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Mean Ejection Fraction (mean + ejection_fraction)
Selected AbstractsBrain Natriuretic Peptide Levels and Response to Cardiac Resynchronization Therapy in Heart Failure PatientsCONGESTIVE HEART FAILURE, Issue 5 2006Reynolds M. Delgado MD The authors used brain natriuretic peptide (BNP) as a reliable marker to identify nonresponders to cardiac resynchronization therapy (CRT) in patients with advanced heart failure. The study included 70 patients with left ventricular dysfunction (mean ejection fraction, 21±4%) and left bundle branch block (QRS duration, 164±25 milliseconds) treated with CRT. The authors reviewed data on New York Heart Association functional class, baseline ejection fraction, sodium, creatinine, QRS duration, and BNP levels 3 months before and after CRT therapy. The authors compared results of 42 patients who survived (973+192 days) after CRT implantation (responders) to those of 28 patients (nonresponders) who either expired (n=21) or underwent heart transplantation (n=5) or left ventricular assist device implantation (n=2) after an average of 371+220 days. Mean BNP levels after 3 months of CRT decreased in responders from 758±611 pg/mLto 479±451 pg/mL (P=.044), while in nonresponders there was increase in BNP levels from 1191 ±466 pg/mL to 1611 ±1583; P=.046. A rise in BNP levels was associated with poor response (death or need for transplantation or left ventricular assist device and impaired long-term outcome), which makes it a good predictor to identify such patients. [source] Outcomes and Prognostic Factors of Systolic as Compared With Diastolic Heart Failure in Urban AmericaCONGESTIVE HEART FAILURE, Issue 1 2005Peter A. McCullough MD We sought to describe a large heart failure (HF) population with respect to systolic and diastolic abnormalities in terms of demographics, echocardiographic parameters, and survival. Using data abstracted from the Resource Utilization Among Congestive Heart Failure (REACH) study, a targeted subpopulation of 3471 patients had electrocardiographic, echocardiographic, and clinical data taken from automated sources during the first year of diagnosis. Among the HF population, 1811 (52.2%) had diastolic HF. Prevalence of diastolic HF trended with age, from 46.4% in those less than 45 years to 58.7% in those 85 years or older (p=0.001 for trend). Patients with diastolic HF had a higher mean ejection fraction (55.7% vs. 28.0%), lower left ventricular end-systolic diameter (3.11 vs. 4.74 cm), and lower left atrium: aortic outlet ratio (1.28 vs. 1.38) (p=0.001 for each comparison). Annualized age, sex, and race-adjusted mortality were 11.2% and 13.0% for those with diastolic and systolic HF, respectively (p=0.001). In a large, racially mixed, urban HF population, those with diastolic HF predominate and enjoy better-adjusted survival than counterparts with systolic HF. [source] Stress-Induced Wall Motion Abnormalities with Low-Dose Dobutamine Infusion Indicate the Presence of Severe Disease and Vulnerable MyocardiumECHOCARDIOGRAPHY, Issue 7 2007Stephen G. Sawada M.D. Background: Patients with left ventricular (LV) systolic dysfunction due to coronary artery disease (CAD) may develop stress-induced wall motion abnormalities (SWMA) with low-dose (10 ,g/kg/min) dobutamine infusion. The clinical significance of low-dose SWMA is unknown. Objective: We investigated the clinical, hemodynamic and angiographic correlates of low-dose SWMA in patients with chronic ischemic LV systolic dysfunction. Methods: Seventy patients with chronic ischemic LV systolic dysfunction who had dobutamine stress echocardiography were studied. Clinical, hemodynamic, and angiographic parameters at rest and low-dose were compared between 38 patients (mean ejection fraction (EF) of 30 ± 8%) with low-dose SWMA and 32 patients (EF 30 ± 11%) without low-dose SWMA. Results: Multivariate analysis showed that the number of coronary territories with severe disease (stenosis ,70%)(P = 0.001, RR = 6.3) was an independent predictor of low-dose SWMA. An increasing number of collateral vessels protected patients from low-dose SWMA (P = 0.011, RR = 0.25). A higher resting heart rate was a negative predictor of low-dose SWMA (P = 0.015, RR = 0.92) but no other hemodynamic variables were predictors. In the patients with low-dose SMA, regions with low-dose SWMA were more likely to be supplied by vessels with severe disease than regions without low-dose SWMA (92% vs 58%, P < 0.001). Conclusion: In patients with ischemic LV systolic dysfunction, the extent of severe disease and a lower numbers of collaterals predict the occurrence of low-dose SWMA. Low-dose SWMA is a highly specific marker for severe disease. [source] Reversal of cardiac complications in thalassemia major by long-term intermittent daily intensive iron chelationEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2003H. Miskin Abstract: Objectives: In patients with thalassemia major (TM) who are non-compliant with long-term deferoxamine (DFO) chelation, survival is limited mainly because of cardiac complications of transfusional siderosis. It was recently shown in a small group of TM patients with established cardiac damage that continuous 24-h DFO infusion via an indwelling intravenous (i.v.) catheter is effective in reversing cardiac toxicity. The aim of the present study was to evaluate the results with intermittent daily (8,10 h) i.v. DFO. Patients: Eight TM patients with cardiac complications treated with intensive intermittent DFO were retrospectively evaluated by the mean annual serum ferritin, radionucleated ventriculography and 24-h electrocardiography recordings. Results: The median age at diagnosis of cardiac disease was 17.5 yr (range 14,21), and the median follow-up time was 84 months (range, 36,120). In the majority of patients (seven of eight) high-dose DFO (mean 95 ± 18.3 mg/kg/d) was administered via a central venous line. During follow-up, there was a significant decrease in the mean ferritin levels (5828 ± 2016 ng/mL to 1585 ± 1849 ng/mL, P < 0.001). Both cardiac failure (mean ejection fraction 32 ± 5) and cardiac arrhythmias were resolved in four of five patients. One non-compliant patient died during the follow-up. Following discontinuation of the i.v. therapy, compliance with conventional DFO therapy improved. The complications of this regimen, mainly catheter-related infections and catheter-related thrombosis, were similar to those described earlier. Conclusions: These results with the longest follow-up period in the literature suggest that i.v. high-dose DFO for 8,10 h daily may be as effective as continuous 24-h infusion for the reversal of established cardiac disease in TM. [source] Identification and Ablation of Three Types of Ventricular Tachycardia Involving the His-Purkinje System in Patients with Heart DiseaseJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2004GUSTAVO LOPERA M.D. Introduction: Ventricular tachycardia (VT) with involvement of the His-Purkinje system (HPS) can be difficult to recognize in patients with heart disease, but it may be particularly susceptible to ablation targeting the HPS. This study defines the incidence and types of HPS involvement in VT. Methods and Results: Involvement of the HPS was sought during electrophysiologic study with catheter mapping in 234 consecutive patients referred for catheter ablation of recurrent VT associated with heart disease. HPS VT was observed in 20 (8.5%) patients (mean ejection fraction 29%± 17%); in 9 (11%) of 81 patients with nonischemic heart disease and 11 (7.1%) of 153 patients with coronary artery disease (P = NS). Three types of HPS VT were observed: 16 patients (group 1) had typical bundle branch reentry, 2 patients (group 2) had bundle branch reentry and interfascicular reentry, and 2 patients (group 3) had VT consistent with a focal origin in the distal HPS. In all three groups, the VT QRS had morphologic similarity to the sinus rhythm QRS. Ablation of HPS VT was successful in all patients in whom it was attempted but produced high-degree AV block in 6 (30%). In 12 patients (60%), other VTs due to reentry through scar also were inducible. Conclusion: Involvement of the HPS in VT associated with heart disease has three distinct clinical forms, all of which are susceptible to ablation. Ablation often is not sufficient as the sole therapy due to other induced VT's and conduction abnormalities, requiring pacemaker and/or defibrillator implantation. (J Cardiovasc Electrophysiol, Vol. 15, pp. 52-58, January 2004) [source] Marked Improvements in Outcomes of Contemporary Percutaneous Coronary Intervention in Patients with Diabetes MellitusJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2006ANDREW M. FREEMAN M.D. We sought to determine if advances in percutaneous coronary intervention (PCI) are associated with better outcomes among patients with diabetes mellitus (DM). Patients with DM enrolled in the National Heart, Lung, and Blood Institute (NHLBI) early PTCA Registry (1985,1986) were compared to those in the subsequent contemporary Dynamic Registry (1999,2002) for in-hospital and one-year cardiovascular outcomes. The study population included 945 adults with DM, 325 from the PTCA Registry and 620 from the Dynamic Registry. Multivariable Cox regression models were built to estimate the risk of clinical events. Dynamic Registry patients were older, had more noncardiac comorbidities, and a lower mean ejection fraction (50.5% vs 57.8%, P , 0.001) compared to the PTCA Registry patients. The incidence of in-hospital mortality (1.9% vs 4.3%, P , 0.05), myocardial infarction (MI) (1.0% vs 7.4%, P , 0.001), and coronary artery bypass grafting (CABG) (0.8% vs 6.2%, P , 0.001) were all significantly lower and independent of the use of stents. One-year adverse events including MI (4.9% vs 11.0%, P , 0.001), CABG (6.4% vs 15.0%, P , 0.001), and need for repeat revascularization (18.7% vs 33.3%, P , 0.001) were all lower in the Dynamic Registry. The relative risk of death at 1 year was significantly less for patients in the Dynamic Registry (RR 0.56, 0.34; 0.92, P = 0.02). Although Dynamic Registry patients with diabetes had more advanced coronary disease, in-hospital and late adverse events were lower. A combination of the use of stents and an increase in adjunctive medical therapy are likely responsible for the observed improvements in outcomes in contemporary PCI. [source] The Effects of Rate-Adaptive Atrial Pacing Versus Ventricular Backup Pacing on Exercise Capacity in Patients with Left Ventricular DysfunctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009M.S.C.E., ROD PASSMAN M.D. Background: Atrial rate-adaptive pacing may improve cardiopulmonary reserve in patients with left ventricular dysfunction. Methods: A randomized, blinded, single-crossover design enrolled dual-chamber implantable defibrillator recipients without pacing indications and an ejection fraction ,40% to undergo cardiopulmonary exercise treadmill stress testing in both atrial rate-adaptive pacing (AAIR) and ventricular demand pacing (VVI) pacing modes. The primary endpoint was change in peak oxygen consumption (VO2). Secondary endpoints were changes in anaerobic threshold, perceived exertion, exercise duration, and peak blood pressure. Results: Ten patients, nine males, eight with New York Heart Association class I, mean ejection fraction 24 ± 7%, were analyzed. Baseline VO2 was 3.6 ± 0.5 mL/kg/min. Heart rate at peak exercise was significantly higher during AAIR versus VVI pacing (142 ± 18 vs 130 ± 23 bpm; P = 0.05). However, there was no difference in peak VO2 (AAIR 23.7 ± 6.1 vs VVI 23.8 ± 6.3 mL/kg/min; P = 0.8), anaerobic threshold (AAIR 1.3 ± 0.3 vs VVI 1.2 ± 0.2 L/min; P = 0.11), rate of perceived exertion (AAIR 7.3 ± 1.5 vs VVI 7.8 ± 1.2; P = 0.46), exercise duration (AAIR 15 minutes, 46 seconds ± 2 minutes, 54 seconds vs VVI 16 minutes, 3 seconds ± 2 minutes, 48 seconds; P = 0.38), or peak systolic blood pressure (AAIR 155 ± 22 vs VVI 153 ± 21; P = 0.61) between the two pacing modes. Conclusion: In this study, AAIR pacing did not improve peak VO2, anaerobic threshold, rate of perceived exertion, or exercise duration compared to VVI backup pacing in patients with left ventricular dysfunction and no pacing indications. [source] Evidence for Electrical Remodeling of the Native Conduction System with Cardiac Resynchronization TherapyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2007CHARLES A. HENRIKSON M.D. Background:Cardiac resynchronization therapy (CRT) improves hemodynamics and decreases heart failure symptoms. However, the potential of CRT to bring about electrical remodeling of the heart has not been investigated. Methods and Results:We studied 25 patients, of whom 17 had a nonischemic cardiomyopathy, and 8 had an ischemic cardiomyopathy; 16 had left bundle branch block (LBBB), 1 right bundle branch block (RBBB), and 8 nonspecific intraventricular conduction delay. During routine device clinic visits, patients with chronic biventricular pacing (>6 months) were reprogrammed to VVI 40 to allow for native conduction to resume. After 5 minutes of native rhythm, a surface electrocardiogram (ECG) was recorded, and then the previous device settings were restored. This ECG was compared to the preimplant ECG. Preimplant mean ejection fraction was 19% (range, 10%,35%), and follow-up mean ejection fraction was 35% (12.5%,65%). Mean time from implant to follow-up ECG was 14 months (range, 6,31). The QRS interval prior to CRT was 155 ± 29 ms, and shortened to 144 ± 31 ms (P = 0.0006), and the QRS axis shifted from ,1 ± 59 to ,26 ± 53 (P = 0.03). There was no significant change in PR or QTc interval, or in heart rate. Conclusion:CRT leads to a decrease in the surface QRS duration, without affecting other surface ECG parameters. The reduced electrical activation time may reflect changes in the specialized conduction system or in intramyocardial impulse transmission. [source] Improvement of Congestive Heart Failure by Upgrading of Conventional to Resynchronization PacemakersPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2006IBRAHIM MARAI Aims: To compare the clinical response of patients with right ventricular apical pacing (RVAP) upgraded to cardiac resynchronization therapy (CRT) to that of previously nonpaced heart failure (HF) patients who had de novo CRT implantation. Background: The role of CRT in patients with wide QRS and HF due to RVAP is less well established than in other CRT candidates. Methods: Ninety-eight consecutive patients with CRT were studied (mean age 70, mean ejection fraction 0.23). Group A: patients having RVAP prior to CRT implantation (n = 25), group B: patients without prior RVAP (n = 73). Clinical and echocardiographic parameters were recorded prior to, and 3 months after, CRT implantation. Results: Group A patients had a wider QRS at baseline compared to group B (203 ± 32 ms vs 163 ± 30 ms respectively, P < 0.001), and a shorter 6-minute walking distance (222 ± 118 m vs 362 ± 119 m, respectively, P < 0.005). Otherwise, clinical and echocardiographic parameters were not different. At follow up, group A patients had an average 0.7 ± 0.5 decrease in their NYHA functional class, compared to 0.3 ± 0.7 in group B patients (P < 0.05). Six-minute walking distance increased by 93 ± 113 m in group A, versus 36 ± 120 m in group B (P = 0.22). There was no difference in echocardiographic response to CRT between the groups. Conclusions: HF patients with prior RVAP demonstrate clinical improvement after upgrading to CRT that is comparable, and in some aspects, even better than that observed in HF patients with native conduction delay who undergo de novo CRT implantation. 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