Tricuspid Annular Motion Velocity Research Articles

A novel diagnostic score to differentiate between athlete"s heart and ARVC

Abstract Funding Acknowledgements Type of funding sources: None. Background The 2010 Task Force Criteria (TFC), although representing the current gold standard to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC), have not been tested to differentiate ARVC from the athlete’s heart. Furthermore, not all 6 diagnostic categories are easy to obtain. Purpose We hypothesized that atrial dimensions are useful to differentiate between both entities. Therefore, we developed a new diagnostic score based upon readily available clinical parameters including atrial dimensions on TTE to help distinguishing the athlete’s heart from ARVC in daily clinical practice. Methods In this observational study, 37 patients with definite ARVC (from the Zurich ARVC Program) were compared to 68 athletes. Base on ROC analysis, the following echocardiographic, laboratory and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions and depolarization abnormalities according to the TFC. Results ARVC patients had a higher RAVI/LAVI ratio (1.78 ± 1.6vs0.95 ± 0.3,p < 0.001), lower right-ventricular function (fac:28 ± 9.7vs42.1 ± 4.8%,p < 0.001; TAM:17.9 ± 5.6vs23.3 ± 3.7mm,p < 0.001) and higher serum NT-proBNP levels (491 ± 771vs44.8 ± 50.6ng/l,p < 0.001). Our novel score outperformed the performance of the 2010 TFC using those parameters, which are available in routine clinical practice (AUC95%,p < 0.001(95%CI.91-.99)vs.AUC90%,p < 0.001(95%CI.84-.97). A score value of 7/12 points yielded a specificity of 98% and a sensitivity of 61% for a diagnosis of ARVC. Conclusions ARVC patients present with significantly larger RA as compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete´s heart. Abstract Figure. Novel clinical score

The echocardiographic impact of the systemic hypertension on the right ventricular: A Tunisian Cohort

Only few echocardiographic data are available in literature concerning the impact of the systemic hypertension on the right ventricle (RV) comparing to the left ventricle's impact. To describe the echocardiographic parameters concerning the impact of the systemic hypertension on the RV. Prospective and comparative study including 100 patients from June 2016 to June 2017, subdivided into two groups: Group A (50 patients, systemic hypertension) and group B (50 healthy patient, a control group). We compared the echocardiography parameters of the RV identified in both groups. The RV diameter, the RV ejection fraction (RVEF) and the right ventricular fractional area change (RV-FAC) were preserved and comparable in both groups. RV wall thickness was more increased in group A. The tricuspid annular plane systolic excursion (TAPSE) were comparable in both groups. TEI index was significantly higher ( P < 0.01) and the peak of systolic tricuspid annular motion velocity was significantly lower ( P < 0.01) in group A, reflecting the subclinical and asymptomatic RV systolic dysfunction. The RV global longitudinal strain (GLS-RV) was significantly lower in patient with hypertension. Tissue-Doppler and 2Dstrain were more reliable then RVEF, RV-FAC and TAPSE to determine a latent RV systolic dysfunction. The peak of Ea wave was significantly lower in group A and the peak of Aa wave was significantly higher in this group. The Ea/Aa ratio was lower in patient with hypertension ( P = 0.001) suggesting a RV diastolic dysfunction. Our study confirms that the impact of the systemic hypertension includes the RV as is well known about the LV. Therefore, the functional and morphological analysis of the RV must be evaluated during the regular echocardiographic follow-up of patients with hypertension to allow an early identification of subclinical systolic and diastolic RV dysfunction in order to revise the current therapeutic strategy.

Accuracy of echocardiographic indices for serial monitoring of right ventricular systolic function in patients with precapillary pulmonary hypertension.

BackgroundSerial assessment of right ventricular ejection fraction (RVEF) predicts the clinical outcome of patients with pulmonary hypertension (PH). Cardiac magnetic resonance imaging (CMRI) enables RVEF monitoring, but its applicability is limited in clinical practice. This study aimed to examine the correlation between changes in CMRI-derived RVEF with those in echocardiographic indices in patients with precapillary PH.MethodsCMRI and echocardiographic indices of RV systolic function were evaluated at baseline and follow-up in 54 consecutive patients with precapillary PH (pulmonary arterial hypertension (PAH), n = 23; non-PAH, n = 31). During follow-up, medical treatment was optimized according to the guidelines for PH. Using CMRI-derived RVEF as the gold standard, we examined the accuracy of five echocardiographic indices by correlation analysis and receiver operating characteristic (ROC) analysis and by calculating sensitivity, specificity, and positive and negative predictive values.ResultsAfter an average period of 9.5 months, CMRI-derived RVEF improved from 30.2% ± 10.6% at baseline to 41.4% ± 11.3% at follow-up. These changes significantly correlated with those in the five echocardiographic indices, i.e., %RV fractional shortening (r = 0.27), %RV area change (r = 0.46), tricuspid annular plane systolic excursion (TAPSE) (r = 0.84), RV myocardial performance index (RVMPI) (r = −0.72), and systolic lateral tricuspid annular motion velocity (TVlat) (r = 0.66). Of these indices, %RV area change, TAPSE, and TVlat significantly correlated with those of CMRI-derived RVEF in both PAH and non-PAH subgroups. ROC analysis showed that improvement in echocardiographic indices predicted a pre-specified improvement in CMRI-derived RVEF (>2.9%), with TAPSE and TVlat showing better accuracy over the other three indices.ConclusionsEchocardiographic indices modestly correlate with the changes in CMRI-derived RVEF in precapillary PH patients. Comparison among the five echocardiographic indices revealed that TAPSE and TVlat provide better accuracy than %RV fractional shortening, %RV area change, and RVMPI.

Echocardiographic assessment of right ventricular function in routine practice: Which parameters are useful to predict one-year outcome in advanced heart failure patients with dilated cardiomyopathy?

BackgroundRight ventricular (RV) function has recently gained attention as a prognostic predictor of outcome even in patients who have left-sided heart failure. Since several conventional echocardiographic parameters of RV systolic function have been proposed, our aim was to determine if any of these parameters (tricuspid annular plane systolic excursion: TAPSE, tissue Doppler derived systolic tricuspid annular motion velocity: S′, fractional area change: FAC) are associated with outcome in advanced heart failure patients with dilated cardiomyopathy (DCM). MethodsWe retrospectively enrolled 68 DCM patients, who were New York Heart Association (NYHA) Class III or IV and had a left ventricular (LV) ejection fraction <35%. All patients were undergoing evaluation for heart transplantation or management of heart failure. Primary outcomes were defined as LV assist device implantation or cardiac death within one year. ResultsThirty-nine events occurred (5 deaths, 32 LV assist devices implanted). Univariate analysis showed that age, systolic blood pressure, heart rate, NYHA functional class IV, plasma brain natriuretic peptide concentration, intravenous inotrope use, left atrial volume index, and FAC were associated with outcome, whereas TAPSE and S′ were not. Receiver-operating characteristic curve analysis showed that the optimal FAC cut-off value to identify patients with an event was <26.7% (area under the curve=0.74). The event-free rate determined by Kaplan–Meier analysis was significantly higher in patients with FAC≥26.7% than in those with FAC<26.7% (log-lank, p=0.0003). Moreover, the addition of FAC<26.7% improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes. ConclusionsFAC may provide better prognostic information than TAPSE or S′ in advanced heart failure patients with DCM.

Temporal Sequential Pattern of Right Ventricular Free Wall Contraction in Normal Children.

The temporal sequence of right ventricular (RV) deformation is related to RV dysfunction. The sequence of RV free wall contraction was investigated.Methods and Results:In this prospective study, strain profiles using speckle-tracking echocardiography and tissue Doppler-derived pulmonary and tricuspid annular motion were assessed in 60 normal children. Circumferential RV free wall strain of 3 individual segments (anterior, lateral, and inferior) was evaluated. Longitudinal strain was assessed in 3 individual segments (RV outflow tract [RVOT], apical, and RV inflow tract [RVIT]). The isovolumetric contraction time (ICT) and the time interval between the onset of the QRS wave to the peak s' wave were measured for pulmonary and tricuspid annular motion velocities. The time to peak circumferential strain was significantly lower in the anterior than in the lateral and inferior segments (339.1±19.5, 358.3±21.8, and 366.6±22.4 ms, respectively; P<0.0001). Longitudinal deformation of the RVOT segment occurred before the apical and RVIT segments (351.8±23.1, 366.3±20.1, and 369.2±21.3 ms, respectively; P<0.0001). The ICT and the time to peak s' were significantly shorter in pulmonary than in tricuspid annular motion (49.4±10.1 vs 58.0±13.2 ms; and 104.7±12.2 vs. 160.5±27.1 ms; P<0.0001 for each). Longitudinal deformation of RVOT precedes RVIT. Circumferential deformation occurs in the anterior segment before the lateral and posterior segments. The presence of mechanical time heterogeneity appears important for RV performance.

Abstract 12350: Pressure-flow Relationship of Pulmonary Circulation Determines Six-minute Walk Distance in Connective Tissue Disease

Introduction: The 6-minute walk distance (6MWD) as a surrogate of exercise capacity is often shown to be the best predictor of mortality in pulmonary hypertension (PH). Recent studies have described that mean pulmonary artery pressure (mPAP) - cardiac output (CO) relationships have a potential to assess the detail of pulmonary circulation. Hypothesis: We hypothesized that pressure-flow relationships of the pulmonary circulation (mPAP/CO) would be associated with 6MWD in connective tissue disease (CTD). Methods: We prospectively performed 6-minute walk test and echocardiographic studies in 202 CTD patients (56±14 years; 11% male) with measurements of cardiac output using electric cardiometry. We have calculated the pulmonary artery pressure-cardiac output relationships as mPAP divided by CO (mPAP/CO). Results: Firstly, we have checked the accuracy of CO by electric cardiometry. In our cohort with invasive data, there is a good correlation between right heart catheter and electric cardiometry values of cardiac output (r=0.85; p &lt;0.001) with electric cardiometry measurements slightly underestimating cardiac output (bias -14% of the mean). Correlates of 6MWD were age (partial R= -0.19, p=0.009), early-diastolic mitral annular motion velocity (e’, partial R= 0.20, p=0.005), E/e’ (partial r= -0.16, p=0.028) and CO (partial r= 0.21, p=0.019) in the univariate analysis. In multivariate analysis, the mPAP/CO was strongly associated with 6MWD (t= -2.06, p= 0.042). Male gender and early-diastolic tricuspid annular motion velocity were also associated with 6MWD (t= 2.09, p=0.038 and t =2.92, p =0.004, respectively). Conclusions: Elevated mPAP/CO was associated with reduced 6MWD independent from LV and RV diastolic function. These results may recommend that we would assess not only the pressure but also the pressure-flow relationships of the pulmonary circulation in high risk group of PH.

Tricuspid annular motion velocity as a differentiation index of hypertrophic cardiomyopathy from hypertensive heart disease

BackgroundHypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) are the most frequently encountered entities presenting left ventricular hypertrophy in routine echocardiographic examination, and their differentiation is sometimes difficult. Abnormalities in right ventricular (RV) myocardium have been reported frequently in patients with HCM more than in those with HHD. We therefore hypothesized that tricuspid annular motion (TAM) velocity determined by pulsed tissue Doppler echocardiography can be used to detect RV dysfunction in HCM and discriminate these etiologies. MethodsTAM velocities were compared among clinically stable patients with 60 HCM and 60 HHD patients as well as 60 age-matched healthy controls. Peak systolic, early diastolic (TAM-e′), and atrial systolic velocities were measured. RV myocardial performance index was measured by tissue Doppler method. To more accurately differentiate HCM from HHD, electrocardiographic findings and brain natriuretic peptide levels, which can both be examined simply and noninvasively, were investigated in addition to echocardiography. ResultsRV wall thickness of the HCM group was greater than the HHD group (p=0.092), while there was no significant difference in RV myocardial performance index between the HCM and HHD groups (p=0.606). TAM-e′ was significantly lower in the HCM group than in HHD and control groups (p=0.001). To differentiate HCM from HHD, TAM-e′ was a powerful predictor as per multivariate logistic regression analysis (hazard ratio, 0.665; p<0.001) of parameters other than those of left ventricular parameters, and the area under the receiver operating characteristic curve (AUC) was 0.686 and the best cut-off value was ≤8.0cm/s (62% sensitivity, 65% specificity). Multivariate logistic analysis revealed that electrocardiographic ST–T changes were the next most effective marker for differentiating HCM after TAM-e′. When TAM-e′ and ST–T changes were combined, the AUC increased to 0.748. ConclusionsTAM-e′ is a potentially useful index to differentiate HCM from HHD.

Age- and gender-specific changes of tricuspid annular motion velocities in normal hearts

BackgroundMitral annular motion (MAM) and tricuspid annular motion (TAM) velocities obtained by pulsed tissue Doppler echocardiography have been used to evaluate left ventricular (LV) and right ventricular (RV) functions. Although TAM velocity has been clinically applied for evaluating various cardiac diseases, the effects of age and gender remain unclear. Therefore, we aimed to determine the effects of age and gender on TAM velocity in normal hearts. MethodsWe randomly selected 265 subjects (mean age, 59 years; range, 20–89 years) without abnormal clinical, electrocardiographic, and echocardiographic findings from a pool of subjects who had undergone transthoracic echocardiography. They were classified into four age groups: 20–39, 40–59, 60–79, and >80 years. Pulsed wave Doppler was applied to obtain MAM velocity of the lateral side and TAM velocity of the RV free wall side. The peak systolic (s′), early diastolic (e′), and atrial systolic (a′) velocities of MAM and TAM were measured in all subjects. ResultsWhile MAM-s′ (r=−0.267, p<0.001) correlated with age, TAM-s′ did not (p=0.755). TAM-s′ in any age groups had no significant gender differences. TAM-e′ (r=−0.447, p<0.001) and MAM-e′ (r=−0.724, p<0.001) correlated with age, respectively. In those aged 40–59 years, both TAM-e′ (p=0.002) and MAM-e′ (p=0.048) in females were significantly higher than those in males. The gender differences diminished in the ≥60 years age groups. ConclusionsThere was no age-associated decline in TAM-s′, while TAM-e′ varied with age and gender as did MAM-e′. Although the same criteria for the TAM-s′ can be used for identifying abnormal RV systolic function regardless of age and gender, age and gender differences must be considered when one utilizes the TAM-e′ for the diagnosis or management of cardiovascular disease.

Validation Study on the Accuracy of Echocardiographic Measurements of Right Ventricular Systolic Function in Pulmonary Hypertension

The accuracy of echocardiographic parameters of right ventricular (RV) function has not been sufficiently validated in patients with pulmonary hypertension (PH). The aim of this study was to evaluate whether echocardiographic measurements reliably reflect RV systolic function in PH using cardiac magnetic resonance imaging (CMRI)-derived RV ejection fraction (RVEF) as a gold standard. A total of 37 consecutive patients with PH, 20 with pulmonary arterial hypertension, 12 with chronic thromboembolic PH, and five others, were prospectively studied. All patients underwent echocardiography, CMRI, and right-heart catheterization within a 1-week interval. Associations between five echocardiography-derived parameters of RV systolic function and CMRI-derived RVEF were evaluated. All five echocardiography-derived parameters were significantly correlated with CMRI-derived RVEF (percentage RV fractional shortening: r = 0.48, P = .0011; percentage RV area change: r = 0.40, P = .0083; tricuspid annular plane systolic excursion [TAPSE]: r = 0.86, P < .0001; RV myocardial performance index: r = -0.59, P < .0001; and systolic lateral tricuspid annular motion velocity: r = 0.63, P < .0001). Compared with the other indices, TAPSE exhibited the highest correlation coefficient. Of the five echocardiographic measurements, only TAPSE significantly predicted CMRI-derived RVEF in multiple regression analysis (P < .0001). Intraobserver and interobserver reproducibility was favorable for all five indices and was particularly high for TAPSE and systolic lateral tricuspid annular motion velocity. Echocardiographic measurements are promising noninvasive indices of RV systolic function in patients with PH. In particular, TAPSE is superior to other indices in accuracy.

Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure

Normal values and the prognostic significance of right ventricle (RV)-2D strain in chronic heart failure (CHF) patients are unknown. Between 2005 and 2010, we prospectively enrolled 43 controls and 118 stable CHF patients. Standard echocardiographic variables, tricuspid annular plane systolic excursion, peak systolic velocity of tricuspid annular motion using tissue Doppler imaging, and RV and left ventricle (LV) 2D-strain were measured. The primary outcome was death or emergency transplantation or emergency ventricular assist device implantation or acute heart failure. RV-2D strain was measurable in 39 controls (58±17 years, 50% men), whose median value was 30% (95% confidence interval [95%CI], 39%; 20%); and in 104 CHF patients (80% men, mean age 57±11 years, and mean LV ejection fraction 29%±8%), whose median value was 19% (95%CI, 34%; 9%). During the mean follow-up of 37±14 months, 44 experienced the primary outcome. By Cox proportional hazards multivariate analysis, only RV-2D strain and log B-type natriuretic peptide independently predicted experiencing the primary outcome within the first year. The best RV-2D strain cut-off by receiver-operating characteristics analysis was 21%, and patients with values >21% were at greatest risk (χ(2)-log-rank test=14.1, P<0.0001). RV-2D strain is a strong independent predictor of severe adverse events in patients with CHF and may be superior to other systolic RV or LV echocardiographic variables.

The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction

Few data are available on the exercise-induced abnormalities of myocardial function in patients with exertional dyspnoea and normal left ventricular ejection fraction (LV EF). The main aims of this study were to determine the prevalence of isolated exercise-induced heart failure with normal ejection fraction (HFNEF) and to assess whether disturbances in LV or right ventricular longitudinal systolic function are associated with the diagnosis of HFNEF. Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF. A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.

139 Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles

Aims Conventional echocardiographic parameters of LV and RV systolic and diastolic function have been shown to be load-dependent. The impact of preload reduction on tissue Doppler parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis on conventional and TDI indices of systolic and diastolic function of the LV and RV. Methods and results 17 uremic patients (age 31+10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Haemodialysis led to reduction in LV end-diastolic volume (P,0.0001), end-systolic volume (P, 0.001), peak early (E wave) transmitral flow velocity (P 1/4 0.0001), and the ratio of early to late Doppler velocities of diastolic mitral inflow (P 1/4 0.021).For the LV, early diastolic (E0) TDI velocities and the ratio of early to late TDI diastolic velocities (E0/A0) only on the septal side of the mitral annulus decreased significantly after HD (P 1/4 0.0001and P 1/4 0.009, respectively). In a subgroup of 7 patients who sustained significantly larger fluid volume loses following HD, E0 and the ratio of E0/A0 at the lateral side of mitral annulus also decreased suggesting a greater resistance of the lateral annulus to preload changes. Systolic velocities decreased after HD on both sides of mitral annulus (septal P 1/4 0.006; lateral, P 1/4 0.011). For the RV, systolic tricuspid annular velocities decreased (P 1/4 0.002) together with early diastolic velocities after HD (P 1/4 0.0001). Both systolic and early diastolic tricuspid annular velocities correlated directly with fluid removal (P,0.01). Conclusion This study shows that both systolic and diastolic TDI velocities of the LV and RV are preload dependent.The lateral mitral annulus is more resistant to preload changes than either the septal mitral annulus or the lateral tricuspid annulus.

Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle*

To determine whether peak systolic velocity of tricuspid annular motion assessed by tissue Doppler echocardiography (Sta), a right ventricular function parameter, can discriminate patients with true- and false-positive pulse pressure variation. Pulse pressure variation is used to predict fluid responsiveness in mechanically ventilated patients. However, this parameter has been reported to be falsely positive, especially in patients with right ventricular dysfunction. A prospective study. Medical and surgical intensive care unit of a university hospital. Thirty- five mechanically ventilated patients hospitalized for >24 hrs with a pulse pressure variation of >12%. Doppler echocardiography (including measurement of Sta and stroke volume) was performed before and after infusion of 500 mL of colloid solution. Patients were classified into two groups according to their response to fluid infusion: responders (at least 15% increase in stroke volume) and nonresponders. Twenty-three patients (66%) were responders (true-positive group) and 12 (34%) were nonresponders (false-positive group). Before volume expansion, Sta was statistically lower in the nonresponder group (0.13 [0.04] vs. 0.20 [0.05], p = .0004). The area under the curve of the receiver operating characteristic curve was 0.87 (95% confidence interval, 0.74-1). In patients with pulse pressure variation of >12%, a Sta cutoff value of 0.15 m/s discriminated between responders and nonresponders with a sensitivity of 91% (80-100) and a specificity of 83% (62-100). A Sta value of <0.15 m/s seems to be an accurate parameter to detect false-positive pulse pressure variation. Echocardiography should therefore be performed before fluid infusion in patients with pulse pressure variation of >12%.

Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles

Conventional echocardiographic (ECHO) parameters of left ventricular (LV) and right ventricular (RV) systolic and diastolic function have been shown to be load-dependent; however, the impact of preload reduction on tissue Doppler (TD) parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis (HD) on conventional (ECHO) and TD imaging (TDI) indices of systolic and diastolic function of the left and right ventricles. Seventeen chronically uremic patients (age 31 +/- 10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Fluid volume removed by HD was 2706 +/- 1047 cm(3). Haemodialysis led to reduction in LV end-diastolic volume (P < 0.0001), end-systolic volume (P < 0.001), peak early (E wave) transmitral flow velocity (P = 0.0001), and the ratio of early to late Doppler velocities of diastolic mitral inflow (P = 0.021). For the LV, early diastolic (E0) TDI velocities and the ratio of early to late TDI diastolic velocities (E0/A0) only on the septal side of the mitral annulus decreased significantly after HD (P = 0.0001 and P = 0.009, respectively). In a subgroup of seven patients who sustained significantly larger fluid volume loses following HD, E0 and the ratio of E0/A0 at the lateral side of mitral annulus also decreased suggesting a greater resistance of the lateral annulus to preload changes. Systolic velocities decreased after HD on both sides of mitral annulus (septal 6.90 +/- 1.10 vs. 5.97 +/- 1.48 cm/s, P = 0.006; lateral 8.68 +/- 2.67 vs. 6.94 +/- 1.52 cm/s, P = 0.011). For the RV, systolic tricuspid annular velocities decreased (13.45 +/- 1.47 vs.11.73 +/- 1.90 cm/s, P = 0.002) together with early diastolic velocities after HD (13.95 +/- 2.90 vs.10.62 +/- 2.45 cm/s, P = 0.0001). Both systolic and early diastolic tricuspid annular velocities correlated directly with fluid removal (P < 0.01). This study shows that both systolic and diastolic TDI velocities of the LV and RV are preload-dependent. However, the lateral mitral annulus is more resistant to preload changes than either the septal mitral annulus or the lateral tricuspid annulus.

The Effects of Age and Heart Rate on Tricuspid Annular Motion Velocities in Healthy Nonsedated Cats

Background: Age and heart rate have effects on myocardial velocities as assessed by color tissue Doppler imaging (TDI) in people. A similar phenomenon has been identified when left ventricular velocities are assessed in cats. To date, the effects of age and heart rate on tricuspid annular velocities of cats have not been assessed. Objectives: This study was designed to determine the relationships between age and heart rate and tricuspid annular velocities in cats as assessed by 2‐dimensional (2D) color TDI. Animals: Fifty healthy nonsedated cats with age range from 3 months to 19 years old were studied. Methods: Tricuspid annular velocities were obtained with 2D color TDI. Effects of age and heart rate on tricuspid annular velocities were evaluated by simple linear regression. The strength of the linear relationship was determined by using coefficient of determination (R2). Results: A significant weak negative relationship was found between age and peak early diastolic annular velocity (E'; R2= 0.135, P= .018). No significant relationships between age and right ventricular (RV) systolic TDI values were found. Diastolic and systolic TDI parameters were not affected by heart rate with the exception of deceleration rate of early diastolic motion (DR; R2= 0.100, P= .025). Conclusions and Clinical Importance: Age and heart rate have minimal effects on tricuspid annular velocities. The present study provides reference ranges for tricuspid annular velocities in healthy cats and information for assessing the clinical utility of color TDI for evaluation of RV function in cats.

The Effects of Age and Heart Rate on Tricuspid Annular Motion Velocities in Healthy Nonsedated Cats

Age and heart rate have effects on myocardial velocities as assessed by color tissue Doppler imaging (TDI) in people. A similar phenomenon has been identified when left ventricular velocities are assessed in cats. To date, the effects of age and heart rate on tricuspid annular velocities of cats have not been assessed. This study was designed to determine the relationships between age and heart rate and tricuspid annular velocities in cats as assessed by 2-dimensional (2D) color TDI. Fifty healthy nonsedated cats with age range from 3 months to 19 years old were studied. Tricuspid annular velocities were obtained with 2D color TDI. Effects of age and heart rate on tricuspid annular velocities were evaluated by simple linear regression. The strength of the linear relationship was determined by using coefficient of determination (R2). A significant weak negative relationship was found between age and peak early diastolic annular velocity (E'; R2 = 0.135, P = .018). No significant relationships between age and right ventricular (RV) systolic TDI values were found. Diastolic and systolic TDI parameters were not affected by heart rate with the exception of deceleration rate of early diastolic motion (DR; R2 = 0.100, P = .025). Age and heart rate have minimal effects on tricuspid annular velocities. The present study provides reference ranges for tricuspid annular velocities in healthy cats and information for assessing the clinical utility of color TDI for evaluation of RV function in cats.

Systolic right ventricular function assessment by pulsed wave tissue Doppler imaging of the tricuspid annulus.

Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. So far, tricuspid annular motion velocity in systole as obtained by pulsed wave tissue Doppler imaging (TDI) has rarely been investigated for RV function assessment in a sizeable adult patient population. 258 individuals were included in the study. Among them, there were 107 individuals without cardiovascular disease, 71 patients with predominant RV dysfunction, 40 patients with pulmonary artery hypertension, and 40 patients with predominant left ventricular dysfunction. The reference methods for RV systolic function assessment were biplane two-dimensional echocardiography and magnetic resonance imaging (MRI; n = 31) for the calculation of RV ejection fraction (EF). Lateral tricuspid valve annular motion velocities in systole (TVlat, cm/s) were recorded using pulsed wave TDI from the apical 4-chamber view (long axis function). RV EF as determined by biplane echocardiography correlated significantly with respective values as assessed by MRI: RVEFecho = RV EFMRI + 1.6; r2 = 0.569, p <0.0001. Using the best TVlat threshold of 12 cm/s, distinction between the group with RV dysfunction and the other groups was possible with 86% sensitivity and 83% specificity. There was a direct and significant correlation between TVlat and RV ejection fraction (p <0.0001). Using TVlat thresholds of 12 and 9 cm/s, distinction between normal RV EF (>55%), moderately reduced (30-55%) and severely reduced RV EF (<30%) was possible with 84% sensitivity and 81% specificity, respectively with 83% sensitivity and 67% specificity. Systolic long axis velocity measurement of the lateral tricuspid annulus is useful and accurate to assess RV systolic function in a broad patient population. Thresholds of 12 and 9 cm/s allow differentiation between normal, moderately reduced and severely reduced RV ejection fraction.

Systolic right ventricular function assessment by pulsed wave tissue Doppler imaging of the tricuspid annulus.

Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. So far, tricuspid annular motion velocity in systole as obtained by pulsed wave tissue Doppler imaging (TDI) has rarely been investigated for RV function assessment in a sizeable adult patient population. 258 individuals were included in the study. Among them, there were 107 individuals without cardiovascular disease, 71 patients with predominant RV dysfunction, 40 patients with pulmonary artery hypertension, and 40 patients with predominant left ventricular dysfunction. The reference methods for RV systolic function assessment were biplane two-dimensional echocardiography and magnetic resonance imaging (MRI; n = 31) for the calculation of RV ejection fraction (EF). Lateral tricuspid valve annular motion velocities in systole (TVlat, cm/s) were recorded using pulsed wave TDI from the apical 4-chamber view (long axis function). RV EF as determined by biplane echocardiography correlated significantly with respective values as assessed by MRI: RVEFecho = RV EFMRI + 1.6; r2 = 0.569, p <0.0001. Using the best TVlat threshold of 12 cm/s, distinction between the group with RV dysfunction and the other groups was possible with 86% sensitivity and 83% specificity. There was a direct and significant correlation between TVlat and RV ejection fraction (p <0.0001). Using TVlat thresholds of 12 and 9 cm/s, distinction between normal RV EF (>55%), moderately reduced (30-55%) and severely reduced RV EF (<30%) was possible with 84% sensitivity and 81% specificity, respectively with 83% sensitivity and 67% specificity. Systolic long axis velocity measurement of the lateral tricuspid annulus is useful and accurate to assess RV systolic function in a broad patient population. Thresholds of 12 and 9 cm/s allow differentiation between normal, moderately reduced and severely reduced RV ejection fraction.

Right ventricular dysfunction in chronic heart failure patients

To evaluate any differences in haemodynamic and echocardiographic parameters in patients with both left (LV) and right ventricular (RV) systolic dysfunction and in patients with isolated LV systolic dysfunction. One hundred patients with RV systolic dysfunction defined as peak velocity of tricuspid annular motion in systole (Sa)<11.5 cm/s, and 55 patients without RV systolic dysfunction Sa>11.5 cm/s. All patients had LV systolic dysfunction, LV ejection fraction (EF) below 40%, NYHA II-IV. LV diameters, volumes and EF were measured by echocardiography. Patients underwent tissue Doppler imaging (TDI) of tricuspid annular motion with measurement of peak systolic velocity (Sa), peak early (Ea) and peak late (Aa) diastolic velocities. Right heart catheterization was also performed. Patients with RV systolic dysfunction did not differ from those without RV systolic dysfunction in terms of LV function. Patients with RV systolic dysfunction had larger RV dimension 30.6+/-5.8 vs. 33.9+/-6.7 mm, p<0.002. The patients with RV systolic dysfunction had higher values on right heart catheterization: MPAP 29.6+/-12.1 vs. 24.9+/-11.4 mm Hg, p<0.02, PCWP 20.8+/-10.0 vs. 17.3+/-9.3 mm Hg, p<0.03, PVR 189.9+/-123.3 vs. 137.7+/-94.9 dyn s cm(-5), p<0.008, CVP 7.7+/-5.6 vs. 5.1+/-3.9 mm Hg, p<0.002. The patients with RV systolic dysfunction had more pronounced diastolic dysfunction measured by TDI: Ea 9.9+/-2.3 vs. 11.4+/-2.5 cm/s, p<0.0001 and Aa 13.1+/-4.0 vs. 16.5+/-4.7 cm/s, p<0.000007. Patients with heart failure and both left and right ventricular systolic dysfunction showed more serious findings on central haemodynamics as well as more pronounced right ventricular diastolic dysfunction than those with isolated left ventricular systolic dysfunction.