Taking It Is Finished To heart __FULL__
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Taking It Is Finished To heart __FULL__
Heart function including ejection fraction (EF) is important in clinical practice because it is related to prognosis. Whether the patient suffers from valvular heart disease or ischemic heart disease, a measure of heart function including ejection fraction (EF) can predict future clinical outcome and assist in risk stratification. Several approaches to detect patients at risk for cardiac events have proven to be of value. These include exercise testing, assessment of exercise capacity, and determination of left ventricular function.
The stroke volume (SV) is calculated by taking the amount of blood estimated when the left ventricle is completely filled (end diastole= LVEDV = 131 ml) and subtracting the amount of blood remaining within the left ventricle when it is finished contracting (end-systole = LVESV = 55 ml). The derived stroke volume (SV = 76 ml) is then divided by the amount of blood contained when the left ventricle is completely filled (LVEDV = 131 ml) to obtain the ejection fraction (EF = 58%) (diagram below).
A borderline heart function and ejection fraction (EF) (41-49%) can result from a cardiomyopathy, valvular heart disease or ischemic heart disease (pts with coronary artery blockages). This usually leads to shortness of breath during activity. Below is a patient with coronary disease and critical stenosis of the proximal LAD. There is hypokinesis or reduced contraction in the distal anterior wall and apex. This also contributes to a mildly reduced heart function and ejection fraction at 49%. This patient experienced shortness of breath running up a hill.
The MRI below was performed at Brookwood Baptist Medical Center at Princeton. The patient suffered an anterior myocardial infarction few months prior. Dr Bracer obtained the images using a 1.5T GE MRI system. We can see some hypokinesis of the anterior wall and overall mildly reduced heart function and ejection fraction.
Below is an MRI of a patient who suffered an extensive myocardial infarction. The patient presented as an anterior STEMI with total occlusion of the LAD. Despite early intervention and PCI with coronary stenting of the LAD, the patient suffered extensive damage with a large scar involving the distal antero-septum, apex and distal antero-lateral walls (yellow arrow). Notice the thinning and absence of contraction of these walls. The global function is severely reduced and there is evidence of clinical heart failure with bilateral pleural effusions (blue arrow). In addition, there is a small pericardial effusion surrounding the right ventricle and in part the right atrium (red arrow).
In patients with valvular insufficiency or ischemic heart disease, the enlargement of the left ventricular volume (particularly end-systolic LVESV) can be related to a poor prognosis. For this reason, serial measurements of left ventricular size and function are used to follow these patients so that surgical intervention can be performed prior to irreversible damage to the heart is done. Similarly, patients recovering from a large myocardial infarction can develop adverse left ventricular remodeling leading to irreversible damage and the development of clinical heart failure. Below is an MRI study of a patient who sustained a large anterior myocardial infarction. At baseline (upper image), the left ventricular end-diastolic volume (LVEDV) measured 250 ml, the end systolic volume (LVESV) 173 ml with reduced heart function and ejection fraction (EF) 30%. One year later, another MRI study (lower image) was performed on the same patient and revealed an enlargement of left ventricular size with LVEDV of 314 ml, LVESV of 241 ml and a weakening of the heart function and ejection fraction EF of 23%. This is called adverse remodeling and has a poorer prognosis in patients after a myocardial infarction.
Assessing regional function or wall motion of the left ventricle allows for the detection of ischemic heart disease (patien