Richard O. Russell

Left Ventricular Volumes and Ejection Fraction by Echocardiography

Left ventricular end-diastolic and end-systolic volume, stroke volume, and ejection fraction were determined by biplane angiocardiography and echocardiography in 27 patients suspected of having heart disease. Angiographic volumes were calculated by the area-length method and echocardiographic volumes, from the left ventricular dimension of the echograms. The angiographic minor diameter and the semilength correlated significantly with the echocardiographic left ventricular dimensions in diastole and systole. Left ventricular size over a wide range compared favorably by each technique, with a correlation coefficient of r = 0.97 for end-diastolic volume (range by angiography 80-585 ml, SEE ± 27.76), r = 0.97 for end-systolic volume (range by angiography 24-485 ml, SEE ± 23.64), r = 0.83 for total left ventricular stroke volume (range by angiography 35-229 ml, SEE ± 25.45), and r = 0.80 for left ventricular ejection fraction (range by angiography 0.18-0.70, SEE ± 0.09). These data indicate that left ventricular dimensions in systole and diastole can be reliably determined and left ventricular chamber size and ejection fraction can be quantitated in man by the noninvasive technique of echocardiography.

Clinical effects of glucose-insulin-potassium on left ventricular function in acute myocardial infarction: Results from a randomized clinical trial

Abstract The effects of glucose-insulin-potassium (GIK) on hemodynamics and left ventricular (LV) function in patients with acute myocardial infarction (AMI) were investigated in a prospective randomized study. Patients who presented with suspected AMI were candidates for this study if prerandomization evaluation was completed within 12 hours from onset of chest pain. Patients over 75 years of age, insulin-dependent diabetics, patients with renal insufficlency, and comatose patients were excluded. Following completion of baseline hemodynamic measurements, patients were randomly allocated to 48-hour infusion of 300 gm G, 500 units I, and 80 mEq KCl per liter at rate of 1.5 ml/kg/hr or to conventional therapy. In addition to serial hemodynamic measurements, dextran LV function curves (LVFC) were constructed during the second and third days to assess extent of LV injury. Eighty-five of 118 patients who were initially randomized into this study had AMI documented by diagnostic rise and fall of CK-MB isoenzyme. Baseline characteristics and hemodynamics were similar for GIK and control patients with AMI. GIK patients who presented with their initial AMI had significant reduction in pulmonary arterial end-diastolic pressure from prerandomization value of 16 ± 1 to 10 ± 1 by day 3, compared to 18 ± 1 to 16 ± 1 mm Hg for control patients ( p 2 for control patients ( p p p

Left ventricular function in acute myocardial infarction and its clinical significance.

Investigations on left ventricular function in patients with acute myocardial infarction and the relatonship to clinical findings have shown: (1) limitations in the use and interpretation of central venous pressure; (2) pulmonary artery end-diastolic pressure accurately reflects left ventricular filling pressure in the absence of pulmonary vascular or mitral valve disease; (3) left ventricular filling pressure is frequently elevated in mild or clinical uncomplicated infarction; (4) left ventricular function frequently improves during the immediate as well as late convalescent period; (5) the hemodynamic and clinical evaluations may frequently be at variance; (6) a left ventricular gallop is usually associated with an abnormally elevated left ventricular filling pressure; (7) anterior infarctions present greater depression of left ventricular function than inferior infarctions; and (8) monitoring of hemodynamics can be useful in following the changes in left ventricular function and the response to therapy in patients with heart failure and cardiogenic shock.

Surgical versus medical treatment of occlusive disease confined to the left anterior descending coronary artery

The results of saphenous vein bypass grafting and medical treatment were compared in 53 patients with stable angina pectoris, high grade occlusive disease confined to the left anterior descending coronary artery and normal or minimally impaired left ventricular function. Survival, incidence of myocardial infarction, relief of angina and response to exercise testing were evaluated. In the 29 surgically treated patients, followed up a mean of 24 months, there were two late deaths (7 percent) and five myocardial infarctions (17 percent). Twelve patients (41 percent) were free of angina and the majority had increased exercise performance when tested up to 18 months postoperatively. In the 24 medically treated patients, there were no deaths and one myocardial infarction (4 percent) in a mean follow-up period of 37 months. Six patients (25 percent) were free of angina. Less improvement in exercise performance was observed than in the surgically treated group. This subset of patients with isolated left anterior descending coronary artery disease has a favorable prognosis that is not enhanced by bypass grafting. Surgical treatment is more effective than medical treatment in relieving angina and improving exercise performance in the early years after coronary arteriography.

Left Ventricular Size and Function and Heart Size in the Year Following Myocardial Infarction

Interrelationships among left ventricular (LV) size, LV function, and heart size were investigated in 49 patients studied 2-12 months after myocardial infarction. LV end-diastolic volume (EDV) and ejection fraction (EF) were determined by biplane ventriculography. Heart size was estimated from chest films by the cardiothoracic ratio (CTR) and cardiac volume (CV) methods. Ventricular function (i.e., EF) was related to chamber size (i.e., EDV), but the correlation coefficient was not high (r = 0.74); thus, chamber size was not an accurate predictor of EF. Because of the close linear relation that exists between LV end-systolic volume and EDV (r = 0.98), a hyperbola describes the relation between EF and EDV. In general, EF was depressed (<0.50) when EDV exceeded 70 ml/m2, was <0.35 when EDV exceeded upper normal limits (110 ml/m2), and was <0.25 with chamber size >150 ml/m2. Thus relatively small chamber size (<150 ml/m2) was associated with a wide range in ventricular function, while large chamber size was associated with severe dysfunction (EF < 0.30). By either heart size method, cardiomegaly (CTR > 0.50 or CV > 540 ml/m2) was not found consistently until EDV exceeded 150 ml/m2. Hence normal heart size was often associated with moderate EF depression (0.49-0.30), while cardiomegaly was often associated with severe dysfunction. Clinical heart failure (CHF) was usually accompanied by EF < 0.30, but chamber size ranged from 101 to 331 ml/m2. Primarily because of this variation in chamber size, both normal heart size and cardiomegaly were at times associated with CHF.The poor correlations of EF with CTR (r = −0.43) and CV (r = −0.52) preclude use of the heart size indices as accurate predictors of LV function. When the data were analyzed according to the presence or absence of cardiomegaly, the following generalizations could be made regardless of the heart size method used. Cardiomegaly was a reasonable indicator of postinfarction LV function, being associated with depressed function and often with CHF. However normal heart size was associated with either normal LV function, or commonly, with depressed function, often not clinically apparent.

Quantitative axial oblique contrast left ventriculography: Validation of the method by demonstrating improved visualization of regional wall motion and mitral valve function with accurate volume determinations

To compare the relative merits of conventional and axial RAO/LAO angiography, we performed biplane left ventricular (LV) cineangiograms in 36 patients in both the conventional 30-degree RAO/60-degree LAO projection and in the axial 45-degree RAO/60-degree LAO/25-degree cranial projection, in random sequence. LV volumes were calculated by a computerized system utilizing modification of the area-length method. Eng-diastolic volume, end-systolic volume, and ejection fraction correlated closely between the two projections (r = 0.93, 0.95, and 0.86, respectively). The axial 60-degree LAO view projected the LV apex inferiorly, the LV outflow tract superiorly, reduced LV foreshortening, and uncovered the LV outflow tract in all cases. Segmental wall motion abnormalities of the ventricular septum, apex, and posterior wall were better evaluated by the axial 60-degree LAO view in patients with regional asynergy in these zones. The 45-degree RAO, compared to the 30-degree RAO view, allowed a true tangential view of the mitral valve and provided a large clear area between the mitral valve and descending aorta, which improved the ability to quantify mitral regurgitation. Thus, axial oblique LV angiography improves evaluation of LV regional wall motion and mitral valve function without compromising LV volume quantitation.