Quantitation of regional left ventricular function by two-dimensional echocardiography in normals and patients with coronary artery disease

Regional endocardial motion and wall thickening of the left ventricle were quantitatively assessed in nine normal subjects and in 21 patients with coronary artery disease using two-dimensional echocardiography (2DE) and a computerized light pen system. Eight equal sectors of a cross-sectional image from parasternal short-axis, apical four-and two-chamber views were used for measuring sector area difference of endocardial motion and wall thickness between end diastole and end systole. In 13 patients with anterior wall motion abnormalities, area difference of wall thickening found by 2DE was abnormal in 12 of 13 (92%) patients, and only in 6 of 13 (46%) patients by endocardial motion. In 10 patients with dyskinetic regions in apex or anterior wall, dyskinesia by wall thickening was found in all patients, but only in 6 of 10 (60%) by endocardial motion. Thus, wall thickening assessed by 2DE is a more sensitive technique than analysis of endocardial motion in evaluating regional wall motion abnormalities in patients with coronary artery disease.     

Effects of the cold pressor test on the left ventricular function of patients with coronary artery disease

We used the cold pressor test as provocative of myocardial ischemia in 23 subjects evaluated for chest pain on effort. Seven of them (group N) had normal coronary arteries, and 16 (group CAD) had critical stenoses along the main branches of the left coronary artery. In both groups exposure to cold induced increase in arterial pressure and double product. Left ventricular end-diastolic pressure increased +60% from baseline (P less than 0.001). Angiocardiographic parameters, unchanged in group N, showed an impairment of left ventricular function in group CAD. End-diastolic volume increased +11% (P less than 0.01), ejection fraction decreased -8% (P less than 0.0025), with a significant reduction in segmental wall motion in the area of the diseased artery (P less than 0.001). The mean Vcf was slightly and not significantly reduced, while early-systolic and end-diastolic stress and the constant of stiffness consistently increased in both groups. The appearance or extension of ventricular wall contraction abnormalities in group CAD, in the absence of demonstrable coronary spasm and in the presence of a remarkable increase in left ventricular end-diastolic pressure and stress, was interpreted as due to ischemia secondary to increased extravascular resistances to coronary flow. The cold pressor test is proposed as a useful tool for the diagnosis and evaluation of patients with ischemic heart disease.     

Quantitative study of left ventricular function by two-dimensional echocardiography

The results of two dimensional echocardiography and cineventriculography in the calculation of left ventricular volumes and ejection fractions were compared. The study was performed experimentally in dogs and also in 12 patients with ischaemic heart disease. 25 measurements were performed in the animal: 19 basal and 6 measurements one hour after occlusion of the LAD. Reconstruction by Simpson's method showed good correlations with angiography (p less than 0,001) for enddiastolic volume (r = 0,94), end systolic volume (r = 0,97) and ejection fraction (r = 0,89). A preliminary clinical study was performed in 12 patients. All had significant stenosis of at least one main coronary artery and 10 had segmental abnormalities of left ventricular wall motion. Left ventricular volumes were calculated from the simplified 5/6 AL formula which only requires one long axis view and one short axis view at the level of the papillary muscles. The comparison between echocardiography and angiography showed a better correlation for end systolic volume (r = 0,91) than for end diastolic volume (r = 0,73). Echo underestimated end diastolic volume by 14% and end systolic volume by 13%. The correlation obtained for ejection fraction was excellent (r = 0,97) with no underestimation of this parameter by echocardiography. In conclusion, left ventricular volumes and ejection fractions may be calculated by two dimensional echocardiography. The technique allows a sequential quantitative study from beat to beat and in real time of cardiac function. It is a simple non-invasive method of following the evolution of cardiac disease and of assessing the effects of therapy on left ventricular function.     

Right ventricular function in coronary artery disease as assessed by two-dimensional echocardiography

Two-dimensional echocardiography (2DE) was performed in 64 patients with coronary artery disease. There were 46 men and 18 women, aged 58.7 +/- 11.4 years. An apical four-chamber view, a two-chamber right ventricular (RV) view, and a subcostal four-chamber view were obtained in 58 of 64 (91%) patients. Regional wall motion abnormalities ( RWMA ) of the RV free or diaphragmatic wall were detected in 4 of 18 (22%) patients with acute inferior myocardial infarction (IMI) and in 3 of 14 (21%) patients with old IMI. All seven patients with RWMA by 2DE had two or more of the following findings: hypotension, second- or third-degree atrioventricular block, atrial arrhythmias, or ventricular tachycardia. The RV ejection fraction by first-pass radionuclide angiography was 19.7 +/- 8.3% in patients with IMI and RV RWMA by 2DE compared to 35.3 +/- 9.6% (p less than 0.005) in patients without. A hyperdynamic RV wall motion was seen in 12 of 15 (80%) patients with acute anterior MI (AMI). No RV RWMA was observed in 17 patients with greater than 75% obstruction of right coronary artery and absent infarction. Thus, RWMA of the right ventricle were detected by 2DE in 22% of patients with IMI and identified patients with clinically significant RV dysfunction, probably due to RV infarction; a compensatory hyperdynamic RV wall motion was observed in 80% of patients with acute AMI.     

Serial analysis of regional left ventricular wall motion by two-dimensional echocardiography in patients with coronary artery enlargement after Kawasaki disease.

OBJECTIVES. This study was designed to assess the temporal relation between early coronary artery abnormalities and left ventricular function in Kawasaki disease. BACKGROUND. Although late segmental wall motion abnormalities may be seen in patients with Kawasaki disease who have coronary artery stenosis, the impact of early coronary artery abnormalities is unclear. METHODS. Regional left ventricular wall motion was assessed by two-dimensional echocardiography in 18 patients with Kawasaki disease and echocardiographic evidence of coronary artery enlargement at 3 weeks and 3 months and at either 6 or 12 months after the onset of fever. Four patients had a persistent left coronary artery aneurysm, four had regression of their aneurysm, two had persistent left coronary artery ectasia and eight had regression of ectasia. Left ventricular wall motion was assessed by measuring regional area change in parasternal and apical views. After planimetry of an end-systolic and an end-diastolic frame, the ventricle was divided into eight equal segments and the percent area change was calculated. A floating system correcting for translation and rotation was applied. The measurements in the patient group were compared with values previously obtained in 55 normal age-matched infants and children. RESULTS. A transient regional wall motion abnormality 3 and 6 months after the onset of fever was discovered in the inferolateral wall of one patient with a persistent left coronary artery aneurysm. One patient with regression of coronary artery ectasia had a persistent wall motion abnormality in the anterolateral left ventricular wall. There was no correlation between the extent of coronary artery enlargement and the presence or absence of wall motion abnormalities. CONCLUSIONS. These early changes are most likely secondary to associated myocarditis rather than coronary artery abnormalities.     

实时三维超声心动图评价冠心病左心室收缩同步性

目的：探讨实时三维超声心动图评价冠心病患者左心室收缩同步性的临床价值。方法：对32例冠心病患者和30例健康体检者进行实时三维超声心动图（RT-3DE）检查，获得左心室收缩同步性指标：Tmsv 16-SD，Tmsv 12-SD，Tmsv 6-SD，Tmsv 16-Dif，Tmsv 12-Dif，Tmsv 6-7Dif。结果：冠心病组左心室收缩同步性指标均大于正常对照组（P〈0．01）。结论：实时三维超声心动图能够评价冠心病左心收缩同步性，为临床提供简便、直观、无创的新方法。     

冷加压试验超声心动图评价高脂血症患者的冠状动脉内皮功能

目的 :应用冷加压试验超声心动图评价高脂血症患者的冠状动脉内皮功能。方法 :将 80例研究对象对分为两组 :高脂血症组、正常对照组。高脂血症组又分为高胆固醇血症、高三酰甘油血症和混合性高脂血症三个亚组。应用超声心动图仪显示静息状态下、冷加压负荷试验后、舌下含服硝酸甘油后的冠状动脉左主干图像 ,测量其内径并计算内径变化百分率。结果 :与正常对照者相比 ,高脂血症患者冷加压负荷试验前后冠状动脉左主干内径变化百分率明显降低 [(15 .6± 6 .0 ) %∶(9.8± 3.5 ) %、(9.9± 3.5 ) %、(8.0± 3.4 ) % ,均P <0 .0 5 ],其中又以混合性高脂血症者为甚。结论 :冷加压试验超声心动图可用于检测冠状动脉内皮功能 ;高脂血症患者冠状动脉内皮功能异常。     

冠心病患者左心功能的改变

目的:观察不同程度冠心病患者左心功能的变化。方法;78例冠心病患者分成稳定性心绞痛(SA)、不稳定性心绞痛(UA)、急性心肌梗死(AMI)和陈旧性心肌梗死(OMI)4组,并与30例健康成人(对照组)比较。采用无创伤自动检测仪及彩色多普勒血流显像仪测定心功能指标;心排血指数(CI),外周阻力(TPR),左室射血前期(PEP)及左室射血时间(LVET);左室收缩功能:射血分数,每搏量,心搏出量;左室舒张功能:A峰,E峰,峰值速度比值,峰值充盈,标准化充盈速度。结果:AMI和OMI组心功能明显减低(P<0.01):CI减少,TPR增高,PEP延长,LVET缩短,左室收缩功能减弱,舒张功能降低;UA和SA组心功能减低(P<0.05～<0.01);AMI和OMI组比UA和SA组心功能减低有显著差异(P<0.05)。结论;冠心病随病情加重,心功能明显恶化。     

Quantitative intravenous myocardial contrast echocardiography predicts recovery of left ventricular function after revascularization in chronic coronary artery disease

BACKGROUND: Quantitative intravenous myocardial contrast echocardiography (MCE) has been shown to measure regional myocardial blood flow velocity noninvasively. PURPOSE: To determine whether quantitative intravenous MCE could be used clinically to predict functional recovery after revascularization in patients with chronic coronary artery disease. METHODS: Twenty-eight patients with chronic stable coronary artery disease and resting regional left ventricular dysfunction were included in this study. The study permits myocardial perfusion analysis by intravenous MCE before revascularization with continuous infusion of Levovist and intermittent ultrasonic exposure. Wall motion assessment by echocardiography at rest was repeated after long-term follow-up period (7 +/- 2 months). In dysfunctional segments, we analyzed myocardial perfusion quantitatively by fitting to an exponential function, Y = A(1 - e-betat) to obtain the rate of rise (beta) of background-subtracted intensity, which represented myocardial blood flow velocity. RESULTS: Of the 101 revascularized dysfunctional segments, MCE was adequately visualized in 91 (90%) segments, and wall motion was recovered in 45 (49%) segments. The value of beta in the recovery segments was significantly higher than that in nonrecovery segments (0.80 +/- 0.50 vs 0.39 +/- 0.24, P < 0.001). The value of beta > 0.5 predicted recovery of segmental function with a sensitivity of 71%, specificity of 78%. CONCLUSION: Quantitative intravenous MCE can predict functional recovery after revascularization in patients with chronic coronary artery disease.     

Improvement of left ventricular contractile function by exercise training in patients with coronary artery disease

To determine whether prolonged, intense exercise training can improve left ventricular function in patients with coronary artery disease, we studied 25 patients, 52 +/- 2 years old (mean +/- SE), who completed a 12 month program of endurance exercise training and 14 additional patients with comparable maximal exercise capacities and ejection fractions who did not exercise. The training program consisted of endurance exercise of progressively increasing intensity, frequency, and duration. During the last 3 months the patients were running an average of 18 miles/week, or doing an equivalent amount of exercise on a cycle ergometer. Maximal attainable VO2 increased 37% (p less than .001). Of the 10 patients with effort angina, five became asymptomatic, three experienced less angina, and two were unchanged after training. Ejection fraction was determined by equilibrium radionuclide ventriculography. At rest, ejection fraction was 53 +/- 3% before and 54 +/- 3% after training (p = NS). Ejection fraction did not change during maximal supine exercise before training (52 +/- 3%), but after training it increased to 58 +/- 3% (p less than .01). During maximal exercise, systolic blood pressure and the rate-pressure product were higher after training. The systolic blood pressure-end-systolic volume relationship was shifted upward and to the left, with an increase in maximal systolic blood pressure (p less than .001) and a smaller end-systolic volume (p less than .05), providing evidence for an improvement in contractile state after training. In patients who did not participate in training neither this relationship nor the ejection fraction response to exercise was changed after 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Computer-assisted two-dimensional echocardiography in preoperative evaluation of left ventricular function in patients with aortic valve disease

Seventy-six healthy adults and 228 patients with aortic valve disease were studied by means of two-dimensional echocardiography (2D-EchoCG). Functional properties of the left ventricle in patients with aortic valve disease were studied by means of computer analysis of echocardiograms and patients requiring cardiac surgery were identified. It was found that an increased left ventricular (LV) end-systolic volume (110 ml and more), assessed by 2D-EchoCG, is an unfavourable prognostic sign, and elevated risk factor of cardiac surgery. It invariably proved to be related to LV dysfunction after the surgery. A decreased diastolic LV mass/volume ratio (1.255 and less), found in 16% of patients with pressure overload, means nonadequate development of hypertrophy and an elevated risk of cardiac surgery.     

An analysis of regional left ventricular function utilizing pressure-length relationship in patients with coronary artery disease

Mechanisms related to increased left ventricular filling pressure associated with myocardial ischemia were studied in 13 patients with coronary artery disease. Single-plane left ventriculograms were obtained using a high fidelity micromanometer-tipped catheter in the control and post-pacing periods. All patients developed typical anginal pain during pacing tachycardia. Seven patients (group I) demonstrated no significant changes in ejection fraction (EF) and peak systolic pressure-end-systolic volume ratio (P/Ves) after rapid pacing. End-diastolic pressure (EDP), however, increased significantly from 14.9 +/- 4.9 to 24.4 +/- 8.5 mmHg (p less than 0.01). Six patients (group II) exhibited significant decreases in EF and P/Ves. Here again, EDP increased significantly from 14.0 +/- 7.6 to 28.0 +/- 7.7 mmHg (p less than 0.01). The regional myocardial function was expressed by a radial coordinate system with its origin at the center of gravity of the end-diastolic contour. In the normal segment, the end-diastolic length (EDL) was augmented by 13.6%, associated with a 22.4% increase in stroke excursion with pacing stress. In the ischemic segment, EDL remained unchanged, but stroke excursion was significantly reduced. The diastolic pressure-volume curve shifted directly upward or more to the right, while the diastolic pressure-length curve moved up on the single curve in the normal segment and shifted directly upward in the ischemic segment, so that pressure was higher at any given segment length in the ischemic segment, indicating regional alteration of the diastolic properties. Thus, an ischemic response to pacing tachycardia involves both systolic and diastolic impairment, but the latter is more sensitive.(ABSTRACT TRUNCATED AT 250 WORDS)     

Left ventricular diastolic filling in patients with coronary artery disease and normal left ventricular function

Abnormal left ventricular diastolic filling (DF) has been noted in coronary disease (CD) patients with normal left ventricular function (NLVF). Inclusion of patients with regional wall disease, hypertension, and left ventricular hypertrophy may be responsible for abnormal DF. We evaluated left ventricular DF curves derived from gated blood pool scans in 21 normals (group 1), in 38 CD patients with NLVF specifically defined (group 2), and in 28 CD patients with ejection fractions greater than 50% and regional disease (group 3). The peak filling rate (PFR), mean filling rate (MFR), the percentage of stroke volume filled at one third of diastole (%SV-1/3 DT) and at the end of the rapid filling period (%SV-RFP) were determined. Groups 1 and 2 had similar DF parameters. Group 2 patients with 75% obstructive left anterior descending disease (LAD) had a reduced %SV-RFP and PFR (2.56 +/- 0.56 end-diastolic volumes/sec [EDV/S]) as compared to normals (3.11 +/- 0.65 EDV/S, p less than 0.01). Group 3 patients had a reduced PFR (2.14 +/- 0.53 EDV/S, p less than 0.001), MFR, %SV-1/3 DT, and %SV-RFP. DF in CD patients with NLVF was similar to normals in a select group of patients but was abnormal in patients with regional disease and greater than 75% LAD disease with NLVF.     

冠心病心室晚电位与左室功能的关系

目的：观察心室晚电位（ＶＬＰ）、心律失常事件（ＡＥ）与左室功能之间的关系。方法：１４５例冠心病患者均进行信号平均心电图（ＳＡ－ＥＣＧ）检测和２４小时ＨＯＬＴＥＲ监测，同期进行冠状动脉造影和左室造影及随访观察。结果：１１４５例冠心病患者（心绞痛５５例、陈旧性心肌梗死９０例），随访１４１±７１（４－３６）月，发生ＡＥ７例。２ＶＬＰ阳性组左室射血分数（ＬＶＥＦ）显著降低（Ｐ＜００５）。３发生ＡＥ组ＬＶＥＦ显著降低（Ｐ＜００５）。结论：左室功能障碍者ＶＬＰ阳性率高、容易发生ＡＥ。     

Effects of digoxin on left ventricular function in coronary artery disease patients

To assess whether digitalis modifies or prevents the deterioration of the left ventricular ejection fraction and wall motion during acute ischemia, we performed gated blood pool radionuclide ventriculograms in 15 patients with angiographically documented coronary artery disease. All patients were studied in the resting state and during maximal supine bicycle exercise, both before and 1 hour after 1 mg intravenous digoxin.There was no significant difference, pre-digoxin vs post-digoxin, in exercise tolerance (415 ± 84 vs 418 ± 107 seconds), number of segments with abnormal resting wall motion (12 vs 11) or exercise wall motion (21 vs 19). Ten patients developed angina during the same exercise load, irrespective of digoxin administration. Twelve patients had subnormal left ventricular ejection fraction during exercise pre-digoxin, vs 13 patients post-digoxin (P = ns). In the resting state, the left ventricular ejection fraction was higher after digoxin (53 ± 14% pre vs 58 ± 14% post, P < 0.05). During exercise, however, the left ventricular ejection fraction was not significantly improved after digoxin (50 ± 16% pre vs 53 ± 17% post, P = ns).These data indicate that although acute administration of digoxin improves the resting left ventricular function, it does not improve exercise tolerance to angina. Furthermore, intravenous digoxin does not appear to prevent the deterioration of left ventricular wall motion and ejection fraction during exercise induced ischemia.     

多巴酚丁胺负荷试验中冠心病患者左室舒张功能的参数变化

目的 :探讨多巴酚丁胺负荷试验中左室舒张功能的参数变化及其在冠心病诊断中的意义。方法 :对 18例正常人和 30例冠心病患者进行多巴酚丁胺负荷超声心动图检查 ,分析比较静息状态与峰值负荷状态下两组左室舒张功能各参数的变化情况。结果 :多巴酚丁胺负荷后 ,两组心率、收缩压均明显增加 ,组间比较有明显差异 ;左室舒张早期峰值血流速度 （E）和左室舒张早期血流传播速度 （RFP）在对照组表现为增加 ,在冠心病组为减低 ;冠心病组出现局部室壁运动异常 （RWMA） 2 5例 ,对照组有 1例出现 RWMA。结论 :多巴酚丁胺负荷试验中左室舒张功能的参数变化是反映冠心病心肌缺血的敏感指标 ,可为冠心病诊断提供有力帮助。