SUMMARYThe left ventricular function curve was obtained in 14 patients with atrial fibrillation (af) by plotting the left ventricular stroke volume (SV) against end-diastolic volume (LVEDV) measured by echocardiography in 60-100 consecutive beats. Of the 14 patients, 7 had left ventricular failure due to a variety of cardiac abnormalities including CCM, perimyocarditis and AR. The other 7 patients with lone af who had normal LV function were used as normal controls.LV function curves in patients with ventricular failure were shifted downward and to the right of normal control curves. The slopes of LV function curves were decreased significantly in these patients.LV function curves shifted to the left and upwards and the slopes of the LV function curves were increased after treatment with digitalis and diuretics. In a patient with perimyocarditis and large pericardial effusion, LVEDV and SV were increased after treatment with diuretics alone, as a result of improved LV filling after disappearance of effusion. However, the LV function curve showed no shift and was situated on the extension of the curve before treatment.To know the effect of potentiation on LVEDV-SV relation in af, endsystolic LV pressure-volume ratio was derived approximately from direct brachial artery pressure at dicrotic notch (BAP(DN))/LVESV and compared with the relative degree of cycle-length change. There was a significant correlation between BAP(DN)/LVESV and preceding/prepreceding RR interval, representing the possibility that the relation between LVEDV and SV in af was influenced by so-called potentiation.Accordingly, LV function curve obtained from LVEDV-SV relation in af could be a modified function curve. Nevertheless, this reflects LV function documented by clinical symptoms and other widely utilized indices very well and is useful for assessing LV function.
SUMMARYThe left ventricular function and severity of LV volume overload were assessed in 30 patients with aortic regurgitation by a combined use of echocardiography and indicator dilution method.With decreasing functional capacity of patients, there tended to be greater increase in EDV, and decreases in CO, EF, Vcf, and BAP (DN)/ESV, and shift of LV function curve downward and to the right, reflecting LV myocardial dysfunction.There was a substantial correlation between functional capacity and the severity of regurgitation as well as LV myocardial function, suggesting the possibility that clinical symptoms may depend upon both the myocardial function and severity of aortic regurgitation. In contrast with many patients with AR of functional class I or II, who had relatively normal LV function, the patients of class III consistently showed substantial LV myocardial dysfunction.After sublingual administration of ISDN, BAP lowered, EDV and RF decreased. Lowering of BAP and RF were more prominent in class III than in class I.It has been proved that a combined use of echocardiography and indicator dilution method is of value in assessing the left ventricular function and regurgitant fraction in patients with aortic regurgitation, allowing a better understanding of the disease process and the potential for recognizing patients who may require early valve replacement.
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