Taking “It is finished” to heart: The ultimate expression of God's love and grace

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.

Taking “It is finished” to heart

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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 (patients with coronary artery blockages). It can also detect areas of myocardial fibrosis or scarring. Regional wall motion abnormality has been linked to prognosis. In the Strong Heart study for example, men older than 60 years of age with segmental wall motion were found to have a 2.5 fold increase in coronary vascular events.

The normal wall motion of the heart is represented by a normal wall thickening during the contraction of the left ventricle. Regional heart function abnormality can be described as a weakening of the contraction of some parts of the heart muscle. This does not always lead to weakening of the global heart function. It usually depends on the degree and the extent of the heart walls involved. Below are two MRI studies depicting extensive antero-apical scars (yellow arrows). These patients suffered anterior STEMIs caused by occlusion of the proximal LAD or widow maker. This results in a large area of myocardial damage with thinning and absence of contraction (akinesis) of the walls. The area of damage is large and affects the global function of the heart. The left ventricle is enlarged and the heart function and ejection fraction EF is severely reduced (

If you like the information in this article, make sure you read: Can heart attack damage be reversed? Stem cells in the treatment of a heart attack: a non-STEMI. Surviving a heart attack; the Big one and Stem cells in the treatment of Heart Failure.

Dear AlainMany thanks for the great article.I recently had an heart echocardiogram and the only parameter that bothers me is LVIDD in 59 mm other parameters completely fine (EF 70 % ,no problems with any of the valves and normal wall function).Am very physically active (basketball, running and weightlifting )My question is should I be really concern with this LVIDD 59 mm ?am 178 cm tall and weigh in 84 kilogramsYour answer would be greatly appreciated

Can anyone explain what this means please ? My Dr skid pp15.7 mCi Tc-99m Sestamibi was given for the rest and 34.3 mCi Tc-99mSestamibi was given for the stress. The patient was exercised to amaximum heart rate of 171 bpm and a maximum blood pressure of193/95,Conventional short axis, vertical long axis and horizontal long axisreconstruction images were obtained. Visually, there appears to beperfusion defect to anterior septal wall that, suggestively, is slightlygreater on stress than rest imaging and is of some suspicion for mildischemia. There is, also, suggestion of subtle perfusion defect to inferiorwall that may be little changed from stress to rest and could representslight scarring. Subsequent gating maneuvers suggest diminishedsystolic wall thickening, particularly, anteriorly. There, also, appears to bediminished anterior or anterior septal wall movement. Subsequentsurface rendering images were performed. Surface rendering imagesshow an ejection of 43%. Apex probably moves satisfactorily.IMPRESSION:1. Findings of suspicion or concern for possible sum scarring to anteriorseptal wall with appearance suggestive of some underlying associatedischemia to anterior septal wall and there also may be mild scarring toinferior wall. Sum stress scale score measures 14 and, typically, a sumstress scale score of less than 4 is considered normal.

What was finished? What was this mission that was nowfinished? Why did Jesus come? Let's look at how Jesus defined his mission -- andlater, how his apostles understood it. We read about his commission to "preachthe Gospel to the poor" (Luke 4:18, 43), "to bring life" (John 10:10b), "todestroy the devil's work" (1 John 3:8b), "to bring fire upon the earth," (Luke12:49), "to testify to the truth" (John 18:37). But each of these seems like ameans or aspect of the ultimate purpose, to save us from our sins. Considerthese purpose statement verses:

The cross in all its horror -- and in its redemptive power tobear the sins of the world -- hung heavily on Jesus during his last days in theflesh. His struggle in the Garden of Gethsemane was the climax, the point atwhich he surrendered ultimately to the Father's will. And now the cup had beendrunk, the baptism completed. It is finished.

"Completed / finished / accomplished" in verses 28 and 30 isthe related verb teleō, "to complete an activity or process, bringto an end, finish, complete something." With regard to time, it means, "come to an end, be over."54Moreover the tense of this verb is important to us -- perfect tense (tetelestai).In Greek the perfect tense signifies a past action, the effect of whichcontinues into the present. It has been completed and is still complete. Theeffect of the tense in this verb is a sense of finality.

In the last couple of centuries scholars have foundthousands of papyrus scraps with Greek writing on them. Many of these aremundane commercial documents in which we find this word. Moulton and Milliganpored over many of these receipts and contracts to better understand NewTestament Greek. They observed that receipts are often introduced by the phrasetetelestai, usually written in an abbreviated manner indicating that thebill had been paid in full.55The obligation has been completed. The debt has been paid off. Tetelestai-- it is finished.

It is clear from Matthew and Mark that just before Jesusbreathed his last, he "cried out again in a loud voice" (Matthew 27:50, cf.Mark 15:37). John gives us the content of this loud cry: "It is finished!"

Those who are defeated go out with a whimper, but the victorannounces his victory loudly and broadly: "It is finished!" The victory shoutof Jesus echoed across the small flat hilltop and to the world beyond. It isfinished!

It is a cry of accomplishment, but it is also anannouncement of obedience fulfilled. This shout began in the painful will ofthe Father -- the cup, the baptism, the suffering, the cross. "It is finished"announces the full obedience of the One who, though equal with God:

Make no mistake. The ability to say, "It is finished" to theFather's commission was not the beginning of some kind of "glory road," but theend. It was the final culmination of a life of obedience, humility, andsuffering that now ushers in a new era. 2ff7e9595c