Isovolumetric Acceleration Research Articles

Interaction between right atrial function reserve and liver stiffness after complete repair of tetralogy of fallot: a pilot study

Abstract Background Impaired right atrial mechanics is reported in patients with repaired tetralogy of Fallot (TOF) and is associated with liver stiffness. However, whether right atrial functional reserve correlates with liver stiffness is unknown. Purpose This study tested the hypothesis that right atrial reserve capacity is limited in patients with repaired TOF and explore its relationships with right ventricular function and liver stiffness. Methods 10 patients (45% male) aged 19.04 ± 3.76 at 16.70 ± 4.30 years after repair and 15 controls (60% male, aged 20.31 ± 1.25 years) were studied. RA mechanics was assessed by speckle-tracking echocardiography (STE) at rest and during bicycle exercise, with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac). Right atrial function reserve (RAFR) is calculated as (∆RA total strain x [1-1/ RA total strain at baseline]). RV systolic and diastolic function was quantified using Doppler interrogation and STE. Hepatic shear wave velocity (c) and tissue elasticity (E) were measured using two-dimensional shear wave elastography. Results At rest, patients had significantly lower RA positive, negative and total strain, aSRs and aSRed than control subjects (all P<0.02). Shear wave velocity and hepatic E value were significantly higher in patients than controls (both P<0.02). Compared with controls, patients had significantly lower RA positive, negative and total strain, aSRs, aSRed, and aSRac at exercise (all P<0.05). No significant difference in hepatic shear wave velocity and tissue elasticity were found between patients and control subjects at exercise (all P>0.05). Both baseline liver stiffness indices correlated negatively with RAFR, RA positive and total strain and aSRed at exercise (p<0.05 for all). RV function parameters, including baseline trans-tricuspid early and late diastolic inflow velocity (E, A), systolic, early and late diastolic tricuspid annular velocity (s, e, a), isovolumetric acceleration (IVA), RV systolic and diastolic reserve correlated significantly with RA positive and total strain at exercise (P<0.05 for all). Conclusions In young adults with repaired TOF, right atrial function reserve is impaired, and is associated with increased liver stiffness and RV dysfunction.RA mechanics from rest to exerciseStress RA mechanics and liver stiffness

Improvements of right ventricular function after intervention with CPAP in patients with obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is present in 40-80% of patients with cardiovascular morbidity and is associated with adverse effects on cardiovascular health. Continuous positive airway pressure (CPAP) maintains airway patency during sleep and is hypothesised to improve cardiac function. In the present study, we report on the impact of 12 weeks of CPAP and improvements in echocardiographic parameters of the right ventricle (RV). Nineteen newly diagnosed patients with OSA and a respiratory disturbance index (RDI) greater than 10 were enrolled. Echocardiography was performed before treatment and with a follow-up assessment after 12 weeks of CPAP. Echocardiographic and Doppler measurements were made following the American Society for Echocardiography guidelines. The primary outcome was isovolumetric acceleration (IVA). Secondary outcomes include tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV % strain, TEI index and RV dimension (RVD1). There was significant improvement in isovolumetric acceleration of 0.5ms2 (P = 0.0012 (95% CI -0.72, -0.20)) and significant improvement of 2.05mm in TAPSE (p = 0.0379 (95% CI -3.98 - -0.13). There was no significant difference in FAC, RV % strain, TEI index or RVD1 with twelve weeks of CPAP therapy. The present study highlights significant improvement in TAPSE and IVA with 12 weeks of CPAP treatment and no significant improvement in FAC, RVD1 and RV % strain. These data indicate favourable characteristics on both load dependent and load independent markers of RV function with CPAP.

Correlations among noninvasive right ventricular myocardial work indices and the main parameters of systolic and diastolic functions.

BackgroundRight ventricular (RV) myocardial work (RVMW) is the latest method used to assess RV function. To date, correlations among RVMW indices and RV systolic and diastolic functions have not been studied.MethodsA total of 106 healthy volunteers (median age, 34 years; 46% male) were prospectively enrolled. RVMW indices were measured using the RV pressure–strain loop using specific software. The correlations among RVMW indices and other RV functions were analyzed.ResultsDuring the multivariate analysis, the RV global work index (RVGWI) was significantly correlated with RV global longitudinal strain (RV GLS) (p < .0001), pulmonary systolic artery pressure (PASP) (p < .0001), and tricuspid annular (TA) plane systolic excursion (TAPSE) (p = .036). RV global constructive work (RVGCW) was correlated with RV GLS (p < .0001) and PASP (p < .0001). RV global wasted work (RVGWW) was correlated with RV GLS (p = .008) and TA isovolumetric acceleration (TA IVA) (p = .008). RV global work efficiency (RVGWE) was correlated with RV GLS (p < .0001) and tissue Doppler (TD) RV myocardial performance index (TD RMPI) (p = .043).ConclusionRVMW indices showed good correlations with RV myocardial systolic function.

Comparison of Outcomes in Adults With Ventricular Septal Defect Closed Earlier in Life Versus Those in Whom the Defect Was Never Closed

Ventricular septal defects (VSDs) have recently demonstrated poorer functional outcome with disrupted ventricular contractility during exercise in young patients. It is not known whether this will change with age. Therefore, echocardiography was performed in older patients with congenital VSDs, either surgically closed or unrepaired and all without Eisenmenger physiology, to compare functional outcomes with healthy peers. Transthoracic echocardiography was performed at rest and during supine bicycle exercise, with tissue velocity Doppler for assessment of primary end points: isovolumetric acceleration and systolic velocities. In total, 30 surgically closed VSDs (51 ± 8 years) with 30 healthy controls (52 ± 9 years) and 30 unrepaired VSDs (55 ± 12 years) with 30 matched controls (55 ± 10 years) were included. Surgical patients displayed lower right ventricular (RV) systolic and early diastolic-filling velocities compared with controls, p <0.01, lower tricuspid annular plane systolic excursion (17.8 ± 5 vs 22.7 ± 3mm, p <0.01) and lower fractional area change (37.8 ± 6 vs 46.4% ± 7%, p <0.01). Unrepaired VSDs also had lower RV fractional area change than matched controls (39.9 ± 7 vs 48.4% ± 7%, p <0.01). Both patient groups had more tricuspid regurgitation and larger RV outflow tract dimensions than controls, p <0.01. During exercise, isovolumetric acceleration and systolic velocities were lower in both patient groups compared with controls, with the difference increasing with workload level. In conclusion, adults in their mid-50s with surgically closed or unrepaired VSDs have abnormal RV function at rest, with even more pronounced differences during exercise. These results suggest that a VSD, whether repaired early or considered hemodynamically insignificant, is not a benign lesion and continuous follow-up of adults is warranted.

Reduced biventricular contractility during exercise in adults with small, unrepaired ventricular septal defects: an echocardiographic study.

Small ventricular septal defects are often considered to be without long-term haemodynamic consequences and so the majority remains unrepaired. However, we recently showed reduced functional capacity and altered right ventricular morphology in adults with small, unrepaired ventricular septal defects. The underlying mechanisms behind these findings remain unclear, and so, biventricular contractility during exercise was evaluated. Adults with small, unrepaired ventricular septal defects and healthy controls were examined with echocardiography during supine bicycle exercise with increasing workload. Tissue velocity Doppler was used for evaluating isovolumetric acceleration and systolic velocities during exercise. In total, 34 patients with ventricular septal defects, a median shunt- ratio of 1.2 (26 ± 6 years), and 28 healthy peers (27 ± 5 years) were included. Right ventricular isovolumetric acceleration was lower in patients as compared with controls at rest (97 ± 40 vs 158 ± 43 cm/s2, P = 0.01) and at peak heart rate (222 ± 115 vs 410 ± 120 cm/s2, P < 0.01). Peak systolic velocities were similar at rest, but differed with exercise (13 ± 3 vs 16 ± 3 cm/s, P = 0.02). Left ventricular isovolumetric acceleration was lower in patients as compared with controls throughout the test (P < 0.01). Septal isovolumetric acceleration was similar at rest, but reduced during increasing exercise as compared with controls (220 ± 108 vs 303 ± 119 cm/s2, P = 0.03). Left ventricular isovolumetric acceleration was negatively correlated with the shunt- ratio, and right ventricular and septal peak systolic velocities were positively correlated with lower functional capacity. Altered biventricular contractility is present during exercise in adults with small, unrepaired ventricular septal defects. These results add to the growing number of studies showing that long-term outcome in unrepaired ventricular septal defects may not be benign.

Biventricular contractility during exercise in adults with small, unrepaired atrial septal defects.

Adult patients with a small, unrepaired atrial septal defect (ASD) have higher mortality and increased risk of several comorbidities compared to general population. Further, reduced submaximal and peak exercise capacity was recently demonstrated in these patients. The mechanisms behind these findings remain unexplained and, therefore, biventricular contractility during exercise was assessed by evaluating the force-frequency relationship in the same group of patients. Adults patients with a small, unrepaired ASD and healthy age- and gender-matched controls were examined using echocardiography during supine bicycle exercise. Continuous tissue velocity Doppler was used to evaluate isovolumetric acceleration (IVA) and systolic velocities during an incremental workload protocol. All data were analyzed post hoc in a blinded fashion. We included 30 patients previously diagnosed with a small, unrepaired ASD (mean age 35years, 63% female) and 25 controls (mean age 34years, 64% female). Patients had similar values of IVA and systolic velocities at rest when compared with the healthy controls. Further, no differences in IVA was found at peak heart rate for neither the left ventricle (90±39 vs 129±68cm/s2 , P=0.1547) nor the right ventricle (128±56 vs 154±56cm/s2 , 0.5691). There were no correlations between peak velocities and the lower exercise capacity previously reported in these patients. Adult patients with a small, unrepaired ASD have normal biventricular contractility at rest and during exercise when compared with healthy peers. Consequently, the pathophysiological mechanisms behind the impaired exercise capacity previously demonstrated in these patients remains unknown and will be a target for future work.

Right ventricular pressure response to exercise in adults with isolated ventricular septal defect closed in early childhood.

We previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30-45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score -0.4, 95% CI -2.8-0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.

Use of Isovolumetric Acceleration as an Afterload-Independent Marker of RV Dysfunction in Scleroderma

Use of Isovolumetric Acceleration as an Afterload-Independent Marker of RV Dysfunction in Scleroderma

Role of Tissue Doppler Echocardiography in the Diagnosis of Early Left Ventricular Dysfunction in Rheumatoid Arthritis

AbstractObjective: Rheumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. The purpose of our study is the usefulness of Tissue Doppler echocardiography to detect the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample.Methods: We selected 21 patients affected by rheumatoid arthritis. No patient had any symptoms of cardiac disease. As a control group we studied 21 volunteers, randomly selected among a larger group of subjects who had come for routine check-up. All were in sinus rhythm and without any cardiac symptom. Standard two-dimensional, M-mode and Doppler echocardiographic examination was carried out on each subject.Results: out of 21 RA patients, 16 females 5 males with an average age of 38±9 years. Both the study group and control were matched with respect to age and sex. In RA patients we found a higher prevalence of several tissue Doppler parameters abnormalities. Patients with RA showed significantly higher tricuspid annular plane systolic ejection (TAPSE) 2.49±0.19 vs. 2.36±0.22 (p= 0.04), isovolumetric contraction time (IVCT) 48.8±11.7 vs. 41.2±7.7 msec, (p=0.02), isovolumetric velocity (IVV) 12.26±2.23 vs. 15.71±1.89 m/sec ( p = 0.00) acceleration time (AT) 0.43±0.05 vs. 0.35+0.05 msec (p = 0.00) lower isovolumetric acceleration (IVA) 28.68±6.57 vs. 45.8±10.1 m/sec2 (p = 0.00) early diastolic velocity (E)′ 10.48±1.99 vs. 13.02±1.54 cm/sec (p = 0.00). No significant difference was noted with IVRT (isovolumetric relaxation time) and A′ (late diastolic velocity). Duration of RA did not affect the significance of these parameters.Conclusion: There was subclinical LV systolic and diastolic dysfunction with normal EF, detected by tissue Doppler imaging in Rheumatoid arthritis patients.

The Role of Cardiovascular T2*MRI and Tissue Doppler Measurement in Assesment of Cardiac Status in β-Thalassemia Major

Introduction: Early detection of myocardial dysfunction and modification of treatment may prevent from progressing into the end stage heart failure and lethal arrhythmias in beta-thalassemia major (β-TM). T2* magnetic resonance imaging (MRI), a non-invasive technic determining iron accumulation in myocardium has been widespreadly used in these patients. Cardiac T2* MRI is not capable to evaluate cardiac functions but, indicates patients with risk for developing cardiac disease. Therefore, combining T2*MRI with tissue Doppler (TD) echocardiography, another technic defining both functional and structural evaluation of myocardium, could give a better information in evaluating the actual status of myocardium.The aim of this study was to evaluate cardiac status of thalassemics by using both T2*MRI and TD measurement.Methods: The study group includedpatientswith β-TM on regular transfusion and chelation program with preserved systolic function; ejection fraction > 55% and fractional shortening > 30% determined by conventional echocardiography. None of them had other organ dysfunctions adversely effecting cardiac functions. The control group was consisted of age and sex matched healthy persons. Serum ferritin levels were measured in both groups. In addition, TD measurements (S,E,A waves, time intervals; ejection time, total systolic time, isovolumetric accelaration time, isovolumetric contraction time, isovolumetric relaxation time and myocardial performance index) were obtained from three different regions of myocardium; septum, left and right ventricular posterior walls. T2* MRI was only determined in thalassemics.The study group was divided into two different subgroups according to serum ferritin level (low ferritin < 2500 ng/ml and high ferritin > 2500 ng/ml) and T2* MRI score (iron overloaded <20 ms and unloaded >20ms). The results obtained by TD within these subgroups were compared. TD measurements in thalassemics without cardiac iron overload were separately compared with the controls.Results: The study and control groups were consisted of 33 β-TM patients (16 girls/17 boys, mean age 18,7±7,7 years) and 37 healthy individuals (18 girls/19 boys, age 19,9±8,4 years), in respectively. Gender and age were similar (p>0,05). Systolic and diastolic functions by TD were found significantly impaired in thalassemics compared to the controls (p<0,05). S-lateral wave measurement showing early myocardial systolic function was more adversely effected in thalassemics (p<0,001). The patients’ mean ferritin level was found 2242,3±2174,2 ng/ml (109-9843). Twelve patients (36,4%; 12/33) had high ferritin level and the rest (63,6%; 21/33) had low. T2*MRI and TD measurements did not differ in both subgroups (p>0.05). The mean T2*MRI score was 18,7±7,7 (7,3-29,8) ms in the study group. Twenty-one patients (63,6%; 21/33) had myocardial iron overload. Serum ferritin levels were similar between iron overloaded and unloaded groups (p>0.05). Both isovolumetric acceleration time of left ventricule and myocardial performance index (MPI-septal) showing systolic and diastolic functions were found significantly impaired in iron overloaded subgroup (p<0,05). There was negative correlation between MPI-septal and T2*MRI measurements in thalassemics (r:-0,343, p=0,050, fig 1).When we compared the velocity measurements (S,E,A waves) of iron unloaded thalassemics with the controls; only S wave velocity obtained from left ventricular wall was found significantly low (p<0,05). The time intervals measured from septum were found similar with the controls (p>0,05) but, the same measurements obtained from left and right ventricular posterior walls were significantly impaired (p<0,05). [Display omitted] Conclusions: This study showed that thalassemics with iron overload had significantly impaired TD measurements and MPI-septal index worsened when the mycardial iron load was increased (fig 1). Patients considered as iron unloaded according to T2*MRI result had left and right ventricular dysfunction determined by TD. Normal cardiac T2*MRI does not always associated with normal cardiac function. Therefore, we conclude that combining T2*MRI with TD measurements in evaluating cardiac status in β-TM, especially in patients with normal T2*MRI score, could lead to a better management of cardiac complications. DisclosuresNo relevant conflicts of interest to declare.

Disrupted right ventricular force–frequency relationships in adults operated for ventricular septal defect as toddlers: Abnormal peak force predicts peak oxygen uptake during exercise

Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricular septal defect (VSD), and in order to explore possible mechanisms, we performed non-invasive assessment of ventricular force–frequency relationships during exercise in adults operated for VSD in early childhood.We conducted a prospective study at a tertiary referral center. Patients (n=23) and healthy controls (n=20) underwent continuous Doppler-echocardiographic imaging during supine bicycle ergometry. The cycling workload was individually and manually incremented during the test session in response to heart rate. The heart was imaged in an apical 4-chamber view, and color-coded myocardial velocities were recorded. Post hoc, peak systolic velocity and isovolumetric acceleration (IVA) were blindly determined in the basal ventricular segments.VSD-operated patients differed markedly in all right ventricular endpoints compared with controls. IVA was lower prior to the test, 70±30cm/s2 vs. 150±60cm/s2 among controls, and during the entire test session ending at a heart rate of 160beats/min; 140±50cm/s2 vs. 300±30cm/s2, p<0.01 at both points. A similar pattern was revealed in terms of peak right ventricular systolic velocity. Left ventricular and septal measurements showed a similar, although less significant, tendency with a clearly lower left ventricular optimum heart rate among patients: 140beats/min vs. 154beats/min among controls. In the diseased cohort biventricular force–frequency relationships were directly correlated to peak oxygen uptake.VSD repair in early childhood is associated with disruption of the right ventricular force–frequency relationship, which may contribute to the previously observed reduction in functional capacity.

Evaluation of global function of the heart in scleroderma patients.

Scleroderma is a connective tissue disease characterized by diffuse vascular lesions and fibrosis of the skin and major organs including lungs, kidneys, and heart. When cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. The early detection of cardiac involvement in scleroderma would be desirable both for implementation of preventive measures in the early stages of the disease and for optimal treatment. Left (LV) and right (RV) ventricular function were examined in 31 scleroderma patients and 21 healthy controls. Conventional and tissue Doppler echocardiography was used to evaluate systolic and diastolic function. Systolic indices including systolic (S) velocity, isovolumetric acceleration (IVA), ejection time (ET), and isovolumetric contraction time (IVCT) were measured. Early diastolic (E) velocity, late diastolic (A) velocity, E/A and E'/A' ratios, isovolumetric relaxation time (IVRT), and deceleration time (DT) were the diastolic measurements obtained. Myocardial performance index (Tei index) calculated by 2 different methods was used to assess global ventricular function. In our study; mitral S velocity, biventricular ET, E', E/A, E'/A', RV IVA, LV IVA, and tricuspid S velocity were significantly lower in scleroderma patients. Mitral DT, IVCT, and biventricular IVRT, were significantly higher in scleroderma patients (P<0.0001). In addition, RV and LV Tei indices were significantly increased in scleroderma patients compared with the control group (P<0.0001 and P<0.001, respectively). In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.

Association between right ventricular dysfunction and restrictive lung disease in childhood cancer survivors as measured by quantitative echocardiography.

Restrictive lung disease is a complication in childhood cancer survivors who received lung-toxic chemotherapy and/or thoracic radiation. Left ventricular dysfunction is documented in these survivors, but less is known about right ventricular (RV) function. Quantitative echocardiography may help detect subclinical RV dysfunction. The aim of this study was to assess RV function quantitatively in childhood cancer survivors after lung-toxic therapy. We identified records of 33 childhood cancer survivors who (1) were treated with lung-toxic therapy and/or radiation, (2) were cancer-free for ≥ one year after therapy, and (3) had pulmonary function tests and echocardiograms from their most recent follow-up visit. Participants' mean age was 11.6 ± 4.5 years at cancer diagnosis and 23 ± 8.6 years at evaluation. The most common diagnosis was lymphoma/leukemia (n = 27). Twenty-nine subjects had anthracycline exposure. Eleven of the 33 subjects demonstrated restrictive pulmonary impairment (total lung capacity 3.69 ± 1.5 L [69.3 ± 22.4% predicted]). Among quantitative measures of RV function, isovolumetric acceleration (IVA), a measure of contractility, was significantly lower in the group with restrictive lung disease (2.42 ± 0.56 vs. 1.83 ± 0.78 m/sec(2); P < 0.05). There was a trend towards lower tissue Doppler derived S' and tricuspid annular plane systolic excursion in the group with restrictive lung disease. Subjects with restrictive lung disease were found to have ≥ 2 abnormal parameters (P < 0.01). IVA may detect early RV dysfunction in childhood cancer survivors with restrictive lung disease. Our findings require confirmation in a larger study population and validation by cardiac MRI.

Early Left Ventricular Function Abnormalities in Obstructive Sleep Apnea

Introduction: Our aim was to assess by Tissue Doppler Imaging (TDI) the early left ventricular (LV) myocardial function abnormalities in obstructive sleep apnea (OSA). Methods: Thirty four patients (11 females, 23 males, aged 25-51) with newly diagnosed, nontreated OSA and normal echocardiographic parameters of LV diastolic and systolic function were investigated. The patients with known cardiovascular or respiratory disease were excluded. The LV end-systolic longitudinal strain (LS), peaksystolic longitudinal strain rate (LSR) and isovolumetric acceleration (IVA) of the septal and lateral mitral annulus was evaluated by TDI. Twenty two healthy persons (9 women, 13 men, and aged 23-48) were assessed as controls. Results: All OSA patients demonstrated significant decrease of the LV end-systolic LS: -15.7 ± 0.42% vs controls: -18.9 ± 0.56% (p<0.01) and LV peak-systolic LSR: 1.72 ± 0.63 s-1 vs 3.19 ± 0.68 s-1, respectively (p<0.001). The IVA was also reduced: the septal mitral annulus: -2.82 ± 0.45 cm/sec in OSA vs -4.03 ± 0.6 cm/sec in healthy subjects (p<0.01) and the lateral mitral annulus: -3.37 ± 0.54 cm/sec in gr. I vs -4.29 ± 0.42 cm/sec in gr. II (p<0.01). Conclusions: Tissue Doppler Imaging might be a reliable method for detection of early abnormalities in LV function in patients with OSA. Reduction of longitudinal strain, strain rate and isovolumetric acceleration might be present in patients with OSA, even without overt diastolic or systolic LV dysfunction. Further studies with larger sample size are needed.

The Effect of Cilostazol on Right Heart Function and Pulmonary Pressure

Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. After cilostazol administration, there were significant increases in the TAPSE (1.9±0.3cm vs. 2.2±0.3cm, P<0.001). Peak longitudinal strain (-18.7±4.5% vs. -21.3 ±3.7%, P=0.001), isovolumetric acceleration (IVA) (176.6±62.7cm/sec(2) vs. 200.6±61.9cm/sec(2) , P=0.025), right ventricular FAC increased significantly (37.6±8.0% vs. 41.5±8.9%, P<0.001). Pulmonary artery pressure decreased significantly (39.9±7.9 vs. 36.6±5.5mmHg, P=0.001) after cilostazol administration. Our study demonstrated that cilostazol improved right ventricular systolic function and reduced pulmonary artery pressure.

GW24-e3081 Evaluation of right ventricular systolic function of patients with pulmonary hypertension by pulse wave tissue Doppler imaging

ObjectivesThe study purpose is to investigate the value of pulse wave tissue Doppler imaging (PW-TDI) in evaluating right ventricular systolic function of patients with pulmonary hypertension.Methods78 patients with pulmonary hypertension...

Regional Analysis of Longitudinal Systolic Function of the Right Ventricle After Corrective Surgery of Tetralogy of Fallot Using Myocardial Isovolumetric Acceleration Index

To assess regional longitudinal systolic function of the right ventricle in patients with repaired tetralogy of Fallot (TOF) by tissue Doppler imaging-derived isovolumetric acceleration (IVA) index and determine the effect of right-ventricular (RV) enlargement on regional systolic function. In 30 consecutive TOF patients and 30 age-matched controls, myocardial velocity of the RV ventricular free wall in the basal and middle regions were examined in the apical four-chamber view. Peak myocardial velocity during IVA was recorded on the free RV wall. IVA index was calculated as the difference between baseline and peak velocity divided by their time interval. In 23 of the studied TOF patients, magnetic resonance imaging was performed on the same day to determine global RV volume and ejection fraction. IVA index of the RV lateral free wall was significantly lower in the basal (8.31 ± 6.00 vs. 19.00 ± 10.85 m/s(2), p = 0.0001) and middle segments (6.56 ± 5.22 vs. 16.17 ± 7.44 m/s(2), p = 0.0001) in patients than in controls. Among TOF patients, a negative correlation was found between IVA index in the middle segment and RV end-diastolic volume/body surface area (r = -0.549, p < 0.01). Similar to other longitudinal RV wall parameters, the IVA index showed a decreased value in the RV free wall, which is related to the impaired regional and global longitudinal RV systolic dysfunction. RV enlargement adversely affects regional longitudinal systolic function.

The Relationship of Pulmonary Vascular Resistance and Pulmonary Arterial Compliance with Right Ventricular Function in Pulmonary Arterial Hypertension

Purpose Pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC) are important determinants of right ventricular (RV) afterload. We compared the relationship between PVR and PAC and indices of systolic and diastolic RV function in PAH. Methods and Materials We conducted a retrospective cohort study of adult patients with a diagnosis of PAH who underwent right heart catheterization and echocardiography within 24 hours between January 2000 and December 2010. RV function was assessed using indexed stroke volume, RV fractional area change (RVFAC), tricuspid annular systolic excursion, RV myocardial performance index, and RV myocardial isovolumetric acceleration and right atrial pressure. Regression analysis was performed to determine the association between PVR and PAC with several indices of systolic and diastolic function and Cox proportional hazard model was used to determine independent correlates of death or transplantation. Results A total of 85 patients with PAH were included. Average age was 45±11years and 75% were female. Mean pulmonary arterial pressure averaged 52±14 mmHg, indexed PVR was 13±7 WU and indexed PAC was 1.1±0.7 mL/ mmHg. A strong inverse relationship was observed between PAC and PVR (R2=0.84, p Conclusions In patients with PAH, resistance and compliance are inversely related and are moderately associated with indices of RV function. Indices of RV function and remodeling are more strongly associated with outcome than PAC or PVR.

Non-invasive assessment of myocardial contractility from force-frequency relationship in patients with implanted pacemakers: first results

In the normal heart, myocardial contractility is augmented at elevated heart rates. This effect is known as force-frequency relationship (FFR). The FFR is altered in failing hearts and may be used to detect myocardial function impairment. Force-frequency relationship measurements usually require invasive techniques and have therefore rarely been used in clinical practice. We studied the feasibility of FFR determination by implanted pacemakers as a non-invasive method in pacemaker patients. During follow-up visits in 30 patients with implanted pacemakers and normal heart function, the intracardiac impedance (IZ) was recorded by the pacemaker during incremental pacing at 80, 100, and 120 bpm. The time interval between the ventricular pacing pulse and IZmax (tIZm) and the maximum acceleration of the IZ change during myocardial contraction (IZacc: d2Z/dt2 max) were determined. Isovolumetric acceleration (IVA) was measured in parallel by tissue Doppler echocardiography at the right free wall, the left free wall, and the septum. With increasing pacing rates, the time interval tIZm shortened significantly and maximum acceleration IZacc increased significantly, consistent with the FFR. The best correlation was achieved between IZacc and IVA septal. Permanent pacemakers offering intracardiac IZ measurements can be used for monitoring FFR changes and, possibly, for low-effort first-line monitoring of myocardial disease.

Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study

BackgroundIsovolumetric acceleration (IVA) is a novel tissue Doppler parameter for the assessment of systolic function. The aim of this study was to evaluate IVA as an early parameter for the detection of right ventricular (RV) systolic dysfunction in patients with systemic sclerosis (SSc) without pulmonary hypertension.Methods22 patients and 22 gender- and age-matched healthy subjects underwent standard echocardiography with tissue Doppler imaging (TDI) and speckle tracking strain to assess RV function.ResultsTricuspid annular plane systolic excursion (TAPSE) (23.2 ± 4.1 mm vs. 26.5 ± 2.9 mm, p < 0.006), peak myocardial systolic velocity (Sm) (11.6 ± 2.3 cm/s vs. 13.9 ± 2.7 cm/s, p = 0.005), isovolumetric contraction velocity (IVV) (10.3 ± 3 cm/s vs. 14.8 ± 3 cm/s, p < 0.001) and IVA (2.3 ± 0.4 m/s2 vs. 4.1 ± 0.8 m/s2, p < 0.001) were significant lower in the patient group. IVA was the best parameter to predict early systolic dysfunction with an area under the curve of 0.988.ConclusionIVA is a useful tool with high-predictive power to detect early right ventricular systolic impairment in patients with SSc and without pulmonary hypertension.