Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension
Ana Rita AlmeidaMaria Jose Ze LoureiroLiliana LopesCarlos CotrimLuís Felipe Dias LopesDébora RepolhoHélder Pereira
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Abstract:
Right ventricular function is a major determinant of prognosis in pulmonary hypertension. The aim of this study was to assess and compare right ventricular contractile reserve in healthy subjects (controls) and in subjects with pulmonary hypertension (cases). In this prospective study of seven cases and seven controls undergoing treadmill stress echocardiography, right ventricular S-wave velocity, tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and stroke volume index were assessed at rest and with exercise. The increase in each parameter between rest and exercise for cases and controls was analyzed and the magnitude of change in each parameter with exercise between cases and controls was compared. A significant increase in S-wave velocity was observed in cases (rest: 9.4±3.1; exercise: 13.7±4.8 cm/s [p<0.05]). In controls there was a statistically significant increase in S-wave velocity (12.9±2.3 to 23.0±7.2 cm/s [p<0.005]), TAPSE (25.7±2.4 to 31.0±3.5 mm [p<0.05]) and RVFAC (53.8±14.7% to 64.4±9.9% [p<0.005]). The magnitude of change in S-wave velocity (cases: 4.3±3.3; controls: 10.1±5.5 cm/s [p<0.05]), TAPSE (cases: 0.6±2.5; controls: 5.3±3.8 mm [p<0.05]) and RVFAC (cases: −0.4±11.8; controls: 10.6±5.9% [p<0.05]) was significantly different between cases and controls. S-wave velocity, TAPSE and RVFAC increased significantly with exercise in controls. S-wave velocity was the only parameter that showed a significant increase in cases, although the magnitude of this increase was significantly less than in controls. A função ventricular direita é um determinante major do prognóstico na hipertensão pulmonar. Caracterização e comparação da reserva contrátil do ventrículo direito em indivíduos saudáveis (controlos) e doentes com hipertensão pulmonar (casos). Estudo prospetivo de sete casos e sete controlos submetidos a ecocardiograma de esforço. Avaliámos, em repouso e no esforço, a velocidade da onda S ventricular direita, a excursão sistólica do plano anular tricúspide, a área de encurtamento fracional do ventrículo direito e o volume sistólico indexado. Analisámos o aumento de cada parâmetro entre repouso e esforço para casos e controlos e comparámos a magnitude de variação com o exercício de cada parâmetro entre casos e controlos. Nos casos observámos aumento significativo da onda S (repouso 9,4 ± 3,1; esforço 13,7 ± 4,8 cm/seg [p < 0,05]). Nos controlos ocorreu aumento significativo da onda S (repouso 12,9 ± 2,3; esforço 23,0 ± 7,2 cm/seg [p < 0,005]), da excursão sistólica do plano anular tricúspide (repouso 25,7 ± 2,4; esforço 31,0 ± 3,5 mm [p < 0,05]) e da área de encurtamento fracional (repouso 53,8 ± 14,7%; esforço 64,4 ± 9,9% [p < 0,005]). A magnitude de variação da onda S (casos 4,3 ± 3,3; controlos 10,1 ± 5,5 cm/seg [p < 0,05]), da excursão sistólica do plano anular tricúspide (casos 0,6 ± 2,5; controlos 5,3 ± 3,8 mm [p < 0,05]) e da a área de encurtamento fraccional (casos 0,4 ± 11,8; controlos 10,6 ± 5,9% [p < 0,05]) foi significativamente diferente entre casos e controlos. A onda S, a excursão sistólica do plano anular tricúspide e a área de encurtamento fracional aumentaram significativamente com o esforço nos controlos. A onda S foi o único parâmetro que aumentou significativamente nos casos, embora a magnitude desse aumento seja significativamente menor do que nos controlos.Keywords:
Ventricular Function
Right heart
Ventricular Function
Ventricular pacing
Right heart
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As the special structure of right ventricular,anaccurate measurement of right heart function has always been a problem.Ultrasound cardiogram(UCG) is the most convenient and effective method of assessment of the right heart morphology,blood flow and function.Three-dimensional ultrasonography has its own unique advantage on right ventricular volume and ejection fraction(EF).MRI and CT may be good choices to measure right ventricular volume and EF.Some biochemical markers may also play roles in assessment of right heart.
Ventricular Function
Right heart
Ventricular volume
Left and right
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Ventricular Function
Right heart
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The right ventricular function is an independent prognostic indicator of morbidity and mortality in patients with right heart diseases such as right heart failure and pulmonary hypertension and so on,so exacting evaluation of the right ventricular function has becoming an inevitable clinic problem.The 3-dimensional echocardiography(3DE)leads to a better evaluation of the right heart function.The application progresses of 3DE for evaluation on right heart function were reviewed in this article.
Right heart
Ventricular Function
Right heart failure
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Ventricular Function
Right heart
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Objective To evaluate the right ventricular function of congenital heart disease with left to right shunt by Tei index which were measured by tissue Doppler imaging.Methods 60 patients with CHD were divided into two groups,while 35 patients with pulmonary hypertension in group A and 25 patients with no pulmonary hypertension in group B.There were 33 healthy volunteers in healthy control group.RV Tei index was measured by tissue Doppler imaging to analyze the differences of the Tei indexes among all the three groups.Results The right ventricular Tei index in group A was significantly higher than those in the controls and group B(P0.05).The difference of Tei index between the group B and the controls was not significant(P0.05).There was better correlation between the Tei index and the pulmonary hypertension(P0.01).Conclusion The right ventricular function of CHD with left to right shunt and pulmonary hypertension decreases in various extent.The right ventricular Tei index measured by tissue Doppler imaging can be used to estimate the right ventricular global function comprehensively and exactly.
Ventricular Function
Right heart
Doppler imaging
Tissue Doppler echocardiography
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Objective: In patients with repaired tetralogy of Fallot, to assess the value of new parameters derived from nonconventional echocardiography in reflecting the right ventricular insufficiency status determined by N-terminal pro-B-type natriuretic peptide (NT-pro BNP).
Ventricular Function
Right heart
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Subclinical infection
Right heart failure
Right heart
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Background: We performed clinical studies to assess the significance of right ventricular (RV) regional strain of a novel 3D-speckle tracking imaging (STE) system in determining the RV ejection fra...
Ventricular Function
Right heart
Right ventricular failure
Strain (injury)
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