonary edema is particularly lethal.' 4, 10 Presumably, pulmonary edema reflects the severity and extent of acute and chronic abnormalities in left ventricular contraction. Thus, pulmonary edema is more common in patients with a history of infarction and in patients with large initial infarctions, which are usually anterior wall infarctions. It is not surprising that in a study by Schelbert et al.,14 measuring radionuclide ejection fractions after myocardial infarction, patients with pulmonary edema had severely depressed ejection fractions and no patient had a normal ejection fraction (> 0.52).Since January 1980, we have routinely obtained a predischarge radionuclide angiocardiogram for all survivors of acute myocardial infarction. It became apparent that certain patients who had manifested pulmonary edema had an unexpectedly normal or only mildly depressed ejection fraction at...

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Section: Ejection Fractionsmentioning

confidence: 99%

Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction.

Warnowicz¹,

Parker

Cheitlin

1983

Circulation

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“…The measurement of ejection fraction is a more direct and clinically useful assessment of ventricular function (Cohn and Gorlin, 1975;Nelson et al, 1974) and with the technique used in this study is less invasive than the standard angiographic technique, requiring only a venous catheter. Similar findings have been reported recently by DeMaria et al (1978).…”

Section: Discussionmentioning

confidence: 99%

“…Since it is generally accepted that the state of ventricular function is a powerful prognostic sign in patients with coronary artery disease (Cohn and Gorlin, 1975;Nelson et al, 1974) any intervention which might alter ventricular function is of potential significance.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Physical Conditioning Program upon Left Ventricular Ejection Fractions Determined Serially by a Noninvasive Technique

et al. 1979

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6 clinically normal subjects underwent a 3-month physical conditioning program with ejection fractions determined before and after physical conditioning using a scintillation probe. All subjects achieved a conditioning effect as evidenced by increased treadmill test duration after conditioning (mean duration before conditioning: 658 vs. 715 sec after conditioning; p < 0.02). All 6 subjects increased resting ejection fractions after conditioning (mean ejection fraction before conditioning: 54.5 ± 5.4%; mean ejection fraction after conditioning: 67.0 ± 9.0%; p < 0.01). Thus, an aerobic physical conditioning program appears to increase resting ejection fractions in normal subjects.

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“…The techniques and protocols involved in both methods have been previously described in detail." 2 Briefly, the epinephrine ventriculogram was performed in 14 subjects approximately 30 min after the control ventriculogram, and 9 min after a [1][2][3][4] ,ug/min infusion of l-epinephrine had begun. Ejection March 1975 for introducing ventricular premature contractions when this device is not available: 1) by pulling a catheter back through the right ventricle into the right atrium, and 2) as a result of the power injection of angiographic contrast medium into the left ventricle.…”

Section: Contractile Reserve and Prognosis In Cad Catheterization Stumentioning

confidence: 99%

Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction.

Cohn¹,

Gorlin²,

Herman³

et al. 1975

Circulation

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Postextrasystolic potentiation (PESP) and 1-epinephrine infusion have previously been shown by the ventriculographic technique to augment left ventricular wall motion in patients with coronary artery disease. The present study relates the magnitude of this augmentation to short-term prognosis in 56 patients with coronary artery disease and a factor already identified with reduced life expectancy, i.e., an abnormal ejection fraction (EF less than .50). Forty-two patients received PESP and 14 1-epinephrine infusion. Based on severity of symptoms and technical suitability, 37 were treated surgically and 19 medically. Mean follwo-up times were 11.7 and 14.3 months, respectively. The mean increase in EF induced by PESP or 1-epinephrine infusion was significantly greater in patients who subsequently had good results from either surgical or medical therapy than in those who died or had progressive cardiac deterioration. In addition, those patients with an increase in EF of .10 or greater had a statistically greater chance of doing well than patients with less augmentation. Evaluation of change in ejection fraction after inotropic stimulation in patients with depressed ejection fractions is helpful in identifying those patients with greatest contractile reserve and hence better short-term prognosis with eigher medical or surgical therapy. Because of its ease of performance and greater enhancement of contractility, PESP is preferred to 1-epinephrine infusion as the inotropic stimulus of choice.

show abstract

Prognosis in medically-treated coronary artery disease: influence of ejection fraction compared to other parameters.

Cited by 201 publications

References 17 publications

Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction.

Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction.

Effect of a Physical Conditioning Program upon Left Ventricular Ejection Fractions Determined Serially by a Noninvasive Technique

Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction.

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