Left Ventricular Function and Hypertrophy in Cardiomyopathy with Depressed Ejection Fraction

Abstract

Left ventricular (LV) function and hypertrophy, assessed during cardiac catheterization by quantitative biplane angiocardiography, were related to postcatheterization course in 36 patients found to have cardiomyopathy with depressed ejection fraction (EF). EF ranged from 0.09 to 0.41, LV mass (M) from 99 to 317 g/m 2 , LV end-diastolic volume (V) from 104 to 347 ml/m 2 , and ratio of M/V from 0.66 to 1.63. In this study, EF was used as an index of LV function; M/V ratio was considered to represent a relative degree of LV hypertrophy. Postcatheterization survival rates (PCSR) for all patients at 12, 24, and 36 months were 68.8 ± 7.8%, 49.9 ± 9.2%, and 32.8 ± 10.2%. The 36-month PCSR was significantly higher for patients (N = 15) with EF ≥ 0.20 (75.1 ± 14.5%) than for those (N = 21) with EF < 0.20 (0%) ( P < 0.01). The 36-month PCSR was also significantly higher for patients (N = 19) with M/V ratio ≥ 0.90 (53.6 ± 14.8%) than for those (N = 17) with M/V ratio < 0.90 (12.4 ± 10.4%) ( P < 0.05). M/V ratio appeared to influence survival at least in part independently of EF. For patients with EF ≥0.20 M/V ratio ≥ 0.90 was associated with a higher 36-month PCSR (100%) than was M/V ratio < 0.90 (25.0 ± 6.5%). Likewise, for patients with EF < 0.20, M/V ratio ≥ 0.90 was associated with a higher 24-month PCSR (65.1 ± 16.8%) than was M/V ratio < 0.90 (6.8 ± 9.1%); but at 36 months, PCSR was < 10% for both subgroups. Patients (N = 16) with mitral regurgitation (MR) > 0.70 liters/min/m 2 had a mean value for V (212.9 ± 74.1 ml/m 2 ) significantly larger than for those (N = 20) without MR or with MR < 0.70 liters/min/m 2 (168.8 ± 40.7 ml/m 2 ) ( P = 0.0278). Although this suggests that dilatation of the mitral valve annulus contributed to the development of the regurgitation, the large overlap in V values implies that additional mechanisms played a role. This study describes quantitatively a spectrum of hemodynamic abnormalities in patients who had cardiomyopathy with depressed EF, and demonstrates that the present series of patients had a high postcatheterization mortality rate. Both EF and M/V ratio were of prognostic value and thus appear to be useful indices for classifying such patients.

Chronic aortic regurgitation: the effect of aortic valve replacement on left ventricular volume, mass and function.

“…The deviation of the group 3 patients from the normal R/Th relation reflects a failure of hypertrophy to match the load imposed on the ventricle. Based on this analysis and on the observations of Feild et al, 24 we conclude that LV hypertrophy is not only a critical compensatory mechanism, but that insufficient muscle mass, relative to chamber size, implies a poor prognosis.…”

“…24 Furthermore, their data suggest that the influence of this ratio on survival is "at least in part independent of the ejection fraction. "…”

Dilated Congestive Cardiomyopathy in Saudi Patients

“…8 The QS pattern is known to occur and was noted by Mariott 8 and Gava et al 9 The diagnosis in all 22 patients was established by poor global contractility of the left ventricle and an ejection fraction less than 40 percent. 10,11 Twenty-one patients (95 percent) in fact had an ejection fraction less than 30 percent. The LV end-diastolic pressure was less than 15 mmHg in eight patients (32 percent), but 7 of these 8 patients had an ejection fraction less than 30 percent, signifying that diastolic pressure in dilated cardiomyopathy is lower for a given diastolic volume than is normally the case.…”

Partial left ventriculectomy: a retrospective study

“…"Myocardial remodeling" has been the expression used to define these permanent and progressive alterations, involving muscular and non-muscular myocardial cells and evolving different periods of time for different cellular groups [1][2][3][4][5][6][7][8][9][10].…”

“…Clinical studies [7][8][9] and findings from autopsies have demonstrated that the quantitative relation of ventricular myocardial mass with the final diastolic volume of the LV has prognostic value and that lower survival can be expected in patients with great dilations of the LV.…”