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Morita T, Nakamura K, Osuga T, Kawamoto S, Miki S, Takiguchi M. Evaluation of Right Ventricular Function and Dyssynchrony in a Dog Model of Acute Pulmonary Embolism: Diagnostic Utility and Reversibility. Front Vet Sci 2022; 9:861064. [PMID: 35795787 PMCID: PMC9251490 DOI: 10.3389/fvets.2022.861064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background The diagnosis of acute pulmonary thromboembolism is challenging in dogs. Little has been reported on changes in echocardiographic indices in dogs with acute pulmonary thromboembolism. The objective of this study was to validate the relationship between echocardiographic indices and right heart catheterization variables in dogs with acute pulmonary embolism and to identify a useful echocardiographic index for diagnosing acute pulmonary embolism. Materials and Methods Six healthy laboratory beagles were included in the study. Echocardiography and right heart catheterization were performed in a dog model of acute pulmonary embolism produced by microsphere injection. Echocardiographic indices, including the right ventricular (RV) Tei index, RV longitudinal strain, and the dyssynchrony index using speckle tracking echocardiography, transmitral flow, and eccentricity index, were measured. Results The mean pulmonary arterial pressure increased (22.2 ± 1.2 mmHg) and the blood pressure decreased after microsphere injection. Although the mean pulmonary arterial pressure remained elevated, the blood pressure recovered 2 days after the microsphere injection. Most echocardiographic indices of RV function were significantly impaired following microsphere injection and recovered after 2 days. In contrast, the RV Tei index was significantly impaired after microsphere injection and the impairment persisted after 2 days. Multivariable analysis revealed that the RV Tei index was an independent echocardiographic predictor of pulmonary vascular resistance (β = 0.88, P < 0.001), and transmitral early diastolic wave was an independent predictor of the cardiac index (β = −0.86, P = 0.001). Conclusions The RV Tei index is a useful echocardiographic index for diagnosing acute pulmonary embolism. Ventricular interdependence may be an important factor causing low cardiac output in dogs with acute pulmonary embolism.
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Affiliation(s)
- Tomoya Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- *Correspondence: Kensuke Nakamura
| | - Tatsuyuki Osuga
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Sciences, Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - Sei Kawamoto
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Miki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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Hsiao S, Hsiao C, Chiou K. Systolic pulmonary regurgitation affects the outcome of patients with severe systolic heart failure. ESC Heart Fail 2021; 8:5121-5131. [PMID: 34477322 PMCID: PMC8712814 DOI: 10.1002/ehf2.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/22/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. METHODS AND RESULTS According to recent 10 year echocardiographic database of E-Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time-velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow-up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e', sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682-3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. CONCLUSIONS Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.
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Affiliation(s)
- Shih‐Hung Hsiao
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
| | - Chao‐Sheng Hsiao
- Division of Cardiology, Department of Internal MedicineE‐Da Hospital, I‐Shou UniversityKaohsiungTaiwan
- Department of Internal Medicine, College of MedicineFu Jen Catholic UniversityNew Taipei CityTaiwan
| | - Kuan‐Rau Chiou
- Division of Cardiology, Department of Internal Medicine, Shuang Ho HospitalTaipei Medical UniversityNo. 291, Jhongzheng Road, Jhonghe DistrictNew Taipei City23561Taiwan
- School of MedicineTaipei Medical UniversityTaipeiTaiwan
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Mandoli GE, Sciaccaluga C, Bandera F, Cameli P, Esposito R, D'Andrea A, Evola V, Sorrentino R, Malagoli A, Sisti N, Nistor D, Santoro C, Bargagli E, Mondillo S, Galderisi M, Cameli M. Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings. Heart Fail Rev 2020; 26:263-275. [PMID: 32860180 PMCID: PMC7895796 DOI: 10.1007/s10741-020-10014-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS, Policlinico San Donato, San Donato Milanese and Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Antonello D'Andrea
- Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Vincenzo Evola
- Department of Health Promotion Sciences, Maternal-Infant Care, Internal Medicine and Specialities of Excellence "G. D'Alessandro", University of Palermo, Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, "S. Agostino-Estense" Public Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Dan Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant Targu Mures, Targu Mures, Romania
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
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Scalia IG, Scalia WM, Hunter J, Riha AZ, Wong D, Celermajer Y, Platts DG, Fitzgerald BT, Scalia GM. Incremental Value of ePLAR—The Echocardiographic Pulmonary to Left Atrial Ratio in the Assessment of Sub-Massive Pulmonary Emboli. J Clin Med 2020; 9:jcm9010247. [PMID: 31963483 PMCID: PMC7020061 DOI: 10.3390/jcm9010247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Acute pulmonary embolism (PE) is characterized hemodynamically by abrupt obstruction in trans-pulmonary blood flow. The echocardiographic Pulmonary to Left Atrial ratio (ePLAR, tricuspid regurgitation Vmax/mitral E/e’) has been validated as a non-invasive surrogate for trans-pulmonary gradient (TPG) that accurately differentiates pre-capillary from post-capillary chronic pulmonary hypertension. This study assessed ePLAR as an incremental echocardiographic assessment tool compared with traditional measures of right ventricular pressure and function. Methods: In total, 110 (57.4 ± 17.6 years) patients with confirmed sub-massive pulmonary emboli with contemporaneous echocardiograms (0.3 ± 0.9 days) were compared with 110 age-matched controls (AMC). Results: Tricuspid velocities were higher than AMC (2.6 ± 0.6 m/s vs. 2.4 ± 0.3 m/s, p < 0.05), although still consistent with “normal” right ventricular systolic pressures (34.2 ± 13.5 mmHg vs. 25 ± 5.3 mmHg, p < 0.05) with lower mitral E/e’ values (8.2 ± 3.8 vs. 10.8 ± 5.1, p < 0.05). ePLAR values were higher than AMC (0.36 ± 0.14 m/s vs. 0.26 ± 0.10, p < 0.05) suggesting significantly elevated TPG. Detection of abnormal echocardiographic findings increased from 29% (TRVmax ≥ 2.9 m/s) and 32% (reduced tricuspid annular plane systolic excursion) to 70% with ePLAR ≥ 0.3 m/s. Conclusions: Raised ePLAR values in acute sub-massive pulmonary embolism suggest elevated trans-pulmonary gradients even in the absence of acutely increased pulmonary artery pressures. ePLAR dramatically increases the sensitivity of echocardiography for detection of hemodynamic perturbations in sub-massive pulmonary embolism patients, which may offer clinical utility in diagnosis and management.
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Affiliation(s)
- Isabel G. Scalia
- Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; (I.G.S.); (Y.C.)
- Department of Medicine, University of Queensland, Brisbane, QLD 4032, Australia;
| | | | - Jonathon Hunter
- Redcliffe District Hospital, Redcliffe, QLD 4032, Australia;
| | - Andrea Z. Riha
- The Wesley Hospital, Brisbane, QLD 4066, Australia; (A.Z.R.); (D.W.); (B.T.F.)
| | - David Wong
- The Wesley Hospital, Brisbane, QLD 4066, Australia; (A.Z.R.); (D.W.); (B.T.F.)
| | - Yael Celermajer
- Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia; (I.G.S.); (Y.C.)
| | - David G. Platts
- Department of Medicine, University of Queensland, Brisbane, QLD 4032, Australia;
- The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
| | - Benjamin T. Fitzgerald
- The Wesley Hospital, Brisbane, QLD 4066, Australia; (A.Z.R.); (D.W.); (B.T.F.)
- Genesis Care, Auchenflower, QLD 4066, Australia
| | - Gregory M. Scalia
- Department of Medicine, University of Queensland, Brisbane, QLD 4032, Australia;
- The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
- The Wesley Hospital, Brisbane, QLD 4066, Australia; (A.Z.R.); (D.W.); (B.T.F.)
- Genesis Care, Auchenflower, QLD 4066, Australia
- Correspondence:
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Morita T, Nakamura K, Osuga T, Hanazono K, Morishita K, Takiguchi M. Change in right ventricular function in an American cocker spaniel with acute pulmonary thromboembolism. J Vet Med Sci 2019; 81:1259-1265. [PMID: 31292347 PMCID: PMC6785625 DOI: 10.1292/jvms.19-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 12-year-old neutered female American cocker spaniel weighing 9.9 kg was presented for evaluation with a 2-day history of dyspnea and anorexia. Echocardiography revealed severe pulmonary
hypertension (estimated systolic pulmonary arterial pressure, 93.4 mmHg) with right heart enlargement, pulmonary arterial dilation, and right ventricular dysfunction. The dilation of left
heart and congenital cardiac shunt were not observed. Pulmonary thromboembolism (PTE) was confirmed by computed tomographic angiography. After treatment with antiplatelet and anticoagulant,
the clinical sign and the echocardiographic abnormality of right heart were improved. These echocardiographic findings are not specific for PTE, but it can be useful as a rule-in test for
PTE when other causes of pulmonary hypertension are excluded and a monitor of therapeutic efficacy.
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Affiliation(s)
- Tomoya Morita
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Kensuke Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192, Japan
| | - Tatsuyuki Osuga
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Kiwamu Hanazono
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, N18 W9, Sapporo, Hokkaido 060-0818, Japan
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Albaghdadi MS, Dudzinski DM, Giordano N, Kabrhel C, Ghoshhajra B, Jaff MR, Weinberg I, Baggish A. Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism. J Am Heart Assoc 2018; 7:JAHA.117.006841. [PMID: 29502109 PMCID: PMC5866315 DOI: 10.1161/jaha.117.006841] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Little data exist regarding the functional capacity of patients following acute pulmonary embolism. We sought to characterize the natural history of symptom burden, right ventricular (RV) structure and function, and exercise capacity among survivors of massive and submassive pulmonary embolism. Methods and Results Survivors of submassive or massive pulmonary embolism (n=20, age 57±13.3 years, 8/20 female) underwent clinical evaluation, transthoracic echocardiography, and cardiopulmonary exercise testing at 1 and 6 months following hospital discharge. At 1 month, 9/20 (45%) patients had New York Heart Association II or greater symptoms, 13/20 (65%) demonstrated either persistent RV dilation or systolic dysfunction, and 14/20 (70%) had objective exercise impairment as defined by a peak oxygen consumption (V˙O2) of <80% of age‐sex predicted maximal values (16.25 [13.4–20.98] mL/kg per minute). At 6 months, no appreciable improvements in symptom severity, RV structure or function, and peak V˙O2 (17.45 [14.08–22.48] mL/kg per minute, P=NS) were observed. No patients demonstrated an exercise limitation attributable to either RV/pulmonary vascular coupling, as defined by a VE/VCO2 slope >33, or a pulmonary mechanical limit to exercise at either time point. Similarly, persistent RV dilation or dysfunction was not significantly related to symptom burden or peak V˙O2 at either time point. Conclusions Persistent symptoms, abnormalities of RV structure and function, and objective exercise limitation are common among survivors of massive and submassive pulmonary embolism. Functional impairment appears to be attributable to general deconditioning rather than intrinsic cardiopulmonary limitation, suggesting an important role for prescribed exercise rehabilitation as a means toward improved patient outcomes and quality of life.
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Affiliation(s)
- Mazen S Albaghdadi
- Fireman Vascular Center, Massachusetts General Hospital, Boston, MA.,Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA
| | - David M Dudzinski
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA
| | - Nicholas Giordano
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, MA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, MA
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael R Jaff
- Department of Medicine, Newton-Wellesley Hospital, Newton, MA
| | - Ido Weinberg
- Fireman Vascular Center, Massachusetts General Hospital, Boston, MA
| | - Aaron Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, MA
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7
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Scalia IG, Riha AZ, Kwon A, Newbigin K, Scalia GM. Dramatic Normalization of the Echocardiographic Pulmonary-to-Left Atrial Ratio with Thrombolysis in a Case of Life-Threatening Submassive Pulmonary Emboli. CASE (PHILADELPHIA, PA.) 2017; 1:124-127. [PMID: 30062262 PMCID: PMC6058219 DOI: 10.1016/j.case.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
•A 74 year old male presented with bilateral submassive pulmonary emboli with moderately severe pulmonary hypertension with right ventricular systolic pressure (RVSP) 63 mm Hg. •Echocardiographic pulmonary-to-left atrial ratio (ePLAR) markedly elevated at 0.78 m/s (normal range for age 0.30 ± 0.09 m/s) suggesting significantly elevated transpulmonary gradient. •Thrombolysis almost fully resolved symptomatic embolic burden and normalized right ventricular function. RVSP 37 mm Hg, ePLAR 0.32 m/s. •One month after lysis, RVSP 26 mm Hg, ePLAR 0.22 m/s, now within the normal range for age.
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Affiliation(s)
| | - Andrea Z Riha
- Department of Cardiology, Wesley Hospital, Brisbane, Australia
| | | | | | - Gregory M Scalia
- Heart Care Partners, Brisbane, Australia
- Department of Cardiology, Wesley Hospital, Brisbane, Australia
- School of Medicine, the University of Queensland, Brisbane, Australia
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Choi YE, Cho HJ, Song ES, Jeong IS, Yoon N, Choi YY, Ma JS, Cho YK. Clinical Utility of Echocardiography for the Diagnosis and Prognosis in Children with Bronchopulmonary Dsyplasia. J Cardiovasc Ultrasound 2016; 24:278-284. [PMID: 28090255 PMCID: PMC5234346 DOI: 10.4250/jcu.2016.24.4.278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/06/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) may result in chronic pulmonary artery hypertension and right ventricular (RV) dysfunction. Various echocardiographic assessments of RV dysfunction have been used to determine whether echocardiographic measurements of premature infants with BPD could provide sensitive measures of RV function that correlates with BPD severity. Methods Twenty-eight control subjects without BPD (non BPD group), 28 patients with mild BPD, 11 patients with moderate BPD, and six patients with severe BPD underwent echocardiograms with standard measurement such as ejection fraction by M-mode, tricuspid regurgitation pressure gradient, myocardial performance index (MPI) derived from pulse Doppler, and tissue Doppler imaging (TDI) measurements. BPD severity was classified by the NICHD/NHLBI/ORD workshop rating scale. Twenty-eight control subjects without BPD (non BPD group), 28 patients with mild BPD, 11 patients with moderate BPD, and six patients with severe BPD underwent echocardiograms with standard measurement such as ejection fraction by M-mode, tricuspid regurgitation pressure gradient, myocardial performance index (MPI) derived from pulse Doppler, and TDI measurements. BPD severity was classified by the NICHD/NHLBI/ORD workshop rating scale. Results None of the standard echocardiographic findings was significantly different between the control group and BPD groups. However, mean septal TDI-MPI of the severe BPD group (0.68 ± 0.06) was significantly (p < 0.01) higher than that of the non-BPD (0.58 ± 0.10) or the mild BPD group (0.59 ± 0.12). In addition, mean RV TDI-MPI of the severe BPD group (0.71 ± 0.13) was significantly (p < 0.05) higher than that of the non-BPD group (0.56 ± 0.08) or the mild BPD group (0.60 ± 0.125). Linear regression showed a good correlation between the severity of BPD and RV TDI-MPI (p = 0.01, R = 0.30) or septal TDI-MPI (p = 0.04, R = 0.24). Conclusion Echocardiographic evaluation of RV function based on an assessment of RV TDI-MPI can provide RV dysfunction parameter in premature infants with BPD.
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Affiliation(s)
- Young Earl Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Namsik Yoon
- The Heart Center of Chonnam National University Hospital, Chonnam National University Medical School and The Research Institute of Medical Sciences of Chonnam National University, Gwangju, Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, KS Hospital, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Zimbarra Cabrita I. Cardiac imaging in pulmonary embolism: assessment of right ventricular dysfunction by tissue Doppler. Rev Port Cardiol 2014; 33:597-8. [PMID: 25444229 DOI: 10.1016/j.repc.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022] Open
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10
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Cardiac imaging in pulmonary embolism: Assessment of right ventricular dysfunction by tissue Doppler. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gromadziński L, Targoński R, Januszko-Giergielewicz B, Ostrowski P, Pruszczyk P. The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure. Arch Med Sci 2014; 10:39-46. [PMID: 24701212 PMCID: PMC3953976 DOI: 10.5114/aoms.2014.40732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/10/2012] [Accepted: 10/06/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI). MATERIAL AND METHODS The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE-). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio. RESULTS PE+ subjects were found to have higher SmLV than PE- subjects (6.0 cm/s (2.0-13.8 cm/s) vs. 4.2 cm/s (1.3-9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50-2.50) and 1.56 (0.62-4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53-25.59; p = 0.009). CONCLUSIONS Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.
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Affiliation(s)
- Leszek Gromadziński
- Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital, University of Warmia and Mazury, Olsztyn, Poland
- Department of Internal Medicine, Cardiology and Nephrology, Hospital, Ostroda, Poland
| | - Ryszard Targoński
- Department of Internal Medicine and Cardiology, Municipal Hospital, Olsztyn, Poland
| | - Beata Januszko-Giergielewicz
- Department of Internal Medicine, Gastroenterology and Hepatology, University Hospital, University of Warmia and Mazury, Olsztyn, Poland
- Department of Internal Medicine, Cardiology and Nephrology, Hospital, Ostroda, Poland
| | - Philip Ostrowski
- Department of Internal Medicine and Cardiology, Warsaw Medical University, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Warsaw Medical University, Warsaw, Poland
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12
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Usefulness of right ventricular tissue Doppler imaging for diagnosis of right ventricular myocardial infarction. J Echocardiogr 2013; 11:89-96. [PMID: 27278612 DOI: 10.1007/s12574-013-0166-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 12/30/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Right ventricular myocardial infarction (RVMI) is a complication of acute inferior myocardial infarction and sometimes causes severe hemodynamic disturbance. It is therefore important to promptly detect RVMI and assess the severity of right ventricular (RV) dysfunction. Tissue Doppler imaging (TDI) is a useful method to assess left ventricular function and RV function. In this study, we investigated the possibility of diagnosing RVMI using tricuspid annular velocity determined by TDI. METHODS Thirty consecutive patients with first acute inferior myocardial infarction were studied. The diagnosis of RVMI was based on an ST-segment elevation of at least 0.1 mV in lead V4R. The patients were classified into 12 patients with RVMI (the RVMI group) and 18 patients without RVMI (non-RVMI group). All patients underwent two-dimensional echocardiography, pulsed Doppler and TDI, and coronary angiography within 48 h after onset of myocardial infarction. Tricuspid inflow velocity was recorded by pulsed Doppler and early diastolic tricuspid inflow velocity (TVE) was measured. Peak early diastolic velocity of the tricuspid annulus (TVe') at the RV free wall was recorded using TDI. The ratio of TVE to TVe' (TVE/TVe') was calculated. RESULTS TVe' was significantly lower in the RVMI group compared to that in the non-RVMI group (5.9 ± 1.3 vs. 9.1 ± 3.1; p = 0.0025). On the basis of a TVe' cutoff value of less than 8.3 cm/s, RVMI was diagnosed with 100 % sensitivity and 61 % specificity. CONCLUSIONS The early diastolic tricuspid annular velocity determined by TDI is a noninvasive and sensitive index for diagnosing RVMI.
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Right Ventricular End-Diastolic Wall Stress: Does It Impact on Right Atrial Size, and Does It Differ in Right Ventricular Pressure vs Volume Loading Conditions? Can J Cardiol 2013; 29:858-65. [DOI: 10.1016/j.cjca.2012.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/23/2012] [Accepted: 06/28/2012] [Indexed: 11/18/2022] Open
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Cardiac findings and long-term thromboembolic outcomes following pulmonary embolism in children: a combined retrospective-prospective inception cohort study. Cardiol Young 2013; 23:344-52. [PMID: 23088931 DOI: 10.1017/s1047951112001126] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children - age less than or equal to 21 years - with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.
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15
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Rydman R, Söderberg M, Larsen F, Alam M, Caidahl K. d-Dimer and simplified pulmonary embolism severity index in relation to right ventricular function. Am J Emerg Med 2012; 31:482-6. [PMID: 23154103 DOI: 10.1016/j.ajem.2012.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Right ventricular (RV) involvement in pulmonary embolism (PE) is an ominous sign. The aim of this study was to investigate the extent to which the d-dimer level or simplified PE severity index (sPESI) indicates RV dysfunction in patients with preserved systemic arterial pressure. METHODS Right ventricular function was studied in 34 consecutive patients with acute nonmassive PE by echocardiography including Doppler tissue imaging within 24 hours after arrival to the hospital. d-Dimer and sPESI were assessed upon arrival. RESULTS d-Dimer correlated with RV pressure (Rs, 0.60; P < .001) and pulmonary vascular resistance (PVR; Rs, 0.68; P < .0001) and tended to be related to myocardial performance index (MPI; Rs, 0.31; P = .067). Compared to a level less than 3.0 mg/L, patients with d-dimer 3.0 mg/L or higher had lower systolic tricuspid annular velocity (11.3 ± 2.7 vs 13.5 ± 2.7 cm/s; P < .05), a prolonged MPI (0.8 ± 0.3 vs 0.5 ± 0.2; P < .01), increased RV pressure (58 ± 13 vs 37 ± 12 mm Hg; P < .001), and increased PVR (3.3 ± 1.1 vs 1.8 ± 0.4 Woods units; P < .001). Patients in the high-risk sPESI group had higher filling pressure than those in the low risk sPESI group. CONCLUSIONS In the acute stage of PE, a d-dimer level 3 mg/L or higher may identify nonmassive PE patients with RV dysfunction and thereby help to determine their risk profile. We found no additional value for sPESI in this context.
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Affiliation(s)
- Riikka Rydman
- Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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16
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Ayuela Azcarate JM, Clau Terré F, Ochagavia A, Vicho Pereira R. [Role of echocardiography in the hemodynamic monitorization of critical patients]. Med Intensiva 2012; 36:220-32. [PMID: 22261614 DOI: 10.1016/j.medin.2011.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 11/25/2011] [Accepted: 11/27/2011] [Indexed: 11/30/2022]
Abstract
The use of echocardiography in intensive care units in shock patients allows us to measure various hemodynamic variables in an accurate and a non-invasive manner. By using echocardiography not only as a diagnostic technique but also as a tool for continuous hemodynamic monitorization, the intensivist can evaluate various aspects of shock states, such as cardiac output and fluid responsiveness, myocardial contractility, intracavitary pressures, heart-lung interaction and biventricular interdependence. However, to date there has been little guidance orienting echocardiographic hemodynamic parameters in the intensive care unit, and intensivists are usually not familiar with this tool. In this review, we describe some of the most important hemodynamic parameters that can be obtained at the patient bedside with transthoracic echocardiography in critically ill patients.
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Cohen R, Loarte P, Navarro V, Mirrer B. Echocardiographic findings in pulmonary embolism: An important guide for the management of the patient. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjcd.2012.23027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Abstract
Pulmonary hypertension (PH) is a relatively misunderstood disease, partly related to the fact that many perceive PH to be a singular diagnosis. An unintended consequence of this is the misapplication of the role of the Doppler-Echocardiographic (DE) examination, as well as an underappreciation for its ability to help discern PH pathophysiology prior to right heart catheterization. Since DE often serves as the "gatekeeper" to invasive right heart catheterization, misinterpretation of the DE can lead to missed or delayed diagnosis with devastating consequences. Too often, the primary or nearly exclusive focus of the DE examination is placed on the pulmonary artery pressure estimation. Two main issues with this approach are that Doppler pressure estimations can be inaccurate and even when accurate, without integration of additional 2-D and Doppler information, the clinician will often still not appreciate the pathophysiology of the PH nor its clinical significance. This review will focus on the 2-D and Doppler features necessary to assess pulmonary vascular disease (PVD), discern the salient differences between PVD and pulmonary venous hypertension (PVH), and how to integrate these key DE parameters such that PH pathophysiology can be determined noninvasively and early in the patient workup. Overreliance on any single DE metric, and especially PA pressure estimation, detracts from the overall diagnostic potential of the DE examination. Integrating the relative balance of right and left heart findings, along with proper Doppler interpretation provides a wealth of clinical and pathophysiologic insight prior to invasive hemodynamic assessment. The end results are heightened awareness and improved identification of which patients should be referred for further invasive testing, as well the use of the DE information to compliment the findings from invasive testing.
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Affiliation(s)
- Justin D Roberts
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gromadziński L, Ciurzyński M, Januszko-Giergielewicz B, Targoński R, Cygański P, Pruszczyk P. Diagnostic value of mitral and tricuspid annular excursion in the diagnostics of acute pulmonary embolism patients with chronic heart failure. Int J Cardiol 2011; 149:118-9. [PMID: 21345501 DOI: 10.1016/j.ijcard.2011.01.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 01/23/2011] [Indexed: 11/26/2022]
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20
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Do DH, Therrien J, Marelli A, Martucci G, Afilalo J, Sebag IA. Right Atrial Size Relates to Right Ventricular End-Diastolic Pressure in an Adult Population with Congenital Heart Disease. Echocardiography 2010; 28:109-16. [DOI: 10.1111/j.1540-8175.2010.01277.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Park JH, Park YS, Kim YJ, Lee IS, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department. Heart Vessels 2010; 26:435-9. [DOI: 10.1007/s00380-010-0072-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 07/09/2010] [Indexed: 10/18/2022]
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22
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Rydman R, Larsen F, Caidahl K, Alam M. Right Ventricular Function in Patients With Pulmonary Embolism: Early and Late Findings Using Doppler Tissue Imaging. J Am Soc Echocardiogr 2010; 23:531-7. [DOI: 10.1016/j.echo.2010.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Indexed: 11/26/2022]
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Watts JA, Marchick MR, Kline JA. Right ventricular heart failure from pulmonary embolism: key distinctions from chronic pulmonary hypertension. J Card Fail 2010; 16:250-9. [PMID: 20206901 DOI: 10.1016/j.cardfail.2009.11.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/05/2009] [Accepted: 11/30/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND The right ventricle normally operates as a low pressure, high-flow pump connected to a high-capacitance pulmonary vascular circuit. Morbidity and mortality in humans with pulmonary hypertension (PH) from any cause is increased in the presence of right ventricular (RV) dysfunction, but the differences in pathology of RV dysfunction in chronic versus acute occlusive PH are not widely recognized. METHODS AND RESULTS Chronic PH that develops over weeks to months leads to RV concentric hypertrophy without inflammation that may progress slowly to RV failure. In contrast, pulmonary embolism (PE) results in an abrupt vascular occlusion leading to increased pulmonary artery pressure within minutes to hours that causes immediate deformation of the RV. RV injury is secondary to mechanical stretch, shear force, and ischemia that together provoke a cytokine and chemokine-mediated inflammatory phenotype that amplifies injury. CONCLUSIONS This review will briefly describe causes of pulmonary embolism and chronic PH, models of experimental study, and pulmonary vascular changes, and will focus on mechanisms of right ventricular dysfunction, contrasting mechanisms of RV adaptation and injury in these 2 settings.
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Affiliation(s)
- John A Watts
- Emergency Medicine Research, Carolinas Medical Center, 1542 Garden Terrace, Charlotte, NC 28203, USA.
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Sugiura E, Dohi K, Onishi K, Takamura T, Tsuji A, Ota S, Yamada N, Nakamura M, Nobori T, Ito M. Reversible Right Ventricular Regional Non-Uniformity Quantified by Speckle-Tracking Strain Imaging in Patients With Acute Pulmonary Thromboembolism. J Am Soc Echocardiogr 2009; 22:1353-9. [PMID: 19836202 DOI: 10.1016/j.echo.2009.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Indexed: 10/20/2022]
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25
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Horton KD, Meece RW, Hill JC. Assessment of the right ventricle by echocardiography: a primer for cardiac sonographers. J Am Soc Echocardiogr 2009; 22:776-92; quiz 861-2. [PMID: 19560657 DOI: 10.1016/j.echo.2009.04.027] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Indexed: 10/20/2022]
Abstract
The assessment of right ventricular (RV) structure and function by echocardiography has been improved by advancements that include Doppler tissue imaging, strain imaging, and three-dimensional imaging. Doppler tissue imaging and strain imaging can be useful for the assessment of regional RV systolic and diastolic function. Three-dimensional imaging has been reported to determine RV volumes and ejection fraction, which have previously been cumbersome to measure with conventional two-dimensional echocardiography. This article addresses the role of conventional and newer methods of echocardiography to assist sonographers in understanding the technical considerations, limitations, and pitfalls of image acquisition and analysis of RV structure and function.
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Correlation of Automated Function Imaging (AFI) to Conventional Strain Analyses of Regional and Global Right Ventricular Function. J Am Soc Echocardiogr 2009; 22:1031-9. [DOI: 10.1016/j.echo.2009.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Indexed: 11/22/2022]
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27
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López-Candales A, Rajagopalan N, Gulyasy B, Edelman K, Bazaz R. Differential strain and velocity generation along the right ventricular free wall in pulmonary hypertension. Can J Cardiol 2009; 25:e73-7. [PMID: 19279990 DOI: 10.1016/s0828-282x(09)70045-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND In contrast to the homogeneously distributed deformation properties within the left ventricle, the right ventricular (RV) free wall (RVFW) shows a more inhomogeneous distribution. It has been demonstrated that pulmonary hypertension (PH) results in significant RVFW mechanical delay. OBJECTIVE To assess the effect of the degree of pulmonary arterial systolic pressure on the RVFW strain gradient and on myocardial velocity generation. METHODS Peak longitudinal strain and velocity data were collected from three different segments (basal, mid- and apical) of the RVFW in 17 normal individuals and 31 PH patients. RESULTS A total of 144 RV wall segments were analyzed. RVFW strain values in individuals without PH were higher in the mid and apical segments than in the basal segment. In contrast, RVFW strain in PH patients was higher in basal segments and diminished toward the apex. In terms of RVFW velocities, both groups showed decremental values from basal to apical segments. Basal and mid-RVFW velocities were significantly lower in PH patients than in individuals without PH. CONCLUSIONS PH results in significant alterations of strain and velocity generation that occurs along the RVFW. Of these abnormalities, the reduction in strain from the mid and apical RVFW segments was most predictive of PH. It is important to be aware of these differences in strain generation when studying the effect of PH on the right ventricle. Additional studies are required to determine whether these differences are due to RV remodelling.
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Doppler imaging predicts cardiac events in chronic pulmonary thromboembolism. Int J Cardiol 2009; 133:167-72. [DOI: 10.1016/j.ijcard.2007.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 12/11/2007] [Indexed: 11/13/2022]
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Sade LE, Gülmez Ö, Özyer U, Özgül E, Ağıldere M, Müderrisoğlu H. Tissue Doppler Study of the Right Ventricle with a Multisegmental Approach: Comparison with Cardiac Magnetic Resonance Imaging. J Am Soc Echocardiogr 2009; 22:361-8. [DOI: 10.1016/j.echo.2009.01.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Indexed: 11/16/2022]
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Utility of Right Ventricular Tei Index in the Noninvasive Evaluation of Chronic Thromboembolic Pulmonary Hypertension Before and After Pulmonary Thromboendarterectomy. JACC Cardiovasc Imaging 2009; 2:143-9. [DOI: 10.1016/j.jcmg.2008.10.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/08/2008] [Accepted: 10/15/2008] [Indexed: 11/23/2022]
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31
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Yates AR, Welty SE, Gest AL, Cua CL. Myocardial tissue Doppler changes in patients with bronchopulmonary dysplasia. J Pediatr 2008; 152:766-70, 770.e1. [PMID: 18492512 DOI: 10.1016/j.jpeds.2007.11.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 10/24/2007] [Accepted: 11/28/2007] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether tissue Doppler measurements provide sensitive measures of right ventricular function that correlate with the severity of bronchopulmonary dysplasia (BPD). STUDY DESIGN 21 subjects (6 control subjects with no/mild BPD, 7 patients with moderate BPD, and 8 patients with severe BPD) underwent limited echocardiograms with standard M-mode, mitral and tricuspid inflow velocities, and tissue Doppler features measured. BPD severity was scored by using the NICHD/NHLBI/ORD workshop rating scale by physicians blinded to the echocardiogram results. Groups were compared by using 1-way analysis of variance with post-hoc testing and linear regression. RESULTS Patients with moderate BPD had a higher early Doppler inflow velocity to the early tissue Doppler velocity ratio (E/E' ratio; P = .03), corresponding to increased end diastolic pressure, compared with patients with no/mild BPD. Patients with severe BPD had a higher E/E' ratio (P = .004) than patients with no/mild BPD. Linear regression demonstrated a correlation between BPD category and right ventricle E/E' (P = .007, R(2) = 0.33) and left ventricular myocardial performance index (P = .02, R(2) = 0.28). CONCLUSION Increasing right ventricle E/E' ratio correlates with clinical severity of BPD. Abnormal left ventricular myocardial performance index was noted to correlate with the grade of BPD. Further longitudinal studies of tissue Doppler echocardiographic assessment of cardiac function in premature infants with BPD are needed.
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Affiliation(s)
- Andrew R Yates
- Department of Pediatrics, Ohio State University, and Columbus Children's Hospital Heart Center, Columbus, Ohio 43205, USA.
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Park JH, Park YS, Park SJ, Lee JH, Choi SW, Jeong JO, Seong IW. Midventricular peak systolic strain and Tei index of the right ventricle correlated with decreased right ventricular systolic function in patients with acute pulmonary thromboembolism. Int J Cardiol 2008; 125:319-24. [PMID: 17434620 DOI: 10.1016/j.ijcard.2007.02.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Revised: 01/10/2007] [Accepted: 02/17/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assessment of right ventricular (RV) systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with strain analysis in patients with acute pulmonary thromboembolism (PTE). PATIENTS AND METHODS From March 2005 to June 2006, 28 consecutive patients with acute PTE were included in this study. After excluding four patients, three with recurrent episodes of PTE and one with permanent pacemaker, the remaining 24 patients (10 males, mean age 69.0+/-10 years) were analyzed. RESULTS Mean RV fractional area change (RVFAC) was 20.1+/-8.7%; RV Tei index was 0.86+/-0.23; tricuspid annular plane systolic excursion (TAPSE) was 1.56+/-0.31 cm; and TR Vmax was 3.6+/-0.4 m/s at the time of diagnosis. Midventricular peak systolic strain of RV was markedly decreased (base: -18.0+/-6.6%, midventricle: -5.4+/-12.8%, apex: -10.6+/-8.1%). After treatment, follow-up echocardiographic data were obtained from 20 patients (mean: 11.0+/-8.2 days, duration: 4-34 days). Mean RVFAC, RV Tei index, TAPSE and TR Vmax were significantly improved (P<0.001). Midventricular peak systolic strains of RV were also significantly improved (base: -20.9+/-7.0%, P=0.055, midventricle: -21.1+/-6.8%, P<0.001, apex: -12.7+/-8.1%, P=0.314). Midventricular peak systolic strain of RV showed significant negative correlation with RVFAC (r=-0.660, P<0.001) and TAPSE (r=-0.642, P<0.001). Also, the RV Tei index showed significant correlation with RVFAC (r=-0.646, P<0.001) and TAPSE (r=-0.647, P<0.001). CONCLUSIONS Midventricular peak systolic strain and RV Tei index decreased in the patients with acute PTE and improved after stabilization. These values can therefore be used to assess RV systolic function in patients with acute PTE.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Salehian O, Burwash IG, Chan KL, Beauchesne LM. Tricuspid Annular Systolic Velocity Predicts Maximal Oxygen Consumption During Exercise in Adult Patients with Repaired Tetralogy of Fallot. J Am Soc Echocardiogr 2008; 21:342-6. [PMID: 17904816 DOI: 10.1016/j.echo.2007.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with repaired tetralogy of Fallot (TOF) have clinically important pulmonary regurgitation that can eventually lead to right ventricular (RV) dilatation and dysfunction and associated morbidity and mortality. Unfortunately, standard echocardiographic techniques to evaluate RV size and function can be inaccurate. Newer Doppler modalities such as Doppler tissue imaging (DTI) can detect subtle changes in myocardial velocities and may better identify subclinical RV dysfunction in these patients. METHODS A total of 25 patients with repaired TOF prospectively underwent complete echocardiographic assessment (including DTI) of the RV and cardiopulmonary stress testing to evaluate exercise capacity. Echocardiographic variables were compared with age- and sex-matched control subjects. RESULTS Patients with repaired TOF had significantly lower RV DTI indices compared with control subjects. In patients with repaired TOF, RV peak systolic velocity had a significant correlation with maximal oxygen consumption during exercise (r = 0.80, P < .001) and was the only independent predictor of maximal oxygen consumption on multivariate analysis (r = 0.80, P < .001). CONCLUSION DTI identifies abnormalities of RV systolic and diastolic function in patients with repaired TOF. Importantly, RV systolic velocity is predictive of exercise capacity in these patients.
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Wu DK, Hsiao SH, Lin SK, Lee CY, Yang SH, Chang SM, Chiou KR. Main Pulmonary Arterial Distensibility Different Presentation Between Chronic Pulmonary Hypertension and Acute Pulmonary Embolism. Circ J 2008; 72:1454-9. [DOI: 10.1253/circj.cj-08-0223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Den-Ko Wu
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Shih-Hung Hsiao
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
- School of Medicine, National Yang-Ming University
| | - Shih-Kai Lin
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Chiu-Yen Lee
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Shu-Hsin Yang
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Shu-Mei Chang
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Kuan-Rau Chiou
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital
- School of Medicine, National Yang-Ming University
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Chung T, Emmett L, Mansberg R, Peters M, Kritharides L. Natural History of Right Ventricular Dysfunction After Acute Pulmonary Embolism. J Am Soc Echocardiogr 2007; 20:885-94. [PMID: 17617316 DOI: 10.1016/j.echo.2006.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute pulmonary embolism (PE) associated with right ventricular (RV) dysfunction has an adverse prognosis. We investigated individual parameters of RV dysfunction after acute PE, assessing their correlation with the PE extent and recovery during 6 months. METHODS In all, 35 patients (age 63 +/- 18 years) with acute PE were prospectively investigated for 6 months with serial echocardiography, incorporating longitudinal myocardial-velocity and strain imaging. The extent of PE was quantified on day 1 by ventilation/perfusion pulmonary scintigraphy with PE defined as large when there was greater than 30% lung involvement. RESULTS PE extent correlated strongly with a number of parameters of RV function, and the strongest univariate correlates were tricuspid annular motion (TAM) (r = -0.65, P < .0001) and the ratio of RV apical to RV basal systolic velocity (r = 0.66, P < .0001). Multivariate analysis identified TAM (P < .0001) and RV basal late-diastolic velocity (P = .01) as independently predicting PE extent, with a combined correlation (R2 = 0.52, P < .0001). A TAM of less than 2.0 cm had sensitivity, specificity, and positive- and negative-predictive values of 75%, 84%, 75%, and 79%, respectively, in predicting large PE. Prospective follow-up identified that RV:left ventricular end-diastolic area ratio returned to normal within 6 weeks, whereas TAM and ratio of RV apical to RV basal systolic velocity normalized after 3 to 6 months. CONCLUSION TAM and ratio of RV apical to RV basal systolic velocity are useful indicators of the extent of PE, and provide unique insights into the recovery of RV function after acute PE.
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Affiliation(s)
- Tommy Chung
- Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, University of Sydney, Sydney, Australia
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Gondi S, Dokainish H. Right Ventricular Tissue Doppler and Strain Imaging: Ready for Clinical Use? Echocardiography 2007; 24:522-32. [PMID: 17456072 DOI: 10.1111/j.1540-8175.2007.00430.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although tissue Doppler (TD) imaging of the left ventricle is now commonly used in clinical settings, TD imaging of the right ventricle (RV) is not routinely practiced. Yet, there are significant data on clinical uses of RV TD imaging, including established normal values using both color and spectral TD. In acute left ventricular (LV) inferior wall myocardial infarction, depressed RV TD velocities have been shown to correlate with the presence of RV impairment, and with patient outcome. In patients with LV heart failure, TD imaging has been correlated to RV ejection fraction by radionuclide angiography, and is an independent predictor of outcome. In patients with congenital heart disease, RV TD has been especially valuable for assessing RV function, and has been correlated to invasive hemodynamic indices, and RV ejection fraction by magnetic resonance imaging. The RV performance (Tei) index has been calculated and validated using TD-derived, rather than conventional pulsed Doppler time intervals. RV TD indices have been shown to be useful in the detection of subclinical and clinical disease in morbid obesity, chronic pulmonary, and systemic disease. TD-derived RV strain imaging can detect segmental myocardial dysfunction, overcoming limitations to conventional TD imaging resulting from tethering. For both TD velocity and strain imaging, however, appreciation of the limitations of these techniques is necessary for their appropriate use. Given its rapid acquisition times, reproducibility, and ease of addition to standard transthoracic echocardiographic protocols, RV TD and strain imaging are important additional modalities in the comprehensive echo-Doppler assessment of RV function.
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Affiliation(s)
- Sreedevi Gondi
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA
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