Early Diastolic Tricuspid Inflow Research Articles

Insulin Resistance Is Associated with Right Ventricular Dysfunction.

Rationale: The effect of insulin resistance on left ventricular function is well documented; however, less is known regarding its effect on the right ventricle (RV). Objectives: To evaluate the association between insulin resistance and RV function by echocardiography in a cohort of adults without baseline cardiovascular disease. Methods: We performed a retrospective cohort study in the MESA (Multi-Ethnic Study of Atherosclerosis). Linear regression was used to examine the association between overall insulin resistance measured by the mean triglyceride (TG) to high-density lipoprotein (HDL) cholesterol ratio (TG:HDL) and change in TG:HDL over time for each participant with echocardiographic RV function. Logistic regression was used to calculate the odds ratios (ORs) of RV systolic and diastolic dysfunction. Results: Among 3,032 participants, higher mean TG:HDL was associated with lower (worse) absolute RV longitudinal strain (β, -0.38; 95% confidence interval [CI], -0.64 to -0.13; P < 0.01), tricuspid annular plane systolic excursion (β, -0.05; 95% CI, -0.07 to -0.04; P < 0.001), and higher odds of abnormal RV strain (OR, 1.26; 95% CI, 1.08 to 1.47; P < 0.01) and abnormal tricuspid annular plane systolic excursion (OR, 1.31; 95% CI, 1.14 to 1.51; P < 0.001). TG:HDL was also associated with lower ratio of tricuspid early to late ventricular filling velocities (E/A) (β, -0.03; 95% CI, -0.04 to -0.01; P < 0.01), higher ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (E/e') (β, 0.15; 95% CI, 0.07 to 0.23; P < 0.001), and higher odds of graded RV diastolic dysfunction (OR, 1.19; 95% CI, 1.03 to 1.39; P < 0.05). These associations remained following multivariable adjustment. Conclusions: Insulin resistance was associated with decreased RV systolic and diastolic function after adjusting for alternative causes of RV dysfunction, suggesting that insulin-resistant individuals are at risk for early RV dysfunction, even in the absence of cardiovascular disease.

Pre-bypass levosimendan in ventricular dysfunction-effect on right ventricle.

Levosimendan is an effective calcium sensitizer with complementary mechanisms of action: calcium sensitization and opening of adenosine triphosphate-dependent potassium channels, both on the sarcolemma of the smooth muscle cells in the vasculature and on the mitochondria of cardiomyocytes. Levosimendan has a long-acting metabolite with a half-life of approximately 80 h. There have been a few small studies on this drug regarding right ventricular function. In view of this, we investigated the effect of levosimendan on right ventricular function in patients with coronary artery disease. This was a prospective, randomized, double-blind study on 50 patients with coronary artery disease and severe left ventricular dysfunction (left ventricular ejection fraction ≤35%) undergoing elective off-pump coronary artery bypass. Levosimendan had an inotropic effect on right ventricular myocardium and a vasodilatory effect on blood vessels. It caused a decline in pulmonary vascular resistance (p < 0.018), right ventricular systolic pressure (p < 0.001), and pulmonary artery systolic pressure (p < 0.001), and improved right ventricular diastolic function as shown by the decrease in right ventricular Tei index (p < 0.001), right ventricular end-diastolic pressure, and the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (p < 0.006). However, we found no beneficial effects on intensive care unit or hospital stay (p = 0.164, p = 0.349, respectively) nor a mortality benefit. Levosimendan has salutary effects on right ventricular function in patients with severe left ventricular dysfunction undergoing coronary artery bypass, in terms of improved hemodynamic parameters.

Right ventricular functions in subphenotypes of sickle cell disease.

ObjectivesSickle cardiomyopathy is the most important cause of death in patients with sickle cell disease (SCD). Based on recent evidence, SCD can be divided into two subphenotypes, namely, the viscosity vasoocclusion (VVO) subphenotype and the hemolysis endothelial dysfunction (HED) subphenotype. The aim of our series is to study right ventricular (RV) functions in both subphenotypes.MethodsEchocardiography including conventional and tissue Doppler imaging as well as speckle tracking echocardiography was performed in 50 patients (23 from the VVO subgroup and 27 from the HED subgroup) based on a serum lactate dehydrogenase (LDH) level below or above 270 U/L, respectively, and in 50 controls. Reticulocyte count and hemoglobin levels were assessed in different groups of patients.ResultsThe HED subgroup showed RV dysfunction. Patients in this subgroup also showed systolic and diastolic functions similar to those seen in the VVO subgroup and controls. In addition, a tight correlation exists between LDH and both RV global longitudinal strain (−0.68) and RV E/E′ ratio (0.9), defined as the ratio of early diastolic tricuspid inflow velocity to tricuspid annular early diastolic velocity.ConclusionsResults reveal a marked discrepancy in RV functions between HED and VVO subphenotypes of SCD, with patients in the former subgroup being more prone to RV dysfunction. This warrants early screening of such patients in daily practice.

Right ventricular functions in subphenotypes of sickle cell disease

ObjectivesSickle cardiomyopathy is the most important cause of death in patients with sickle cell disease (SCD). Based on recent evidence, SCD can be divided into two subphenotypes, namely, the viscosity vaso-occlusion (VVO) subphenotype and the hemolysis endothelial dysfunction (HED) subphenotype. The aim of our series is to study right ventricular (RV) functions in both subphenotypes. MethodsEchocardiography including conventional and tissue Doppler imaging as well as speckle tracking echocardiography was performed in 50 patients (23 from the VVO subgroup and 27 from the HED subgroup) based on a serum lactate dehydrogenase (LDH) level below or above 270 U/L, respectively, and in 50 controls. Reticulocyte count and hemoglobin levels were assessed in different groups of patients. ResultsThe HED subgroup showed RV dysfunction. Patients in this subgroup also showed systolic and diastolic functions similar to those seen in the VVO subgroup and controls. In addition, a tight correlation exists between LDH and both RV global longitudinal strain (–0.68) and RV E/E′ ratio (0.9), defined as the ratio of early diastolic tricuspid inflow velocity to tricuspid annular early diastolic velocity. ConclusionsResults reveal a marked discrepancy in RV functions between HED and VVO subphenotypes of SCD, with patients in the former subgroup being more prone to RV dysfunction. This warrants early screening of such patients in daily practice.

Acute and Chronic Effect of Cigarette on Right and Left Ventricular Diastolic Function

function. Patients and Methods: One hundred healthy male, 50 smokers and 50 non-smokers, underwent echocardiography, before smoking and 5 and 30 minutes after it to compare diastolic function of left ventricular (LV) and RV and examine the chronic and acute effects of smoking. Results: Atrial late diastolic mitral inflow velocity (A m) Atrial and late diastolic septal mitral annular velocity (a ms ) were high in smokers in comparison to those of the control group before smoking, but there was no difference in tricuspid diastolic parameters. Five minutes later, isovolumetric relaxation time (IVRT) was prolonged and a ms further increased as a sign of LV diastolic dysfunction. Similar changes occurred in RV, in favor of acute RV diastolic dysfunction. After 30 minutes, early diastolic tricuspid inflow (E t) decreased and a ms and late diastolic tricuspid inflow (A t) remained high. After five minutes, diastolic blood pressure increased, but returned to normal state after 30 minutes. Pulmonary arterial pressure did not change before and after smoking. Conclusions: Chronic smoking caused left ventricular diastolic dysfunction. Acute intake caused left and right ventricular diastolic dysfunction. Changes persisted up to 30 minutes after smoking, although diastolic blood pressure returned to normal state.

Tissue Doppler Findings in Patients with Pulmonary Arterial Hypertension

: Background: Pulmonary hypertension is an untreatable condition with poor prognosis and factors such as more elevated pulmonary arterial systolic pressure and right ventricular dysfunction are associated with a worse outcome. Objectives: Considering the limitations of the current modalities, this study aimed to find the relationship between tissue Doppler-derived systolic and diastolic parameters and elevated pulmonary arterial pressure in order to assess the routine application of tissue Doppler imaging in evaluation of pulmonary arterial hypertension. Patients and Methods: This study was conducted on 100 inpatient and outpatient individuals referred to the Department of Echocardiography in Shahid Faghihi hospital, Shiraz, Iran from July 2012 to March 2013. The individuals who had preserved right ventricular function in the presence of pulmonary arterial hypertension were included in the case group. On the other hand, the patients who did not have echocardiographic signs of pulmonary arterial hypertension were enrolled into the control group. All the patients underwent a complete transthoracic echocardiogram including 2-dimensional, color flow, and spectral Doppler as well as tissue Doppler imaging using a vivid E9 system, and the desired systolic and diastolic parameters were recorded. The relationship among these parameters was evaluated by independent sample t-test using the SPSS statistical software, version 16. Besides, P Results: The mean time to peak strain was significantly longer in the case group (203.98 ± 47.54 milliseconds) compared to the controls (81.20 ± 25.76 milliseconds). The mean early diastolic tricuspid inflow velocity/early diastolic tricuspid annulus velocity (E/E’a) ratio was also significantly higher in the case group (10.24 ± 6.19) compared to the controls (4.70 ± 0.80). In contrast, Isovolumic Contraction (IVC) acceleration time/IVC time ratio was reduced in the case group (0.44 ± 0.09) in comparison to the control patients (0.56 ± 0.05). Conclusions: In conclusion, our results suggested that increasing degrees of pulmonary artery systolic pressure affected timing of some tissue Doppler-derived intervals within the cardiac cycle, including IVC time, time to peak systolic myocardial velocity (Sm), and time to peak strain. Therefore, tissue Doppler imaging could be used in assessment of patients with suspected pulmonary arterial hypertension.

Comparison of Doppler echocardiographic and tissue Doppler velocity data in beta-thalassaemia major with high and normal NT-proBNP levels of children in the south-east region of Turkey.

It has been reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is early biomarker of iron- induced cardiomyopathy in β-thalassemia major (β-TM). In this study, we aimed to assess the Doppler echocardiographic, tissue Doppler velocity datas and clinical characteristics in β-TM patients with high and normal NT-proBNP levels who have normal systolic function. Fifty-eight β-TM patients who were on regular transfusion in every 3-4 weeks for more than one year and 20 healthy children were included into the study. According to NT-proBNP levels, β-TM patients are divided in two groups. Group I: the patients with high NT-proBNP levels; Group II: the patients with normal NT-proBNP levels. The mean serum NT-proBNP levels were significantly increased in patients with β-TM compared to control group (P<0.05). The serum ferritin levels were ranged between 676-9,476 ng/mL (mean: 3,716±2,003 ng/mL) in β-TM. No correlation was found between ferritin and NT-pro BNP in patients with β-TM. The mean age and body surface area (BSA) were significantly low in group with high NT-proBNP compared to group with normal NT-proBNP (P<0.01). The mean heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were elevated, but not significantly in group with high NT-proBNP. Also, the mean ferritin and hemoglobin levels were decreased in this group compared to group with normal NT-proBNP, but statistically not significant. The left ventricular end diastole (LVED) diameters and left ventricular mass index (LVMI) values were found significantly decreased in group with high NT-proBNP compared to other group respectively (P<0.001, P<0,05). Right ventricular early diastolic tricuspid inflow velocity/early diastolic tissue Doppler indices (TDI) tricuspid annular velocity (RV E/E') were found increased in group with high NT-proBNP levels and difference was statistically significant (P<0.05). In addition, NT-pro BNP was found correlated with RV E/E' (r: 0.320). According to our result, elevated NT-proBNP level was correlated with RVE/E', but it was not associated with ferritin level. The serum NT-proBNP level may be increased as a response to increased myocardial workload and decreased hemoglobin level in patients who have an increased need for transfusion.

Bedside assessment of right atrial pressure in critically ill septic patients using tissue Doppler ultrasonography

PurposeRight atrial pressure (RAP) is considered a surrogate for right ventricular filling pressure or cardiac preload. It is an important parameter for fluid management in patients with septic shock. It is commonly approximated by the central venous pressure (CVP) either invasively using a catheter placed in the superior vena cava or by bedside ultrasound, in which the size and respiratory variations of the inferior vena cava (IVC) are measured from the subcostal view. Doppler imaging of the tricuspid valve from the apical 4-chamber view has been proposed as an alternative approach for the estimation of RAP. The tricuspid E/Ea ratio is measured, where E is the peak velocity of the early diastolic tricuspid inflow and Ea is the peak velocity of the early diastolic relaxation of the lateral tricuspid annulus. We hypothesized that the tricuspid E/Ea ratio may represent an alternative to IVC metrics, using invasive CVP as the criterion standard, for the assessment of RAP in critically ill septic patients. Materials and methodsA convenience sample of 30 septic patients, both mechanically ventilated and non–mechanically ventilated, was enrolled. Using a portable ultrasound system, maximum velocity of tricuspid E and Ea was measured from the apical 4-chamber view; and IVC diameter and degree of collapse were measured from the subcostal view. Decision tree induction was used to determine the performance of each model compared with invasive CVP. ResultsOur results suggest that a tricuspid E/Ea ratio of greater than 4.7 can predict a CVP greater than 10 mm Hg in septic patients with sensitivity greater than 85% and specificity greater than 90%. ConclusionsIn this pilot study, Doppler imaging of the tricuspid valve provided a valuable alternative for noninvasive bedside estimation of RAP in septic patients.

Usefulness of right ventricular tissue Doppler imaging for diagnosis of right ventricular myocardial infarction.

Right ventricular myocardial infarction (RVMI) is a complication of acute inferior myocardial infarction and sometimes causes severe hemodynamic disturbance. It is therefore important to promptly detect RVMI and assess the severity of right ventricular (RV) dysfunction. Tissue Doppler imaging (TDI) is a useful method to assess left ventricular function and RV function. In this study, we investigated the possibility of diagnosing RVMI using tricuspid annular velocity determined by TDI. Thirty consecutive patients with first acute inferior myocardial infarction were studied. The diagnosis of RVMI was based on an ST-segment elevation of at least 0.1mV in lead V4R. The patients were classified into 12 patients with RVMI (the RVMI group) and 18 patients without RVMI (non-RVMI group). All patients underwent two-dimensional echocardiography, pulsed Doppler and TDI, and coronary angiography within 48h after onset of myocardial infarction. Tricuspid inflow velocity was recorded by pulsed Doppler and early diastolic tricuspid inflow velocity (TVE) was measured. Peak early diastolic velocity of the tricuspid annulus (TVe') at the RV free wall was recorded using TDI. The ratio of TVE to TVe' (TVE/TVe') was calculated. TVe' was significantly lower in the RVMI group compared to that in the non-RVMI group (5.9±1.3 vs. 9.1±3.1; p=0.0025). On the basis of a TVe' cutoff value of less than 8.3cm/s, RVMI was diagnosed with 100% sensitivity and 61% specificity. The early diastolic tricuspid annular velocity determined by TDI is a noninvasive and sensitive index for diagnosing RVMI.

Ratio of Early Diastolic Tricuspid Inflow to Tricuspid Lateral Annulus Velocity Reflects Pulmonary Regurgitation Severity but Not Right Ventricular Diastolic Function in Children With Repaired Tetralogy of Fallot

The current study assessed relationships between the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity (tricuspid E/e') and right ventricular (RV) function in children after tetralogy of Fallot (TOF) repair. The RV function of 25 asymptomatic children with surgically repaired TOF (age 3.3 ± 2.0 years) was assessed by echocardiography and cardiac catheterization. Right ventricular end-diastolic pressure and volume (RVEDP and RVEDV), systolic pressure, and ejection fraction, as well as mean pulmonary arterial pressure, mean right atrial pressure (RAP), and the severity of both pulmonary regurgitation (PR) and tricuspid regurgitation (TR) were assessed in terms of the contribution to tricuspid E/e'. Univariate analysis discovered a relationship between tricuspid E/e' and RVEDV (R(2) = 0172), pressure half-time of PR (PR-PHT) (R(2) = 0.173), and TR grade (R(2) = 0.145) (p < 0.01 for each). After multivariate adjustment, PR-PHT was significantly associated with tricuspid E/e' (β = 0.210; p < 0.001). Tricuspid E/e' was not significantly associated with RVEDP or RAP. In conclusion, tricuspid E/e' does not indicate RV diastolic function but reflects the severity of PR in asymptomatic children after TOF repair.

Value of Estimated Right Ventricular Filling Pressure in Predicting Cardiac Events in Chronic Pulmonary Arterial Hypertension

Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus, but few data are available on the usefulness of Doppler-derived RV filling pressure in predicting the prognosis of chronic pulmonary arterial hypertension (PAH). In 50 consecutive patients with PAH, TDI was performed within 24 hours of right-sided catheterization to measure early diastolic myocardial velocity at the tricuspid lateral annulus (E(a)) and early diastolic tricuspid inflow (E). The tricuspid E/E(a) ratio was calculated and compared with the invasive hemodynamic variables. Cardiac events were defined as cardiac death or rehospitalization due to RV failure. Mean right atrial pressure (RAP) averaged 6 +/- 5 mm Hg (range, 1-25 mm Hg). E/E(a) correlated positively with mean RAP (r = 0.80, P < .001), irrespective of RV systolic function. We divided patients into group A with cardiac events (n = 19) and group B without events (n = 31) in a mean follow-up period of 14 months. Plasma brain natriuretic peptide level and E/E(a) were significantly higher in group A than in group B (349 +/- 310 pg/dL vs 129 +/- 136 pg/dL, P = .001; 7.0 +/- 3.2 vs 4.5 +/- 1.9, P = .004, respectively), whereas mean pulmonary artery pressure did not differ significantly. In a multivariate model, E/E(a) remained predictive for cardiac events (hazard ratio 1.227; 95% confidence interval, 1.042-1.444; P = .014). An E/E(a) cutoff value of 6.8 discriminated cases with cardiac events with a sensitivity of 42% and specificity of 97% (area under the curve 0.71). The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH.

Tricuspid Flow Propagation Velocity Predicts Exercise Tolerance and Readmission in Patients With Systemic Lupus Erythematosus

Evaluating right ventricular dysfunction, pulmonary artery systolic pressure (PASP), and exercise tolerance is critical in patients with systemic lupus erythematosus (SLE) because of the high mortality rate in such patients with pulmonary arterial hypertension (PAH). The aim of this study was to use the flow propagation velocity (FPV) of early diastolic tricuspid inflow to evaluate exercise tolerance and PAH severity and to predict readmission in patients with SLE. A total of 66 patients with SLE with or without PAH and 30 healthy control subjects were enrolled. Controls were age-matched to patients with SLE and without PAH. All patients completed the 6-minute walking distance (6MWD) test and underwent standard echocardiography. Tricuspid FPV was measured in the modified parasternal short-axis view using the color M-mode technique. PAH was defined as PASP > 35 mm Hg using the tricuspid regurgitant method. Patients with SLE and PAH had significantly lower tricuspid FPVs and 6MWDs than patients in the other 2 groups (both P values < .001). Tricuspid FPV was well correlated with 6MWD (r = 0.748, P < .001). In multivariate analysis, right atrial pressure was the only independent factor affecting tricuspid FPV (R(2) = 0.394, P < .001), and 6MWD was affected only by tricuspid FPV and PASP (R(2) = 0.629, P < .001). Patients with SLE who had been readmitted had lower tricuspid FPVs than those who had not (P = .035). Furthermore, FPV > or = 35.4 cm/s predicted 6MWD > or = 350 m and a lower 1-year readmission rate with good sensitivity and specificity. The tricuspid FPV technique provides a simple method for predicting exercise tolerance, the severity of PAH, and readmission among patients with SLE.

Abstract 2436: Tricuspid E/Ea is a Powerful Predictor of Cardiac Events in Patients with Chronic Pulmonary Hypertension

Background: Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus. There are sparse data on the significance of estimated RV filling pressure in predicting the prognosis of chronic pulmonary hypertension (PH). Methods: In 50 consecutive patients with chronic PH undergoing right heart catheterization, early diastolic myocardial velocity (E a ) at the tricuspid lateral annulus and early diastolic tricuspid inflow (E) were obtained from 4-chamber view using TDI. The tricuspid E/E a ratio was calculated and compared with the invasive hemodynamic variables including pulmonary arterial systolic pressure (PASP), mean right atrial pressure (RAP) and RV end-diastolic pressure (RVEDP). Cardiac events including cardiac death or rehospitalization due to RV failure were assessed at long-term follow-up (mean 14.0±1.4 months). Results: The tricuspid E/E a ratio was significantly positively correlated with RAP (r=0.80, p&lt;0.001) and RVEDP (r=0.72, p&lt;0.001), irrespective of RV systolic function (depressed RV systolic function, n=32, r=0.81; preserved RV systolic function, n=18, r=0.75; both p&lt;0.001). An E/Ea ratio &gt; 7.3 had a sensitivity of 87% and a specificity of 97% for mean RAP ≥ 10mmHg. We divided patients into group A with cardiac events (n=19) and group B without events (n=31). There was no significant difference in PASP between the groups. However, serum brain natriuretic peptide and E/Ea ratio were significantly higher in group A than in group B (349±310 vs 129±136 pg/dl, p=0.001; 7.0±3.2 vs 4.5±.9, p=0.004, respectively). Multivariate Cox’s analysis using TDI and conventional echocardiographic variables showed that the tricuspid E/E a ratio (relative risk 1.226, 95%CI 1.011–1.486, p = 0.039) and RA area index (relative risk 1.078, 95%CI 1.002–1.159, p = 0.043) were predictive for cardiac events. Kaplan-Meier analysis showed patients with E/E a &gt; 7.3 had a significantly worse outcome than those with E/E a ≤ 7.3 (log-lank: 10.5, p = 0.0012). Conclusion: RV filling pressure can be well estimated using the tricuspid E/Ea ratio. This index and RA size are powerful predictors of cardiac events in patients with chronic PH, suggesting the prognostic importance of RV diastolic dysfunction.

Doppler imaging predicts cardiac events in chronic pulmonary thromboembolism

Purpose We evaluated whether right ventricular (RV) diastolic dysfunction assessed by pulsed tissue Doppler imaging (TDI) predicts cardiac events in patients with chronic pulmonary thromboembolism (CPTE). Materials and methods In 63 consecutive patients with CPTE, early diastolic myocardial velocity (Ea) at the tricuspid annulus by TDI and early diastolic tricuspid inflow (E) by conventional pulsed Doppler were obtained, and E/Ea was calculated as an indicator of RV diastolic dysfunction. Brain natriuretic peptide (BNP) and other echo parameters were also obtained. A cardiac event (rehospitalization caused by congestive heart failure or cardiac death) was the study endpoint. Incidence of cardiac events was determined over a 374 ± 451 day follow-up period. Results In the follow-up period twelve patients had cardiac events. We divided patients into group A with cardiac events and group B without events. E/Ea was significantly increased in group A as compared with group B (8.3 ± 4.1 vs. 5.7 ± 2.6, p < 0.01). BNP was higher in group A than group B (221 ± 191 vs. 121 ± 140 mg/dl, p < 0.05), and in addition E/Ea was significantly positively correlated with BNP (r = 0.48, p < 0.001). A logistic regression model for predicting cardiac events was constructed and E/Ea was associated with an increased incidence of cardiac events (relative risk = 1.33, 95% CI 1.00–1.75). Conclusion Elevated values of E/Ea obtained by TDI may predict cardiac events in patients with CPTE. BNP may also be a significant predictor.

Quantitative evaluation of chronic pulmonary thromboemboli by multislice CT compared with pulsed Tissue Doppler Imaging and its relationship with brain natriuretic peptide

Purpose Chronic pulmonary arterial thromboembolism (CPATE) often causes right ventricular (RV) pressure overload but the relationship between the degrees of CPATE and RV pressure overload is not clear. To quantify the degrees of CPATE and RV pressure overload, we performed multislice computed tomography (CT) and Tissue Doppler Imaging (TDI) and compared the two modalities. Materials and methods Sixteen consecutive subjects (4 men, 12 women; age 27–72 with proven CPATE underwent CT. The right vascular obstruction index (VOI), the left VOI, and the total VOI (TVOI) were determined using the scoring system of Qanadli. The early systolic myocardial velocity (Sw) and diastole myocardial velocity (Ew) at the tricuspid annulus and the early diastolic tricuspid inflow ( E) were obtained by TDI in the apical four chamber view; RV systolic pressure (RVSP) was estimated by pressure gradient of tricuspid valve regurgitation. E/Ew was calculated as the parameter of RV diastolic function. Results The right VOI was 23 ± 10%, the left VOI was 18 ± 10%, and TVOI was 41 ± 14%. The means with ranges of Sw, Ew, E/Ew, RVSP, and brain natriuretic peptide (BNP) were 10.7 (range 7.7–14.6) cm/s, 7.7 (range 4.2–10.6) cm/s, 5.0 (range 2.2–8.1), 55 (range 26–90) mm Hg, and 50.3 (range 12.2–165) pg/ml, respectively. The correlation coefficients between Sw, Ew, E/Ew, RVSP, and BNP and either larger of right or left side (LVOI) and TVOI were 0.041, − 0.163 (Sw vs. LVOI, TVOI), − 0.153, − 0.232 (Ew vs. LVOI, TVOI), 0.145, 0.241 ( E/Ew vs. LVOI, TVOI), 0.255, 0.401 (RVSP vs. LVOI, TVOI), and 0.192, 0.170 (BNP vs. LVOI, TVOI), respectively. The correlation coefficient between RVSP and BNP was 0.390. Conclusions TVOI was better correlated with RVSP ( R = 0.401) than the other parameters (Sw, Ew, E/Ew, and BNP), and this was similar to the degree that BNP was correlated with RVSP ( R = 0.390). TVOI can be a better indicator of RVSP than LVOI. CT VOI may be a useful parameter to assess CPATE morphologically.

Cardiac Involvement in the Churg-Strauss Syndrome

Churg-Strauss syndrome (CSS) is a rare systemic disease characterized by necrotizing vasculitis and peripheral eosinophilia. Cardiac involvement is considered common and is given a high rank among the causes of morbidity and mortality. The aim of this study was an update on the cardiac manifestations of this syndrome using a noninvasive approach. Sixteen patients with CSS were compared with a gender- and age-matched group of 20 healthy subjects. All patients but 1 were receiving treatment (steroids and/or immunosuppressive drugs). According to the Birmingham vasculitis activity score, 12 patients were in an active phase, and 4 were in drug-induced remission. All subjects underwent M-B-mode echocardiography and Doppler tissue echocardiography. Heart failure, life-threatening arrhythmias, and other prominent manifestations of heart disease were not observed. No differences were found in left ventricular diameter, volume, mass, or ejection fraction. The 2 groups did not differ in right ventricular diameter and pulmonary pressure. Few and nonspecific changes were detected by 2-dimensional echocardiography, including subclinical pericardial effusion and mitral regurgitation, in fewer than half the subjects. Subjects with CSS showed an impairment of ventricular relaxation. Changes were more prominent in the right ventricle. The peak velocity (PV) of early diastolic tricuspid inflow (E) was about 8% less than in controls, and the velocity of late diastolic inflow (A) was 35% greater. The E/A(PV) ratio was, on average, 33% less. In the left ventricle, E(PV) was 11% less and A(PV) 11% greater. The E/A ratio was decreased by 22%. Doppler analysis of tissue kinetics confirmed these indications. In the right ventricle, E(PV) was decreased by 10% and A(PV) was increased by 20% in the patient group. The E/A(PV) ratio was decreased by 29%. In the left ventricle, in which different sites were sampled, the average changes were -15%, +1%, and -23%, respectively. In the left ventricle, the velocity of systolic contraction was also decreased by 12%. Because of the small group size, only some of these differences were statistically significant. In conclusion, these moderate changes, devoid of clinical correlates, contrast with early reports emphasizing cardiac morbidity and poor prognosis in this syndrome.