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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The cardiac function of 37 cases of ventricular dyskinesia were studied by cineangiography. The amplitude and speed of contraction of the contracting parts was evaluated as well as the volume of the akinetic zone. A score of coronary artery obstruction was made for those patients who underwent coronary arteriography. All the patients had resection of their aneurysm. Four patients died in the immediate post-operative period. Six patients developed a temporary low output state requiring circulatory assistance. Twenty-seven patients were operated on successfully without posing any haemodynamic problem. Good immediate and late post-operative results were associated with an ejection fraction of the contracting part greated than 0,40, a dyskinetic area less than 40% and a coronary artery obstruction index of less than 6. Resection of the aneurysm, sometimes associated with aorto-coronary bypass grafting (5 cases), led to a marked improvement in heart failure and/or disappearance of ventricular arrhythmias.
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PMID:[Left ventricular aneurysms. Hemodynamic studies and surgical results]. 10 90

The method of radionuclide cardangiography (RNCA) has become a well-established method amongst non-invasive assessments in coronary heart disease (CHD). By means of RNCA the most important parameters of left ventricular function, viz. ejection fraction (EF) and wall motion (WM), can be determined very exactly. The first bolus pass method (FBP), which allows satisfactory separation between right and left heart, enables the additional determination of EF distribution, stroke volume (SV) and SV distribution. This method requires the technical necessity of a multicrystal gamma camera. Special nuclear medicine characteristics have been worked out for different groups of CHD. EF and WM show typical signs of angina pectoris, caused by exercise correlating with reduced perfusion in the referring section of WM. While these changes may be reversible after nitrate administration, pathological myocardial function caused by acute myocardial infarction (AMI) or manifest heart failure is not reversed by nitroglycerine. Typical findings were seen in the course of AMI: initial decrease in global EF and diffuse (multilocated) asynergies in the left ventricular wall; in the second week possible start of recovery, including regression of dyskinesia to akinesia at the end of hospitalization. Especially in the early phase of AMI it was demonstrated that FBP--as a non-invasive technique--gives high information quality which is unequalled by other comparable methods. Therefore, the described method of FBP should be classified as very useful and effective in clinical cardiology.
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PMID:[Radionuclide cardangiography as non-invasive assessment in coronary heart disease (author's transl)]. 39 49

51 patients with coronary heart disease had exercise tests on a bicycle ergometer (86 +/- 32 watts). Compared to a normal control group, only 13 patients had normal contractile reserve (group 4.1). In 32 patients the increase in contractility during exercise was reduced (max dP/dt below 3200 mm Hg/s, group 4.2). Patients with reduced contractile reserve were graded according to the height of left ventricular enddiastolic pressure during exercise: In patients with grade 1, enddiastolic pressure was normal. In patients with grade 2, enddiastolic pressure increased between + 4 and + 15 mm Hg and in the patients with grade 3a a above + 15 mm Hg. Contractile and relaxation reserve decreased along with a rise in enddiastolic pressure and an increase in the complaints of the patients. Severe chest pain led to termination of exercise in patients of grade 3b. Enddiastolic pressure increased above + 15 mm Hg. During ischemia, peak-measured velocity of contractile elements (dP/dt/P) and the maximal rate of left ventricular pressure fall (min dP/dt) decreased. In conclusion, with increasing chest pain a decrease of contractile reserve was observed. Left ventricular enddiastolic pressure rose excessively. This has to be taken as a sign of myocardial failure due to ischemic dyskinesia and impeded relaxation.
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PMID:[Contractile and relaxation reserve of the left ventricle. IV. Patients with coronary heart disease (author's transl)]. 62 71

Recent epidemiologic studies have suggested that cardiac disease in common in diabetics and may often have a noncoronary basis. To examine the status of the left ventricle, 17 adult-onset diabetics of familial type without hypertension or obesity underwent hemodynamic study and were compared to 9 controls of similar age. Of the 17, 12 subjects had no significant occlusive lesions by coronary angiography. From this group eight without heart failure had a modest, but significant, elevation of left ventricular end-diastolic pressure. End-diastolic and stroke volumes were reduced, but ejection fraction and mean rate of fiber shortening were within normal limits. The left ventricular end-diastolic pressure/volume ratio was significantly higher than controls. Afterload increments effected a significant increase of filling pressure compared to normals without a stroke volume response, consistent with a preclinical cardiomyopathy. Four patients with prior heart failure had similar but more extensive abnormalities. None had local dyskinesia by angiography, and lactate production was not observed during pacing-induced tachycardia. Left ventricular biopsy in two patients without ventricular decompensation showed interstitial collagen deposition with relatively normal muscle cells. These findings suggest a myopathic process without ischemia. Postmortem studies were performed in 11 uncomplicated diabetics. Nine were without significant obstructive disease of the proximal coronary arteries, and the majority succumbed with cardiac failure. On left ventricular sections, none had evident luminal narrowing of the intramural vessels. All nine exhibited periodic acid-Schiff-positive material in the interstitium. Collagen accumulation was present in perivascular loci, between myofibers, or as replacement fibrosis. Multiple samples of left ventricle and septum revealed enhanced triglyceride and cholesterol concentrations, as compared to controls. Thus, a diffuse extravascular abnormality may be a basis for cardiomyopathic features in diabetes.
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PMID:Evidence for cardiomyopathy in familial diabetes mellitus. 89 79

Thirty-one patients, mean age 54 years, had been on chronic ambulatory peritoneal dialysis (CAPD) for an average of 38 months. Mean values (mg/dl) for triglycerides (567), total-C (267), LDL-C (133), and Apo-B (154) were elevated, and HDL-C (30) were low. The low values for total-C/Apo-B and LDL-C/Apo-B suggest an increase in the number of low density lipoprotein (LDL) particles, rather than in the amount of cholesterol per LDL particle. Without knowledge of lipids, ischemic heart disease for the 31 patients was categorized into five grades in the following manner. All patients were graded based on history (angina, myocardial infarction, and bypass surgery), electrocardiogram (EKG), and echocardiography. In addition, five patients underwent coronary angiography, the results of which were considered in their grading. The five grades were assigned as follows: Grade I, no evidence (n = 15); Grade II, angina with EKG ischemia (n = 4); Grade III, myocardial infarction (MI) (n = 1); Grade IV, MI with dyskinesia-akinesia on echo (n = 4); Grade V, severe three vessel disease on angiography, or multiple infarcts, or Grade IV with heart failure (n = 7). Only Apo-B (r = 0.56) and total-C/HDL-C (r = 0.57) correlated with severity of grade, with p less than 0.001. When patients with and without detectable ischemic heart disease were compared by stepwise logistic regression, Apo-B was the only variable that independently predicted heart disease (p = 0.001). However, contribution of the lipid changes induced by CAPD has not been established.
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PMID:Ischemic heart disease, serum cholesterol, and apolipoproteins in CAPD. 175 Dec 58

The relationship was examined between the severity of heart failure, the degree of asynergy and exercise tolerance in 40 males under 60 years with postinfarction cardiosclerosis. Fifteen healthy males were matched for as a control. Echocardiography was performed before and after bicycle ergometer exercise test, allowing the patients to be divided into 4 groups: Groups 1 and 2 without an ischemic response in the absence or presence of akinesia or dyskinesia, respectively; Groups 3 and 4 with an ischemic response in the absence or presence of akinesia or dyskinesia, respectively. The lowest exercise tolerance was observed in Group 4. Echographic findings showed that the overall left ventricular contractility was diminished in all the patients; there was no noticeable quantitative difference in the values between the groups. No differences were found in segmental ejection fractions. The combination of ischemic response to exercise tolerance and akinesia-dyskinesia asynergy indicates a more severe disease of the coronary bed and myocardium.
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PMID:[Cardiac contractility in males with post-infarction cardiac sclerosis as evidenced by ultrasonic scanning]. 180 64

A case is reported of a neonate with transposition of the great arteries, undergoing an arterial switch operation, in whom the cause for postbypass cardiac failure was diagnosed by intraoperative epicardial echocardiography. Obvious regional dyskinesia was seen by two-dimensional echocardiography in the posterolateral segments of the left ventricle, supplied by the circumflex coronary artery. After the switch procedure, the reimplanted circumflex artery ran between the aorta and the pulmonary artery. Lifting the pulmonary artery off the circumflex artery resulted in immediate improvement of regional myocardial function, which could be monitored on-line with echocardiography. Thus compression of the circumflex by the pulmonary artery was the cause for cardiac failure. On the basis of the echocardiographic information, immediate and successful surgical revision was performed. Intraoperative epicardial echocardiography has a unique diagnostic potential in the case of cardiac failure after cardiopulmonary bypass.
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PMID:Intraoperative ultrasonographic identification of coronary artery compression after an arterial switch procedure. 196 Sep 87

The purpose of this clinical study was to (1) evaluate mortality rates after surgical interventions for patients in cardiogenic shock (CS) secondary to acute coronary occlusion, acute ventricular septal defect (VSD) or acute valvular heart disease, (2) determine the pre-operative regional wall motion, and (3) ascertain the recovery of preoperative regional wall motion abnormalities after surgical intervention. The hospital records of twenty-five consecutive patients in CS were reviewed retrospectively. Regional wall motion was assessed preoperatively by ventriculography and postoperatively by 2D echocardiography (Sonotron Kardio VUE 60) after 1 and 3 days and at the day of discharge from the surgical ward (7-10 days). The left ventricle was divided in three segments according to the blood supply: LAD artery (antero-lateral wall), circumflex artery (lateral wall), and right coronary artery (inferior and basal wall). Regional wall motion was analyzed with the use of a scoring system in which grading was from 0 to 4 according to the following criteria: 0 = hyperkinesia, 1 = normokinesia, 2 = hypokinesia, 3 = dyskinesia, 4 = akinesia. Postmortem examination was performed in 8/9 patients. Data are presented as mean +/- SD. Significant differences were defined as probabilities for each test of p less than 0.05. The hospital mortality was higher for patients with acute coronary occlusion as compared to those with acute valvular disease or VSD (54.5%, 27.3%, 0%, resp.). The cause of death was cardiac in 7/9 patients. However, postmortem examination revealed loss by infarction of only moderate quantities of myocardium which could not explain the severe postoperative heart failure in those patients. Previous myocardial infarctions and preoperative cardiac arrest were significant risk factors for hospital mortality. In all patients with acute coronary occlusion (11/11) at least one region of the left ventricle was either a- or dyskinetic in the region supplied by the acute occluded vessel. In addition five patients had akinetic regions due to previous infarctions. The remaining remote myocardium was hypocontractile due to significant stenosis in coronary arteries supplying remote areas. Of 10 dyskinetic segments before surgical intervention, 5 were akinetic postoperatively, and only 5 developed slight hypokinetic contractions. The overall hypokinetic regions were not different as compared to the preoperative data (36.4% vs 39.4%). The normokinetic segments increased from 9.1% to 33.% (p less than 0.05).
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PMID:Prolonged abnormalities of LV regional wall motion after normal reperfusion in patients with preoperative cardiogenic shock. 237 33

In a consecutive series of 96 patients with coronary artery occlusion, 67 had good and 29 had no or poor collateral circulation. Patients with good collaterals had the severest degree of coronary artery disease. Good collaterals are associated with a higher incidence of angina pectoris and normal electrocardiogram and with lower incidence of Q-waves, positive exercise tests, heart failure, previous myocardial infarction, and dyskinesia at ventriculography. Survival rates after 10 years were (1) 51.5% with good and 34.5% with poor collaterals (p less than 0.1), (2) 59.4% with angina pectoris and good collaterals and 41.2% with angina pectoris and poor collaterals (p less than 0.05), (3) 64.8% without and 24.4% with heart failure and good collaterals (p less than 0.001), and (4) 58.3% without and 16.1% with heart failure and poor collaterals (p less than 0.01). Good collaterals protect the myocardium by prevention of acute myocardial infarction and heart failure and thus improve survival.
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PMID:Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion. 291 4

Echocardiography was used to explore regional myocardial contractility in 92 patients with postinfarction cardiosclerosis complicated by heart failure developed in the late postinfarction period. All the patients were shown to display regional myocardial contractile dysfunctions as hypo-, a-, and dyskinesia accompanied with hyperfunction of intact myocardial segments. The most severe asynergy was present in anterior postinfarction scars. Peripheral vasodilators were found to improve contractility in the hypokinetic and intact areas of the myocardium.
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PMID:[Effect of peripheral vasodilators on the local contractile function of the myocardium in patients with post-infarction cardiosclerosis]. 306 64


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