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Evaluation of Left Ventricular Size

and Function by Echocardiography
Results in Normal Children
HOWARD P. GUTGESELL, M.D., MARC PAQUET, M.D.
DESMOND F. DUFF, M.D., AND DAN G. MCNAMARA, M.D.
With the Technical Assistance of Linda Kaufman

SUMMARY Left ventricular (LV) size and function were studied
by echocardiography in 145 normal children. The LV end-diastolic
diameter (EDD) and its percentage change with systole (%ALVD)
were measured and mean velocity of circumferential fiber shortening
(Vcf) calculated. The LV pre-ejection period (PEP) and ejection
time (LVET) were determined from recordings of aortic valve motion.
The EDD increased by approximately threefold during childhood
and was best correlated with the log of body weight (r = 0.95) and

the log of body surface area (r = 0.96). The mean %lALVD was
36 ± 4 (SD), and this index of LV function was independent of age
and heart rate. Mean Vcf was higher, and the absolute values of
PEP and LVET shorter, in younger children with a faster heart rate.
The mean ratio of PEP/LVET was 0.31 ± 0.003, and was relatively
independent of age (r = -0.41) and heart rate (r = 0.37). The
%ZALVD and PEP/LVET appear to be particularly useful indices of
LV function because they remain constant during the course of
childhood.

ONE OF THE MOST PROMISING APPLICATIONS of
echocardiography is the noninvasive evaluation of left ventricular (LV) function. A variety of echographic indices of
LV performance have been described,' 8 based largely on
studies of adults. The demonstration that systolic time intervals can be measured by echocardiography9g12 adds another
index of LV function to the conventional echocardiographic
measurements.
In this study, we have used echocardiography to study left
ventricular size and function in a group of normal children
with a wide range of age and heart rate. We have attempted
to determine which of the indices of LV function change during the course of childhood and where changes occur, to
determine if they are related to age, heart rate, or a combination of these variables.

casionally a shallow left lateral decubitus position was required to record the ventricular septum clearly.
Left ventricular dimensions were measured in the standard
manner (fig. 1). End-diastolic diameter (EDD) was measured
at the start of the QRS complex. End-systolic diameter
(ESD) was measured at the point in late systole where the
septum and LV posterior wall were in closest apposition.
These measurements were made with the transducer angled
slightly inferiorly and laterally from the point of maximal
excursion of the mitral valve in subjects over one year of age.
In younger children, as previously noted by Sahn et al.,7 the
mitral leaflets appear to extend farther toward the apex, and
the LV diameter decreases rapidly as the transducer is
directed below the mitral valve. Therefore, in infants under
one year of age the LV dimensions were measured at the
point of maximal excursion of the mitral valve, from a position from which both leaflets could be visualized. Recordings
satisfactory for determination of LV dimensions were obtained in 143 of the 145 subjects (99%).
Left ventricular systolic time intervals were determined
from recordings of the aortic valve at 100 mm/sec paper
speed (fig. 2). The pre-ejection period (PEP) was measured
from the onset of ventricular depolarization in lead II of the
electrocardiogram to the onset of opening of the aortic valve.
The left ventricular ejection time (LVET) was measured
from aortic valve opening to closing. An average was obtained from three cardiac cycles and the value was rounded
off to the nearest five milliseconds. Recordings satisfactory
for measuring systolic time intervals were obtained in 118 of
the 145 subjects (81%).
During the first half of this study, 0.5 sec time lines
generated by the echograph were employed. For the
remainder of the study, 0.02 sec time lines from a quartz
crystal oscillator were available. The time lines of the echograph differed from those produced by the oscillator by less
than 3%. We considered this error insignificant and the data
from the two phases of the study were combined.
From these measurements, the following calculations were
made.

Materials and Methods
Echocardiograms were obtained from 145 normal
children, 80 boys and 65 girls. The ages of the subjects
ranged from one day to 19 years. None had heart disease as
judged by history and physical examination. Their age distribution was as follows: 1 day to 30 days, N = 30; 1 month
to 24 months, N = 27; 2 to 6 years, N = 37; 7 to 11 years,
N = 26; 12 to 19 years, N = 25.
The echocardiograms were obtained with a Hoffrel Model
101 Ultrasonoscope interfaced to a Honeywell Model 1856
strip chart recorder. Transducers of 2.25, 3.5 or 5.0 MHz
were used, depending on the subject's size. Studies were obtained from the third or fourth intercostal space at the left
parasternal edge with the subject in the supine position. Oc-

From the Section of Cardiology, Department of Pediatrics, Baylor
College of Medicine, and Texas Children's Hospital, Houston, Texas.
Supported in part by Grant HL-5756 from the USPHS, Grant RR-00188
from the General Clinical Research Branch, NIH, and by a grant from the
Texas Affiliate, American Heart Association.
Address for reprints: Howard P. Gutgesell, M.D., Section of Pediatric
Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, Texas 77030.
Received February 3, 1977; revision accepted April 29, 1977.

457
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Echocardiogram demonstrating method by which left ventricular dimensions were determined. Results E _G t. two variable. End-diastolic diameter (EDD) was measured between the endocardial surfaces of the ventricular septum (IVS) and the left ventricular posterior wall (L VPW) at the start of the QRS complex of the electrocardiogram (ECG).458 4't- CI RCULATION VOL 56.E I). SEE = 2.f Left Ventricular Diameter FIGURE 1.96. No 3. 2016 . 2) multiple. To relate %ALVD. r. I - I 12 EC 1 it I IA- .78) although the correlations with the log of body weight and height as well as with the root functions of height and BSA. The LV diameter was compared to body size by linear regression analysis. height. End-systolic diameter (ESD) was defined as the shortest distance between the septum and the posterior wall. 60 40 EDD 320 20 u0 . The mean %ALVD was 36 ± 4%.st9 t-o t '+ s t*_ X _ F0 _~~~~~~~~~~~~~~~4 . the value for LVET was that obtained from the recording of aortic valve motion. I. and surface area (BSA).ESD A EDD Left ventricular EDD increased by approximately threefold as body weight increased from 3 to 60 kg. Paper speed 100 mm/sec. 1) The percentage change in left ventricular diameter with systole (%zALVD): EDD . %ALVD Left ventricular diameter decreased by slightly over onethird with systole. the following types of linear regression analysis were performed: 1) simple.... and 3) partial. The correlation coefficients and regression equations relating EDD to body size are shown in table 1. and log of each of these variables. Correlation coefficients were determined for the relationship of EDD to body weight. Echocardiogram of aortic valve showing method by which left ventricular systolic time intervals were determined.org/ by guest on February 5. were nearly as strong. as well as the square root. . time lines 0. Downloaded from http://circ...- FIGURE 2.5 sec. the solid diagonal line represents the regression line and the dashed lines estimate the upper and lower limits of 95% of the normal population. Portions of mitral valve (MV) are recorded. The EDD was best correlated with the log of BSA (r .. 2 3 4 5 6 7 8 g 15 20 J3 1. SEPTEMBER 1977 .ahajournals.. The horizontal axis is logarithmic. with one variable constant. cube root..0. The linear relationship between EDD and the log of body weight is shown in figure 3.. and Vcf to age and heart rate.. 40 50 60 J90 m0 BODY WEIGHT (Vg) FIG&URE 3. In this and the subsequent graphs. The 100 2) The ratio of the pre-ejection period to ejection time: PEP LVET 3) Mean velocity of circumferential fiber shortening (Vcf): EDD -ESD EDD X LVET In the latter calculation. Relationship of left ventricular end-diastolic diameter (EDD) to body weight in kilograms. systolic time intervals.

65).96 'TWR 3it Log ht* BSA(m2) -VBSA a NBSTA Log BSA* = = = = = = = = = = = = Standard Regression equation 21.70* -0.73 + 0.67* +0.93 0.02 +0. who also had faster heart rate (tables 2 and 3). the ratio PEP/LVET was slightly higher for subjects with faster heart rates (fig. 2016 = . with a faster heart rate.65* +0.14 + 4.03.2 3.22 (Ht) -13. PEP left ventricular ejection time.22 (log wt) 8. 459 TABLE 1. Very little increase in correlation was achieved by use of multiple regression analysis. Vcf = mean velocity of circumferential fiber shortening.37* +0. similar graphs with the opposite slope could be constructed with age as the independent variable. Mean Vcf Mean Vcf. the ratio PEP/LVET was relatively independent of age and heart rate.92 0.16 +0.37) and age (r = -0.16 +0. LVET Abbreviations: HR = heart rate. SC).81* -0.26 + 4.- Index of left ventricular function - I . the partial correlation coefficients were all less than 0.26 (JBA) -8.37* -0.51 (3VBT-) 37.60 3. Partial regression analysis with age or heart rate held constant showed that both PEP and LVET had a positive correlation with age and a negative correlation with heart rate (table 2).17 (3 vWt) 6. Thus.05. Since LVET is directly related to age and inversely related to heart rate. was higher in the younger children. with the exception of the partial correlation coefficient relating LVET to heart rate with age held constant (r = -0. Since the slope of the regression line of heart rate versus LVET was steeper than that for PEP.92 0.36 + 45.53 ( Vw-t 2.org/ by guest on February 5.89.41) were weak and in practice can probably be disregarded. Abbreviations: Wt = weight. As illustrated in figures 5A and SB. although we have only illustrated the relationship of the systolic time intervals to heart rate.86 (log Ht) 17.10 + 14. %zALVD was greater than 44% in only seven subjects and was less than 28% in two.35* +0. Systolic Time Intervals As expected. had a shorter ejection time and thus a higher value of Vcf.9 3.85 0.55 + 21. Discussion We have combined two commonly used noninvasive techniques to obtain a profile of left ventricular function in nor- TABLE 2. The mean PEP/LVET was 0. The constancy of %ALVD despite wide variations in heart rate is illustrated in figure 4.09 -0.35 (3 ffTl) -68.67). However.75 + 12.92 V--IR a+ii VW-0.95 0. both PEP and LVET were inversely related to heart rate (r = -0.42 3. BSA = body surface area.49 + 32. *Correlation coefficient statistically significant. that relating LVET to heart rate and age was -0.89* -0.27* = pre-ejection period.08 I %ALVD PEP LVET PEP/LVET VCf HR age +0.ECHO OF LV SIZE AND FUNCTION/Gutgesell et al.5 3. For example.61 and 0. those relating heart rate to PEP and LVET were higher than those for age. Ht = height.94 + 9.7 Jt'- - --- .67* +0. P <0.88* +0.95 0.61* +0. %ALVD = percent change in left ventricular diameter.44 (wt) 12.44 ( VrU -35. As in the case of PEP and LVET.88 (log BSA) (mm) 5.93 Log wt* Ht (cm) 0. there was an association between Vcf and both heart rate (r = 0. The relationship of Vcf to heart rate and age simply reflects the formula from which Vcf is calculated: Vcf= DDX LVET The enclosed measurements represent the %ALVD which was independent of heart rate and age (table 2 and figure 4). There was no correlation between %ALVD and age or heart rate (table 2). The correlation coefficients between PEP/LVET and heart rate (r = 0.88.94 0. However.09 -0.88. simultaneously taking both age and heart rate into consideration (table 2). respectively).41* -0.52 3.31 ± 0.43* +0.56 + 0.04 -0.92 (BSA) 4.08 -0.98 3. there was an inverse correlation between age and heart rate (r = -0. Simple linear Simple linear Multiple linear HR and age Partial HR (Age constant) Partial age (HR constant) +0. Relationship of Left Ventricular End-diastolic Diameter to Body Size in Normal Children Independent variable Correlation cooefficient Wt (kg) EDD EDD EDD EDD EDD EDD EDD EDD EDD EDD EDD EDD 0. Correlation Coefficients Relating Echocardiographic Indices of Left Ventricular Function to Heart Rate and Age analysis Type of regression -e.36* +0.81).95 3.2 3. Downloaded from http://circ.ahajournals.41 + 17. The correlation coefficients and regression equations relating the systolic time intervals to age and heart rate are shown in tables 2 and 3. the correlation coefficient between LVET and heart rate was -0.50.70* +0.80).96 2.15 2.95 0.93 0.67) and age (r = -0. younger subjects.72* +0.70 and -0. In contrast to PEP and LVET. the correlations of PEP and LVET with age were nearly as strong (r = 0. normalized for EDD.78 error *Natural log.83 + 11.

while Vcf increased as heart rate increased. The %ALVD appears to be of particular value in the assessment of LV function in children because it remains constant throughout childhood.'3-l8 However.369 -0-00007(HR) r = 005 SEE .2 m2 is 70[ 60 5C o 4C ALVD 30 20 % ALVD .03.01 sec y = 0. It appears to make little difference whether EDD is predicted from weight.01 sec SEE = 0. The EDD is proportionally greater (per unit of body size) in the newborn than in adolescents or adults. the average EDD in a 3 kg newborn with a BSA of 0.0004 (age) SEE = 0. The average value of 36 ± 4% obtained in the present study.0.042 (age) y = 1. when afterload was acutely increased by the administration of phenylephrine.008 (HR) SEE = 0.80) between age and heart rate makes it impossible. Hirshleifer et al.26 cire/sec y SEE = 0.CIRCULATION 460 VOL 56.648 + 0.02 sec y = 1. 21.0. the %ALVD was the same for younger subjects with a fast heart rate as for older subjects with a slower heart rate.3' 20 28 This confirms the observation that the LV ejection fraction measured by angiocardiography is virtually the same in normal children 2 6 and adults. while Epstein et al.0.002 (age) SEE = 0. The %AL VD remains constant within a wide range of heart rates. we prefer weight (fig.0003 (HR) Heart rate and age 0.02 Vef y = 0.075 + 0.'0 12 Since satisfactory aortic valve tracings can be obtained in most children.'8 obtained essentially the same results by acutely increasing the heart rate of adults by the administration of atropine: %ALVD (which they expressed as ejection fraction) remained constant.389 . Lundstrom'7 found a strong correlation between EDD and the cube root of body weight. and carotid or axillary pulse tracing is difficult to use in small children. 16 mm. or 80 mm/M2n. although not as much as Vcf.'6' 27 In the present study.001 (HR) . For example.0. The left ventricular EDD is perhaps the most elementary index of LV function.740 . SEPTEMBER 1977 TABLE 3. is essentially the same as reported values for normal adults. 22 and have thus expressed %ALVD as ejection fraction.'8 found EDD linearly related to BSA.28 circ/sec SEE = 0.0. however. to attribute changes of systolic intervals in childhood to either one or the other of these variables. and perhaps unrealistic.org/ by guest on February 5. Echocardiographic recording of septal and left ventricular posterior wall motion has been shown to be a reproducible method' of evaluating left ventricular function." with external pulse and phonocardiographic methods.020 (age) SEE = 0.005 (HR) . an average EDD as low as 32 mm/Mi was not obtained until BSA reached 1. the strong correlation (r = -0. Thus. have been used to assess left ventricular function under a variety of conditions. The conversion has the disadvantage that it magnifies any errors in the original measurement.008 sec LVET y = 0.ahajournals.0. or BSA. either by the cube method' or by regression equations derived from angiocardiographic comparisons8.0.066 + 0.104 . Conversion of the LV dimensions to volumes has the advantage that terms such as end-diastolic volume or ejection fraction have more general familiarity. Our results are in accord with previous studies of cardiac growth in childhood.31 ± 0. There is disagreement regarding the relative contributions of age and heart rate to the changes in systolic time intervals which occur during the course of childhood. and LVET varied inversely with heart rate if age was held constant. Feigenbaum'9 and Popp20 propose 19-32 mm/M2 as the normal range for adults.2 M2n.001 (HR) SEE = 0.094 . Most investigators have chosen to convert the LV dimensions to volumes.0. No 3.'93' In the present study.001 (age) y = 0. In general. In the present study. we have adopted this technique.ALVD did fall. The percent change in the left ventricular minor axis (%ALVD) was one of the first echocardiographic indices of LV function described3 but has been somewhat overlooked since. the conventional method employing simultaneous recording of the electrocardiogram.342 .6" 6 Systolic time intervals. 3) because it is easily and more accurately determined in small infants. Our slightly larger EDD compared to that of Lundstrom may result from our measuring LV diameter higher in the ventricle in children under one year of age. phonocardiogram.03 sec SEE = 0.007 (age) y = 0.5 (table 2). 2016 . suggesting that %zALVD is independent of heart rate. PEP and LVET were slightly better correlated with heart rate than age. Plot of percent change in left ventricular diameter (%AL VD) against heart rate.0002 (HR) + 0. Regression Equations Relating Selected Indices* of Left Ventricular Function to Age and Heart Rate Heart rate (beats/min) PEP Age (yr) y = 0.004 50 60 70 80 90 100 110 0 HEART RATE 00 140 B- 60 TB FIGURE 4. mal children. The %. It likewise has been shown to have a good correlation with angiographic techniques.27 circ/sec = *Includes those relationships with a correlation coefficient greater than 0. Since PEP tends to lengthen while LVET shortens in the presence of left ventricular Downloaded from http://circ.206 + 0. The mean PEP/LVET for children in this study was 0. Several recent studies have shown a good correlation between systolic time intervals obtained by echocardiography and those obtained by conventional external methods10-12 or by intracardiac recording. it does not appear possible to use a simple mm/M2 index to predict EDD in childhood. which is the same as that obtained in 76 normal children studied by Spitaels et al. particularly the ratio of PEP/LVET. height.

. Jaferi GA. Howard Thompson for assistance in the statistical analysis of the data. Lea and Febiger.101. Schoenfeld CD: Systolic time intervals in heart failure in man. 1975 9.ular dimensions and LV systolic time intervals has several advantages.30 Acknowledgment 1. Wood J: Great vessel.. _ _ . Chang S: Analysis of left ventricular wall motion by reflected ultrasound: Application to assessment of myocardial function. Harris WS.. Circulation 49: 232. Circulation 51: 304. Philadelphia. Caution is therefore required in using Vcf to compare subjects of different ages or heart rates. Circulation 37: 149. Circulation 46: 914. Weissler AM. Dalen JE.: ECHO OF LV SIZE AND FUNCTION/Gutgesell et al. 1972 5.2 5 26 By adding an element of time to the measurement of change in left ventricular dimensions. Grossman W. 1974 10. _ = PEL/ET 0. Circulation 51: 297. Konecke L. is directly related to heart rate and inversely related to age. Peterson KL. Alexander JK: Echocardiographic assessment of left ventricular function: With special reference to normalized velocities. 1972 6. Weissler AM. 0LVET025 015 o0io . Russell RO Jr: Left ventricular volumes and ejection fraction by echocardiography. 32 and adults. Circulation 46: 26. _ z 020 . 1974 8. Epstein ML. I. . Schiller NB: The measurement of systolic time intervals by echocardiography. Circulation 50: 42.I I LVET (sec) I I 025 I II I I I I 020 I. Narang RM. 70 60 530 90 80 1p3 120 HEART RATE 130 150 140 170 160 C 050 045 _ _ .. 60 150 140 LVE 10 000134(HR) 461 settle the issue it does emphasize the fact that Vcf. PEP and L VET are inversely related to heart rate. Craige E: Evaluation of left ventricular function by echocardiography. 0. Kaplan S: Echographic determination of left ventricular volumes in pediatric patients. Circ Res 29: 610. 012 0.1 _~ I 0 . Quinones MA. I 1. Graph illustrating relationship of A) pre-ejection period (PEP). 1975 19. it still may be possible to make some estimation of left ventricular function from the other parameter. Deely WJ. Pombo JF. Circulation 51: 114. Creekmore SP.55. Paraskos JA. 1. Troy BL. Leopold GR: Comparison of ultrasound and cineangiographic measurements of the mean rate of circumferential fiber shortening in man. Cooper RH. unlike %ALVD. Schwartz DC. 1976 Downloaded from http://circ. U. Schoenfeld CD: Bedside technics for the evaluation of ventricular function in man. Both determinations can be made fairly rapidly by one person with the same piece of equipment. PEP/L VET tends to be slightly higher at faster heart rates.37 =006 150 e6 mi HEART RATE FIGURE 5.. Witham AC: Systolic time intervals by echocardiography. 1971 2. 1974 18. B) left ventricular ejection time (L VET). Am Heart J 89: 200. Am Heart J 89: 153. 1975 12. Regan TJ: Preclinical abnormality of left ventricular function in diabetes mellitus. Ahmed SS. If one of the measurements cannot be made reliably (for example.15. Hirschfeld S.*. Gaasch WH. Meyer RA. Regan TJ: Depression of myocardial contractility with low doses of ethanol in normal man. Investigation of infants and children without heart disease. Curiel R: The use of echocardiography to measure isometric contraction time. and C) the ratio PEP/L VET to heart rate in normal subjects. 1975 11. 1975 13. Feigenbaum H. The %ALVD and the ratio of PEP/LVET appear to be particularly useful indices of LV function in children because they remain relatively constant during childhood. Feigenbaum H: Echocardiography. SEE= 0022 0. Zaidy GM.94 0 60 70 0 80 0 loo 90 110 HEART F 035 130 STE0 ~~~~~~~F3 11. Circulation 54: 538. Hood WP. 009 PEP (sec) 008 007 006 OD5 PEP= 010 -000028((HR) r Q70 SEE 0008 *.14 an elevated ratio has been used widely as an indicator of myocardial dysfunction. Karliner JS. Mean Vcf has been advocated as a valuable index of LV function in both children7 25. . Hardarson T. Lundstrom NR: Clinical applications of echocardiography in infants and children. 2016 . Although the present study does not 1. Kaplan S: Measurement of right and left ventricular systolic time intervals by echocardiography. 1974 7. Circulation 51: 1124. Goldberg SJ. Harris WS. O'Rourke RA.11 A 0. Sahn DJ. ""V I 1. Friedman WF: Echocardiographic assessment of left ventricular performance in normal newborns. Circulation 43: 480. Saltz S. in two recent studies38 "4 the percent of minor axis shortening (%ALVD) was as sensitive as Vcf in detecting depressed LV function. The use of the echocardiogram to determine both ventric~ . cardiac chamber. Circulation 46: 14. p 464 20. 1973 17. 1972 4. Vredevoe LA. Dexter L: A noninvasive technique for the determination of velocity of circumferential fiber shortening in man. I References I I 1. failure.2265000007(HR) SEE 005 c0D 0 m0 0 90 10 no 12 13 r =0. _-. Stockert J. or the same subjects before and after interventions which may alter heart rate. and wall growth patterns in normal children. Meyer R. Fortuin NJ. ed 2. 1968 15. Popp RL: Echocardiographic assessment of cardiac disease. Circulation 48: 378.40 035 PE&- 030 . McDonald IG. Korfhagen J.ahajournals. %ALVD in a subject with paradoxical septal motion).. We are indebted to Dr. Ahmed SS. 1976. Allen HD.1 25 However. Acta Paediat Scand 63: 23.. 1975 16. 1969 14. Levinson GE.org/ by guest on February 5. Am J Cardiol 23: 577. Vcf has been reported to offer better separation of normals from patients with abnormal left ventricular function than ejection fraction alone. Stefadouros MA. 1971 3. J Clin Ultrasound 2: 99. We would like to thank Sue Lambert for editing and typing the manuscript. Hagan AD.

04 after infusion of PA (0. Dodge HT. Fortuin NJ. 1976. Thus a longer portion of the ventricular recovery period is refractory after administration of the drug. 31. Circulation 44: 575. 1975 26. all cardiac medicines had been discontinued at least 48 hours before study. 1975 Harris LC. Hospital of the University of Pennsylvania. Blackmon JR: Quantitative angiocardiography: 1. Clark R. Guss. Circulation 52: 835. Morristown. Department of Cardiology. Goldberg SJ. Hospital of the University of Pennsylvania and the Cardiovascular Section. New Jersey 07960. The ratio remained unchanged in one patient. Address for reprints: John A. HOROWITZ. SEPTEMBER 1977 acute alterations in heart rate and systemic arterial pressure on echocardiographic measures of left ventricular performance in normal human subjects.. It appears to work by several mechanisms: 1) decreasing the slope of spontaneous phase 4 depolarization in ventricular Purkinje cells.. Danford BH. help to explain how PA may suppress human re-entrant ventricular arrhythmias. 1964 Golde D. were described and each patient gave informed consent.1`4 None of these mechanisms has been conclusively demonstrated in man. Ross J Jr: Comparison of isovolumic and ejection phase indices of myocardial performance in man. Circulation 42: 1029. 1972 25.01 to 0. Circulation 34: 272. Electrode catheters were inserted as follows: a tripolar catheter from the femoral vein across the tricuspid valve to record the bundle of His potential. Baxley WA. 1977.org/ by guest on February 5. Prog Cardiovasc Dis 15: 191. Kastor. Graham TP Jr. 1970 Spitaels S. M. Weissler AM. Circulation 54: 509. Hood WP Jr.ahajournals. The QT intervals increased from a group mean value of 421 ± 8 msec to 461 ± 9 msec after PA (P < 0. 3400 Spruce Street. The normal left ventricle in man. 1974 Kaye HH. Am J Cardiol 38: 73. a quadripolar catheter via a femoral or antecubital vein to the high right atrium for Patients and Methods The effects of procainamide on human ventricular electrophysiologic function were evaluated in eight patients referred to the Clinical Cardiac Electrophysiology Laboratory (table 1). Manske AO. SUMMARY The effects of procainamide (PA) on the ventricular effective refractory period (ERP-V) and on the relationship of refractoriness to recovery of excitability were evaluated in eight patients during ventricular pacing.62 ± 0. Pennsylvania 19104. 3) affecting the relationship of refractoriness to the recovery of the threshold of excitability. Circulation 41: 493. The development of the ventricular extrastimulus method permits evaluation of ventricular refractoriness to be per- formed with safety and reproducibility in man. Davignon A: The influence of heart rate and age on the systolic and diastolic time intervals in children. Hunter S: Validity of echocardiographic estimates of left ventricular size and performance in infants and children. Peak increase occurred at maximal drug levels five minutes after administration of PA. Williams DE. DuBrow IW. 1975 24. Popp RL. VOL 56. Am J Cardiol 14: 448. Crawford M. Fisher EA. Arbogast R. 1974 27. In this study. KASTOR. 1966 28. Ross RS: Acute effects of low doses of alcohol on left ventricular function by echocardiography. Southeastern Pennsylvania and Berks County Affiliates. Skloven D. White GD. Cohn K: Echocardiographic assessment of the level of cardiac compensation in valvular heart disease. Burstin L: Systolic phases of the cardiac cycle in children. Allen HD. Harrison DC: Ultrasonic cardiac echography for determining stroke volume and valvular regurgitation.1 < P < 0. 1976 Human Ventricular Refractoriness LI. Department of Medicine. Uther JB.01). Karliner JS: Influence on 29. Delgado CE. Burgess J. O'Rourke RA. Peterson KL. Figley MM. The purpose and nature of the studies Downloaded from http://circ. Kennedy JW.. which correlate with animal studies. From the Cardiac Clinical Electrophysiology Laboratory. Fortuin NJ. M. Circulation 49: 1107. Effects of Procainamide JOHN A..5 Total ventricular recovery can be estimated from the familiar QT interval of the electrocardiogram. Supported in part by grants from the National Institutes of Health (HL 14807) and the American Heart Association. Friedman WF: Echocardiographic detection of large left to right shunts and cardiomyopathies in infants and children. Dr. MARK E. Jarmakani JM: Hemodynamic investigation of congenital heart disease in infancy and childhood. Fouron JC.56 ± 0. Received September 30. Br Heart J 37: 371. 1971 22.2). Circulation 49: 1088. we have evaluated the effects of procainamide on these two electrophysiological characteristics of the human ventricle in eight patients and have correlated the data with blood levels of the drug.D. In each patient. Hammill WA: Duration of the phases of mechanical systole in infants and children. 942 Gates Building. The data. Guss' present address is Morristown Memorial Hospital. The investigative evaluations were performed after completion of electrophysiological diagnostic studies for which the patient had been referred to the laboratory. The ERP-V was prolonged from a group mean value of 237 ± 7 msec (SE) to 279 ± 16 msec (P < 0. 1975 Sahn DJ. Sherman ME. Philadelphia. Hirshleifer J. M. STEPHEN B.05).D. University of Pennsylvania School of Medicine.D. 2016 . Circulation 51: 535. Pennsylvania. M. Tynan M. JOSEPHSON. This study reveals that PA increases ERP-V in man and usually increases the ratio ERP-V/QT. 1970 23. 34. AND LEONARD N. The ratio ERPV/QT increased in seven of eight patients from 0. 32. 30. M. Ludbrook P. 1976 Rosenblatt A. No 3.D. revision accepted April 22. Circulation 52: 916. PROCAINAMIDE is one of the most effective and frequently employed drugs for the treatment of ventricular arrhythmias. Hastreiter AR: Comparison of ejection phase indices of left ventricular performance in infants and children.D. Measurements of ERP-V and plasma levels of PA were taken before and after intravenous administration of 500 mg of PA. 33. Vaucher Y. Philadelphia.CIRCULATION 462 21. Craige E: Determination of left ventricular volumes by ultrasound. 2) slowing and equalizing conduction and refractoriness in regions of unidirectional block or converting unidirectional to bidirectional block.

TX 75231 Copyright © 1977 American Heart Association. Results in normal children. click Request Permissions in the middle column of the Web page under Services. or portions of articles originally published in Circulation can be obtained via RightsLink. 1977. Reprints: Information about reprints can be found online at: http://www.ahajournals. D F Duff and D G McNamara Circulation. along with updated information and services.ahajournals. 2016 . All rights reserved.CIR. a service of the Copyright Clearance Center.org/ by guest on February 5. Once the online version of the published article for which permission is being requested is located. Further information about this process is available in the Permissions and Rights Question and Answer document.Evaluation of left ventricular size and function by echocardiography.56. Dallas. Print ISSN: 0009-7322.org/content/56/3/457 Permissions: Requests for permissions to reproduce figures. Online ISSN: 1524-4539 The online version of this article.lww.3. Inc. is located on the World Wide Web at: http://circ.ahajournals.457 Circulation is published by the American Heart Association.56:457-462 doi: 10. M Paquet.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.1161/01. H P Gutgesell.org//subscriptions/ Downloaded from http://circ. 7272 Greenville Avenue. not the Editorial Office. tables.