PubMed · 9922343
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M Y Henein, D G Gibson. 1999. Normal long axis function.. https://doi.org/10.1136/hrt.81.2.111
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Pulsus alternans is usually found in patients with reduced systolic ventricular function. We describe a patient with shortness of breath, hypertension, and left ventricular hypertrophy, but with normal left and right systolic function. Pulsus alternans was demonstrated in the pulmonary wedge position, pulmonary artery, and right ventricle, but not in the aorta or left ventricle. Cathet. Cardiovasc. Intervent. 47:336-339, 1999.
BACKGROUND: Left (LV) and right (RV) ventricular diastolic dysfunction is common in heart failure but the prognostic value of RV diastolic dysfunction is not known. HYPOTHESIS: As a follow-up to a previously undertaken study, this study was carried out to investigate whether LV and RV diastolic dysfunction affect prognosis differently and, in addition, whether changes in diastolic filling patterns over time correlate with clinical outcome. METHODS: We studied a cohort of 105 patients (mean age 62.7 +/- 1.3 years, 66% male) with heart failure (ejection fraction < 50%) by Doppler echocardiography in both RV and LV. RESULTS: An LV restrictive filling pattern (RFP) was present in 48% of the patients and, when compared with non-RFP subgroups, it was associated with poorer systolic function, higher New York Heart Association functional class, and higher cardiac mortality at 1 year (all p < 0.001). The coexistence of an LV-RFP and poor LV systolic function (ejection fraction < 25%) markedly decreased the 1-year survival that was significant when compared with other subgroups (p = 0.001). In contrast, RV diastolic dysfunction that occurred in 21% of patients was not a prognostic factor for mortality either alone or in combination with LV diastolic dysfunction, but predicted nonfatal hospital admissions for heart failure or unstable angina (p = 0.016). CONCLUSION: An LV restrictive filling pattern is a powerful predictor of a poor prognosis, especially when combined with low ejection fraction, but in this study RV diastolic dysfunction did not appear to be an independent predictor of subsequent mortality.
BACKGROUND/AIMS: Determination of the pulsatility index by means of duplex sonography provides the opportunity to evaluate the vascular resistance of the hepatic artery noninvasively. The aim of this study was to investigate the relationship between the hepatic arterial pulsatility index and the hepatic venous pressure gradient in cirrhosis. METHODS: In 50 patients with cirrhosis, hepatic venous pressure gradient was determined in the fasting state. Immediately thereafter, hepatic arterial pulsatility index and portal blood flow velocity were measured by duplex sonography with no knowledge of hepatic venous pressure values. In addition, the duplex parameters were determined in 20 controls. RESULTS: Hepatic arterial pulsatility index was significantly higher in patients with cirrhosis than in controls (0.92+/-0.1 vs. 1.14+/-0.18; p<0.001) and directly correlated with the hepatic venous pressure gradient (r = 0.7; p<0.001). Furthermore, weak correlations were found between hepatic arterial pulsatility index and Child-Pugh score (r = 0.49; p<0.01) and between portal blood flow velocity and hepatic venous pressure gradient (r = -0.48; p<0.01). CONCLUSION: In cirrhosis the hepatic arterial vascular resistance seems to increase parallel to the rise of the portal pressure. Therefore, duplex sonographic determination of the hepatic arterial pulsatility index may contribute to the noninvasive evaluation of portal hypertension.