Reproducibility of the angiographic left ventricular ejection fraction in patients with coronary artery disease

Cohn, Peter F.; Levine, Jay A.; Bergeron, Gary A.; Gorlin, Richard

doi:10.1016/0002-8703(74)90280-4

Cited by 90 publications

(17 citation statements)

References 25 publications

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“…Mean interobserver variabilities in ejection fraction in this study were less than 2%, while Cohn et al 23 reported a mean variability of 5% in ejection fraction from contrast angiograms. Interobserver mean variations of 1-6% in interpretation of resting radionuclide ventriculograms have been reported.'…”

Section: Discussion Ejection Fractioncontrasting

confidence: 59%

Factors that affect the reproducibility of measurements of left ventricular function from first-pass radionuclide ventriculograms.

Dymond¹,

Elliott²,

Stone³

et al. 1982

Circulation

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SUMMARY To examine which factors affect the reproducibility of ejection fraction (EF), pulmonary transit time (PTT) and segmental wall motion assessed from first-pass radionuclide angiograms (FPRA), 32 patients who had FPRA were randomized for site of injection of isotope (right or left arm) and projection (right or left anterior oblique [RAO or LAO]). The quality of injected bolus was measured from the full width at half maximum (FWHM) Each patient was studied on 2 consecutive days, yielding 16 possible combinations of arm and projection. Each combination was assigned a letter from A-P and was randomly allocated to each patient. The scheme was balanced for order and combination of arm and projection. Each letter was entered twice, yielding 32 patients for this study. Two radionuclide ventriculograms were obtained in each patient on each of the 2 days.

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Section: Discussion Ejection Fractioncontrasting

confidence: 59%

Factors that affect the reproducibility of measurements of left ventricular function from first-pass radionuclide ventriculograms.

Dymond¹,

Elliott²,

Stone³

et al. 1982

Circulation

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“…is ± 0.05 and + 27 ml, respectively in our laboratory. 23 In our study the positive inotropic effects of epinephrine on wall motion are well demonstrated by the augmented or hyperdynamic contraction pattern of the entire left ventricle in the normal subjects and of all normal zones in the sixteen subjects with asynergy. In no instance was contraction in such a normal zone rendered abnormal.…”

Section: Intraoperative and Pathological Observationssupporting

confidence: 67%

Augmentation of Left Ventricular Contraction Pattern in Coronary Artery Disease by an Inotropic Catecholamine

et al. 1974

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SUMMARYIn order to assess potential improvement in abnormal left ventricular (LV) wall motion, eighteen subjects sixteen with obstructive coronary artery disease and LV asynergy and two with no evidence of organic heart disease were studied by cardiac catheterization and cineangiography. Ventriculograms were performed at rest and during a constant infusion of l-epinephrine (EPI) at 1-4 ,gg/min after an average of nine minutes steady state. EPI infusion induced augmentation of LV contraction pattern in both normal subjects and in all normal zones in the sixteen subjects with asynergy, and in no instance was contraction in a normal zone rendered abnormal. Eleven of sixteen patients showed improved contraction in previously asynergic areas, two of whom also demonstrated paradoxical motion in an abnormal zone. Of a total of forty-four resting asynergic zones, twenty-three exhibited an improved contraction pattern with EPI, one showed depressed contraction, two demonstrated both an increase and deterioration in the same zone (paradoxical motion), and eighteen showed no change. Quantitative motion analysis generally corroborated these qualitative ventriculographic observations. Heart rate, LV systolic pressure and LV end-diastolic pressure increased slightly with EPI, but were not significantly changed from control values. While there was wide variation in end-diastolic volume in the subjects with asynergy, EPI resulted in an increase in both stroke volume and ejection fraction, the latter significantly (P < 0.05). In the four subjects who subsequently underwent aneurysmectomy, preoperative lack of improvement with EPI correlated with a pathologic diagnosis of fibrosis. Other than angina pectoris of brief duration in two subjects, EPI provoked no untoward reactions, arrhythmias or complications. It is concluded that LV motion abnormalities can be improved or changed in certain cases by the inotropic stimulus of EPI, suggesting residual contractile ability; the agent may differentiate between zones of potentially functional cardiac muscle and frank fibrosis.

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“…In comparing the RV angiographic stroke volume to its LV counterpart, the levophase analysis36 of the RV injection would theoretically appear to be an ideal approach because it almost instantaneously reflects the performance of both ventricular chambers, and so minimizes the variations in the constantly changing physiological parameters during cardiac catheterization. 1,28 Unfortunately, resolution of the levophase is often suboptimal37' 38 and volumes calculated from it differ from volumes calculated following direct LV injection of contrast material.39 40 Little is known about the extent of permanent or even transient RV dysfunction that can be induced by CAD,41-4' and whether there are alterations similar to those described for the LV. The common changes in LV function, usually encountered in the early stages Volume 52, October 1975 changes in RV volume-pressure characteristics.…”

Section: Patient Studiesmentioning

confidence: 99%

Right ventricular performance in patients with coronary artery disease.

Ferlinz¹,

Gorlin²,

Cohn³

et al. 1975

Circulation

175

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While left ventricular (LV) performance in patients with coronary artery disease (CAD) has been extensively investigated, little attention has been given to right ventricular (RV) function in this disease. For this purpose, a new geometric model for RV volume has been developed and RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI) and ejection fraction (EF) have been determined from biplane RV cineangiograms in 26 patients.Eight patients served as normal (control) subjects (group I). Eighteen patients with obstructive CAD comprised two other groups: six who had no significant disease of the right coronary artery (RCA) (group II) and 12 who had a high grade RCA lesion (group III). The mean values for EDVI, SVI and EF in group I were 76 ± 11 ml/m2, 50 ± 6 ml/m2, and 66 ± 6%. The only significant difference between groups I and II was that SVI was lower in group II tha.n in group I (P < 0.01). No measurements in groups II and III were statistically different from each other. However, markedly subnormal values were found in group III (EDVI: 61 ± 16 ml/m2, SVI: 33 ± 10 ml/m2 and EF: 52 ± 7%); all values being significantly lower (SVI and EF: P < 0.001; EDVI: P < 0.05) than in group I. RV end-diastolic pressure was normal in all patients. These findings may be related to 1) reduced RV compliance, 2) distorted LV geometry, 3) possible RV ischemia or 4) reduced Frank-Starling effect.LEFT VENTRICULAR GEOMETRY, volume and contractile parameters in normal hearts have been analyzed in great detail within the last 15 years.1-9 In addition, the effects of coronary artery disease on left ventricular performance have also been extensively studied.'0-"5 In contrast, much less attention has been given to the performance of the right ventricle in either normal subjects or patients with coronary artery disease. This has been due partially to the fact that the left ventricle was always considered the more important chamber of the heart. The relative neglect of right ventricular performance has been further compounded by difficulties in analyzing the geometry of the right ventricular chamber: while the left ventricular configuration approximately resembles an ellipsoid of revolution (and therefore renders itself to relatively simple mathematical analysis), the right ventricle has always been considered a somewhat Autopsied intact human hearts of various sizes without any significant gross abnormalities were used to prepare casts. A silicone disk, fitted with a cannula for injection of plastic compound, was sutured into the tricuspid valve orifice. The pulmonary artery was clamped just above the pulmonary valve. Dow-Corning Silastic A-RTV Mouldmaking Rubber treated with RTV-4 catalyst was then injected through the cannula. Filling pressure was maintained at approximately 15 cm H20. The filled heart was then suspended by sutures from a small stand, and the compound inside the right ventricle allowed to harden in this suspended state in order to minimize any potential distortion of the ri...

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Reproducibility of the angiographic left ventricular ejection fraction in patients with coronary artery disease

Cited by 90 publications

References 25 publications

Factors that affect the reproducibility of measurements of left ventricular function from first-pass radionuclide ventriculograms.

Factors that affect the reproducibility of measurements of left ventricular function from first-pass radionuclide ventriculograms.

Augmentation of Left Ventricular Contraction Pattern in Coronary Artery Disease by an Inotropic Catecholamine

Right ventricular performance in patients with coronary artery disease.

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