Calculation of the ejection fraction from simultaneously recorded systolic intervals and angiography. Comparative study

Garrard, Weissler and Dodge have reported a close correlation (r = -0,90) between angiographic ejection fractions (EF) and the ratio of left ventricular preejection and ejection periods (PEP/LVET) in patients with left ventricular disease without simultaneous recording equation Y" = 1,25 - 1,25 x where x is the PEP/LVET ratio and Y" the ejection fraction. Using this formula a theoretical EF may be calculated when the PEP/LVET ratio is known. A number of precautions must be taken in measuring systolic time intervals (synchronous recordings, rapid and constant recording speeds of at least 100 mm/s, good quality tracings). Respecting these conditions, close correlations between the theoretical and angiographic EF were obtained. However, discrepancies were observed in some cases and so the relationship was examined with and without simultaneous recordings in 28 patients (19 with coronary artery disease). The equations obtained were Y = 1,2 - 1,51 x and Y = 1,04 - 1,04 x respectively. The correlations in the whole group and in the coronary subgroup were not as good when the recording was not simultaneous (r = -0,78, compared to r = -0,85). The theoretic EF appeared to be "optimised" under these conditions. The "optimisation" increased with increasing values of the PEP/LVET ratio. A downward correction had to be made for abnormally high values (for example for a PEP/LVET of 0,38, the EF had to be corrected by -3,1% and for a value of 0,50 by -10,5%). This was also applicable in the patients with coronary artery disease. Curiously, the equation relating simultaneous EF and PEP/LVET was very close to that obtained by Garrard (Ya = 1, 12 - 1,27 x, ra = -0,80). The theoretical EF calculated from this equation was very close to the angiographic value. However, it was slightly higher or lower in coronary patients with or without myocardial infarction. Garrard's equation would appear to be useful for repeated studies of the ejection fraction in these patients.     

Problems posed by professional rehabilitation of cardiac patients]

The authors have followed up children with cardiac defects over almost a twenty year period. During the 1960's most of their patients had come of age, and they conclude that despite the enthusiasm of these young people and their potential, they have the greatest difficulties in finding work. This seems regrettable from the human as well as the socio-economic point of view. They propose that the law should be changed as, indeed, should the spirit of the law, so that; a subject with heart disease should no longer be considered as incapable of useful work, and that each person should be assessed according to his potential. They envisage the setting up of medico-administrative cardiological centres. Thus, in addition to the purely medical cardiological consultation, three additional persons would add their expertise: a social worker, an industrial medicine inspector, and an employment officer. These centres could be instituted easily, without making the existing system too unworkable.     

Familial congenital heart disease: How are the various types related?

The distribution of congenital heart lesions was studied in 238 families with at least 2 affected members. A statistical analysis was performed. Concordant lesions were found in 48% of the affected first degree relatives and in 28% of the affected second and third degree relatives. The concordance rate is highly significant for all lesions studied in the first degree relatives, with the exception of ventricular septal defect (VSD). Among the discordant pairs of lesions, some occur significantly more often than expected (tetralogy of Fallot associated with VSD, pulmonary stenosis, and transposition of the great arteries); others, such as the association between VSD and pulmonary stenosis, are significantly less common than would be expected on a random hypothesis. An explanation is proposed suggesting that malformations anatomically dissimilar but resulting from the same heart segment disorder may have some common genes, and that interaction between genes may be responsible for "antagonism" between 2 defects. The embryologic segmental approach to congenital heart disease is reinforced by this genetic study.