Radionuclide and hemodynamic assessment of left ventricular functional reserve in patients with left ventricular aneurysm and congestive cardiac failure. Response to exercise stress and isosorbide dinitrate.

Stephens, J; Dymond, D. S.; Spurrell, R. A. J.

doi:10.1161/01.cir.61.3.536

Cited by 16 publications

(7 citation statements)

References 26 publications

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“…Thus, the overall yield in detecting resectable aneurysms is very low, even in those patients with poor left ventricular function. It is interesting to note that in our patients with resectable ventricular aneurysms and those patients reported by Rogers et a1 [19] and Stephens et a1 [20], the left ventricular ejection fraction was in the range of 20-30%.…”

Section: Discussionsupporting

confidence: 60%

Assessment of left ventricular function by first‐pass radionuclide angiography in patients with poor left ventricular function

Iskandrian

Segal

Kane

et al. 1982

Cathet. Cardiovasc. Diagn.

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One-hundred consecutive patients with poor left ventricular systolic function (ejection fractions of 5 0.30) were selected 1) to determine the accuracy and reproducibiii.ty of radionuclide angiography (RNA) In estimating the ejection fraction and wall motlon abnormalities; and 2) todefine the spectrum of wall motion abnormalities and the prevalence of resectable aneurysms. All RNA studies were performed with the firstpass technique by means of a computerized multicrystal scintillation camera. Twentyfive patlents underwent cardlac catheterization, left ventricuiography, and coronary angiography. in these 25 patients there was fair correlation in the measurementsof theejectionfraction(r = 0.59;~ = 0.59 x + 0.06,~ c 0.01)andgood correlation in the measurement of left ventricular end-diastolic volume (r = 031). Wall motion analysis in these 25 patients showed that there were 50 hypokinetic segments, 18 akinetic segments, and 7 dyskinetic segments as defined by contrast angiography, compared with 54 hypokinetic, 17 akinetic, and 4 dyskinetic segments as defined by RNA studies. Eighteen patients had either akinesia or dyskinesia by contrast angiography compared to 16 patients by RNA. Only one of the 25 patients was considered a candidate for aneurysmectomy.Of the remaining 75 patients who did not undergo cardiac catheterization, 15 patients each had dyskinetic segments, 25 patients had at least one akinetic segment, and 35 patients had neither akinetic or dyskinetic segments. Only three of the 75 patients were possible candidates for aneurysmectomy.Fifteen patients underwent a second RNA study at least one week after the initial study, with excellent reproducibility results (r = 0.91; y = 1.01 x -0.01, P < 0.001).Ten patients underwent two RNA studies, one In the anterior projection and one in the right anterior oblique projection. Both projections proved to be comparable in assessing wall motion and ejection fraction. The right ventricular ejection fraction assessed in ten patients was depressed in all. lskandrlan el a1We conclude: In patients with poor left ventricular function: 1) First-pass radionuclide angiography with a multicrystal camera provides reliable and reproducible assessment of the regional and global functions of the left ventricle; and 2) resectable ventricular aneurysms are rare; therefore, the suspicion of ventricular aneurysm may be a poor indlcation for either radionucllde anglography or contrast angiography. However, since radionucllde angiography is safer and more cost effective it should be considered the procedure of choice in screening such patients.

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Section: Discussionsupporting

confidence: 60%

Assessment of left ventricular function by first‐pass radionuclide angiography in patients with poor left ventricular function

Iskandrian

Segal

Kane

et al. 1982

Cathet. Cardiovasc. Diagn.

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“…Differences in functional reserve of the contractile segment might to some extent account for such behaviour. Stephens et al (25) found that a rest segmental EF (sEF) less than 40% usually predicts a poor left contractile reserve, while the opposite is not always true of patients with a sEF over 40%. It appears then that other factors besides the rest sEF play some role in determining left ventricular response to exercise.…”

Section: Discussionmentioning

confidence: 99%

“…It appears then that other factors besides the rest sEF play some role in determining left ventricular response to exercise. The degree of coexisting coronary artery disease has been shown to be of little predictive value since its severity does not correlate with poor left ventricular response (25). The ventricular response to submaximal exercise is most likely conditioned also by the direct effects of the aneurysm on ventricular mechanics.…”

Section: Discussionmentioning

confidence: 99%

“…Attempts have been made to predict the results of aneurysmectomy by performing hemodynamic evaluation at rest (11,18,21,25), on exercise (11,18,25) and after vasodilator therapy (7,19), by studying the status of the coronary arteries (5,7,19), using a mathematical model to predict the degree of postoperative fiber shortening (8) or by assessing the segmental ventricular contractility (4,10,25,27). Here, radionuclide angiocardiography has been successfully used (10,20,28).…”

Section: Introductionmentioning

confidence: 99%

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Equilibrium Radionuclide Angiocardiography to Select Inotropic Therapy in Patients with Left Ventricular Aneurysm

Cl¹,

R³

et al. 1986

Nuklearmedizin

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Fourteen patients with postinfarctual ventricular aneurysm underwent equilibrium radionuclide angiocardiography at rest (ERNA) before and after oral digoxin administration in order to evaluate the effects of increasing myocardial contractility upon both ventricular aneurysm mechanical behaviour and global ventricular function. The ejection fraction (EF) was not significantly affected by digoxin therapy. However, digoxin induced changes in EF (ΔEF) correlated inversely with changes in aneurysm size and directly with changes in the extent of the hypokinetic area. Two types of aneurysm were observed: a) highcompliance aneurysm the size of which increased after digoxin administration while both EF and the extent of the hypokinetic area fell, and b) low compliance aneurysm for which opposite changes occurred. This different behaviour of ventricular aneurysm may have important practical implications as surgery would be probably more effective than medical treatment in improving resting ventricular function in patients with high-compliance aneurysm.

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“…However, we performed a subgroup analysis of patients with available LVEDP. For this analysis, LVSWI was calculated as 0.0136*SVI*(MAP + dp mean − LVEDP) 21 …”

Section: Methodsmentioning

confidence: 99%

Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

et al. 2022

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Aims Blood pressure (BP) targets in patients with aortic stenosis (AS) are controversial. This study sought to describe the haemodynamic profile and the clinical outcome of severe AS patients with low versus high central meaarterial pressure (MAP). Methods and results Patients with severe AS ( n = 477) underwent right and left heart catheterization prior to aortic valve replacement (AVR). The population was divided into MAP quartiles. The mean systolic BP, diastolic BP, and MAP in the entire population were 149 ± 25, 68 ± 11, and 98 ± 14 mmHg. Patients in the lowest MAP quartile had the lowest left ventricular ejection fraction (LVEF), systemic vascular resistance, and valvulo‐arterial impedance, whereas there were no significant differences in mean right atrial pressure, mean pulmonary artery wedge pressure, pulmonary vascular resistance, and stroke volume index across MAP quartiles. However, left ventricular stroke work index (LVSWI) was lowest in patients in the lowest and highest in those in the highest MAP quartile. After a median (interquartile range) post‐AVR follow‐up of 3.7 (2.6–5.2) years, mortality was highest in patients in the lowest MAP quartile [hazard ratio 3.08 (95% confidence interval 1.21–7.83); P = 0.02 for lowest versus highest quartile]. In the multivariate analysis, lower MAP [hazard ratio 0.78 (95% confidence interval 0.62–0.99) per 10 mmHg increase; P = 0.04], higher mean right atrial pressure and lower LVEF were independent predictors of death. Conclusions In severe AS patients, lower MAP reflects lower systemic vascular resistance and valvulo‐arterial impedance, which may help to preserve stroke volume and filling pressures despite reduced left ventricular performance, and lower MAP is a predictor of higher long‐term post‐AVR mortality.

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Radionuclide and hemodynamic assessment of left ventricular functional reserve in patients with left ventricular aneurysm and congestive cardiac failure. Response to exercise stress and isosorbide dinitrate.

Cited by 16 publications

References 26 publications

Assessment of left ventricular function by first‐pass radionuclide angiography in patients with poor left ventricular function

Assessment of left ventricular function by first‐pass radionuclide angiography in patients with poor left ventricular function

Equilibrium Radionuclide Angiocardiography to Select Inotropic Therapy in Patients with Left Ventricular Aneurysm

Systemic blood pressure in severe aortic stenosis: Haemodynamic correlates and long‐term prognostic impact

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