1
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Ujvári A, Fábián A, Lakatos B, Tokodi M, Ladányi Z, Sydó N, Csulak E, Vágó H, Juhász V, Grebur K, Szűcs A, Zámodics M, Babity M, Kiss O, Merkely B, Kovács A. Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study. Int J Sports Med 2024; 45:473-480. [PMID: 38301728 PMCID: PMC11150038 DOI: 10.1055/a-2259-2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs. controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r=0.138, P=0.044). Similarly to the adult athlete's heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.
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Affiliation(s)
- Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Vencel Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márk Zámodics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Máté Babity
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
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2
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Flanagan H, Cooper R, George KP, Augustine DX, Malhotra A, Paton MF, Robinson S, Oxborough D. The athlete's heart: insights from echocardiography. Echo Res Pract 2023; 10:15. [PMID: 37848973 PMCID: PMC10583359 DOI: 10.1186/s44156-023-00027-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023] Open
Abstract
The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
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Affiliation(s)
- Harry Flanagan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University and University of Manchester, Manchester, UK
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
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3
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Zimmermann P, Eckstein ML, Moser O, Schöffl I, Zimmermann L, Schöffl V. Left Ventricular, Left Atrial and Right Ventricular Strain Modifications after Maximal Exercise in Elite Ski-Mountaineering Athletes: A Feasibility Speckle Tracking Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13153. [PMID: 36293734 PMCID: PMC9603167 DOI: 10.3390/ijerph192013153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Eleven world elite ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological remodeling as the primary aim of our feasibility speckle tracking study. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography, including speckle tracking analysis of the left atrium (LA), right ventricle (RV) and left ventricular (LV) global longitudinal strain (LV-GLS) at rest and post-peak performance. The feasibility echocardiographic speckle tracking analysis was performed on eleven elite Ski-Mo athletes, which were obtained in 2022 during the annual medical examination. The obtained data of the professional Ski-Mo athletes (11 athletes, age: 18-26 years) were compared for different echocardiographic parameters at rest and post-exercise. Significant differences were found for LV-GLS mean (p = 0.0036) and phasic LA conduit strain pattern at rest and post-exercise (p = 0.0033). Furthermore, negative correlation between LV mass and LV-GLS (p = 0.0195, r = -0.69) and LV mass Index and LV-GLS (p = 0.0253, r = -0.66) at rest were elucidated. This descriptive reporting provided, for the first time, a sport-specific dynamic remodeling of an entire elite national team of the Ski-Mo athlete's left heart and elucidated differences in the dynamic deformation pattern of the left heart.
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Affiliation(s)
- Paul Zimmermann
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Max L. Eckstein
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Isabelle Schöffl
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nurnberg, 91054 Erlangen, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
| | - Lukas Zimmermann
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Volker Schöffl
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
- Department of Orthopedic and Trauma Surgery, Friedrich-Alexander-University Erlangen-Nurnberg, 91054 Erlangen, Germany
- Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, 96049 Bamberg, Germany
- Section of Wilderness Medicine, Department of Emergency Medicine at the University of Colorado School of Medicine, Denver, CO 80045, USA
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4
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St. Pierre SR, Peirlinck M, Kuhl E. Sex Matters: A Comprehensive Comparison of Female and Male Hearts. Front Physiol 2022; 13:831179. [PMID: 35392369 PMCID: PMC8980481 DOI: 10.3389/fphys.2022.831179] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/02/2022] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular disease in women remains under-diagnosed and under-treated. Recent studies suggest that this is caused, at least in part, by the lack of sex-specific diagnostic criteria. While it is widely recognized that the female heart is smaller than the male heart, it has long been ignored that it also has a different microstructural architecture. This has severe implications on a multitude of cardiac parameters. Here, we systematically review and compare geometric, functional, and structural parameters of female and male hearts, both in the healthy population and in athletes. Our study finds that, compared to the male heart, the female heart has a larger ejection fraction and beats at a faster rate but generates a smaller cardiac output. It has a lower blood pressure but produces universally larger contractile strains. Critically, allometric scaling, e.g., by lean body mass, reduces but does not completely eliminate the sex differences between female and male hearts. Our results suggest that the sex differences in cardiac form and function are too complex to be ignored: the female heart is not just a small version of the male heart. When using similar diagnostic criteria for female and male hearts, cardiac disease in women is frequently overlooked by routine exams, and it is diagnosed later and with more severe symptoms than in men. Clearly, there is an urgent need to better understand the female heart and design sex-specific diagnostic criteria that will allow us to diagnose cardiac disease in women equally as early, robustly, and reliably as in men. Systematic Review Registration https://livingmatter.stanford.edu/.
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Affiliation(s)
- Sarah R. St. Pierre
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Mathias Peirlinck
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, Netherlands
| | - Ellen Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
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5
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Lewicka-Potocka Z, Kaleta-Duss AM, Lewicka E, Kubik M, Faran A, Szymeczko P, Gała Ska R, Raczak G, Da Browska-Kugacka A. Post-marathon Decline in Right Ventricular Radial Motion Component Among Amateur Sportsmen. Front Physiol 2022; 12:811764. [PMID: 35082697 PMCID: PMC8784683 DOI: 10.3389/fphys.2021.811764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Moderate physical activity has a positive impact on health, although extreme forms of sport such as marathon running may trigger exercise-induced cardiac fatigue. The explicit distinction between the right ventricular (RV) physiological response to training and maladaptive remodeling has not yet been determined. In this study, we aimed to analyze the impact of running a marathon on RV mechanics in amateur athletes using three-dimensional (3D) echocardiography (ECHO) and the ReVISION method (RV separate wall motion quantification). A group of 34 men with a mean age of 40 ± 8 years who successfully finished a marathon underwent ECHO three times, i.e., 2 weeks before the marathon (stage I), at the marathon finish line (stage II), and 2 weeks after the marathon (stage III). The ECHO findings were then correlated with the concentrations of biomarkers related to myocardial injury and overload and also obtained at the three stages. On finishing the marathon, the amateur athletes were found to have a significant (p < 0.05) increase in end-diastolic (with a median of 51.4 vs. 57.0 ml/m2) and end-systolic (with a median of 24.9 vs. 31.5 ml/m2) RV volumes indexed to body surface area, reduced RV ejection fraction (RVEF) (with a median of 51.0% vs. 46.0%), and a decrease in RV radial shortening [i.e., radial EF (REF)] (with a mean of 23.0 ± 4.5% vs. 19.3 ± 4.2%), with other RV motion components remaining unchanged. The post-competition decrease in REF was more evident in runners with larger total volume of trainings (R2 = 0.4776, p = 0.0002) and higher concentrations of high-sensitivity cardiac troponin I (r = 0.43, p < 0.05) during the preparation period. The decrease in REF was more prominent in the training of marathoners more than 47 km/week. At stage II, marathoners with a more marked decrease in RVEF and REF had higher galectin-3 (Gal-3) levels (r = −0.48 and r = −0.39, respectively; p < 0.05). Running a marathon significantly altered the RV performance of amateur athletes. Transient impairment in RV systolic function resulted from decreased radial shortening, which appeared in those who trained more extensively. Observed ECHO changes correlated with the concentrations of the profibrotic marker Gal-3.
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Affiliation(s)
- Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Kubik
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Faran
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Paweł Szymeczko
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Rafał Gała Ska
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Da Browska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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6
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1594-1604. [DOI: 10.1093/eurjpc/zwac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 02/03/2022] [Indexed: 11/14/2022]
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7
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Bryde R, Applewhite AI, Abu Dabrh AM, Taylor BJ, Heckman MG, Filmalter SE, Pujalte G, Rojas C, Heckman AJ, Brigham TJ, Prokop LJ, Shapiro BP. Cardiac structure and function in elite female athletes: A systematic review and meta-analysis. Physiol Rep 2021; 9:e15141. [PMID: 34894105 PMCID: PMC8665377 DOI: 10.14814/phy2.15141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023] Open
Abstract
We conducted a meta-analysis to synthesize the best available evidence comparing cardiac biventricular structure and function using cardiac magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) in elite female athletes and healthy controls (HC). Chronic exposure to exercise may induce cardiac chamber enlargement as a means to augment stroke volume, a condition known as the "athlete's heart." These changes have not been clearly characterized in female athletes. Multiple databases were searched from inception to June 18, 2019. Outcomes of interest included left ventricular (LV) and right ventricular (RV) dimensional, volumetric, mass, and functional assessments in female athletes. Most values were indexed to body surface area. The final search yielded 22 studies, including 1000 female athletes from endurance, strength, and mixed athletic disciplines. CMR-derived LV end-diastolic volume (LVEDV) and RV end-diastolic volume (RVEDV) were greater in endurance athletes (EA) versus HC (17.0% and 18.5%, respectively; both p < 0.001). Similarly, TTE-derived LVEDV and RVEDV were greater in EA versus HC (16.8% and 28.0%, respectively; both p < 0.001). Both LVEF and RVEF were lower in EA versus HC, with the most pronounced difference observed in RVEF via TTE (9%) (p < 0.001). LV stroke volume was greater in EA versus HC via both CMR (18.5%) and TTE (13.2%) (both p < 0.05). Few studies reported data for the mixed athlete (MA) population and even fewer studies reported data for strength athletes (SA), therefore a limited analysis was performed on MA and no analysis was performed on SA. This evidence-synthesis review demonstrates the RV may be more susceptible to ventricular enlargement. General changes in LV and RV structure and function in female EA mirrored changes observed in male counterparts. Further studies are needed to determine if potential adverse outcomes occur secondary to these changes.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Abd Moain Abu Dabrh
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of General Internal MedicineIntegrative Medicine and HealthMayo ClinicJacksonvilleFloridaUSA
| | - Bryan J. Taylor
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
| | | | - Sara E. Filmalter
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - George Pujalte
- Department of Family MedicineMayo ClinicJacksonvilleFloridaUSA
- Division of Sports MedicineDepartment of OrthopedicsMayo ClinicJacksonvilleFloridaUSA
| | - Carlos Rojas
- Department of RadiologyMayo ClinicJacksonvilleFloridaUSA
| | | | | | | | - Brian P. Shapiro
- Department of Cardiovascular DiseasesMayo ClinicJacksonvilleFloridaUSA
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8
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Conti V, Migliorini F, Pilone M, Barriopedro MI, Ramos-Álvarez JJ, Montero FJC, Maffulli N. Right heart exercise-training-adaptation and remodelling in endurance athletes. Sci Rep 2021; 11:22532. [PMID: 34795399 PMCID: PMC8602371 DOI: 10.1038/s41598-021-02028-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/01/2021] [Indexed: 01/11/2023] Open
Abstract
Long-term sports training leads to myocardial adaptations, with remodelling of the heart chambers. However, while myocardial adaptations of the left heart are well described, remodelling of the right heart and its impact on the development of arrhythmias is still debated. To conduct a systematic review on right ventricle (RV) and right atrium (RA) structural and functional changes in athletes who participate in long-term endurance training. Systematic review. A systematic literature search was conducted. All the articles reporting right heart echocardiographic (ECHO) and cardiac magnetic resonance (CMR) parameters evaluated in endurance athletes and sedentary subjects were considered eligible. A multivariate analysis was conducted to investigate whether age, sex, body surface area (BSA), intensity of training are associated with RV ECHO, CMR parameters and RA ECHO parameters. A positive association between age and right atrium area (RAA) (P = 0.01) was found. This is a negative association to RV E/A (P = 0.004), and RV end diastolic diameter (RVED) longitudinal (P = 0.01). A positive association between BSA and RVED middle (P = 0.001), as well between BSA and RAA (P = 0.05) was found, along with a negative association with RV E/A (P = 0.002). A positive association between intensity of training and RV end systolic area (RVESA) (P = 0.03), RV end diastolic volume indexed (RVEDVI) (P = 0.01), RV end systolic volume indexed (RVESVI) (P = 0.01) was found, along with a negative association with ejection fraction (EF %) (P = 0.01). Endurance athletes demonstrated an association between RV remodelling and age, BSA and intensity of training.
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Affiliation(s)
- Valeria Conti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Recontructive Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Marco Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - María I Barriopedro
- Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Juan José Ramos-Álvarez
- Escuela de Medicina Deportiva. Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Javer Calderon Montero
- Escuela de Medicina Deportiva. Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England, UK
- Department of Musculoskeletal Disorders, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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9
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Dawkins TG, Curry BA, Drane AL, Lord RN, Richards CT, Lodge FM, Yousef Z, Pugh CJA, Shave RE, Stembridge M. Evidence of region-specific right ventricular functional adaptation in endurance-trained men in response to an acute volume infusion. Exp Physiol 2021; 107:6-15. [PMID: 34743381 DOI: 10.1113/ep089882] [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: 07/19/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Endurance athletes demonstrate altered regional right ventricular (RV) wall mechanics, characterized by lower basal deformation, in comparison to non-athletic control subjects at rest. We hypothesized that regional adaptations at the RV base reflect an enhanced functional reserve capacity in response to haemodynamic volume loading. What is the main finding and its importance? Free wall RV longitudinal strain is elevated in response to acute volume loading in both endurance athletes and control subjects. However, the RV basal segment longitudinal strain response to acute volume infusion is greater in endurance athletes. Our findings suggest that training-induced cardiac remodelling might involve region-specific adaptation in the RV functional response to volume manipulation. ABSTRACT Eccentric remodelling of the right ventricle (RV) in response to increased blood volume and repetitive haemodynamic load during endurance exercise is well established. Structural remodelling is accompanied by decreased deformation at the base of the RV free wall, which might reflect an enhanced functional reserve capacity in response to haemodynamic perturbation. Therefore, in this study we examined the impact of acute blood volume expansion on RV wall mechanics in 16 young endurance-trained men (aged 24 ± 3 years) and 13 non-athletic male control subjects (aged 27 ± 5 years). Conventional echocardiographic parameters and the longitudinal strain and strain rate were quantified at the basal and apical levels of the RV free wall. Measurements were obtained at rest and after 7 ml/kg i.v. Gelofusine infusion, with and without a passive leg raise. After infusion, blood volume increased by 12 ± 4 and 14 ± 5% in endurance-trained individuals versus control subjects, respectively (P = 0.264). Both endurance-trained individuals (8 ± 10%) and control subjects (7 ± 9%) experienced an increase in free wall strain from baseline, which was also similar following leg raise (7 ± 10 and 6 ± 10%, respectively; P = 0.464). However, infusion evoked a greater increase in basal longitudinal strain in endurance-trained versus control subjects (16 ± 14 vs. 6 ± 11%; P = 0.048), which persisted after leg raise (16 ± 18 vs. 3 ± 11%; P = 0.032). Apical longitudinal strain and RV free wall strain rates were not different between groups and remained unchanged after infusion across all segments. Endurance training results in a greater contribution of longitudinal myocardial deformation at the base of the RV in response to a haemodynamic volume challenge, which might reflect a greater region-specific functional reserve capacity.
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Affiliation(s)
- Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Bryony A Curry
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Aimee L Drane
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Rachel N Lord
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Cory T Richards
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Freya M Lodge
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Christopher J A Pugh
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Robert E Shave
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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10
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Tokodi M, Oláh A, Fábián A, Lakatos BK, Hizoh I, Ruppert M, Sayour AA, Barta BA, Kiss O, Sydó N, Csulak E, Ladányi Z, Merkely B, Kovács A, Radovits T. Novel insights into the athlete's heart: is myocardial work the new champion of systolic function? Eur Heart J Cardiovasc Imaging 2021; 23:188-197. [PMID: 34432004 PMCID: PMC8788018 DOI: 10.1093/ehjci/jeab162] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 01/09/2023] Open
Abstract
Aims We sought to investigate the correlation between speckle-tracking echocardiography (STE)-derived myocardial work (MW) and invasively measured contractility in a rat model of athlete's heart. We also assessed MW in elite athletes and explored its association with cardiopulmonary exercise test (CPET)-derived aerobic capacity. Methods and results Sixteen rats underwent a 12-week swim training program and were compared to controls (n = 16). STE was performed to assess global longitudinal strain (GLS), which was followed by invasive pressure-volume analysis to measure contractility [slope of end-systolic pressure–volume relationship (ESPVR)]. Global MW index (GMWI) was calculated from GLS curves and left ventricular (LV) pressure recordings. In the human investigations, 20 elite swimmers and 20 healthy sedentary controls were enrolled. GMWI was calculated through the simultaneous evaluation of GLS and non-invasively approximated LV pressure curves at rest. All subjects underwent CPET to determine peak oxygen uptake (VO2/kg). Exercised rats exhibited higher values of GLS, GMWI, and ESPVR than controls (−20.9 ± 1.7 vs. −17.6 ± 1.9%, 2745 ± 280 vs. 2119 ± 272 mmHg·%, 3.72 ± 0.72 vs. 2.61 ± 0.40 mmHg/μL, all PExercise < 0.001). GMWI correlated robustly with ESPVR (r = 0.764, P < 0.001). In humans, regular exercise training was associated with decreased GLS (−17.6 ± 1.5 vs. −18.8 ± 0.9%, PExercise = 0.002) but increased values of GMWI at rest (1899 ± 136 vs. 1755 ± 234 mmHg·%, PExercise = 0.025). GMWI exhibited a positive correlation with VO2/kg (r = 0.527, P < 0.001). Conclusions GMWI precisely reflected LV contractility in a rat model of exercise-induced LV hypertrophy and captured the supernormal systolic performance in human athletes even at rest. Our findings endorse the utilization of MW analysis in the evaluation of the athlete’s heart.
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Affiliation(s)
- Márton Tokodi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - István Hizoh
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest 1122, Hungary
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11
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Wang TKM, Grimm RA, Rodriguez LL, Collier P, Griffin BP, Popović ZB. Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: A meta-analysis. PLoS One 2021; 16:e0256547. [PMID: 34415965 PMCID: PMC8378693 DOI: 10.1371/journal.pone.0256547] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Right ventricular (RV) systolic strain has recently demonstrated prognostic value in various cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the mean and LLN of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and interventricular septal wall (IVSLS) longitudinal strains in healthy individuals and factors that affect strain measurements. METHODS In this meta-analysis, Pubmed, Embase and Cochrane databases were searched until 31 July 2020 for eligible studies reporting RVGLS, RVFWLS and/or IVSLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses. RESULTS From 788 articles screened, 45 eligible studies totaling 4439 healthy subjects were eligible for analysis. Pooled means and LLNs with 95% confidence intervals for 2D- RV strains were RVGLS -23.4% (-24.2%, -22.6%) and -16.4% (-17.3%, -15.5%) in 27 studies; RVFWLS -26.9% (-28.0%, -25.9%) and -18.0% (-19.2%, -16.9%) in 32 studies; and IVSLS -20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies, and similar results for 3D- RV strains. Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs. CONCLUSION We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Richard A. Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - L. Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Patrick Collier
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Brian P. Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zoran B. Popović
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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12
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Bidviene J, Muraru D, Kovacs A, Lakatos B, Ereminiene E, Liptai C, Vaskelyte JJ, Zaliunas R, Surkova E, Badano LP. Global and regional right ventricular mechanics in repaired tetralogy of Fallot with chronic severe pulmonary regurgitation: a three-dimensional echocardiography study. Cardiovasc Ultrasound 2021; 19:28. [PMID: 34362392 PMCID: PMC8349004 DOI: 10.1186/s12947-021-00260-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/20/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. Accordingly, we sought to assess the mechanics of the functional remodeling occurring in the RV of rToF with severe pulmonary regurgitation. METHODS We used three-dimensional transthoracic echocardiography (3DTE) to obtain RV data sets from 33 rToF patients and 30 age- and sex- matched controls. A 3D mesh model of the RV was generated, and RV global and regional longitudinal (LS) and circumferential (CS) strain components, and the relative contribution of longitudinal (LEF), radial (REF) and anteroposterior (AEF) wall motion to global RV ejection fraction (RVEF) were computed using the ReVISION method. RESULTS Corresponding to decreased global RVEF (45 ± 6% vs 55 ± 5%, p < 0.0001), rToF patients demonstrated lower absolute values of LEF (17 ± 4 vs 28 ± 4), REF (20 ± 5 vs 25 ± 4) and AEF (17 ± 5 vs 21 ± 4) than controls (p < 0.01). However, only the relative contribution of LEF to global RVEF (0.39 ± 0.09 vs 0.52 ± 0.05, p < 0.0001) was significantly decreased in rToF, whereas the contribution of REF (0.45 ± 0.08 vs 0.46 ± 0.04, p > 0.05) and AEF (0.38 ± 0.09 vs 0.39 ± 0.04, p > 0.05) to global RVEF was similar to controls. Accordingly, rToF patients showed lower 3D RV global LS (-16.94 ± 2.9 vs -23.22 ± 2.9, p < 0.0001) and CS (-19.79 ± 3.3 vs -22.81 ± 3.5, p < 0.01) than controls. However, looking at the regional RV deformation, the 3D CS was lower in rToF than in controls only in the basal RV free-wall segment (p < 0.01). 3D RV LS was reduced in all RV free-wall segments in rToF (p < 0.0001), but similar to controls in the septum (p > 0.05). CONCLUSIONS 3DTE allows a quantitative evaluation of the mechanics of global RVEF. In rToF with chronic volume overload, the relative contribution of the longitudinal shortening to global RVEF is affected more than either the radial or the anteroposterior components.
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Affiliation(s)
- Jurate Bidviene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania.
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Denisa Muraru
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Csilla Liptai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jolanta-Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
| | - Elena Surkova
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Luigi P Badano
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
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13
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Dawkins TG, Curry BA, Wright SP, Meah VL, Yousef Z, Eves ND, Shave RE, Stembridge M. Right Ventricular Function and Region-Specific Adaptation in Athletes Engaged in High-Dynamic Sports: A Meta-Analysis. Circ Cardiovasc Imaging 2021; 14:e012315. [PMID: 33993732 DOI: 10.1161/circimaging.120.012315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. METHODS A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S'), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI. RESULTS Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest (n=1043:1651; controls:athletes) and 8 studies during exercise (n=240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg [CI, 1.3-4.5 mmHg]; P=0.0005) and during exercise (11.0 [6.5-15.6 mm Hg]; P<0.0001) versus controls. Resting tricuspid annular plane systolic displacement (P<0.0001) and S' (P=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n=450:605), compared with controls but showed greater longitudinal apical strain (16 studies; n=455:669; 0.9%, 0.1%-1.8%; P=0.03) and lower basal strain (-2.5% [-1.4 to -3.5%]; P<0.0001). CONCLUSIONS Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete's heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete's heart.
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Affiliation(s)
- Tony G Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.)
| | - Bryony A Curry
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.).,Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Stephen P Wright
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Victoria L Meah
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada (V.L.M.).,Women and Children's Health Research Institute, University of Alberta, Canada (V.L.M.).,Alberta Diabetes Institute, University of Alberta, Canada (V.L.M.)
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (Z.Y.)
| | - Neil D Eves
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Rob E Shave
- Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, Canada (B.A.C., S.P.W., N.D.E., R.E.S.)
| | - Michael Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, United Kingdom (T.G.D., B.A.C., M.S.)
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14
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Fábián A, Lakatos BK, Tokodi M, Kiss AR, Sydó N, Csulak E, Kispál E, Babity M, Szűcs A, Kiss O, Merkely B, Kovács A. Geometrical remodeling of the mitral and tricuspid annuli in response to exercise training: a 3-D echocardiographic study in elite athletes. Am J Physiol Heart Circ Physiol 2021; 320:H1774-H1785. [PMID: 33666507 DOI: 10.1152/ajpheart.00877.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intense exercise exposes the heart to significant hemodynamic demands, resulting in adaptive changes in cardiac morphology and function. Nevertheless, the athletic adaptation of the atrioventricular valves remains to be elucidated. Our study aimed to characterize the geometry of mitral (MA) and tricuspid (TA) annuli in elite athletes using 3-D echocardiography. Thirty-four athletes presented with functional mitral regurgitation (FMR) were retrospectively identified and compared with 34 athletes without mitral regurgitation (MR) and 34 healthy, sedentary volunteers. 3-D echocardiographic datasets were used to quantify MA and TA geometry and leaflet tenting by dedicated softwares. MA and TA areas, as well as tenting volumes, were higher in athletes compared with controls. MA area was significantly higher in athletes with MR compared with those without (8.2 ± 1.0 vs. 7.2 ± 1.0 cm2/m2, P < 0.05). Interestingly, athletes with MR also presented with a significantly higher TA area (7.2 ± 1.1 vs. 6.5 ± 1.1 cm2/m2, P < 0.05). Nonplanar angle describing the MA's saddle shape was less obtuse in athletes without MR, whereas the values of athletes with MR were comparable with controls. The exercise-induced relative increases in left ventricular (35 ± 25%) and left atrial (40 ± 29%) volumes were similar; however, the increment in the MA area was disproportionately higher (63 ± 23%, overall P < 0.001). The relative increase in TA area (40 ± 23%) was also higher compared with the increment in right ventricular volume (34 ± 25%, P < 0.05). Atrioventricular annuli undergo a disproportionate remodeling in response to regular exercise. Athletic adaptation is characterized by both annular enlargement and increased leaflet tenting of both valves. There are differences in MA geometry in athletes presented with versus without FMR.NEW & NOTEWORTHY We have characterized the annular geometry of mitral and tricuspid valves in elite athletes using 3-D echocardiography. We have found that exercise-induced remodeling of the atrioventricular annuli comprises a disproportionate dilation of annular dimensions and increased leaflet tenting of both valves. Moreover, we have demonstrated a more pronounced saddle shape of the mitral annulus in athletes without mitral regurgitation, which was not present in those who had mild regurgitation.
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Affiliation(s)
- Alexandra Fábián
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | | | - Márton Tokodi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Anna Réka Kiss
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Nóra Sydó
- Semmelweis University Heart and Vascular Center, Budapest, Hungary.,Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Erika Kispál
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Máté Babity
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Andrea Szűcs
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Orsolya Kiss
- Semmelweis University Heart and Vascular Center, Budapest, Hungary.,Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary.,Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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15
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Tokodi M, Staub L, Budai Á, Lakatos BK, Csákvári M, Suhai FI, Szabó L, Fábián A, Vágó H, Tősér Z, Merkely B, Kovács A. Partitioning the Right Ventricle Into 15 Segments and Decomposing Its Motion Using 3D Echocardiography-Based Models: The Updated ReVISION Method. Front Cardiovasc Med 2021; 8:622118. [PMID: 33763458 PMCID: PMC7982839 DOI: 10.3389/fcvm.2021.622118] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022] Open
Abstract
Three main mechanisms contribute to global right ventricular (RV) function: longitudinal shortening, radial displacement of the RV free wall (bellows effect), and anteroposterior shortening (as a consequence of left ventricular contraction). Since the importance of these mechanisms may vary in different cardiac conditions, a technology being able to assess their relative influence on the global RV pump function could help to clarify the pathophysiology and the mechanical adaptation of the chamber. Previously, we have introduced our 3D echocardiography (3DE)-based solution-the Right VentrIcular Separate wall motIon quantificatiON (ReVISION) method-for the quantification of the relative contribution of the three aforementioned mechanisms to global RV ejection fraction (EF). Since then, our approach has been applied in several clinical scenarios, and its strengths have been demonstrated in the in-depth characterization of RV mechanical pattern and the prognostication of patients even in the face of maintained RV EF. Recently, various new features have been implemented in our software solution to enable the convenient, standardized, and more comprehensive analysis of RV function. Accordingly, in our current technical paper, we aim to provide a detailed description of the latest version of the ReVISION method with special regards to the volumetric partitioning of the RV and the calculation of longitudinal, circumferential, and area strains using 3DE datasets. We also report the results of the comparison between 3DE- and cardiac magnetic resonance imaging-derived RV parameters, where we found a robust agreement in our advanced 3D metrics between the two modalities. In conclusion, the ReVISION method may provide novel insights into global and also segmental RV function by defining parameters that are potentially more sensitive and predictive compared to conventional echocardiographic measurements in the context of different cardiac diseases.
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Affiliation(s)
- Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Ádám Budai
- Department of Automation and Applied Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | | | | | | | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Tősér
- Argus Cognitive, Inc., Lebanon, NH, United States
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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16
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Bidviene J, Muraru D, Maffessanti F, Ereminiene E, Kovács A, Lakatos B, Vaskelyte JJ, Zaliunas R, Surkova E, Parati G, Badano LP. Regional shape, global function and mechanics in right ventricular volume and pressure overload conditions: a three-dimensional echocardiography study. Int J Cardiovasc Imaging 2021; 37:1289-1299. [PMID: 33389362 PMCID: PMC8026459 DOI: 10.1007/s10554-020-02117-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
Our aim was to assess the regional right ventricular (RV) shape changes in pressure and volume overload conditions and their relations with RV function and mechanics. The end-diastolic and end-systolic RV endocardial surfaces were analyzed with three-dimensional echocardiography (3DE) in 33 patients with RV volume overload (rToF), 31 patients with RV pressure overload (PH), and 60 controls. The mean curvature of the RV inflow (RVIT) and outflow (RVOT) tracts, RV apex and body (both divided into free wall (FW) and septum) were measured. Zero curvature defined a flat surface, whereas positive or negative curvature indicated convexity or concavity, respectively. The longitudinal and radial RV wall motions were also obtained. rToF and PH patients had flatter FW (body and apex) and RVIT, more convex interventricular septum (body and apex) and RVOT than controls. rToF demonstrated a less bulging interventricular septum at end-systole than PH patients, resulting in a more convex shape of the RVFW (r = − 0.701, p < 0.0001), and worse RV longitudinal contraction (r = − 0.397, p = 0.02). PH patients showed flatter RVFW apex at end-systole compared to rToF (p < 0.01). In both groups, a flatter RVFW apex was associated with worse radial RV contraction (r = 0.362 in rToF, r = 0.482 in PH at end-diastole, and r = 0.555 in rToF, r = 0.379 in PH at end-systole, respectively). In PH group, the impairment of radial contraction was also related to flatter RVIT (r = 0.407) and more convex RVOT (r = − 0.525) at end-systole (p < 0.05). In conclusion, different loading conditions are associated to specific RV curvature changes, that are related to longitudinal and radial RV dysfunction.
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Affiliation(s)
- Jurate Bidviene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania. .,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Denisa Muraru
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | | | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jolanta-Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania.,Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania
| | - Elena Surkova
- Cardiac Division, Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Gianfranco Parati
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | - Luigi P Badano
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
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17
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Lakatos BK, Nabeshima Y, Tokodi M, Nagata Y, Tősér Z, Otani K, Kitano T, Fábián A, Ujvári A, Boros AM, Merkely B, Kovács A, Takeuchi M. Importance of Nonlongitudinal Motion Components in Right Ventricular Function: Three-Dimensional Echocardiographic Study in Healthy Volunteers. J Am Soc Echocardiogr 2020; 33:995-1005.e1. [PMID: 32620323 DOI: 10.1016/j.echo.2020.04.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Global right ventricular (RV) function is determined by the interplay of different motion components related to the myofiber architecture, and the relative importance of these components is still not thoroughly characterized. The aims of this study were to quantify the relative contributions of longitudinal, radial, and anteroposterior motion components to global RV function and to examine their determining factors in a large cohort of healthy volunteers using three-dimensional echocardiography. METHODS Three hundred healthy adults with a balanced age range and an equal sex distribution were investigated at two centers. A three-dimensional mesh model of the right ventricle was generated, and its motion was decomposed along the three anatomically relevant axes. Multiplicative relative contributions were measured by dividing the ejection fraction (EF) values generated by shortening in the longitudinal, radial, and anteroposterior directions by global RV EF (longitudinal EF index [LEFi], radial EF index [REFi], and anteroposterior EF index, respectively). The circumferential contribution was defined as shortening in the radial and anteroposterior directions, omitting only longitudinal shortening. RESULTS Circumferential EF index was markedly higher compared with LEFi (79 ± 7% vs 47 ± 9%, P < .001). LEFi (47 ± 9%) and anteroposterior EF index (49 ± 7%) were found to be similar in the pooled population, whereas REFi (44 ± 10%) was lower (P < .001). In younger individuals (20-39 years of age), the relative contribution of longitudinal shortening was significantly higher compared with the radial component; however, in the older age groups, LEFi and REFi were comparable. Age, body surface area, heart rate, and RV end-diastolic volume were independent predictors of LEFi and REFi, but all with opposite effects on the two motion directions. CONCLUSIONS In contrast to the traditional viewpoint, the contributions of the radial and anteroposterior motion directions may be of comparable significance with that of longitudinal shortening in determining global RV function. Standard parameters referring only to longitudinal shortening of the right ventricle may be inadequate to characterize RV function thoroughly.
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Affiliation(s)
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Márton Tokodi
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | | | - Kyoko Otani
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Tetsuji Kitano
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Alexandra Fábián
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Adrienn Ujvári
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Attila Kovács
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary.
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Kovács A, Lakatos B, Tokodi M, Merkely B. Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening. Heart Fail Rev 2020; 24:511-520. [PMID: 30852772 PMCID: PMC6559995 DOI: 10.1007/s10741-019-09778-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Right ventricular (RV) function has proven to be a prognostic factor in heart failure with reduced and preserved ejection fraction and in pulmonary hypertension. RV function is also a cornerstone in the management of novel clinical issues, such as mechanical circulatory support devices or grown-up congenital heart disease patients. Despite the notable amount of circumferentially oriented myofibers in the subepicardial layer of the RV myocardium, the non-longitudinal motion directions are often neglected in the everyday assessment of RV function by echocardiography. However, the complex RV contraction pattern incorporates different motion components along three anatomically relevant axes: longitudinal shortening with traction of the tricuspid annulus towards the apex, radial motion of free wall often referred as the “bellows effect”, and anteroposterior shortening of the chamber by stretching the free wall over the septum. Advanced echocardiographic techniques, such as speckle-tracking and 3D echocardiography allow an in-depth characterization of RV mechanical pattern, providing better understanding of RV systolic and diastolic function. In our current review, we summarize the existing knowledge regarding RV mechanical adaptation to pressure- and/or volume-overloaded states and also other physiologic or pathologic conditions.
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Affiliation(s)
- Attila Kovács
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary.
| | - Bálint Lakatos
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Városmajor St. 68, Budapest, H-1122, Hungary
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Tokodi M, Németh E, Lakatos BK, Kispál E, Tősér Z, Staub L, Rácz K, Soltész Á, Szigeti S, Varga T, Gál J, Merkely B, Kovács A. Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post-operative dysfunction? ESC Heart Fail 2020; 7:1246-1256. [PMID: 32220010 PMCID: PMC7261576 DOI: 10.1002/ehf2.12682] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 11/20/2022] Open
Abstract
Aims The PREPARE‐MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) sought to investigate the alterations of right ventricular (RV) contraction pattern in patients undergoing mitral valve replacement/repair (MVR) and to explore the associations between pre‐operative RV mechanics and early post‐operative RV dysfunction (RVD). Methods and results We prospectively enrolled 42 patients (63 ± 11 years, 69% men) undergoing open‐heart MVR. Transthoracic three‐dimensional (3D) echocardiography was performed pre‐operatively, at intensive care unit discharge, and 6 months after surgery. The 3D model of the RV was reconstructed, and RV ejection fraction (RVEF) was calculated. We decomposed the motion of the ventricle to compute longitudinal ejection fraction (LEF) and radial ejection fraction (REF). Pulmonary artery catheterization was performed to monitor RV stroke work index (RVSWi). RVEF was slightly decreased after MVR [52 (50–55) vs. 51 (46–54)%; P = 0.001], whereas RV contraction pattern changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic RV function [LEF/RVEF vs. REF/RVEF; 0.53 (0.47–0.58) vs. 0.33 (0.22–0.42); P < 0.001]. Post‐operatively, the radial motion became dominant [0.33 (0.28–0.43) vs. 0.46 (0.37–0.51); P = 0.004]. However, this shift was temporary as 6 months later the two components contributed equally to global RV function [0.44 (0.38–0.50) vs. 0.41 (0.36–0.49); P = 0.775]. Pre‐operative LEF was an independent predictor of post‐operative RVD defined as RVSWi < 300 mmHg⋅mL/m2 [OR = 1.33 (95% CI: 1.08–1.77), P < 0.05]. Conclusions MVR induces a significant shift in the RV mechanical pattern. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict post‐operative RVD.
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Affiliation(s)
- Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Endre Németh
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Bálint K Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Erika Kispál
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | - Kristóf Rácz
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Ádám Soltész
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Szabolcs Szigeti
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Tamás Varga
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Bootsma IT, Scheeren TWL, de Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. J Cardiothorac Vasc Anesth 2020; 34:2140-2147. [PMID: 32139346 DOI: 10.1053/j.jvca.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to identify whether the decrease of longitudinal parameters after cardiothoracic surgery (ie, tricuspid annular systolic plane excursion [TAPSE] and systolic excursion velocity [S']) is accompanied by a reduction in global right ventricular (RV) performance. DESIGN Prospective, observational study. SETTING Single-center explorative study in a tertiary teaching hospital. PARTICIPANTS The study comprised 20 patients who underwent aortic valve replacement with or without coronary artery bypass grafting. INTERVENTIONS During cardiac surgery, simultaneous measurements of RV function were performed with a pulmonary artery catheter and transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS TAPSE and S' were reduced significantly directly after surgery compared with the time before surgery (TAPSE from 20.8 [16.6-23.4] mm to 9.1 [5.6-15.5] mm; p < 0.001 and S' from 8.7 [7.9-10.7] cm/s to 7.2 [5.7-8.6] cm/s; p = 0.041). However, the reduction in TAPSE and S' was not accompanied by a reduction in RV performance, as assessed with the TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF). Both remained statistically unaltered before and after the procedure (MPI from 0.52 [0.43-0.58] to 0.50 [0.42-0.88]; p = 0.278 and RVEF from 27% [22%-32%] to 26% [22%-28%]; p = 0.294). CONCLUSIONS In the direct postoperative phase, the reduction of echocardiographic parameters of longitudinal RV contractility (TAPSE and S') were not accompanied by a reduction in global RV performance, expressed as MPI and RVEF. Solely relying on a single RV parameter as a marker for global RV performance may not be adequate to assess the complex adaptation of the right ventricle to aortic valve replacement.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Relationship between Cardiac Remodeling and Exercise Capacity in Elite Athletes: Incremental Value of Left Atrial Morphology and Function Assessed by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2020; 33:101-109.e1. [DOI: 10.1016/j.echo.2019.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/20/2022]
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