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Cardiac catheterization, angiocardiography and ventricular muscle biopsy were performed in forty patients with idiopathic cardiomyopathy and included 21 cases of hypertrophic cardiomyopathy and 19 cases of congestive cardiomyopathy. 1) Cardiac catheterization revealed normal cardiac index and stroke index in both types, although there was a slight tendency toward decrease in cases of CCM. HCM showed slightly elevated right ventricular end-diastolic pressure and left ventricular end-diastolic pressure with a high incidence of atrial kick. CCM showed an elevated mean pulmonary artery, mean pulmonary wedge and left ventricular end-diastolic pressure. 2) Angiocardiographic findings revealed that in HCM left ventricular end-diastolic volume as well as left ventricular end-systolic volume, ejection fraction, meanVcf and MNSER were within normal range, and left ventricular anterior wall thickness, left ventricular mass and shortening of short axis in systole were increased. In CCM left ventricular end-diastolic volume and end-systolic volume increased, and ejection fraction, meanVcf, MNSER were decreased. The left ventricular anterior wall thickness was normal, and the left ventricular mass was smaller compared to the volume. The shortening of long and short axes in systole was slight. Left ventricular asynergy and mitral regurgitation occurred frequently. Coronary cineangiograms revealed normal patterns in both types. 3) Histological findings revealed hypertrophy of myofibers, degenerative changes, i.e. scarcity of myofibrils, deformity of nucleus and vacuolization of myocardial fibers, and collagen proliferation in both types. 4) No definite relationship was seen between parameters of left ventricular function and the findings of biopsied left ventricular muscle except for increase in wall thickness which might be apparently due to hypertrophy of the myocardial fibers.
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PMID:Angiocardiograms and hemodynamics in idiopathic cardiomyopathy, with reference to histology of biopsied ventricular myocardium. 15 67

The change in left ventricular volume during a representative cardiac cycle was assessed in 19 patients with CAD and 8 control subjects before and after 10 mg isosorbiddinitrate sublingually. 15mCi99mTc-HSA were administered intravenously. After the tracer had equilibrated, the precordial changes of activity were measured with a gamma-camera connected to a computer. In order to determine the overall left-ventricular function from volume curves, the ejection fraction, the maximal systolic ejection rate and the maximal diastolic filling rate of the left ventricle were measured. For the assessment of regional wall motion abnormalities the volume changes were observed in a cinemode on a colour video display. In addition the relative changes of regional EF, regional stroke volume and the timing of endsystole were recorded as a functional scintigram. The results showed very clear differences between control subjects and patients with CAD. Furthermore differences existed between patients with hypokinesia and those with akinesia or aneurysm. The results emphasize that quantitative gated nuclear cardiography not only provides information concerning the left ventricular function but also allows the assessment of local wall motion as to reversible or irreversible asynergy.
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PMID:[Quantitative gated nuclear cardiography in coronary artery disease after administration of isosorbiddinitrate (author's transl)]. 54 1

The left ventricular systolic ejection phase was cineangiographically analyzed in an attempt to evaluate left ventricular performance. Forty-eight patients were classified into five groups: (1) 9 controls; (2) 5 patients with PMD (congestive type) (COCM); (3) 9 patients with PMD hypertrophic type) (HCM), (4) 9 patients with ischemic heart disease (IHD); and (5) 16 patients with mitral stenosis (MS). The rate of volume change (deltaV/deltat) and the volume change as a percentage of stroke volume (deltaV/SV) in patients with COCM and IHD were lower in the early systole and higher in the mid-systole as compared with the control group. Normalized systolic ejection rate (NSER) and velocity of circumferential fiber shortening (Vcf) for the early and late systole were significantly lower in patients with COCM and IHD than in the control group. In two patients with IHD in whom normal indices of left ventricular performance and no asynergy were observed, NSER and Vcf were normal in the late systole but were significantly lower in the early systole. In all 48 patients, deltaV/deltat, deltaV/SV, NSER and Vcf were compared statistically with conventional ejection phase indices and isometric phase indices. delthV/SV for the midstystole showed a negative correlation with EF, MNSER and mVcf. NSER and Vcf for all three phases showed a good correlation with Vmax, max dp/dt and R-max dp/dt but a better correlation with EF, MNSER and mVcf. It was concluded that NSER and Vcf for the early systole were sensitive indices of left ventricular performance and may be utilized to detect subtle depression of left ventricular performance.
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PMID:Quantitative analysis of left ventricular ejection phase by means of left ventricular cineangiography. 59 71

The percentage of shortening of the echocardiographic left ventricular dimension (% delta D) was prospectively evaluated in 42 patients without detectable asynergy during diagnostic cardiac catheterization and was found to correlate well with angiographic ejection fraction (r = 0.90). Ejection fraction was calculated as the product of % delta D X 1.7 or as % delta (D2), both formulae having similar degrees of accuracy and a better correlation with the angiographic determination than conventional formulae. Ejection fractions (angiographic and echocardiographic) of 51 percent or greater were always associated with a % delta D of 30 percent or more. In five patients the echocardiographically derived ejection fractions were normal (greater than or equal to 51 percent), while the angiographic ejection fractions were reduced; four of these patients had valvular regurgitation. End-diastolic volumes were calculated from end-diastolic echocardiographic dimensions utilizing a linear regression equation derived from correlating the end-diastolic echocardiographic dimension with the end-diastolic volume in 27 patients without valvular regurgitation (end-diastolic echocardiographic dimension ranged from 3.7 to 8.2 cm). The value for stroke volume determined as the product of calculated end-diastolic volume times ejection fraction correlated with the angiographically determined stroke volume (r = 0.88; standard error of estimate, +/- 11 ml) better than the value for stroke volume derived from conventional echocardiographic formulae.
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PMID:Percentage of shortening of the echocardiographic left ventricular dimension. Its use in determining ejection fraction and stroke volume. 66 37

The effect of nitroglycerin administration on left venticular performance relative to its ability to improve contraction of asynergic zones was examined in 66 patients with coronary artery disease, divided into those whose asynergic zones responded following nitroglycerin administration and those in whom no response was observed. In the responsive group with asynergy of more than one segment, the ejection fraction improved (P less than 0.001), while in the unresponsive group, it decreased (P less than 0.05). Similarly, in patients with one-segment asynergy, the responsive group exhibited a significant increase in ejection fraction P less than 0.001), while the unresponsive group showed no change. The stroke volume index remained unchanged in the responsive group with asynergy of more than one segment, while it decreased significantly (P less than 0.05) in the unresponsive patients. Left ventricular pressures and volumes changed to a similar degree after nitroglycerin administration in all of the patients, regardless of the responsiveness of asynergic zones. It is concluded that nitroglycerin administration results in a differential effect on total left ventricular performance depending on the responsiveness of asynergic zones.
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PMID:Nitroglycerin and ventricular performance. Differential effect in the presence of reversible and irreversible asynergy. 82 1

Left ventricular volumes were determined by means of ECG-gated RI angiocardiography, which were compared with volumes derived from contrast cineangiocardiography in 25 patients with various heart disease. There was a close correlation of end-diastolic and end-systolic volumes and ejection fraction between RI and contrast angiocardiography, although stroke volume yielded rather scattered values. In 46 of 52 patients with myocardial infarction left ventricular asynergy was demonstrated with our method. Mean velocity of circumferential shortening (mVcf) was exaggerated in patients with apical asynergy. mVcf derived from direct axis measurement yielded a higher value than that from area-length method. Left ventricular volume curve was constructed to obtain normalized systolic ejection rate during initial 100--200 msec after the start of ventricular depolarization. The index was in parallel to ejection fraction in every patient except in moderately severe hypertensive patients. End-diastolic compliance was calculated from Gaasch formula by obtaining pulmonary artery wedge pressure and end-diastolic volume, which was determined by injecting 99mTc pertechnetate into pulmonary artery through Swan-Ganz catheter. This way of access to patient with acute myocard infarction was most useful to evaluate the mechanism of elevated left ventricular end-diastolic pressure.
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PMID:Radioisotope angiocardiographic evaluation of left ventricular function in cardiac patients. 87 30

A new method of measuring left ventricular volume is proposed which utilizes ventricular wall thickness at end systole and end diastole to estimate the ejection fraction. These measurements plus stroke volume allow the calculation of ventricular EDV. Although data from angiocardiographic studies have been used to validate the method it appears that the same data can be derived from ultrasound studies. The use of ultrasound methods would allow long term monitoring of ventricular volume changes during the course of a disease process. The proposed method appears to offer a more consistently accurate means of measuring EDV than previously suggested ultrasound methods. Comparison of EDV data calculated from angiographic and wall thickness measurements reveals the two methods to be statistically identical. In patients with a normal myocardium or valve lesions the correlation between the two methods is 0.97 with a standard error of 21 cc. There is a significant loss of accuracy when estimating ventricular volume in patients having diagnoses compatible with ventricular asynergy. An alternative method is suggested which may improve estimates of ventricular volume in these patients.
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PMID:Determination of ventricular volume from changes in wall thickness. 93 8

Echocardiography has many attributes that are desirable for diagnostic and research studies in acute myocardial infarction patients. It does not alter the physiologic state being evaluated, is relatively inexpensive, and does not interfere with other hospital procedures. For these reasons, the test may be repeated frequently and used to monitor the changes after acute infarction. Useful information about left ventricular volume, diastolic pressure, and segmental wall motion may be obtained. Because echocarciographic estimates of stroke volume, ejection fraction, and velocity of circumferential fiber shortening are based on motion seen in only one "ice-pick" view of the heart, it is likely that they will be less reliable in patients with asynergy of contraction. Although a definite diagnosis of acute myocardial infarction cannot be made by echocardiography, abnormalities of wall motion may occur very early and support a clinical impression of infarction. An echocardiogram may also reveal changes suggesting ischemia or infarction (abnormal motion) in patients who have atypical chest pain and no other objective evidence of coronary artery disease.
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PMID:Applications of echocardiography in acute myocardial infarction. 110 66

Selective coronarography, left ventricular cineangiography were performed three to six months after acute myocardial infarction in 45 patients. Simultaneously, stroke volume (SV), enddiastolic (EDV) and endsystolic volume (ESV), ejection fraction (EF) and left ventricular enddiastolic pressure (LVEDP) were determined. LVEDP was measured at rest and after static (handgrip) exercise. According to the type of the LV abnormality patients were divided in three groups: 1. without LV abnormality (5 patients) 2. asynergy (15 pts) and 3. aneurysm (25 pts). The data were reviewed separately in patients where abnormalities of LV were associated with angina pectoris. The degree of coronary obstruction and the type of LV abnormality did not disclose any correlation. LVEDP at rest was in normal limits in patients in group 1 and 2, elevated in patients with aneurysm. (LVEDP: 15, 15 and 25 mmHg resp.) After handgrip exercise LVEDP increased in each group: 21, 22, 32 mm Hg. SV: decreased significantly in LV aneurysm (53 ml/beat). EDV was 50 ml in patients with asynergy and 118 ml in those with aneurysm. ESV was in normal limits when asynergy was present, 35 ml in patients without abnormality and 118 ml in LV aneurysm. EF was 0.66 and 0.65 in group 1 and 2, in group 3 (aneurysm) this value was 0.49 (significantly lower). The extent of shortening of the longitudinal and transverse diameters were significantly diminished in each group. When angina was associated with LV asynergy a higher SV was observed, when angina was associated with aneurysm, SV and EF were decreased. The conclusion from these data can be drown that the compromised LV after prior AMI works with a different mechanism, according the type (and degree) of abnormality.
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PMID:Abnormalities of left ventricular function associated with prior acute myocardial infarction. 123 42

Total and regional (by 7 zones) contractility of left ventricular functions in 25 patients with hypertrophic cardiomyopathy (HCMP) were characterized by a different combination of normal and elevated values of total and regional ejection fractions, rate indices of systolic expulsion. Normal or slightly changed values of the end-diastolic volume were combined with normal or elevated values of the stroke volume. Comparative analysis of the values characterizing cardiodynamics, led to working out criteria of differential diagnosis in HCMP patients with heart pain and in CHD patients with myocardial hypertrophy (predominance of the signs of left ventricular hyperfunction in the former and contractility hypofunction and asynergy in the latter). Changes in the diastolic filling of the left ventricle indicated its disturbed diastolic function in both groups of patients.
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PMID:[Radionuclide ventriculography in the diagnosis of hypertrophic cardiomyopathy]. 165 88


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