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Left ventricular ejection fractions (EF) were determined in 37 patients by biplane cineventriculography (Angio) and by four modifications of the gated equilibrium blood pool (GBP) method: 1. Region of interest (ROI) in enddiastole (ED), correction by external background, 2. ROI in ED, correction by internal background between ED and endsystole (ES), 3. ROI in ED (maximum) and ES (mimimum); no background correction, 4. ROI in ES, correction by background between ED and ES. EFGBP were determined after injection of 20 mCi 99mTc human albumin (Anger-camera, all-purpose collimator, 16 ECG-segments, 64 x 64 matrix with 1.5 zoom). EF by biplane angiography (EFangio) was calculated by the formula of Dodge. The following correlation between angiographically and scintigraphically determined EF's were found: EFGBP1 = 0.504 EFangio + 8.08, EFGBP2 = 0.847 EFangio + 10.0, EFGBP3 = 0.911 EFangio + 3.75, EFGBP4 = 0.648 EFangio - 3.51 Intraobserver variability of GBP method 2 and 3 was +/- 5%. EFS determined by GBP methods 2 and 3 are as accurate as the EFs determined by cineventriculography.

The systolic time intervals and calculated parameters of PEP/LVET (pre-injection period/left ventricular ejection time-ratio) and 1/PEP2 before and after induction of anaesthesia with the barbiturate enibomal (Narcodorm®) were studied non-invasively in eight surgical patients after pre-treatment with a bolus dose of glucagon. The mean difference between the PEP/LVET-ratio before and after induction was 0.06, and the mean difference between 1/PEP2 before and after induction was -8. The corresponding values in the control group consisting of 12 patients were 0.09 and -28, respectively, suggesting a somewhat greater depression of cardiac function in this group. However, no statistically significant difference at the 5% level was found between changes in the glucagon group and controls. The influence of barbiturates and glucagon on cardiac function is discussed. ZUSAMMENFASSUNG Bei 8 chirurgischen Patienten wurden nach Vorbehandlung niit einer Bolus-Dosis von GIukagon die Systolen-Zeitintervalle und die berechneten Parameter PEP/LVET und l/PEP2 vor und nach Narkoseeinleitung mit dem Barbiturat Enibomal (Narcodorma™) mittels einer nicht-invasiven Technik untersucht. Der mittlere Unterschied zwischen den PEP/LVET-Verhaltnissen vor und nach Narkosecinleitung war 0,06, die mittlere Differenz zwischen den l/PEP2-Werten vor und nach der Einleitung -8. Die korrespondierenden Werte in der Kontrollgruppe waren 0,09 bzw. - 28, was auf eine etwas starkere Depression der Herzfunktion in dieser Gruppe hinweist. Einstatistisch gesicherter Unterschied von p< 0,05 zwischen den Veranderungen in der Glukagongruppe und denen der Kontrollgruppe wurde allerdings nicht gefunden. Der Einflus von Barbituraten und von Glukagon auf die Herzfunktion wird diskutiert.

To determine whether the ECG would be useful in the prediction of impaired left ventricular ejection performance in aortic valve stenosis, the authors evaluated 121 patients according to (1) the time relationship of the R peak in V6 to the S peak in V2; and (2) the negative P wave terminal force in V1 (Morris index, n = 109). Left ventricular ejection fraction (LVEF) was significantly depressed in patients with the R peak in V6 later than the S peak in V2 (R peak delay in V6, n = 24), compared with those with the R peak in V6 preceding the S peak in V2 or with both peaks occurring simultaneously (n = 97) (LVEF 40.8 +/- 11.8% vs 69.9 +/- 13.3%, p = .000). LVEF less than 55% was present in 87.5% of patients with the R peak delay in V6 and in only 23.7% of those without this finding. The Morris Index was significantly greater in patients with LVEF less than 55% (n = 39) than in those with LVEF greater than or equal to 55% (n = 70) (Morris Index 0.063 +/- 0.035 msec vs 0.030 +/- 0.025 msec, p = .000). The R peak delay in V6 is a highly specific (96.1%), but less sensitive (47.7%), indicator of depressed LVEF, its positive predictive value and predictive accuracy being 87.5% and 78.5%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Left and right ventricular ejection fractions (LVEF and RVEF) were calculated by gated equilibrium scintigraphy in 28 normal controls and in 21 patients with heart disease. Regions of interest (ROIs) for the ventricles were assigned on the amplitude and phase Fourier images. Two methods of preprocessing of data were compared. In Method 1 the resolution was improved and the statistical noise was reduced, while in Method 2 only the statistical noise was reduced. There were no differences between the results of the two methods for the left ventricle. The mean LVEF for normal subjects was 0.63 ± 0.06. For the right ventricle, Method 1 showed higher sensitivity in detecting reduced RVEF in pathological situations. The mean RVEF by Method 1 for normal controls was 0.56 ± 0.07, which is significantly different (p < 0.001) than that found by Method 2 (0.36 ± 0.05), and similar to those reported by others employing the firstpass method. The results show the usefulness of the phase Fourier image and the importance of a suitable preprocessing of data for determining RVEF by gated equilibrium scintigraphy.

Validation of an equilibrium radionuclide technique for assessing right and left ventricular function has not been reported in children with heart disease. Resting equilibrium radionuclide ventriculograms were performed in 71 children with diverse types of heart disease (age range 1 to 19 years, mean 10.2) with exercise studies in 52 of the children. Cardiac catheterization was performed in 39 of the 71 children within 2 weeks of radionuclide study. Resting left and right ventricular ejection fractions from radionuclide study and catheterization were compared by linear regression analysis: right ventricular ejection fraction, r = 0.83; left ventricular ejection fraction, r = 0.90. Interobserver correlations for right and left ventricular ejection fractions were 0.93 and 0.94, respectively. With exercise, the interobserver correlations for right and left ventricle were 0.97 and 0.92, respectively. Thus, right and left ventricular ejection fractions showed good correlations with cineangiographic ejection fractions. Furthermore, it was possible to perform this study in exercising children with no deterioration in interobserver correlations. This technique can provide important information on ventricular function in children and aid in long-term evaluation of current methods of treatment for several congenital heart defects.

This paper deals with models of left-ventricular ejection which are based on the hypothesis of optimal performance. The assumptions made in the models published so far are analyzed, and some major modeling difficulties are discussed. In most of the models, the term describing the external work done by the left ventricle during ejection is included in the optimality criterion. In this paper, the minimum external work criterion is analyzed by comparing the values of external work for different theoretical ejection patterns. The ejection patterns used in the comparisons must satisfy certain feasibility and normalization conditions. The results show that an ejection pattern with the peak flow in the first half of ejection, which resembles the experimental observations, is optimal with respect to minimizing the external work. An ejection pattern with the peak flow in the second half of ejection is the least efficient of the patterns studied.

Beat-to-beat left ventricular ejection was evaluated in a group of 20 patients with chronic atrial fibrillation using a computerized single probe detector. The reference group consisted of 10 patients with sinus rhythm. For each patient 30 successive cardiac cycles were analyzed and the relative variations of four parameters were assessed: R-R interval, diastolic and systolic time intervals, and ejection amplitude, corresponding to the left ventricular stroke volume. The mean variations were respectively 3.4%, 10.4%, 8.4%, and 11.8% in patients with sinus rhythm, and 21.9%, 37.9%, 10.6% and 30.5% in patients with atrial fibrillation. This demonstrates that changes in ejection are mainly related to the duration of the filling phase, with nearly constant systolic times. Correlations between R-R intervals and systolic ejection amplitudes were highly significant (P less than 0.001) in patients with atrial fibrillation in 85% of cases. This information complements the average ejection fraction obtained from multiple cycle superimposition.

6 clinically normal subjects underwent a 3-month physical conditioning program with the ejection fractions determined before and after physical conditioning using a scintillation probe. All subjects achieved a conditioning effect as evidenced by increased treadmill test duration after conditioning (mean duration before conditioning: 658 vs. 715 sec after conditioning; p less than 0.02). All 6 subjects increased resting ejection fractions after conditioning (mean ejection fraction before conditioning: 54.5 +/- 5.4%; mean ejection fraction after conditioning: 67.0 +/- 9.0%; p less than 0.01). Thus, an aerobic physical conditioning program appears to increase resting ejection fractions in normal subjects.

Left ventricular ejection dynamics of 15 patients with hypertrophic cardiomyopathy (nine obstructive, six nonobstructive) were compared to those in 12 age-matched normal subjects and 10 patients with valvular aortic stenosis by means of combined two-dimensional and Doppler echocardiography. Doppler peak flow velocities in obstructive (HOCM, 2.5 +/- 1.3 m/sec) and nonobstructive (HNCM, 2.6 +/- 0.6 m/sec) hypertrophic cardiomyopathy, as well as in patients with aortic stenosis (AS, 3.6 +/- 1.3 m/sec) were significantly higher than in the normal population (1.0 +/- 0.2 m/sec; p less than 0.001 for all comparisons), but did not differ from each other. The HOCM patients had time to peak velocity (154 +/- 55.7 msec) that was higher than that in both HNCM (86 +/- 8.4 msec) and normal groups (84.5 +/- 8.9 msec; p less than 0.001 for both comparisons), but did not differ from those in AS (117 +/- 52.5 msec). The total ejection time did not differ between HOCM (348.2 +/- 91.1 msec) and AS (328.8 +/- 30.4 msec) groups, but was prolonged in HOCM compared to HNCM (198 +/- 21.0 msec) and normal groups (233 +/- 28.3 msec; p less than 0.001 for both comparisons). The normal and HNCM groups did not differ in time to peak or total ejection time measurements. The percent of flow velocity present in the initial third of the systolic velocity integral for HOCM (44.5% +/- 5.9) and HNCM (49.4% +/- 2.5) groups was greater than for normals (36.2% +/- 5.4; p less than 0.05 for both comparisons), but HOCM values did not differ from HNCM values.(ABSTRACT TRUNCATED AT 250 WORDS)

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.

Right and left ventricular ejection fractions (RVEF and LVEF) were measured by radionuclide angiography in 423 patients with acute myocardial infarction (AMI). All investigations were performed at hospital discharge. Of 304 patients with first AMI, 26% had normal ejection fractions, 10% had a decrease in RVEF only, 46% a decrease in LVEF only, and 18% decrease in both RVEF and LVEF. Death from cardiac causes occurred in 52 patients in a one-year follow-up period. A reduced RVEF at hospital discharge had little, if any, relation to one-year mortality. In contrast, there was an inverse curvilinear relationship between LVEF and one-year cardiac mortality.

Echocardiography, gated scintigraphy and contrast angiography were used to measure left ventricular ejection fractions in 20 patients with varying degrees of aortic insufficiency. There was good correlation between the radionuclide and the angiographic ejection fractions. Echocardiographic ejection fraction correlated less well with the angiographic ejection fraction. The radionuclide left ventricular ejection fraction may prove valuable in the noninvasive serial evaluation of left ventricular function in patients with chronic aortic insufficiency.

The effects of senescence on the electrophysiological behavior of cardiac tissue have not been studied extensively or systematically. Yet there is a scattered number of reports indicating that the functioning of the cardiovascular system in general, and the physiology of the myocardium in particular undergo very subtle yet profound changes with increasing age. The age effects have been observed both in man and in other mammals. The normal human myocardium of subjects 50 to 70 years of age not suffering from degenerative changes or ischemia has been found to display such electrocardiographic alterations as prolongation of the P-R interval and QRS complex duration (1). In a group of normal, healthy humans, the P-R interval was found to increase progressively from birth through 60 years and over (2). Another study showed that young adults (mean age for men, 34 years, and mean age for women, 23.5 years) had shorter left ventricular ejection times than subjects of 60 years and older (3). Unan-esthetized Wistar rats have been reported to exhibit increased heart rates, decreased blood pressures, and decreased cardiac outputs with increasing age (4). Electrocardiographic changes and increased incidence of arrhythmias have been reported in aged rats under control conditions (5, 6) and following exercise (7).

Simultaneous intraventricular pressure gradients and ejection flow patterns were measured by a multisensor catheter in 6 patients with normal left ventricular function and no valve abnormalities, at rest and in exercise. Peak measured intraventricular pressure gradients were attained very early in ejection, amounted to 6.7 +/- 1.9 (SD) mm Hg at rest, and were intensified to 13.0 +/- 2.3 mm Hg during submaximal supine bicycle exercise. The augmentation of the gradients during exercise was associated with a pronounced accentuation of the flow acceleration and flow at the instant of peak gradient. A peak flow, the intraventricular gradients amounted to 5.4 +/- 1.7 mm Hg at rest and 10.0 +/- 1.8 mm Hg during submaximal exercise. The exercise-induced enhancement of the measured intraventricular pressure difference at the time of peak flow was underlain by an accentuation of the peak flow itself. A semiempirical fluid dynamic model for ejection was applied to the pressure gradient and simultaneous outflow rate and acceleration data to identify the contributions by local and convective acceleration effects to the instantaneous intraventricular gradient values. The peak intraventricular pressure gradient, which is attained very early in ejection, is mostly accounted for by local acceleration effects (85 +/- 5% of the total). Conversely, at peak flow only convective acceleration effects are responsible for the measured pressure gradient. Thus, when inertial effects are augmented, as in exercise and other hyperdynamic states, the intrinsic component of the total left ventricular systolic load can be substantial, even with no outflow tract or valve abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Originally intended to be a modest ancillary tool in diagnosing structural abnormalities of the heart and the pericardium, the noninvasive technique of echocardiography has greatly expanded its diagnostic orbit. It now competes successfully with invasive angiographic techniques for diagnosing and evaluating valvular and myocardial disorders, as well as those of ventricular function—the latter reflected in the measurements of left ventricular diameters and derived hemodynamic indices. Currently, two-dimensional cross-sectional echocardiography is proving even more informative than M-mode techniques in estimating left ventricular ejection fraction—a reliable index of left ventricular performance. Can measuring left ventricular diameters be similarly helpful in studying the action of cardiovascular drugs? Gibson 1 in 1973 and Burggraf and Parker 2 in 1974 suggested this possibility, which has since been explored by a number of investigators with results that varied from endorsement to rejection. Clearly, no satisfactory answer could be given to the value of echocardiography in the

Cardiac output and ejection fractions of the cardiac ventricles are valuable measures of cardiac function. Noninvasive radionuclide techniques for determination of these measures are based on analysis of different data: first passage low frequency, first passage high frequency and multigated equilibrium data. We have evaluated the principles of these methods using a dynamic cardiac phantom. Radiocardiographic determinations of cardiac output and right and left ventricular ejection fractions showed excellent correlation against true phantom values: r = 0.993 (p less than 0.001), r = 0.978 (p less than 0.01) and r = 0.943 (p less than 0.05), respectively. Thus, the findings of the present study demonstrate a high validity of current radiocardiographic measures of cardiac function.

Excerpt Only 10 years have elapsed since the concept of functional obstruction to left ventricular ejection was introduced to clinical medicine (1), and in the interim the features of obstructive c...

Pulmonary artery and aortic pulse tracings were obtained at surgery in two patients without heart disease and in seven patients with patent ductus arteriosus with and without pulmonary hypertension immediately before and after obliteration of the patent ductus, utilizing the technique of simultaneous recording of the two tracings from a single base line at identical sensitivities. Patent ductus arteriosus causes the following changes: a ) delayed inflow into the pulmonary artery relative to aortic inflow; b ) increase in duration of the period of total left ventricular ejection as compared to that of total right ventricular ejection; c ) increase in duration of the phase of maximal right ventricular ejection as compared to the phase of reduced ejection; d ) decrease in duration of maximal left ventricular ejection as compared to the phase of reduced ejection; e ) low aortic dicrotic notch. Pulmonary hypertension appeared to be influential in the production of a delayed inflow into the pulmonary artery and the abnormal duration of ejection of the two ventricles. Submitted on April 26, 1957

The property of digitoxin to inhibit active ion transport in the red blood cell was used to estimate the level of digitoxin in plasma. There was an inverse relation between the plasma level of digitoxin and the left ventricular ejection time after an intravenously administered “digitalizing” dose of digitoxin. The range of plasma digitoxin levels associated with the hemodynamic effect is partially defined. The accuracy of this assay method is not optimal at present.

To assess the time course and magnitude of change in left ventricular (LV) wall stress and ejection performance indices, 24 patients undergoing aortic valve replacement (AVR) for aortic stenosis were prospectively evaluated. Each patient underwent resting radionuclide angiography (RNA), echocardiography, and cardiac catheterization (high fidelity pressure) before AVR, then RNA and echocardiogram at one week and six months after AVR. Patients were stratified by preoperative ejection fraction (EF) into reduced EF (l50%) and normal EF (≥50%) groups. Pre-operatively, peak positive dp/dt was lower in the reduced EF group (1300 vs 1700 mmHg/sec, p = 0.035), and wall stress was elevated similarly in both groups (p = NS). Temporal Relationships of EF and Wall Stress Pre-op 1 Week 6 Mos Normal EF (n = 14) Mean Ejection Fraction (%) 66 64 68 Mean Wall Stress (dyne/cm 2 × 10 3 ) 62 34 44 Reduced EF (n = 10) Mean Ejection Fraction (%) 38 37 57 Mean Wall Stress (dyne/cm 2 × 10 3 ) 78 52 61 Wall stress was reduced at one week post-operatively (p l 0.005) in both groups. Ejection fraction remained depressed in the reduced EF group. By six months, however, EF had dramatically improved in the reduced EF group (p = 0.002). Conclusion In patients with LV dysfunction, EF remains low one week after AVR despite rectification of afterload mismatch. At six months, however, ejection performance improves. Therefore, when measured by ejection phase indices, the surgical benefit from AVR is not evident until late post-operatively.

To the Editor.— In his editorial, Dr. Chalmers states that "a positive inotropic effect on the heart... has now been confirmed by catheterization studies in humans," quoting as a source the review by Levey et al ( Ann Rev Med 25:69, 1974). In turn, this review alludes to Hildner et al, who studied 15 patients requiring cardiac catheterization in whom a bolus injection of 250 mg of tolbutamide, given intravenously, produced a definite inotropic effect as reflected by ventricular function curves. In a less convincing technique (noninvasive, using a carotid sensor), they demonstrated a similar effect by measuring preejection period and left ventricular ejection times. I believe Dr. Chalmers should, in fair balance, have included the following additional statements of Levey et al: The critical question pertaining to whether or not sulfonylureas have inotropic actions on human hearts remains unresolved. Epstein and co-workers examined the effects of tolbutamide on two human

• We assessed the possibility of long-term functional cardiac sequelae in patients who had sustained a traumatic myocardial contusion (group 1) by comparing this group with a cohort group of patients with similar traumatic injuries but exclusive of the cardiac component (group 2). More than one year following injury, patients in group 1 were qualitatively indistinguishable from patients in group 2 according to the New York Heart Association classification. Both the left and the right ventricular ejection fractions, less in group 1 than in group 2 immediately following trauma, were similar between groups during follow-up study at rest. During exercise to maximal work load at follow-up, changes in the mean right and left ventricular ejection fractions were also similar between the two patient groups. We therefore concluded that traumatic myocardial contusion to the left and/or right ventricle almost always resolves without significant functional sequelae within one year of injury. ( Arch Intern Med 1986;146:1765-1769)

• Left ventricular ejection times (LVETs) were obtained in a group of 20 control subjects (group 1) during maximal treadmill exercise testing, using a Bruce protocol, and in conjunction with myocardial scintigraphy. Heart rates (HRs) and LVETs were recorded during standing rest, each minute of exercise, and for eight minutes in the postexercise period. A linear regression equation was constructed and separate correction factors of 1.04×HR+observed LVET (correlation coefficient, -.86) for the exercise period and 0.73× HR + LVET (correlation coefficient, -.71) for the postexercise period were derived. The LVETs were also recorded in 31 subjects with positive ECGs and defects on myocardial scanning with thallous chloride TL201 (group 2) during a similar exercise protocol. Comparison of groups 1 and 2 disclosed that the former had a higher HR and shorter LVET than the latter at peak effort (consonant with the significantly longer duration of exercise achieved by the control subjects). The LVETs in group 1 remained significantly shorter than that of group 2 through the fifth minute postexercise. In the postexercise period, the LVET indexes were significantly shorter in group 1 than group 2 at 1, 3, and 5 minutes. Subjects with presumptive coronary disease (positive ECG and defects on thallium 201 scanning) not only have a decreased exercise tolerance and HR, but after exercise, their ejection times are substantially longer than in normal subjects. This may be attributed to a slower rate of ejection in patients with coronary disease when venous pooling on quiet standing after exercise delivers a smaller volume to the heart. In normal subjects, the lesser volume may be ejected more rapidly. ( Arch Intern Med 1984;144:1386-1391)

The pressure/volume changes during early (E3), mid (M3) and late (L3) thirds of ejection were analyzed in 20 normal children (W), 7 aortic coarctation (Co), and 20 aortic stenosis (AS). Mean peak systolic gradient was 30 mmHg in Co, and 31 in AS. Ejection fraction at E3, M3, and L3 were 0.33, 0.36 and 0.27 for W; 0.35, 0.37 and 0.28 for Co; 0.24, 0.41 and 0.28 for AS. Tension-time index (TTI) in mmHg-sec, stroke index (SI), output index (OI), ejection rate (SI/sec) and SI/TTI ratio in cc/mmHg-sec/m2 were obtained. These are summarized below (P values vs N: *

In Reply.— I thank Dr Spodick for his supporting view with regard to my editorial inThe Journal. Although we agree on most points, I would reiterate my criticisms of large, multicentered, randomized clinical trials for reperfusion therapy in cases of acute myocardial infarction, which make such trials frequently uninterpretable and, therefore, a waste of limited research funds. 1. Preselection, medical-surgical crossovers, data attrition, and, finally different characteristics of randomized groups despite randomization make the final data questionable in many if not most such trials. 2. Mortality is a remote and non-specific end point that provides little insight into mechanisms or actual effects of therapy. That is, the therapy may benefit the problem for which it was intended, but other factors of selection or side effects, which may be investigated or solved as separate problems, obscure these benefits by increasing mortality nonspecifically. 3. In our experience, admission left ventricular ejection

Excerpt The administration of deslanoside to normal individuals is associated with a decrease in the duration of left ventricular ejection (LVET). This effect of the drug, which occurs in the absen...

The name of Doctor Isaac Starr has been almost synonymous with that of ballistocardiography during the past three decades. Doctor Joseph Stokes, Jr., in presenting the Kober Medal to Starr, indicated that 16 of his papers on this subject had been chosen for programs of the annual meetings of the Association of American Physicians between 1932 and 1961. BALLISTOCARDIOGRAPHY IN CARDIOVASCULAR RESEARCH presents Starr and Noordergraff's clinical experience and mathematical studies which resulted in their adopting a very light, freely-suspended platform, the socalled "ultra low-frequency ballistocardiogram," as the method which yields most accurate representation of body movements. The authors emphasize the simplicity, safety, and painlessness of the technique which provides useful information about left ventricular ejection and myocardial contractability. One of the apparent limitations which still awaits adequate solution is that of multidimensional recording. Despite abundant exposure to the leaders of medicine, the ballistocardiograph has not achieved wide acceptance or

Excerpt Since the rate at which systemic arterial pressure rises is determined in part by the instantaneous velocity of left ventricular ejection, it was thought that determination of the rate of c...

Open Access Meeting abstract 2014 Left ventricular ejection function and viability assessed by CMR in patients undergoing anterograde versus retrograde percutaneous coronary interventions for chronic total occlusion: a Ppe and post procedure study Didier Locca*, Chiara Bucciarelli-Ducci, Giuseppe Ferrante, Peter Barlis, Peter Drivas, Agata Grasso, Sanjay K Prasad, Carlo Di Mario and Dudley J Pennell

As per the ASE guidelines, mitral E wave velocity >1.2 m/sec supports severe mitral regurgitation (MR) and a wave dominance excludes severe MR. Determine the sensitivity and specificity of E wave velocity for diagnosis of severe MR in patients with organic MR and normal left ventricular ejection