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PubMed1992

Assessment of right ventricular function. Role of nuclear imaging techniques.

Due to the complex geometry of the right ventricle, contrast angiography is not ideally suited for determining its volumes and for carrying out volume-based analyses. Nuclear cardiological techniques, being free from this limitation, have played an important role in understanding the right ventricular performance in various disease conditions. This technique is currently in clinical use and can be applied for assessing the role of right ventricular function in various cardiopulmonary diseases.

Heart↗
PubMed1994

[Echocardiography online quantification of left and right ventricular function by automatic boundary detection: reference values and reproducibility in healthy probands].

UNLABELLED: Automated border detection (ABD) is a new on-line technique that instantaneously calculates cavity areas from automatic tracking of the endocardial-blood interface with a modified ultrasonic integrated backscatter imaging system. After validation of this new method in comparison with off-line echocardiographic, Doppler- and angiographic analyses, we studied dynamic systolic and diastolic function of the left (LV) and right ventricle (RV) in 50 normal volunteers (31 +/- 9 years) in order to establish ranges of normality for the ABD-parameter. The averaged areas of the LV (apical chamber view) were 25.7 +/- 4.9 sq cm in end-diastole and 14.7 +/- 3.3 sq cm in end-systole, resulting in a fractional area change (FAC) of 43.2 +/- 4.8%. The peak filling (PFR) and peak ejection rate (PER) were 69.3 +/- 11.2 and -61.5 +/- 11.1 sq cm/s. Normalization for end-diastolic area (EDA) yielded 2.7 +/- 0.28 and -2.4 +/- 0.42 EDA/s. The areas of the RV (apical chamber view) were 17.1 +/- 3.8 sq cm in end-diastole and 9.0 +/- 2.0 sq cm in end-systole, resulting in a FAC of 47.3 +/- 9.2%. PFR and PER were 58.2 +/- 13.7 and -51.6 +/- 10.1 sq cm/s. Normalization for EDA yielded 3.4 +/- 0.74 and -2.9 +/- 0.62 EDA/s. The interobserver- and day-to-day-variability for all measured values was less than 10%. CONCLUSION: ABD permits reproducible on-line quantification of systolic and diastolic ventricular function and offers a non-invasive approach for longitudinal monitoring of cardiac patients.

Adult↗
PubMed2005

The relationship between blood pressure, pulse pressure and right ventricular function following an atrial switch procedure for complete transposition of the great arteries.

BACKGROUND: The pressure overload may be responsible for the failure of the systemic ventricle. No study so far has evaluated the association between arterial blood pressure values and right ventricular function in adults with atrially corrected complete transposition. METHODS: This was a retrospective analysis. The studied population consisted of 60 patients with complete transposition, 11.5+/-2.7 years after atrial switch procedure, divided into subgroups according to the severity of systemic ventricular dysfunction (right ventricular ejection fraction < or = 0.40 vs. > 0.40), and the severity of perfusion abnormalities in the radionuclide study (absent or mild vs. moderate-to-severe). RESULTS: All patients had blood pressure values (systolic 109.1+/-11.7 mm Hg and diastolic 72.3+/-9.7 mm Hg) within the normal range. Systolic blood pressure values correlated inversely with right ventricular ejection fraction (r = -0.450; p < 0.001). Compared to patients with systolic blood pressure below median values, patients with "elevated" blood pressure had lower right ventricular ejection fraction (32.6+/-6.3 vs. 38.9.+/-7.2; p < or = 0.002) and more significant perfusion abnormalities (1.5+/-1.0 vs. 2.9+/-1.5; p < or = 0.001). In a multivariate backward logistic regression model age at surgery and at the time of the study, systolic blood pressure at rest predicted impaired right ventricular ejection fraction (p < 0.02). Greater pulse pressure at peak exercise female sex were associated with greater more severe perfusion abnormalities (p < 0.01). CONCLUSIONS: There is a significant correlation between blood pressure values and indices of right ventricular dysfunction in patients who underwent an atrial switch procedure for complete transposition. Blood pressure values might be considered as a surrogate end point in these patients.

Adolescent↗
PubMed1991

Effect of controlled mechanical ventilation without positive end-expiratory pressure on right ventricular function after coronary artery bypass graft surgery.

To evaluate the changes in right ventricular function during controlled mechanical ventilation (CMV) without positive end-expiratory pressure (PEEP) and during spontaneous breathing, we compared right ventricular ejection fraction (RVEF), right ventricular end-diastolic volume index (RVEDVI), and right ventricular end-systolic volume index (RVEDVI) using a thermodilution technique after coronary artery bypass graft surgery. Patients were divided into two groups on the basis of changes in RVEDVI from CMV to spontaneous breathing: group U (n = 6) consisted of patients whose RVEDVI increased during spontaneous breathing compared with mechanical ventilation, group D (n = 3) consisted of patients whose RVEDVI decreased during spontaneous breathing compared with mechanical ventilation. PVRI values during CMV in group D were significantly larger than those in group U. Patients in group U showed no increase in RVEDVI, or decrease in RVEF during CMV without PEEP. However, the remaining 3 patients in group D showed an increase in RVEDVI and a decrease in RVEF during CMV. Mean PAP, RAP, RV systolic pressure, RV end-diastolic pressure, PWP, HR, and mean arterial pressure in both groups were comparable, and showed no significant difference at each of the measured points by 24 hrs postoperatively. Then, RVEF, RVEDVI and RVESVI measured by thermodilution technique is useful in evaluating ventricular function at bedside in ICU.

Journal Article↗
PubMed2005

Non-invasive assessment of right ventricular function in the late follow-up of the Senning procedure.

Deteriorating ventricular function is a major concern after the Senning operation. A Doppler-derived non-geometric measurement, the so-called myocardial performance index, has been described for use in adults and children. We aimed to assess the utility of this index as a method for quantification of right ventricular function in patients in the late follow-up of the Senning procedure, and to correlate the right ventricular ejection fraction and the first derivative of right ventricular pressure as derived using echocardiography with the ejection fraction determined using magnetic resonance imaging. We studied 44 patients within a mean postoperative period of 15.3 years. We calculated the right ventricular myocardial performance index by pulsed wave Doppler interrogation of tricuspid inflow and aortic outflow, the ejection fraction by Simpson's rule, and the first derivative of right ventricular pressure by continuous wave Doppler from tricuspid regurgitation. Mean values of right ventricular myocardial performance index, ejection fraction, and the first derivative of right ventricular pressure were 0.50, 39 percent and 1,398 millimetres of mercury per second, respectively. A cut-off value of 0.47 for the right ventricle myocardial performance index was determined, with a sensitivity of 75 percent and a specificity of 62.5 percent. We found no correlation between ejection fraction and the first derivative of right ventricular pressure as estimated by echocardiography and the ejection fraction as shown by magnetic resonance imaging (r2 equal to 0.29 and 0.04 respectively). We concluded, first, that patients with preserved right ventricular function had values for the right ventricular myocardial performance index lower than 0.47, and second, that ejection fraction and the first derivative of right ventricular pressure as determined echocardiographically did not correlate with values derived using magnetic resonance imaging.

Adolescent↗
PubMed1994

Effects of piroximone on the right ventricular function in severe heart failure patients.

OBJECTIVES: To assess the effects of piroximone, a phosphodiesterase inhibitor, on right ventricular function in patients with heart failure. DESIGN: Randomized study: patients were randomly assigned to the piroximone infusion rate of 5 or 10 micrograms/kg/min. SETTING: Cardiologic intensive care unit. PATIENTS: 12 consecutive patients with severe heart failure. INTERVENTIONS: Right heart catheterization was performed using a Swan-Ganz ejection fraction thermodilution catheter. MEASUREMENTS AND RESULTS: Measurements of right ventricular ejection fraction (RVEF), end-diastolic and end-systolic right ventricular volumes were obtained using the thermodilution principle. To determine contractility indexes, the relationships between end-systolic pulmonary arterial pressure (ESPAP) over right ventricular end-systolic volume (RVESV) and ESPAP over RVEF were calculated during the infusion of prostacyclin at incremental infusion rates of 2, 4, 6 and 8 ng/kg/min. The slope of the relation between ESPAP over RVESV shifted during piroximone therapy from 7.635 +/- 1.632 to 1.975 +/- 0.432 (p < 0.01) and from 6.092 +/- 1.99 to 1.028 +/- 0.853 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively. The slope of the relation between ESPAP over RVEF decreased from -0.414 +/- 0.296 to -0.821 +/- 0.257 (p < 0.01) and from -0.127 +/- 0.048 to - 0.533 +/- 0.135 (p < 0.05) at 5 and 10 micrograms/kg/min piroximone infusion, respectively. CONCLUSIONS: This study suggests a positive action of piroximone on right ventricular contractility at these 2 dosages. This approach using this type of catheter allowed us to determine right ventricular inotropic indexes.

Adult↗
PubMed1996

Pulmonary blood flow profiles with reduced right ventricular function in lambs.

The determinants of right ventricular (RV) performance with damaged RV free wall, such as occurs with RV infarction, are still unclear. Using 20-MHz Doppler ultrasound equipment, we investigated the changes in pulmonary blood flow velocity profiles before and after ligation of the right coronary artery. RV dp/dt, stroke volume, RV stroke work, aortic pressure and cardiac output decreased and central venous pressure rose after the ligation. The RV stroke work-end-diastolic pressure relationship indicated impaired RV function following ligation. We observed shortened acceleration time (65.0 +/- 15.1 vs 54.4 +/- 6.2 ms, P < 0.05) and reduced maximum velocity of forward flow (59.0 +/- 5.9 vs 52.5 +/- 7.6 cm/s, P < 0.05) after the ligation. Acceleration was interrupted earlier after ligation than before ligation. These alterations in flow are thought to be a consequence of the altered movement of the RV free wall and ventricular septum induced by RV infarction.

Animals↗
PubMed1986

Right ventricular function in acute myocardial ischaemia.

A haemodynamic examination of 10 dogs was carried out at rest, during volume loading and after ligation of the right coronary artery in the presence of a closed pericardium. Ligation of the right coronary artery led to haemodynamic signs of depression of right ventricular function--a drop in systolic pressure and an increase in end diastolic pressure, together with a shift of the functional curve to the right and downwards. Overall performance of the heart (cardiac output and the mean systemic pressure, also fell. Our results show that the depression of the systolic function of the myocardium in the presence of right ventricular infarction can be an important factor in the genesis of low cardiac output syndrome observed in clinical situations. Its pathophysiological mechanisms and some of the clinical consequences are discussed.

Acute Disease↗
PubMed1991

Right ventricular diastolic function after experimental right ventricular infarction: effects independent of the pericardium.

To determine if an isolated right ventricular wall infarct (RVI) alters right ventricular diastolic function (RVDF), 6 mongrel dogs were studied before and after a right ventricular wall infarct was produced by ligating the right coronary artery and embolizing the distal right coronary artery with mercury. Right ventricular diastolic function was assessed by prior instrumentation of the animals with an RV Millar catheter and segment length crystals attached to the infarct (I) and non-infarct (NI) territory of the right ventricle. The time constant of RV isovolumic relaxation (Tau) was assessed by fitting right ventricular pressure decline after minimum dp/dt to the equation 1nP = At + B, where A represents the slope of the relationship, a negative number, tau = -1/A. The right ventricular diastolic pressure segment length relationship (RVD PSR) was analyzed using a multiple linear regression model whereby the independent effects of heart rate, segment length, and right ventricular wall infarct could be assessed. Right ventricular wall infarct reduced stroke volume to 63% of baseline values largely by increases in RV-I end-systolic segment length. Tau was significantly prolonged. However, there was no significant upward shift in RVDPSR in any animal. These data suggest that in this model RV diastolic relaxation is impaired. However, the degree of this impairment is not significant enough to shift the right ventricular diastolic pressure segment length relationship, as long as the pericardium remains open.

Animals↗
PubMed1989

Differential effects of triiodothyronine on rat left and right ventricular function and the influence of metoprolol.

The influence of triiodothyronine (T3) on right ventricular functional parameters was tested and compared to the alterations induced in the left ventricle. Female Sprague-Dawley rats received daily injections of T3 (0.2 mg/kg s.c.) for 3 days and a constant i.v. infusion of 0.9% NaCl or the beta 1-receptor blocker metoprolol (1 mg/kg/h). The hyperthyroid state after 3 days administration of T3 was characterized by an increase in heart rate and cardiac output and a decrease in the systemic peripheral resistance. However, pulmonary vascular resistance was unchanged. Beta-Receptor blockade reduced heart rate to the control level without affecting the elevation in cardiac output. The T3 group showed a marked increase in right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure, whereas left ventricular systolic pressure (LVSP) and mean aortic pressure were not significantly changed. Metoprolol had no effect on LVSP, and attenuated the increase in RVSP. Furthermore, T3 induced a considerable increase in dP/dtmax in both ventricles, which was reduced nearly to control level by concomitant metoprolol infusion. The T3-induced percentage weight gain of the right ventricular free wall (RV) was more pronounced than that of the left ventricle (LV) as indicated by the significant increase in the RV/LV weight and the RNA/DNA ratios. Metoprolol did not affect significantly the T3-induced left and right ventricular hypertrophy, but attenuated slightly the elevated RV/LV weight ratio. Our results indicate a different action of T3 on systemic and pulmonary circulation.

Animals↗
PubMed1991

[Right ventricular function before and 6 months after aortocoronary bypass. A radioisotope angiographic study].

The aim of the present paper is the study of the changes induced on right ventricular function after myocardial revascularization with aortocoronary bypass graft. Two-three days before and 6 months after operation gated radionuclide ventriculography has been performed in 25 patients with previous myocardial infarction (MI), anterior in 16 patients and inferior in 9. At postoperative examination, right ventricular ejection fraction (EF) was slightly but significantly reduced (p less than 0.01), while peak ejection and filling rates were unchanged. Symmetric parameters of left ventricular function did not show changes at post-operative control, except a clear-cut rise of left ventricular peak filling rate (p less than 0.05). Before operation, in patients with previous anterior MI, left ventricular EF was slightly less and right ventricular EF slightly more than in patients with previous inferior MI; after operation right ventricular EF significantly decreased (p less than 0.01) only in patients with previous anterior MI. No correlation has been demonstrated in pre- postoperative changes of the observed parameters, neither between the two groups of previous MI nor between right and left ventricular cavity. Six months after myocardial revascularization, left ventricular performance, as examined with radionuclide angiography, was practically unchanged except for improvement of diastolic function, while right ventricular performance was moderately impaired, more in patients with previous anterior MI than in those with previous inferior MI.

Adult↗
PubMed2001

[Left and right ventricular function in acromegalic patients].

Recent studies have proved close relations between cardiovascular and endocrinic systems. This relation has been observed in acromegaly, the disease connected with unrestrained secretion of growth hormone. The aim of the study was to assess Holter monitoring and echocardiography of acromegalic patients. The study group consisted of 28 acromegalic patients, including 15 patients with hypertension, was considered. As control groups we examined 20 patients with essential hypertension and 20 normotensive healthy subjects: All subjects underwent twenty-four hour Holter recordings, complete M-mode, two-dimentional and spectral Doppler echocardiography. Ventricular premature complexes occurred in 65% of acromegalic patients. Frequency and severity of ectopic beats were significantly increased compared to control groups. Left ventricular ejection fraction was considered to be normal, although significant decreased compared to healthy subjects. Left ventricular mass was above normal value in acromegalic patients--no significant difference was found between hypertensive and normotensive acromegalics. Doppler examination has shown the abnormalities of left and right ventricular filling in 89% of acromegalics. We have observed the correlations between left and right ventricular filling indices and the duration of the disease, and left ventricular mass. Left ventricular hypertrophy frequently occurs in acromegalic patients and this is not simply secondary to systemic hypertension. The prevalence of ventricular arrhythmias in acromegalic patients seems to be associated with left ventricular hypertrophy. Doppler examination suggests impaired left and right diastolic filling in patients with acromegaly.

Acromegaly↗
PubMed1996

Transthoracic echocardiography for right ventricular function late after the Mustard operation.

The aim of the study was to assess echocardiographic measurements of right ventricular function in 24 patients aged 10.7 to 28.9 years (mean 18.9 years) receiving the Mustard baffle repair for transposition of the great arteries. Right ventricular ejection fraction (RVEF) from single-plane areas and area length volumes, pulsed Doppler mean aortic acceleration, and tricuspid annular plane systolic excursion were correlated with first-pass radionuclide RVEF. The mean radionuclide RVEF was 39%, the mean echocardiographic apical four-chamber RVEF was 41%, and the mean short-axis RVEF was 37%. Echocardiographic apical four-chamber right ventricular end-diastolic volumes were 102 +/- 24 ml/m2, and RVEF interobserver and intraobserver correlation coefficients were 0.73 and 0.81, respectively. Radionuclide and echocardiographic RVEF correlation coefficients were short axis, 0.40; apical four-chamber, 0.24; average four-chamber and short axis, 0.38; mean aortic acceleration, 0.26; and tricuspid annular plane systolic excursion, 0.06. The range of echocardiographic right ventricular volumes for young adults receiving the Mustard repair is established allowing serial observation of dilatation. However, simple and reliable echocardiographic prediction of RVEF remains elusive in this age group.

Adolescent↗
PubMed1996

[Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy].

The aim of the study was the estimation of the right ventricular function in patients with hypertrophic cardiomyopathy (HC). 20 patients, 14 men and 6 women of age 23-50 with echocardiography diagnosed hypertrophic cardiomyopathy were examined. Equilibrium gated radionuclide angiography was performed in all patients. Right and left ventricle ejection fraction (EF), 1/3 first ejection fraction (1/3EF), maximal and average rate of emptying (MER, AER), time to peak emptying (TTPE), 1/3 first filling fraction (1/3FF), maximal and average rate of filling (MFR, AFR), time to peak filling (TTPF) and MFR/MER ratio were calculated. Analysing function of right ventricle in patients with HC impaired diastolic function was observed. MFR was 1.44 +/- 0.54EDV/s,AFR-0.95 +/- 0.24EDV/s, 1/3 FF-0.49 +/- 0.09. Positive correlation between right and left ventricle MFR was found (r = 0.62; p < 0.01). Mean value of RVEF was 40.8 +/- 7%, 1/3EF-17.5 +/- 5%, MER-1.88 +/- 0.4EDV/s, AER-1.59 +/- 0.4EDV/s. Decreased ejection fractions of the right ventricle in patients with the thickest interventricular septum were observed. Mean value of the time to peak emptying was short (x = 68.6 ms). Regional ejection fractions from septum region of RV were decreased. It was the result of the abnormal function of the interventricular septum in patients with hypertrophic cardiomyopathy. Indexes of RV function in the two groups of patients were also analysed: with and without left ventricular outflow tract obstruction. Mean value of RV systolic and diastolic function indexes were similar in two groups of patients. In conclusion, impairment of the right ventricle diastolic function in patients with hypertrophic cardiomyopathy is predominated. The more diastolic function of the RV deteriorates the worse diastolic function of the left ventricle remains in patients with HC.

Adult↗
PubMed2006

[Quantification of right ventricular function in congenital heart disease: correlation of 3D echocardiography and MRI as complementary methods].

PURPOSE: In congenital heart disease, the exact determination of the right ventricular function is of high importance for therapeutic and especially surgical planning. The aim of this study was to correlate the parameters of the right ventricular function in MRI and 3D echocardiography to determine the agreement of both modalities. MATERIALS AND METHODS: In 18 patients suffering from congenital heart disease, 3D echocardiography was performed using a Philips Sonos 7500 system. In MRI short axis slices with a 4-mm distance were acquired using an SSFP sequence on a Siemens Sonata or Symphony System. Volumetry for both modalities was performed on an external workstation (Tomtec) using the EchoView software. RESULTS: Enddiastolic and endsystolic volumes showed a highly significant correlation with coefficients of 0.996 and 0.990, respectively. In echocardiography there was a systematic slight underestimation of enddiastolic volumes and overestimation of endsystolic volumes. The Wilcoxon test did not show significant differences between the volumes and ejection fractions assessed by both modalities. CONCLUSION: There is an excellent correlation in the quantification of right ventricular volumes in MRI and 3D echocardiography, which allows a comparison of acquired volumes in clinical follow-up.

Adolescent↗
PubMed2002

Celsior solution provides superior post-ischemic right ventricular function as compared with UW solution in a porcine heart transplantation model.

BACKGROUND: Use of the new cardioprotective Celsior solution has been suggested for organ preservation in cardiac transplantation, but selective data for right ventricular function, of special interest in the clinical setting, have not been evaluated. METHODS: Celsior solution was compared with the clinical standard University of Wisconsin solution (UW) in a porcine allogenic heart transplantation model with accurate isovolumic measurement of right ventricular (RV) function. RESULTS: Maximum RV developed pressures were significantly different between Celsior and UW groups (51.1 +/- 9.6 mm Hg vs 42.2 +/- 15.4 mm Hg after 1 hour, respectively, and 55.6 +/- 7.8 mm Hg vs 45.1 +/- 16.2 mm Hg after 2 hours, respectively; p = 0.02, 2-way analysis of variance). CONCLUSIONS: Celsior significantly improves post-ischemic right ventricular function when compared with UW solution in an experimental heart transplantation model.

Adenosine↗
PubMed1988

Influence of verapamil and oxygen on pulmonary hypertension and right ventricular function.

The study was designed to elucidate verapamil action on the pulmonary vascular bed and right ventricular function and to compare it with the effect of oxygen in view of the fact that calcium antagonists can attenuate hypoxic pulmonary vasoconstriction. 16 patients with secondary, and 4 with primary, pulmonary hypertension and with a mean pulmonary artery systolic pressure of 68.6 +/- 28.7 mmHg were examined. After determination of initial haemodynamic values, the oxygen test (OT) was performed; later on, when the values returned to the initial ones, verapamil was infused into pulmonary artery. Measurements were carried out in the 10th min of OT and until the 30th min after verapamil. While verapamil decreased statistically significantly pulmonary artery pressures and resistances, it did not deteriorate right ventricular systolic function, although it lowered its stiffness significantly. The effect of oxygen was comparable with that of verapamil though the magnitude of changes was smaller.

Humans↗
PubMed1998

Assessment of right ventricular function postretrograde cardioplegia by transesophageal echocardiography.

UNLABELLED: The impact of continuous retrograde cardioplegia (RCP) on right ventricular (RV) function was evaluated prospectively with intraoperative transesophageal echocardiography (TEE) in 36 patients (23 males, 13 females) with a mean age of 60.4 years (ages 24-82). Operative procedures included 12 aortic valve replacements, 16 mitral valve repair/replacements, both with or without an associated cardiac operation, and 8 Ross procedures. Mean cardiopulmonary bypass (CPB) time was 123.3 minutes (66-280 minutes) with an average cross-clamp time of 88.9 minutes (43-199 minutes). The amount of cold blood RCP ranged from 3160-18,500 mL (mean = 7382.5), and the average pulmonary artery pressure was 35/18 mmHg. The coronary sinus was distally snared in 11 patients. TEE documented biventricular global dysfunction in two patients and post-CPB with preservation of the left ventricular function in all other patients. Localized akinesis of the RV apex and outflow tract were noted in three patients, and isolated worsening tricuspid insufficiency of moderate to severe intensity in six patients. Two of the six patients with worsening tricuspid insufficiency belonged to the snared coronary sinus group (11 patients). All of the documented RV dysfunctions were new and showed no correlation with the perfusion data. IN CONCLUSION: (1) RV apex, RV outflow tract and tricuspid valve were particularly subject to important dysfunction post-RCP; (2) RCP did not protect RV adequately in 11 patients (31%); and (3) TEE is a convenient intraoperative technique in evaluating RV dysfunction.

Cardiac Surgical Procedures↗