Right Ventricular End-diastolic Diameter Research Articles

Prevalence and prognostic value of liver function abnormalities in patients with chronic systolic heart failure

To evaluate systemically the prevalence and prognostic values of liver function abnormalities in patients with chronic systolic heart failure (HF) have not been systematically evaluated. A total of 16 681 hospitalized patients with a diagnosis of chronic systolic HF and left ventricular ejection fraction (LVEF) < 50% were recruited from 12 hospitals in Hubei Province. All patients were followed up by telephone contacts. And they were divided into the death and survival groups according to the follow-up results. Over a median follow-up period of 3 years, 6453 (38.69%) patients died. The prevalence of liver function abnormality was 71.94% (12 001/16 681). The elevations of direct bilirubin, γ-glutamyl-transferase and alanine aminotransferase were the most common findings accounting for 33.37% (4863/14 574), 32.51% (4337/13 341) and 30.12% (5024/16 681) respectively. The abnormality of alkaline phosphatase was rare and its increase and decrease accounted for 3.82% (474/12 397) and 4.51% (559/12 397) respectively. The prevalence of low albumin and total bilirubin elevation was 23.24% (3408/14 664) and 19.37% (3231/16 681). And high direct bilirubin (HR 1.264, 95%CI 1.103 - 1.423; P = 0.02), high total bilirubin (HR 1.126, 95%CI 1.019 - 1.234; P = 0.02) and low albumin (HR 0.889, 95%CI 0.794 - 0.889; P < 0.01) were determined as the independent risk factors of total mortality. There were the correlations of LVEF with direct bilirubin (r = -0.235, P < 0.01), total bilirubin (r = -0.209, P < 0.01), albumin (r = 0.107, P < 0.01) and right ventricular end-diastolic diameter (RVDD) with direct bilirubin (r = 0.149, P < 0.01), total bilirubin (r = 0.154, P < 0.01) and albumin (r = -0.086, P < 0.01). The prevalence of liver function abnormalities is high in patients with chronic systolic HF. Low albumin, high direct bilirubin and high total bilirubin increase their total mortalities. Low LVEF and high RVDD are positively correlated with a high prevalence of liver function abnormalities.

The prognostic value of right ventricular end-diastolic diameter in patients with chronic systolic heart failure

AimsTo determinate whether right ventricular end-diastolic diameter (RVDD) was an independent and specific prognosis predictor of chronic systolic heart failure (CSHF).Methods and results16681 patients, diagnosed with CSHF, from 12 hospitals...

Quantitative evaluation of cardiopulmonary functional reserve in pulmonary embolism patients after treatment

BackgroundThere is no research focusing on assessing cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism (PE) both at home and abroad, but the benefits of early exercise...

The prevalence and prognostic value of liver function abnormalities in patients with chronic systolic heart failure

BackgroundThe prevalence and prognostic value of liver function abnormalities in patients with chronic systolic heart failure (HF) have not been systematically evaluated.Methods and results16 681 in-hospital patients from 12 hospital...

Different Patterns of Adaptation of the Right Ventricle to Pressure Overload: A Comparison between Pulmonary Hypertension and Pulmonary Stenosis

The study was designed to compare RV morphological and functional parameters derived from conventional and myocardial deformation echocardiography in two instances of right heart pressure overload: pulmonary arterial hypertension (PAH) and pulmonary stenosis (PS). Sixty-two individuals were included: 22 patients with pulmonary arterial hypertension (PAH), 19 patients with PS and 21 healthy individuals who served as a control group. All patients had clinical evaluation with 6-minute walking test, standard and two-dimensional strain echocardiography and B-type natriuretic peptide evaluation. At similar levels of pressure overload (RV systolic pressure, 88.2 ± 31.5 vs 73.4 ± 34.9 mm Hg; P= NS) the right ventricles of patients with PS were less dilated (RV end-diastolic diameter, 31.7 ± 3.7 vs 43.7 ± 10.5 mm; P < .001) and performed significantly better than those of patients with PAH (RV strain, -27.4 ± 5.8% vs 16.2 ± 7.9%; RV fractional area change, 51.1 ± 9.2% vs 29.1 ± 11.3%; P < .001). Although some of the RV functional parameters were comparable with those in healthy individuals, strain rate showed lower values, suggesting subclinical longitudinal dysfunction in patients with PS. Myocardial stress biomarkers were correlated with RV systolic pressure only in patients with PAH (r= 0.64, P= .03), not in those with PS (r=0.22, P= .50). At similar levels of pressure overload, the right ventricle is less dilated and performs better in patients with PS compared with those with PAH.

Range of right heart measurements in top-level athletes: The training impact

ObjectivesTo explore the full range of right heart dimensions and the impact of long-term intensive training in athletes. BackgroundAlthough echocardiography has been widely used to distinguish the athlete's heart from pathologic left ventricular (LV) hypertrophy, only few reports have described right ventricular (RV) and right atrial (RA) adaptations to extensive physical exercise. Methods650 top-level athletes [395 endurance- (ATE) and 255 strength-trained (ATS); 410 males (63.1%); mean age 28.4±10.1; 18–40years] and 230 healthy age- and sex-comparable controls underwent a transthoracic echocardiographic exam. Along with left heart parameters, right heart measurements included: RV end-diastolic diameters at the basal and mid-cavity level; RV base-to-apex length; RV proximal and distal outflow tract diameters; RA long and short diameters; and RA area. Tricuspid annular plane systolic excursion and RV tissue Doppler systolic peak velocity were assessed as indexes of RV systolic function. Pulmonary artery systolic pressure (PASP) was estimated from the peak tricuspid regurgitant velocity. ResultsATS showed increased sum of wall thickness and relative wall thickness, whereas left atrial volume, LV end-diastolic volume, LV stroke volume and PASP were significantly higher in ATE. RV and RA measurements were all significantly greater in ATE than in ATS and controls. ATE also showed improved early diastolic RV function, whereas RV systolic indexes were comparable among groups. On multivariate analysis, type and duration of training (p<0.01), PASP (p<0.01) and LV stroke volume (p<0.001) were the only independent predictors of the main RV and RA dimensions in athletes. ConclusionsThis study delineates the upper limits of RV and RA dimensions in highly-trained athletes. Right heart measurements were all significantly greater in elite endurance-trained athletes than in age- and sex-matched strength athletes and controls. This should be considered as a “physiologic phenomenon” when evaluating athletes for sports eligibility.

Efficacy and safety of high dose versus low dose streptokinase for treatment of submassive pulmonary embolism

Abstract Pulmonary embolism (PE) remains a major cause of morbidity and mortality in the general population, the established treatment for PE is anticoagulation. It has previously been demonstrated that thrombolytic therapy can be lifesaving in patients with massive PE (haemodynamic instability and right heart failure). However, the use of thrombolytic therapy in patients with submassive PE (haemodynamically stable) remains a controversial topic. Recent clinical studies, however, support evidence that thrombolysis may favorably affect the outcomes in a wider spectrum of high risk PE patients presenting with right ventricular dysfunction (RVD) as evidenced by decreased right ventricular end diastolic diameter (RVEDD), disappearance of paradoxical septal motion (PSM), and tricuspid regurge (TR) as well as decrease in the pulmonary artery pressure. The aim of this study was to evaluate the efficacy and safety of high dose streptokinase (SK) in 1 h versus low dose SK in 24 h in patients with submassive PE and RVD (high risk PE). The study included 60 patients (28 males and 32 females, mean age 45.5 ± 13.6 years) with submassive PE (positive spiral CT chest) and RVD (proved by echocardiography). Those without contraindications to SK were randomly assigned to receive either high dose (group I) or low dose (group II) of SK. Those with contraindication(s) to SK received anticoagulation (group III). Echocardiography was done before and 72 h after treatment. Right ventricular dysfunction (RVEDD, PSM, and TR) and mean pulmonary artery pressure (PAP) improved significantly 72 h after treatment in groups I and II, while a slight improvement in PAP was observed after treatment in group III. No significant difference was noticed between groups I and II regarding the effect of treatment on RVD or PAP. Statistically nonsignificant difference was found between groups I and II regarding the complications of SK, however a slightly higher risk of bleeding was observed in group I (high dose SK). No significant difference was found between the three groups regarding the mortality. These data suggest that SK can rapidly and safely reverse the pulmonary hypertension and RVD in contrast to anticoagulation. Both protocols of SK are equieffective in rapid reversal of RVD and pulmonary hypertension. Both protocols were safe as proved by absence of difference in mortality over anticoagulant group.

The Impact of Body Mass Index on Right Ventricular Systolic Functions in Normal and Mildly Obese Healthy Patients: A Velocity Vector Imaging Study

Increasing prevalence of obesity is a significant problem in Western countries. Obesity has many effects on cardiovascular structure, function, and hemodynamics. Our aim was to compare the impact of body mass index (BMI) on right ventricular (RV) functions among healthy subjects with conventional echocardiography, tissue Doppler imaging (TDI), and velocity vector imaging (VVI). Eighty-one healthy subjects divided into three group according to their BMI. All subjects were evaluated by conventional echocardiography, TDI, and VVI. A full polysomnogram were performed in subjects with BMI ≥ 30 km/m(2). RV end-diastolic and end-systolic diameters of patients in these three groups were similar (P > 0.05). There were no differences between each group in RV outflow tract fractional shortening (P = 0.52) and tricuspid annular plane systolic excursion (P = 0.94). No correlation observed between BMI and RV systolic parameters obtained with TDI. Longitudinal peak systolic strain and SRs were similar in all groups through each segment (P > 0.05). The results of our study show no changes in the RV functions in obese and overweight who were otherwise healthy subjects. We also revealed a significant correlation between BMI and left ventricular diameters and wall thickness but no relation with RV diameters or functions.

Significance of Electrocardiographic Right Bundle Branch Block in Trained Athletes

We sought to determine the clinical and physiologic significance of electrocardiographic complete right bundle branch block (CRBBB) and incomplete right bundle branch block (IRBBB) in trained athletes. The 12-lead electrocardiographic and echocardiographic data from 510 competitive athletes were analyzed. Compared to the 51 age-, sport type-, and gender-matched athletes with normal 12-lead electrocardiographic QRS complex duration, the 44 athletes with IRBBB (9%) and 13 with CRBBB (3%) had larger right ventricular (RV) dimensions, as measured by the basal RV end-diastolic diameter (CRBBB 43 ± 3 mm, IRBBB 38 ± 6 mm, normal QRS complex 35 ± 4 mm, p <0.001) and RV end-diastolic area (CRBBB 33 ± 5, IRBBB 27 ± 7, and normal QRS complex 23 ± 3 cm(2); p <0.001). Athletes with CRBBB also had a relative reduction in the RV systolic function at rest as assessed by the RV fractional area change and peak systolic tissue velocity. Finally, QRS prolongation was associated with parallel increases in interventricular dyssynchrony (basal RV to basal lateral left ventricular peak systolic tissue velocity time difference: CRBBB 112 ± 15, IRBBB 73 ± 33, normal QRS complex 43 ± 39 ms, p <0.001). Despite these findings, no athlete with CRBBB or IRBBB was found to have pathologic structural cardiac disease. In conclusion, among trained athletes, CRBBB and IRBBB appear to be markers of a structural and physiological cardiac remodeling triad characterized by RV dilation, a relative reduction in the RV systolic function at rest, and interventricular dyssynchrony.

Intérêt du tricuspid annular displacement (TAD) dans l’évaluation de la dysfonction ventriculaire droite au cours de l’embolie pulmonaire

Background Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue-tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement. Design Prospective and observational study. Methods All adults’ pts who were diagnosed with PE from December 2008 to December 2009 at Princess Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 36 consecutive pts with PE (18 male, mean age 62.7 years), which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge. Results TAD value were significantly lower in pts with abnormal RV function by echocardiogram (15.9 ± 0.3 vs. 12.7 ± 0.2 ; P = 0.026). Pts with a normal BNP (< 80 pg/ml) had an elevated TAD (16.4 ± 0.2 vs. 11.2 ± 0.3 mm ; P < 0.0001). At discharge, echocardiographic data were obtained from 33 pts (mean: 8.3 ± 3.5 days). RV end diastolic diameter, RV to LV diameter, pulmonary arterial systolic pressure, mean pulmonic valve acceleration time, RV FAC, Sa and TAD were significantly improved. There was no difference between TAD among pts with echocardiographic RVD at baseline vs. pts without RVD (14.9 ± 3.7 vs. 16.1 ± 2.9 mm ; P = 0.3). Four pts who deteriorated during short-term observation had substantially lower TAD values than those with uncomplicated courses (7.7 ± 0.4 mm vs. 14.6 ± 0.2 mm ; P = 0.001). In conclusion, impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.

Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation

Left-ventricular assist device (LVAD) implantation complicated by early right ventricle (RV) failure has a poor prognosis. This study details our center's experience with veno-arterial extracorporeal membrane oxygenation (ECMO) as perioperative RV support in patients with preoperative biventricular failure undergoing LVAD implantation. Ten patients, who underwent LVAD implantation, were retrospectively analyzed. Six patients were already supported with ECMO before LVAD implantation. In four patients, the ECMO was implanted before weaning from cardiopulmonary bypass. All patients showed reduced RV function with elevated right-ventricular end-diastolic diameter (RVEDD) (38 ± 4 mm) and RV systolic pressure (48 ± 14 mmHg). The mean pulmonary artery pressure (PAP) was 36 ± 9 mmHg. Nine patients showed dilatation of the tricuspid annulus (≥ 35 mm) with moderate tricuspid valve insufficiency and received tricuspid valve annuloplasty. After removal of the ECMO, none of the patients developed RV failure. ECMO was removed 4±1 days after LVAD implantation. Four patients expired while on LVAD support due to not-device-related sepsis (two patients), mesenteric ischemia (one patient), and gastrointestinal bleeding (one patient), respectively. Overall survival was 60%. ECMO provided a satisfactory perioperative right-heart support in patients with preoperative biventricular failure undergoing LVAD implantations, who otherwise were better candidates for biventricular assist device. ECMO allowed time for the already compromised right ventricle to get attuned to the increasing preload, and avoids distension and RV failure.

E0675 The clinical significance and the expression of N-terminal pro-brain natriuretic peptide in patients with chronic heart failure

ObjectiveTo detect the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with chronic heart failure, and to evaluate the difference of the levels in patients with chronic left and right...

Improvement in Right Ventricular Systolic Function after Cardiac Resynchronization Therapy Correlates with Left Ventricular Reverse Remodeling

Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function in heart failure (HF). However, the effects of CRT on right ventricular (RV) systolic function are not fully understood. We aimed to determine echocardiographic correlates of improvement in RV systolic function after CRT. Fifty-four patients (61.9 ± 10.5 years; 43 men; LV ejection fraction 24.6 ± 4.0%; QRS duration > 120 ms) with HF were enrolled. Standard echocardiography, strain rate (SR), and tissue Doppler imaging were performed in all patients before and 6 months after CRT. Pulsed-wave TDI-derived systolic indices of RV included systolic (RV(S) ) and isovolumic velocity (RV(IVV)) and isovolumic acceleration (RV(IVA)). Response to CRT was defined as decline in LV end-systolic volume (LVESV) ≥ 10%. When indices of RV systolic function were assessed between responders and nonresponders, in responders (38 patients, 70.4%) RV end-diastolic diameters (RVD1-3), mid-RV strain, and mid-RV SR improved significantly (P < 0.01, for all). RV(S) (10.77 ± 4.29 vs 12.62 ± 4.10 cm/sec, P = 0.005), RV(IVV) (14.71 ± 5.88 vs 18.52 ± 6.62 cm/sec, P < 0.001), and RV(IVA) (1.69 ± 0.70 vs 2.39 ± 0.77 m/sec(2) , P < 0.001) significantly increased among responders. There was no significant change in these parameters among nonresponders. Pearson's analyses revealed moderate positive correlations between reduction of LVESV and ΔRV(IVV) (r = 0.467, P = 0.001) and ΔRV(IVA) (r = 0.473, P = 0.001), respectively. RV diameters and systolic indices after CRT improved only in the responder group. Improvement in RV systolic performance after CRT is correlated with the reduction of LVESV.

Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis

To analyse right ventricular (RV) myocardial deformation in patients with left ventricular (LV) hypertrophy secondary to either hypertrophic cardiomyopathy (HCM) or athlete's competitive endurance training. Standard Doppler echo, exercise stress echo, and 2D speckle-tracking strain echocardiography (2DSE) of RV longitudinal deformation in RV septal and lateral walls were performed in 50 top-level endurance athletes and in 35 patients with HCM, all men, having evidence of LV hypertrophy. Right ventricular global longitudinal strain (GLS) was calculated by averaging local strains along the entire right ventricle. The two groups were comparable for age and blood pressure, whereas athletes showed lower heart rate and increased body surface area than HCM. Interventricular septal thickness was higher in HCM, whereas both LV and RV end-diastolic diameters (LVEDD and RVEDD) and LV stroke volume were increased in athletes. Right ventricular tricuspid annulus systolic excursion was comparable between the two groups. Conversely, RV GLS and regional peaks of RV myocardial strain were significantly impaired in patients with HCM (all P < 0.001). Multiple linear regression models detected an independent association between RV GLS and LVEDD (beta-coefficient = -0.68, P < 0.0001) in athletes, as well as an independent correlation of the same RV GLS with septal thickness (beta = 0.63, P < 0.0001) in HCM. An RV GLS cut-off value of -0.16% differentiated athletes and HCM with an 86% sensitivity and a 92% specificity. Furthermore, in the overall population, RV GLS (beta = 0.51, P < 0.0001) was a powerful independent predictor of maximal workload during exercise stress echo. Right ventricular myocardial systolic deformation is positively influenced by preload increase in athletes and negatively associated with increased septal thickness in HCM. Therefore, 2DSE may represent a useful tool in the differential diagnosis between athlete's heart and HCM, underlining the different involvement of RV myocardial function in either physiological or pathological LV hypertrophy.

Preoperative Right Ventricular Function in Patients with Organic Mitral Regurgitation

To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 +/- 10 years). Mean NYHA class was 2.6 +/- 0.4, LVEF was 55.3 +/- 12%, RV end-diastolic diameter was 28.7 +/- 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 +/- 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 +/- 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. Mean preoperative TAPSE and Sa were 19.4 +/- 4.3 mm and 10.3 +/- 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end-diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 +/- 2 cm/sec (P < 0.001), and TAPSE 8.7 +/- 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR.

Relation of Epicardial Fat Thickness to Right Ventricular Cavity Size in Obese Subjects

Epicardial fat is the visceral fat depot of the heart and is commonly increased in obese subjects. Obesity is also associated with right ventricular (RV) enlargement. Nevertheless, whether epicardial fat might be independently associated with RV morphology is unknown. I evaluated the correlation between echocardiographic epicardial fat and RV cavity size in subjects with a wide range of adiposity. Echocardiographic epicardial fat thickness and RV end-diastolic diameter (RVEDD) were assessed in 50 obese and 50 normal weight subjects. Patients with clinical conditions that could affect the RVEDD were excluded. Obese subjects had a significantly greater epicardial fat thickness and RVEDD than normal weight subjects (10 +/- 4 vs 5 +/- 2 mm and 22 +/- 10 vs 15 +/- 5, respectively; p <0.01 for both). The univariate relation between the epicardial fat thickness and RVEDD was very significant (r = 0.82, p <0.01) for overall obese and normal weight subjects. Multiple regression analysis showed that epicardial fat thickness was the best independent correlate of RVEDD (r(2) = 0.42, p <0.01) in overall subjects. In conclusion, increased RV epicardial fat accumulation is associated with enlarged RV cavity size.

The effect of adenoidectomy on right ventricular performance in children

Objective Several studies have shown a reduction in pulmonary artery pressure (PAP) after adenoidectomy in children suffering form upper airway obstruction caused by adenoid hypertrophy (AH). However, it is not clear whether this would be significantly reflected on right ventricle output (RVO). Methods Our aim was to determine if there were any detectable changes in RV performance parameters after adenoidectomy in children with AH. Thirty children with AH (female/male: 11/19) aged between 2.5 and 12 years (median: five years) were included in this study. Adenoidectomy was performed under sinuscopic guide using adenoid curette and microdebrider. All children were examined by echocardiography one day before and one month after adenoidectomy. Velocity time integral of tricuspid valve flow (VTItv) and pulmonary valve flow (VTIpa); E/ A ratio of tricuspid valve flow; RV end-diastolic diameter (RVEDd) and left ventricle fraction shortening (FS) were measured. Heart rate (HR) was also recorded. Results Preoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 18.6 ± 3.0 cm, 20.8 ± 3.1 cm, 1.21 ± 0.31, 11.5 ± 2.1 mm, 35.1 ± 4.3%, and 112 ± 19, respectively. Postoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 21.5 ± 2.5 cm, 24.4 ± 4.3 cm, 1.44 ± 0.32, 9.3 ± 2.6 mm, 33.9 ± 3.5%, and 104 ± 28, respectively. There were significant differences between preoperative and postoperative VTItv ( p = 0.03), VTIpa ( p = 0.01), E/ A ratios ( p = 0.04), and RVEDd ( p = 0.01). FS and HR were not significantly different. Conclusions This study illustrated that in children suffering from AH, relieving upper airway obstruction by adenoidectomy may result in improvement of RV filling and RVO, associated with the reduction in PAP.

Evaluation of right ventricular function in patients with chronic obstructive pulmonary disease by strain rate imaging

Objective To evaluate the right ventricular function in patients with chronic obstructive pulmonary disease (COPD) by strain rate imaging. Methods Echocardiography were performed in 41 patients with COPD and 20 controls. Right ventricular frontal thickness (RVFT), right atrial end diastolic diameter(RAEDd) , right ventricular end diastolic diameter (RVEDd), right ventricular end diastolic area (RVEDa) ,right ventricular end systolic area (RVESa) (fraction of right ventricular area change (RVFA) and E/A of tricuspid valve flow were measured in 4-chamber apical view. Tissue velocity imaging (TVI) were accepted in apical four chamber apical views. The indies included peak systolic strain rate (SRs) ,peak early diastolic strain rate (SRe) ,peak late diastolic strain rate (SRa) and SRe/SRa. Results According the pulmonary pressure, the patients with COPD were divided into 2 groups: group PAH (pulmonary artery hypertension) and group NPAH (non-pulmonary artery hypertension). Compared with controls, RVFT, RAEDd and RVEDd of group PAH increased significantly, RVFA and E/A decreased significantly, the upper indices of group NPAH had no significant difference, SRs, SRe and SRe/ SRa of right ventricular free wall and interventricular septal in group PAH and group NPAH decreased significantly, but there was no significant difference of SRa. Compared with group NPAH,SRs,SRe and SRe/SRa of right ventricular free wall and interventricular septal in group PAH decreased significantly,but there was no significant difference of SRa; there was significant positive correlation between SRs of right ventricular free wall and FEV1 /FVC, DLco/VA in patients with COPD,but there was no significant correlation between SRe of right ventricular free wall and RVFA, E/A,FEV1 /FVC and DLco/VA. Conclusions Function of right ventricle in patients with COPD can be damaged with or without pulmonary hypertention; SRI can detect right ventricular function in these patients easily and noninvasive. Key words: Echocardiography; Pulmonary disease, chronic obstructive; Ventricular function, right; Strain rate imaging

Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly

Background and Objectives: With the exception of bicuspid aortic valves, atrial septal defects (ASDs) are the most common congenital heart lesions found in adults. A mortality and morbidity benefit has clearly been demonstrated in the treatment of this lesion in younger patients. However, the benefits of ASD closure are less well defined in the elderly. We report our experience with transcatheter ASD closure and detail its impact on functional status and right ventricular remodeling as indicators of right heart failure in patients greater than 60 years of age. Subjects and Methods: Fifty-five patients (median age 70 years) underwent ASD closure at a single center during an eight-year period. Data were collected and analyzed retrospectively. Results: Transcatheter closure was successful in all patients. No major complications occurred during the periprocedural or follow-up periods. Complete defect closure was documented in 97% of patients during follow-up. All patients improved by at least one New York Heart Association (NYHA) functional class. Following ASD closure, no patient was in NYHA III or IV. The median right-ventricular end-diastolic diameter decreased from 39 mm to 26.6 mm (p<0.001). Conclusion: Atrial septal defect closure is safe and effective in elderly patients. Our data and prior published data consistently demonstrate that even patients greater than 60 years of age experience improvement in functional status and right ventricular remodeling. Therefore, patient age should not influence the decision of whether an ASD should be closed. (Korean Circ J 2009;39:47-51)

Tricuspid Incompetence and Geometry of the Right Ventricle as Predictors of Right Ventricular Function After Implantation of a Left Ventricular Assist Device

Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular (RV) dysfunction develops in 20% to 50% of patients after LVAD implantation, leading to prolonged ICU stay and elevated mortality. However, the prediction of RV failure remains difficult. The pre-operative echocardiographic parameters, tricuspid incompetence (TI), RV end-diastolic diameter (cut-off >35 mm), RV ejection fraction (cut-off <30%), right atrial dimension (cut-off >50 mm) and short/long axis ratio (cut-off >0.6), were analyzed retrospectively in 54 patients. Patients were divided into two groups. One group consisted of patients with RV failure (n = 9), as defined by the presence of two of the following criteria in the first 48 hours after surgery: mean arterial pressure < or =55 mm Hg; central venous pressure > or =16 mm Hg; mixed venous saturation < or =55%; cardiac index <liters/min/m(2); inotropic support score >20 units; or need for an RVAD. The other patients comprised the non-RV-failure group (n = 45). The RV failure group had a significantly higher short/long axis ratio of the RV (0.63 vs 0.52, p = 0.03; odds ratio 4.4, p = 0.011). For patients with a short/long axis ratio of the RV of <0.6, RV failure occurred in 7% of patients, as compared with 50% for patients with a ratio > or =0.6 (p = 0.013). Among patients with TI Grade III or IV, 75% developed RV failure as compared with 12% in patients with TI Grade I or II (p = 0.054). The odds ratio for RV failure after LVAD implantation for TI Grade III or IV was 4.7 (p = 0.012). Pre-operative evaluation of tricuspid incompetence and RV geometry may help to select patients who would benefit from biventricular support.