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Left Ventricular Systolic Dysfunction (leave + ventricular_systolic_dysfunction)
Selected AbstractsLack of Association between Obesity and Left Ventricular Systolic DysfunctionECHOCARDIOGRAPHY, Issue 2 2009Mohammad Reza Movahed M.D., Ph.D. Background: Previous studies have demonstrated that obesity is one of the risk factors for congestive heart failure (CHF). By analyzing a large database, we investigated any association between body mass index (BMI) and left ventricular (LV) systolic dysfunction. Methods: We retrospectively analyzed 24,265 echocardiograms performed between 1984 and 1998. Fractional shortening (FS) and BMI were available for 13,382 subjects in this cohort which were used for data analysis. FS was stratified into four groups: (1) FS > 25%, (2) FS 17.5,25%, (3) FS 10,17.5%, and (4) FS < 10%. Furthermore, we also used final diagnosis that was coded by the reading cardiologist as mild, moderate, and severe LV dysfunction separately for data analysis. BMI was divided into four groups: BMI < 18.5 kg/m2 (underweight), 18.5,24.9 kg/m2 (normal), 25,30 kg/m2 (overweight), and >30 kg/m2 (obese). Results: There was no association between different BMI categories and LV systolic function. The prevalence of mild, moderate, or severely decreased LV function (based on FS or subjective interpretation of reading cardiologists) was equally distributed between the groups. Obese patients (BMI > 30%) had normal FS of >25 in 16.9%, mildly decreased FS in 18%, moderately decreased FS in 18.4%, and severely decreased FS in 20.1% P = ns. Conclusion: Our study is consistent with previous trials suggesting that obesity is not related to systolic LV dysfunction. The underlying mechanism for the occurrence of congestive heart failure in obese patients needs further investigation. [source] Elongation Index as a New Index Determining the Severity of Left Ventricular Systolic Dysfunction and Mitral Regurgitation in Patients with Congestive Heart FailureECHOCARDIOGRAPHY, Issue 7 2005Mehmet Yokusoglu M.D. The shape of the left ventricle is an important echocardiographic feature of left ventricular dysfunction. Progression of the mitral regurgitation and consequent left ventricular remodeling is unpredictable in heart failure. Elongation index is an index of left ventricular sphericity. The surface area of the elongated ventricle is larger than that of a spherical one. The objective of this study was to assess the relation between elongation index and the degree of mitral regurgitation along with noninvasive indices of left ventricular function. Thirty-two patients (21 male, 11 female, mean age: 57 ± 6 yrs) with congestive heart failure and mitral regurgitation were included. Patients were stratified into three groups according to vena contracta width as having mild (n = 11), moderate (n = 11) and severe mitral regurgitation (n = 10). The elongation index (EI) was considered as equal to {[(left ventricular internal area-measured) , (theoretical area of the sphere with measured left ventricular volume)]/(theoretical area of the sphere with measured left ventricular volume)}. Ejection fractions by the modified Simpson rule, dP/dt and sphericity index (SI) were also recorded. The relationship between (EI), ejection fraction, dP/dt and SI reached modest statistical significance (p < 0.05). When the EI and SI were compared, the correlation was also significant (p < 0.01). The areas under the receiver operator curve of EI and SI for discriminating dP/dt < 1000 mm Hg/s were 0.833 and 0.733, respectively. In conclusion, the elongation, which defines the shape of the left ventricle, might be related to the systolic function of the left ventricle and the degree of the mitral regurgitation. Further studies are needed to demonstrate its use in other clinical entities. [source] Screening for Asymptomatic Left Ventricular Dysfunction Using B-Type Natriuretic PeptideCONGESTIVE HEART FAILURE, Issue 2008Theresa A. McDonagh MD Asymptomatic left ventricular dysfunction (ASLVD), a known precursor phase of heart failure, fulfills the essential criteria that should be met before screening for a disease. It is common and associated with reduced longevity and quality of life. Left untreated, it progresses to heart failure, which incurs a mortality greater than most cancers as well as significant morbidity rates. In addition, we now have several population-based studies that demonstrate that both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP) can accurately exclude left ventricular systolic dysfunction. More recent work shows that this can be done cost-effectively. There is also a wealth of evidence from randomized controlled trials indicating that the treatment of ASLVD can reduce both morbidity and mortality and slow progression to the heart failure state. The main stumbling block to implementation of screening, in addition to the perceived cost, may well be the lack of a randomized study showing that screening the population for ASLVD really does alter the natural history of the condition, something that other screening strategies have so far failed to do. Congest Heart Fail. 2008;14(4 suppl 1):5,8. ©2008 Le Jacq [source] Biocompatibility of Heparin-Coated Cardiopulmonary Bypass Circuits in Coronary Patients With Left Ventricular Dysfunction Is Superior to PMEA-Coated CircuitsJOURNAL OF CARDIAC SURGERY, Issue 6 2006Veysel Kutay M.D. The aim of this study was to evaluate the clinical effectiveness and biocompatibility of heparin-coated and poly-2-methoxyethylacrylate (PMEA)-coated CPB circuits on coronary patients with left ventricular systolic dysfunction. Methods: Thirty-six patients who underwent elective coronary artery bypass grafting were divided into two equal groups: group H (n = 18), heparin-coated; group P (n = 18), PMEA coated. Clinical outcomes, hematologic variables, cardiac enzymes, malondialdehyde (MDA), and acute phase inflammatory response (including myeloperoxidase (MPO), catalase, hsCRP, and IL-8) were analyzed perioperatively. Results: Demographic, CPB, and clinical outcome data were similar for both groups. Plasma fibrinogen, total protein, albumin, and platelet count decreased, neutrophil count, MDA, IL-8, MPO, and catalase levels increased during CPB. During CPB, MPO and catalase values were significantly higher in group P (p = 0.02 and p = 0.01) and postoperative MDA concentration was lower in group H (p = 0.03). Platelet counts were better preserved in group H during and after CPB but neutrophil count and IL-8 level did not differ between the groups. Postoperative total protein, albumin, and fibrinogen levels were higher in group H (p < 0.05). The postoperative first day levels of troponin-I, CK-MB, and CRP increased in both groups without any significant differences between the groups. Conclusions: Heparin-coated circuit provided better suppression of perioperative inflammatory markers and exhibited more favorable effects on hematologic variables than PMEA-coated circuit. [source] Predictors of All-Cause Mortality for Patients with Chronic Chagas' Heart Disease Receiving Implantable Cardioverter Defibrillator TherapyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2007AUGUSTO CARDINALLI-NETO M.D., Ph.D. Background: Implantable Cardioverter Defibrillators (ICD) have sporadically been used in the treatment of either Sustained Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) in Chagas' disease patients. This study aimed at determining predictors of all-cause mortality for Chagas' disease patients receiving ICD therapy. Methods and Results: Ninety consecutive patients were entered the study. Mean left ventricular ejection fraction was 47 ± 13%. Twenty-five (28%) patients had no left ventricular systolic dysfunction. After device implantation, all patients were given amiodarone (mean daily dose = 331, 1 ± 153,3 mg), whereas a B-Blocking agent was given to 37 (40%) out of 90 patients. Results: A total of 4,274 arrhythmias were observed on stored electrogram in 64 (71%) out of 90 patients during the study period; SVT was observed in 45 out of 64 (70%) patients, and VF in 19 (30%) out of 64 patients. Twenty-six (29%) out of 90 patients had no arrhythmia. Fifty-eight (64%) out of 90 patients received appropriate shock, whereas Antitachycardia Pacing was delivered to 58 (64%) out of 90 patients. There were 31 (34%) deaths during the study period. Five patients were lost to follow up. Sudden cardiac death affected 2 (7%) out of 26 patients, whereas pump failure death was detected in the remaining 24 (93%) patients. Number of shocks per patient per 30 days was the only independent predictor of mortality. Conclusion: Number of shocks per patient per 30 days predicts outcome in Chagas' disease patients treated with ICD. [source] Predictors of cardiac events in high-risk patients undergoing emergency surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009A. OSCARSSON Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery. Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included. Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI >0.06 ,g/l and NT-proBNP >1800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded. Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P<0.001) and 30-day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT-proBNP were seen in 59% of the patients. Elevated NT-proBNP was an independent predictor of myocardial damage post-operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1,18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT-proBNP ,1800 pg/ml, P<0.001). Conclusion: Myocardial damage is common in a high-risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post-operative period and increased concentration of NT-proBNP before surgery. The combinations of TnI and NT-proBNP are reliable markers for monitoring patients at risk in the peri-operative period as well as useful tools in our risk assessment pre-operatively in emergency surgery. [source] Underutilization of Implantable Cardioverter Defibrillators Post Coronary Artery Bypass Grafting in Patients with Systolic DysfunctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2010JERRY M. JOHN M.D. Background: Evaluation of the need for prophylactic internal cardiac defibrillators among patients with ischemic cardiomyopathies should be deferred until at least 3 months after revascularization procedures to allow adequate time for recovery of ventricular function. Methods: Among patients with left ventricular systolic dysfunction (LVSD) who undergo coronary artery bypass grafting (CABG), the proportion of patients who are risk stratified postoperatively with reassessment of left ventricular ejection fraction (LVEF) is unknown. Results: One hundred and six patients with LVSD (LVEF < 40%) who underwent CABG during 2004,2006 and survived 3 months post CABG were evaluated. Follow-up was assessed by chart review and telephone contact. LVEF was not reassessed in 24% (25/106) of the population, none of whom underwent internal cardioverter defibrillator (ICD) implantation. Of those with LVEF reassessed, persistent LVSD was present in 20/81 (25%), 12 of whom were referred for prophylactic ICD placement. Conclusion: One-fourth of patients with LVSD who undergo CABG do not have LVEF reassessed postoperatively which may lead to underutilization of ICDs. (PACE 2010; 33:727,733) [source] | ||||||||||