Assessment of left ventricular systolic function by the chest x-ray: comparison with radionuclide ventriculography.

BACKGROUND: The value of the plain chest roentgenogram in predicting cardiac status remains controversial. METHODS AND RESULTS: A total of 111 randomly selected survivors of acute myocardial infarction (age 38 to 83 years) were studied prospectively. X-ray and radionuclide examinations were performed on a morning in the second week after myocardial infarction. From the chest x-ray, left ventricular chamber size and pulmonary vascular congestion were graded visually, and relative cardiac volume was measured to allow for comparison with radionuclide left ventricular end-diastolic volume index (LVEDVI) and left ventricular ejection fraction (LVEF) determined by gated blood pool imaging. Despite significant tendencies for larger radionuclide LVEDVI and lower LVEF with greater radiographic left ventricular size, larger relative cardiac volume, and increasing degrees of pulmonary congestion, wide scatter, and large overlaps between groups precluded reliable radiographic prediction of radionuclide findings. The positive and negative predictive values for radiographic detection of an enlarged LVEDVI ranged from 59% to 80% and 56% to 71%, respectively, and for prediction of a decreased LVEF from 75% to 90% and 40% to 58%, respectively. Accuracy never exceeded 70%. CONCLUSION: Our findings question the value of the chest roentgenogram in the detection and grading of left ventricular systolic dysfunction in patients with recent myocardial infarction.

Acute effects of smoking on left ventricular function and neuro-humoral responses in patients with known or suspected ischaemic heart disease.

Systolic left ventricular function was examined by radionuclide ventriculography in 12 habitual smokers with known or suspected ischaemic heart disease, aged 33-69 years, before, during, and after smoking of two cigarettes in a row and was repeated on a non-smoking control day. Plasma concentrations of adrenaline, noradrenaline, renin, and angiotensin II were determined on the smoking day, before and immediately after smoking. During smoking, there were significant increases in heart rate (+27%), rate-pressure product (+23%), and cardiac output (+14%) in the face of a significant increase in left ventricular end-systolic volume (+5%) and significant decreases in ejection fraction (-6%) and stroke volume (-8%). Blood pressure was virtually unchanged, and total peripheral resistance remained constant. Plasma adrenaline increased by 100%, renin decreased by 21%, and noradrenaline and angiotensin II did not change. The humoral changes were not correlated to changes in any of the haemodynamic variables. Areas of myocardial hypokinesis emerged or widened during smoking in 11 of 12 patients. Thus, in patients with known or suspected ischaemic heart disease, smoking was associated with an acute decrease in systolic ventricular function and development of widespread hypokinesis despite adrenaline stimulation.