Left ventricular function assessment

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 ... 

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. 

Ermis C, Boz A, Tholakanahalli V et al. Assessment of percutaneous coronary intervention on regional and global left ventricular function in patients with chronic total occlusions. Can J Cardiol 2005 21 275-280. 

Palmeri ST, Harrison OG, Cobb FR et al. A QRS scoring system for assessing left ventricular function after myocardial infarction. N Engl J Med 1982 306(1) 4-9. 

Echocardiography provides important prognostic information primarily in two areas assessment of resting left ventricular function (i.e., ejection fraction), and assessment of provokable ischemia and/or myocardial viability. 

Roes SD, Kelle S, Kaandorp TAM, et al. Comparison of myocardial infarct size assessed with contrast-enhanced magnetic resonance imaging and left ventricular function and volumes to predict mortality in patients with healed myocardial infarction. Am J Cardiol 2007 100(6) 930-6. 

It has been hypothesised that abnormal sympathetic activation may actually precede the development of systolic dysfunction in patients with HCM. To investigate the relationship between left ventricular function and changes in neural control of the heart in patients with HCM, left ventricular function was assessed by echocardiography and myocardial P-AR density by PET in a group of patients with HCM, a sub-group with, and another without, heart failure (Choudhury et al., 1996a). P-AR density in the 17 patients was 7.00 + 1.90 pmol/g compared to 11.50 2.18... 

Juergens KU, Seifarth H, Range F, Wienbeck S, Wenker M, Heindel W, Fischbach R (2008) Automated threshold-based 3D segmentation versus short-axis planimetry for assessment of global left ventricular function with dualsource MDCT. AJR Am J Roentgenol 190 308 314... 

Used for preoperative risk assessment, MDCT at the same time allows for quantification of left ventricular function and noninvasive direct assessment of the coronary arteries (see above). With its high negative predictive value, MDCT might therefore be a suitable tool to exclude significant coronary artery stenosis and has the potential to reduce the number of cardiac catheterizations routinely performed to exclude concomi-... 

In summary, a sufficient evaluation of the left ventricular function and waU motion is feasible with CTA datasets acquired for the examination of the coronary arteries, thus adding a comprehensive functional aspect to the static morphological assessment in CT and possibly rendering the modaUty a first choice for cardiac imaging in a wider range of indications. 

Brodoefel H et al. (2007) Dual-source CT with improved temporal resolution in assessment of left ventricular function a pilot study. AJR Am J Roentgenol 189 1064-1070... 

Carabello BA, Nolan SP, McGuire LA (1981) Assessment of preoperative left ventricular function in patients with mitral regurgitation Value of the end-systolic stress-end-systolic volume ratio. Circulation 64 1212-1217... 

Grossman W, Braunwald E, Mann T, McLaurin LP, Green LH (1977) Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations. Circulation 56 845-852 Hunter WC, Janicki JS, Weber KT, Noordergraaf A (1979) Flow-pulse response A new method for the characterization of ventricular mechanics. Am J Physiol 237 H282-H292 Janicki JS, Reeves RC, Weber KT, Donald TC, Walker AA (1974) Application of a pressure servo system developed to study ventricular dynamics. J Appl Physiol 37 736-741 Mehmel HC, Stockins B, Ruffman K, Olshausen K, Schuler G, Kubler W (1981) The linearity of the end-systolic pressure-volume relation in man and its sensitivity for the assessment of left ventricular function. Circulation 63 1216-1222... 

Sapoznikov D, Halon DA, Lewis BS, Gotsman MS (1983) Frame by frame analysis of left ventricular function. Quantitative assessment of regional and temporal function. Cardiology 70 61-72... 

Allows more effective assessment of left ventricular function than a rhythm strip. 

The effects of furosemide withdrawal on postprandial blood pressure have been assessed in 20 elderly patients (mean age 73 years) with heart failure and preserved left ventricular systolic function (ejection fraction 61%) (23). In 13 who were able to discontinue furosemide (mean dose 32 mg/day), maximum systolic blood pressure fell significantly from 25 mmHg to 11 mmHg and diastolic blood pressure from 18 to 9 mmHg over 3 months. In the continuation group (mean furosemide dose 21 mg/day), there was no change in the postprandial fall. 

This chapter will be limited to the description of CSIL therapy to ex vivo studies in adult mammalian hearts. Due to page limitations, cell culture, gene delivery and in vivo studies will not be included. Therapeutic efficacy of CSIL in preservation of myocardial viability as well as function (by left ventricular developed pressure measurements) as assessed in globally ischemic Langendorff instrumented hearts is both dose and time dependent. This approach of cell membrane lesion repair and sealing may have broader applications in other cell systems. 

Myocardial function is assessed as left ventricular developed pressure (LVDP) defined as the difference between the LV end-systolic and diastolic pressures, measured at pre-ischemic, ischemic, and post-ischemic times (5, 10, 15, 20, 25, and 30 min of reperfiision) (18)(see Note 2). 

ECHO remains the procedure of choice in the diagnosis and evaluation of a number of conditions such as valvular dysfunction (aortic and mitral stenosis and regurgitation and endocarditis), wall motion abnormalities associated with ischemia, and congenital abnormalities, such as ventricular or atrial septal defects. Images obtained from ECHO are used to estimate chamber wall thickness and left ventricle ejection fraction, assess ventricular function, and detect abnormalities of the pericardium such as effusions or thickening. 

While the effects of /3-blockers on survival prolongation and left ventricular reverse remodeling could be argued to be greater than those of any other drugs used in heart failure, this is not the case for their symptomatic benefits. Many, but not all studies, have shown improvements in the NYHA functional class, patient symptom scores or quality-of-life assessments (such as the Minnesota Living with Heart Failure Questionnaire), and exercise performance, as assessed by the 6-minute walk test. Thus it is important to educate patients that they will not necessarily notice dramatic symptomatic improvements with /3-blocker therapy. However, even in the absence of symptomatic... 

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