Left ventricular ejection fraction

Heart Failure with Preserved Left Ventricular Ejection Fraction... 

Echo Moderately reduced left ventricular function, left ventricular ejection fraction 35%... 

Intravenous diltiazem can be used cautiously for up to 24 hours in patients with non-decompensated heart failure, bpm, beats per minute CCB, calcium channel blocker (diltiazem or verapamil) HF, heart failure LV, left ventricular LVEF, left ventricular ejection fraction. 

FIGURE 6-6. Decision algorithm for long-term ventricular rate control with oral drug therapy for patients with paroxysmal or permanent atrial fibrillation, bpm, beats per minute CCB, calcium channel blocker (diltiazem or verapamil) HF, heart failure LV, left ventricular function LVEF, left ventricular ejection fraction. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE, Dunsworth TS, et al. (eds.) Pharmacotherapy Self-Assessment Program, 4th ed. Kansas City American College of Clinical Pharmacy 2001 ... 

DCC, direct current cardioversion IV, intravenously LVEF, left ventricular ejection fraction TEE, transesophageal echocardiogram. 

If adenosine therapy is unsuccessful for termination of PSVT, subsequent choices of therapy depend on whether the patient has HF and/or a depressed left ventricular ejection fraction (LVEF). 

FIGURE 6-10. Decision algorithm for termination of paroxysmal supraventricular tachycardia. HF, heart failure LVEF, left ventricular ejection fraction PSVT, paroxysmal supraventricular tachycardia. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE,... 

Cardiotoxicity is a serious, rare adverse effect of mitox-antrone. The incidence of congestive heart failure was 0.15% in patients with normal left ventricular ejection fraction and 2.18% in those who had asymptomatic left ventricular ejection fraction of less than 50% at baseline.46 Therefore, mitoxantrone should not be used in patients with baseline cardiomyopathy, even if asymptomatic. The risk of cardiotoxicity is dose-related. The maximum lifetime dose of mitoxantrone is 140 mg/m2, or about 3 years of MS therapy. The use of cyclooxygenase-2 inhibitors should be avoided in patients receiving mitoxantrone because of a potential for worsening cardiac toxicity.46... 

Left ventricular systolic function is normal. Left ventricular ejection fraction by visual inspection is estimated at 55% to 60%. The left ventricle is grossly normal size. 

If patients are hemodynamicaUy stable, the focus should be directed toward control of ventricular rate. Drugs that slow conduction and increase refractoriness in the AV node should be used as initial therapy. In patients with normal LV function (left ventricular ejection fraction >40%), IV j3-blockers (propranolol, metoprolol, esmolol), diltiazem, or verapamil is recommended. If a high adrenergic state is the precipitating factor, IV /J-blockers can be highly effective and should be considered first. In patients with left ventricular ejection fraction <40%, IV diltiazem and verapamil... 

The echocardiogram is the single most useful evaluation procedure because it can identify abnormalities of the pericardium, myocardium, or heart values and quantify the left ventricular ejection fraction (LVEF) to determine if systolic or diastolic dysfunction is present. 

The SOLVD Investigators, Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure, N. Engl.. Med., 325, 293-302,1991. 

This synthetic benzamide was studied in two different schedules, with the daily schedule exceeding MTD at first dose-level of 2 mg/m, unpredicted, possibly due to long ti/2 from possible enterohepatic recirculation. The fortnightly schedule was found to be feasible, and an MTD of 10 mg/m has been established from 28 patients [133]. There were no cUnically significant cardiac toxicities either from a rhythm perspective or from assessment of left ventricular ejection fraction. Toxicities seen include anorexia, nausea, vomiting, diarrhea, fatigue, myelosuppression, hypoalbiuninemia and hypophospho-temia. 

Left ventricular dysfunction (LVD) following Ml To reduce cardiovascular mortality in clinically stable patients who have survived the acute phase of a Ml and have a left ventricular ejection fraction of 40% or less (with or without symptomatic heart failure). 

Evaluation of left ventricular ejection fraction (LVEF) is recommended prior to administration of the initial dose of mitoxantrone. Subsequent LVEF evaluations are recommended if signs or symptoms of CFIF develop, and prior to all doses administered to patients who have received a cumulative dose of 100 mg/m or more. Do not administer mitoxantrone to MS patients who have received a cumulative lifetime dose of 140 mg/m or more, or those with either LVEF of less than 50% or a clinically significant reduction in LVEF. 

Figure 2.6 illustrates stunned myocardium with normal resting perfusion but a severe stress induced perfusion defect that indicates severe ischemia in the distribution of the RCA and the LAD proximal to the first septal perforator. Metabolic imaging with FDG is not necessary, since resting perfusion is normal without scar with a left ventricular ejection fraction (LVEF) of 30% thereby indicating stunned myocardium that normalized after bypass surgery. This patient with severe stress induced ischemia and reduced LV function characteristic of stunned myocardium contrasts with the patient of Fig. 2.2 with severe ischemia but normal LV function and no stunning. 

Yoshida K, Gould KL. Quantitative relation of myocardial infarct size and myocardial viabihty by positron emission tomography to left ventricular ejection fraction and 3-year mortality with and without revascularization. J Am Coll Cardiol 1993 22 984-997... 

Conduction system abnormalities are common in chronic heart failure, occurring in 15-30% of the population with low left ventricular ejection fraction (LVEF) [1-3]. The prevalence in ischemic heart disease is roughly similar to that seen in other forms of dilated cardiomyopathy. Conduction system disease can occur both at the time of an acute myocardial infarction as well as slowly progressing in chronic ischemic heart disease. Intraventricular conduction delays are associated with a poor prognosis in heart failure, with up to a 70% increase in the risk of death, and are also more prevalent in patients with advanced symptoms [2,4]. In ischemic heart disease, all components of the conduction system are at risk of ischemic injury, from the sinoatrial node to the His-Pukinje system. These conduction system abnormalities have the potential to impair cardiac function by a number of mechanisms. Since conduction abnormalities impair cardiac function, it is logical that pacing therapies to correct or improve these conduction abnormalities may improve cardiac function. 

Kieny JR, Sacrez A, Facello A, et al. Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy. Eur. Heart J. 1992 13 1290-5. 

Fig. 7.3 (A) Left ventricular ejection fraction at rest. Assessments were made at baseline before ameroid placement left), 30 days later at time of cell or saline injection middle), and 60 days after ameroid placement right). (B) Left ventricular ejection fraction with stress. Assessments were made before and 30 days after intramyocardial injection. Reprinted from [63]...

Most of the clinical experience gained with stem cells has involved therapy for AMI, particularly intracoronary infusion of bone marrow cells since skeletal myoblasts are too large for this purpose [133]. Table 7.2 summarizes the experience to date. In all of these trials, revascularization was performed promptly after the index myocardial infarction, and left ventricular systolic compromise was minor (in the BOOST trial, the baseline left ventricular ejection fraction [LVEF] was 50%). 

CCSAS, Canadian Cardiovascular Society, left ventricular ejection fraction METS, square voltage in the terminal 40 ms of the consumption. Reprinted from [129] with... 

A recent study suggests that patients with congestive heart failure who carry the ACE deletion are likely to respond especially well to P-blockers. The researchers followed 328 men and women with heart failure (mean left ventricular ejection fraction, 0.24) to assess the impact of the ACE D allele on transplant-free survival. Patients with two ACE deletion (short) versions of the ACE gene DD) had the highest levels of ACE activity, and patients with two insertion (long) versions of the gene (//) had the lowest levels. 

The availability of frequent background-free determinations of left ventricular function will open additional uses for evaluation of the left ventricular ejection fraction and volume indices. Rapid data acquisition at varying levels of exercise, frequent assessment of pharmacologic and physiologic interventions, and simultaneous acquisition of data using more than one radionuclide becomes readily feasible with agents such as Au-195m. 

---