Right Ventricular Systolic Indices Research Articles

Angiographic Correlates of Acute ST Elevation Inferior Wall Myocardial Infarction with or Without Right Ventricular Involvement

Objectives: Right ventricular infarction (RVI) poses as an added risk factor in patients presenting with acute ST elevation inferior wall myocardial infarction (IWMI) with considerable high mortality. An early interventional therapeutic strategy after a prompt and accurate non-invasive investigative correlate is needed. Material and methods: We sampled 104 patients diagnosed with inferior wall infarction presenting with angina within 12 hours of angina. Investigations included routine blood investigation, 12 lead and right precordial lead electrocardiography, right ventricular (RV) systolic echocardiographic indices, and coronary angiography. Results: Majority of the patients had angiographic evidence of a dominant distal right coronary artery (RCA) culprit lesion. Those patients having ST elevation in RV4 lead had significantly higher incidences of RVI and high-grade atrio-ventricular (AV) blocks. Elderly diabetic patients with azotemia and deranged liver function predicted RVI among the study population. RV systolic indices like TAPSE was most accurate and S’ was found to be most specific in detecting RVI. Chi square test and multivariate regression analysis of echocardiographic parameters like RVDD, RVMPI, and S’ proved excellent surrogate non-invasive surrogate markers for specific angiographic culprit lesions. Conclusion: RV systolic echocardiographic indices shows a diagnostic accuracy of variable degrees in detecting right ventricular involvement in IWMI patients and also act as a surrogate marker in predicting the culprit lesion.

Assessment of Right Ventricular-Pulmonary Arterial Coupling in Chronic Pulmonary Regurgitation

BackgroundWe hypothesized that noninvasively measured right ventricular (RV) to pulmonary arterial (RV-PA) coupling would be abnormal in chronic pulmonary regurgitation (PR) even in the setting of normal RV ejection fraction, and that RV-PA coupling indices would have a better correlation with peak oxygen consumption (VO2) compared with RV systolic indices alone. MethodsThis was a retrospective study of 129 adults (repaired tetralogy of Fallot [TOF] n = 84 and valvular pulmonic stenosis [VPS] with previous intervention n = 45) with ≥ moderate native PR and RV ejection fraction > 50%. The 84 TOF patients were propensity matched with 84 patients with normal echocardiogram (control); age 28 ± 7 years and male sex n = 39 (46%). RV-PA coupling was measured according to fractional area change (FAC)/RV systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE)/RVSP. ResultsRV systolic function indices were similar between TOF and control groups (FAC 43 ± 6% vs 41 ± 5% [P = 0.164] and TAPSE 22 ± 5 mm vs 24 ± 6 mm [P = 0.263]). However, RV-PA coupling was lower in the TOF group (FAC/RVSP 1.10 ± 0.29 vs 1.48 ± 0.22 [P < 0.001]; TAPSE/RVSP 0.51 ± 0.15 vs 0.78 ± 0.11 [P < 0.001]) because of higher RV afterload (RVSP 42 ± 3 mm Hg vs 31 ± 3 mm Hg [P = 0.012]). FAC/RVSP (r = 0.61; P < 0.001) and TAPSE/RVSP (r = 0.69; P < 0.001) correlated with peak VO2 especially in the patients with impaired exercise capacity whereas FAC and TAPSE were independent of peak VO2. Similar comparisons between VPS and control groups showed no difference in TAPSE and FAC between groups, but lower FAC/RVSP and TAPSE/RVSP in the VPS group. ConclusionsThere is abnormal RV-PA coupling in chronic PR, and noninvasively measured RV-PA coupling might potentially be prognostic because of its correlation with exercise capacity.

Comparison of right ventricular measurements by perioperative transesophageal echocardiography as a predictor of hemodynamic instability following cardiac surgery

BackgroundThe relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery. MethodsThis study enrolled consecutive patients referred for cardiac surgeries. Exclusion criteria were non-sinus rhythm or contraindications to transesophageal echocardiography (TEE). TEE exam and simultaneous pulmonary hemodynamics were recorded in two stages: after induction of anesthesia and before sternotomy (stage 1), and after sternal closure (stage 2). RV measurements performed offline included fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), peak systolic tricuspid annular velocity (RVS′), myocardial performance index (RVMPI), and global longitudinal strain (RVGLS). The end point was defined as prolonged use (>24 h) of postoperative inotropic agent in the intensive care unit (ICU). ResultsThe study population included 68 patients (mean age 61 ± 11 y; 49 men). Twenty-two of these patients (32%) were administered inotropic agents for a prolonged period with a mean duration of 63.9 ± 5.3 h, accompanied with significantly longer ventilator use (p = 0.006) and longer ICU stay (p = 0.001) than patients without a prolonged inotropic agent use. Multivariable analysis demonstrated that only RVGLS in either stage 1 (odds ratio [OR] 1.11, p = 0.048) or stage 2 (OR 1.15, p = 0.018) was significantly associated with the outcome, especially a RVGLS > −13.5% in stage 2 demonstrating high risk of prolonged inotropic agent use after cardiac surgery (OR 7.37, p = 0.016). ConclusionRVGLSs performed using perioperative TEE are reliably associated with hemodynamic instability following cardiac surgery. This finding adds substantial information to postoperative critical care.

Echocardiography of the Pulmonary Circulation and Right Ventricular Function: Exploring the Physiologic Spectrum in 1,480 Normal Subjects

<h3>Background</h3> Although transthoracic echocardiography (TTE) is an excellent noninvasive screening test for pulmonary hypertension, the physiologic range of Doppler echocardiography-derived pulmonary pressures remains not completely investigated. The aim of the present study was, therefore, to explore the full spectrum of pulmonary pressures and right ventricular (RV) functional indexes by TTE in healthy subjects and to investigate clinical and echocardiographic correlates. <h3>Methods</h3> A random sample of 1,480 healthy individuals (mean age, 36.1 ± 15.5 years; range, 20-80 years; 905 men) underwent a comprehensive TTE. Pulmonary artery systolic pressure (PASP), mean pressure, and pulmonary vascular resistance were estimated by standard Doppler echocardiography formulas. In addition, RV diastolic (Doppler transtricuspid inflow measurements) and systolic indexes (RV fractional area change, RV tissue Doppler peak systolic velocity, tricuspid annular plane systolic excursion) were calculated. <h3>Results</h3> PASP and mean pulmonary artery pressure values were significantly higher in subjects aged > 50 years and in those with a BMI > 30 kg/m². In particular, a PASP > 40 mm Hg was found in 118 subjects (8%) of those aged > 50 years and in 103 (7%) of those with a BMI > 30 kg/m². No differences by age were registered in RV systolic indexes and in pulmonary vascular resistances. On multivariate analysis, in the overall study population, age, BMI, mitral E/e′ ratio, and left ventricular stroke volume were the only independent predictors of PASP. <h3>Conclusions</h3> This study delineates an estimate of pulmonary hemodynamics in a wide age range cohort of healthy subjects. Pulmonary pressures increased with age and BMI, as expected.

OP-274 Right Ventricular Dysfunction in Patients with End-Stage Renal Disease on Regular Hemodialysis

Although there are considerable data on the changes in left ventricular function in hemodialysis (HD) patients, only a few studies on right ventricular (RV) function can be found in the literature. We investigated the changes in RV function in HD patients. We examined 74 individuals grouped as follows: healthy controls (n = 24) and HD patients (n = 50). Echocardiography including tissue Doppler imaging (TDI) of the RV was performed in all patients. HD patients had significantly lower RV systolic indices than control participants in right ventricle fractional area change (37.54 ± 9.86 vs. 43.5± 4.8%,P<0.001), tricuspid plane systolic excursion (2.09 ± 0.49 vs. 2.61± 0.36 cm, P<0.001),Septal TDIS'(peak systolic velocity at septal tricuspid annulus) (7.99± 1.37 vs. 9.66± 1.86 cm/s,P<0.001), and Lateral TDIS' wave (peak systolic velocity at lateral tricuspid annulus) (11.86 ± 2.86 vs.16.04 ±3.60 cm/s, P<0.001). HD patients had statistically significantly higher systolic pulmonary pressure compared with those in the control group (32.75 ± 10.11 vs. 25.23± 3.99 mmHg, P<0.001). There were no statistically significant correlations between systolic pulmonary pressure and RV dimensions or RV function indices. Subclinical RV dysfunction – as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and Lateral TDIS' – is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.

Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis

Abstract Background Although there are considerable data on the changes in left ventricular function in hemodialysis (HD) patients, only a few studies on right ventricular (RV) function can be found in the literature. We investigated the changes in RV function in HD patients. Methods We examined 74 individuals grouped as follows: healthy controls (n = 24) and HD patients (n = 50). Echocardiography including tissue Doppler imaging (TDI) of the RV was performed in all patients. Results HD patients had significantly lower RV systolic indices than control participants in right ventricle fractional area change (normal 35–63%) (37.54 ± 9.86 vs. 43.5± 4.8%, P&lt;0.001), tricuspid plane systolic excursion (normal 1.6–3 cm) (2.09 ± 0.49 vs. 2.61± 0.36 cm, P&lt;0.001), STDIS′ wave (7.99± 1.37 vs. 9.66± 1.86 cm/s, P&lt;0.001), and LTDIS′ wave (peak systolic velocity at lateral tricuspid annulus; normal: 10–19 cm/s) (11.86 ± 2.86 vs.16.04 ±3.60, P&lt;0.001). HD patients had statistically significantly higher systolic pulmonary pressure (normal&lt;35mmHg at rest) compared with those in the control group (32.75 ± 10.11 vs. 25.23± 3.99, P&lt;0.001). There were no statistically significant correlations between systolic pulmonary pressure and RV dimensions or RV function indices. Conclusion Subclinical RV dysfunction – as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and LTDIS′ – is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.

Quantifying longitudinal right ventricular dysfunction in patients with old myocardial infarction by using speckle-tracking strain echocardiography

BackgroundWe investigated longitudinal right ventricular (RV) function assessed using speckle-tracking strain echocardiography in patient with myocardial infarction (MI), and identified the contributing factors for RV dysfunction.MethodsWe retrospectively studied 71 patients with old MI (the OMI group) and 45 normal subjects (the Control group) who underwent a transthoracic echocardiography. Global and free wall RV peak systolic strains (PSSs) in the longitudinal direction were measured by using speckle-tracking strain echocardiography. Left ventricular (LV) PSSs were measured in the longitudinal, radial and circumferential directions. Cardiac hemodynamics including peak systolic pulmonary artery pressure was also assessed non-invasively. Plasma brain natriuretic peptide (BNP) levels were measured in all patients.ResultsIn the OMI group, 73% of the patients had a normal estimated peak systolic pulmonary artery pressure of less than 35 mmHg. Global and free wall RV PSS were impaired in the OMI group compared with the Control group, and these RV systolic indices were significantly associated with heart rate, logarithmic transformed plasma BNP, greater than 1 year after onset of MI, Doppler-derived estimated pulmonary vascular resistance, LV systolic indices, LV mass index, infarcted segments within a territory of the left circumflex artery and residual total occlusion in the culprit right coronary artery. Multivariable linear regression analysis indicated that reduced longitudinal LV PSS in the 4-chamber view and BNP levels ≥500 pg/ml were independently associated with reduced global and free wall RV PSS. Moreover, when patients were divided into 3 groups according to plasma BNP levels (BNP <100 pg/ml; n = 31, 100 ≤BNP <500 pg/ml; n = 24, and BNP ≥500 pg/ml; n = 16), only patients with BNP ≥500 pg/ml had a strong correlation between RV PSS and longitudinal LV PSS in the 4-chamber view (r = 0.78 for global RV PSS and r = 0.71 for free wall RV PSS, p <0.05).ConclusionLongitudinal RV systolic strain depends significantly on longitudinal LV systolic strain especially in patients with high plasma BNP levels, but not on estimated peak systolic pulmonary artery pressure. These results indicate that process of RV myocardial dysfunction following MI may be governed by neurohormonal activation which causing ventricular remodeling rather than increased RV afterload.

Prognostic Value of Right Ventricular Two-Dimensional Global Strain in Patients Referred for Cardiac Surgery

Right ventricular (RV) function is a strong predictor of patient outcome after cardiac surgery. Limited studies have compared the predictive value of RV global longitudinal strain (RV-GLS) with tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC) in this setting. The study included 250 patients (66 ± 13 years old, LVEF = 52% ± 12%) referred for cardiac surgery (EuroSCORE-II = 4.8% ± 8.0%). RV function before surgery was assessed by RV-GLS by using speckle-tracking analysis (3-segment from the RV free wall), RVFAC and TAPSE was compared with postoperative outcome defined by 1-month mortality. Overall, 19 patients (7.6%) had RVFAC < 35%, 34 (13.6%) had TAPSE < 16 mm, and 99 (39.6%) had impaired RV-GLS > -21% (35% with normal RVFAC ≥ 35%). Postoperative death (n = 25) was higher in patients with abnormal RV-GLS > -21% (22% vs 3%; P < .0001), TAPSE < 16 mm (24% vs 8%; P = .007), and RVFAC < 35% (32% vs 9%; P = .001). Mortality was 3% in patients with preserved RV-GLS. In patients with preserved RVFAC ≥ 35% but abnormal RV-GLS, mortality was similar to that of those with RVFAC < 35% (20% vs 32%; P = .12). Among RV systolic indexes, only RV-GLS was associated with patient outcome by multivariate analysis adjusted to EuroSCORE-II and cardiopulmonary bypass duration. RV-GLS is a sensitive marker of RV dysfunction and correlates with postoperative mortality.

Right Ventricular Morphology and Function in Top-Level Athletes: A Three-Dimensional Echocardiographic Study

Our objective was to explore the right ventricular (RV) dimensions and function and the effect of long-term intensive training in a large population of top level athletes using real-time three-dimensional (3D)echocardiography. A total of 430 top-level athletes (220 endurance-trained athletes [ETAs] and 210 strength-trained athletes; 265 men [61.6%]; mean age 27.4 ± 10.1 years, range 18-40) and 250 healthy controls underwent a transthoracic echocardiographic examination. Three-dimensional RV measurements included serial short-axis reconstructions of the RV volumetric data sets, and the RV endocardial contour was traced with cross-reference to the long-axis images for identification of the tricuspid annulus. The end-diastolic and end-systolic RV volumes and ejection fraction were calculated off-line using the method of the summation of discs. The strength-trained athletes had a greater heart rate, body surface area, and systolic blood pressure at rest than the ETAs and controls. All RV diameters and 3D volumes and all transmitral and transtricuspid Doppler indexes were greater in the ETAs. Also, the left ventricular stroke volume, cardiac index, and pulmonary artery systolic pressure were greater in the ETAs, and all two-dimensional and 3D RV systolic indexes were comparable. On univariate analysis, the 3D RV end-diastolic volume was significantly associated with advanced age, male gender, duration of training, endurance training, increased left ventricular stroke volume, and pulmonary artery systolic pressure. On multivariate analysis, in the overall study population, the type andduration of training (P < .01), pulmonary artery systolic pressure (P < .01), and left ventricular stroke volume (P < .001) were the only independent predictors of RV end-diastolic volume. The results of the present study have delineated the upper limits of the RV dimensions in highly trained athletes as measured by real-time 3D echocardiography. The RV end-diastolic volume was significantly greater in the ETA than in the strength-trained athletes and controls.

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.

Right ventricular volume determinations in children. Normal values and observations with volume or pressure overload.

Right ventricular (RV) volumes were calculated from biplane cineangiocardiograms in 46 patients undergoing diagnostic cardiac catheterization. Validation of methodology was performed by comparison of known and calculated volumes of postmortem RV casts as well as by comparison of cineangiocardiographic RV and left ventricular (LV) stroke volumes of patients without shunts or valvular insufficiency. Seven infants, &lt;1 year of age, with normal right hearts as compared with older children showed smaller RV end-diastolic volumes (39 ± 8 vs 70 ± 13 ml/m 2 , P &lt; 0.001) as well as decreased RV systolic indices (SI) (3.71 ± 0.68 vs 4.66 ± 1.10 liters/min/m 2 , P &lt; 0.05). There were no differences between normal infants and older children for RV ejection fraction (EF), RVEDV/LVEDV = 1.01, RVSI/LVSI = 0.99, and RVEF/LVEF = 1.04 vs 0.99. In 13 patients with isolated pulmonary stenosis, RVEDV, RVEF, RVSI, RVEDV/LVEDV, and RVSI/LVSI were not different from normal, but RVEF/LVEF averaged 1.13 vs 0.99 in normal infants, P &lt; 0.05. In contrast, 11 patients studied with atrial septal defect or total anomalous pulmonary venous connection had significant increases in RVEDV (128 ml/m 2 ), RVSI (9.34 liters/min/m 2 ), RVEDV/LVEDV (2.36), RVSI/LVSI (2.81), and RVEF/LVEF (1.17), but normal values for RVEF. There was a significant linear relationship between Q p /Q s from oxygen data and RVSI/LVSI. In three patients studied an average of 1 year following atrial septal defect (ASD) repair, RVEDV remained elevated. In volume overload, alterations in RV volume characteristics are apparent and can be useful in shunt estimation; adaptation to an RV pressure overload, however, is not associated with detectable volume alterations.