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PubMed1991

Evaluation of right ventricular function using gated equilibrium blood pool radionuclide ventriculography in patients with congenital volume and pressure overload late after surgical repair.

The effects of congenital right ventricular pressure and volume overload were studied in 3 patients with pulmonary stenosis, 7 with atrial septal defect and 6 with atrial septal defect plus pulmonary stenosis late after successful surgical correction. Gated equilibrium blood pool radionuclide ventriculography was used to measure right ventricular function at rest and during exercise and to compare it with eight normal subjects. Right ventricular ejection fractions at rest and during exercise were measured to be 61 +/- 9% and 66 +/- 13%, respectively, in the group with pulmonary stenosis, 49 +/- 7% and 54 +/- 8% in the group with atrial septal defect, and 65 +/- 13% and 69 +/- 13% in the group with atrial septal defect plus pulmonary stenosis. The values in the groups with pulmonary stenosis and atrial septal defect plus pulmonary stenosis were significantly higher than the control subjects (45 +/- 5% and 51 +/- 5%, p less than 0.01). The peak filling rate at rest and during exercise was also significantly higher in the groups with pulmonary stenosis and atrial septal defect plus pulmonary stenosis than in controls (at rest, 2.72 +/- 0.72, 2.53 +/- 0.94 vs. 1.64 +/- 0.24 p less than 0.05; during exercise, 4.38 +/- 1.23, 4.13 +/- 1.18 vs. 2.52 +/- 0.62, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Assessment of right ventricular function and interstitial fibrosis in idiopathic dilated cardiomyopathy: hemodynamic correlates and prognostic value.

BACKGROUND: Right ventricular (RV) function and morphometric quantitation of interstitial fibrosis in idiopathic dilated cardiomyopathy (IDC) have not been the subject of specifically designed clinical observations. In particular, their role in routine assessment and prognostic evaluation of patients (pts) with IDC remains to be settled. METHODS: Eighty-one consecutive IDC patients (63 M, 18 F; mean age 52 +/- 11 yrs) with left ventricular (LV) systolic dysfunction (angiographic ejection fraction - EF - < 55%), normal coronary arteries and no histologic evidence of myocarditis were studied. Cardiac catheterization and endomyocardial biopsy (EMB) were routinely performed in all cases. RV volumes and EF were obtained by angiography according to Ferlinz' method and interstitial fibrosis was quantitated by computer-assisted morphometric analysis. These data were analyzed in order to study correlations with hemodynamic parameters and to assess their prognostic value in a long-term follow-up. RESULTS: In the study population, right ventricular EF was significantly lower than in normal controls (35 +/- 11% vs 53 +/- 6%, p < 0.0001) and showed a significant positive correlation with LV EF (r = 0.54; p < 0.0001), and a weak but significant negative correlation with fibrosis (r = -0.29; p = 0.03). RV volumes, but not EF, were significantly related to mean pulmonary pressure. At multivariate analysis, RV end-diastolic volume (EDV) and EF were the two independent predictors of severe heart failure (NYHA class III-IV). After a mean follow-up of 64 +/- 36 months, 20 pts died and 9 had heart transplantation, for a 63% transplant-free survival rate (TFS). Multivariate analysis identified three independent predictors of TFS: LV stroke work index (p < 0.0001), RV stroke work index (p = 0.02) and RV EDV (p = 0.03). Fibrosis was predictive of survival only in the subgroup with LV EF < 20%. CONCLUSIONS: Assessment of RV function provides useful information in the evaluation of hemodynamic profile and prognosis of pts with IDC. Quantitation of interstitial fibrosis by morphometry provides little additional data.

Adult↗
PubMed1993

Evaluation of left and right ventricular function by transesophageal echocardiography.

Transesophageal echocardiography, especially in the emerging generation of biplane and multiplane probes with the availability of continuous wave Doppler, has increased our capability for evaluating intracardiac hemodynamics and ventricular function. Transesophageal studies have expanded their role both in clinical research and routine monitoring. The available hemodynamic data (assessment of left and right ventricular function, estimation of left atrial and pulmonary artery pressures, evaluation of the hypotensive patient) apply not only to patients monitored in the operating room but also to patients in the critical care and ambulatory setting. These data can be combined with the anatomic pathology to provide bedside diagnoses and often facilitate appropriate therapy. Further improvements in the quality of both images and computer software are likely to allow more detailed studies of subtle changes in cardiac function in humans.

Blood Pressure↗
PubMed2003

Effects of levosimendan on right ventricular function and ventriculovascular coupling in open chest pigs.

OBJECTIVE: Levosimendan is a promising calcium sensitizer that potentially could be useful in settings of pulmonary vasoconstriction and right ventricular dysfunction. There is a shortage of information concerning its effects on right ventricular function and ventriculovascular coupling. The aim of the present study was to characterize the effects of levosimendan on right ventricular and pulmonary vascular function by means of pressure-volume and pulsatile flow analysis. DESIGN: Prospective laboratory investigation. SETTING: University hospital laboratory. SUBJECTS: Eight landrace pigs (mean weight, 37 kg). INTERVENTIONS: Following instrumentation with biventricular conductance catheters, pulmonary and right coronary artery flow probes, a high-fidelity pulmonary pressure catheter, and a right coronary venous catheter, hemodynamic measurements were performed in baseline conditions and during levosimendan infusion at three increasing plasma concentrations (mean values, 27.5, 67.6, and 142.5 ng/mL). MEASUREMENTS AND MAIN RESULTS: Levosimendan increased heart rate and cardiac output, reduced systemic vascular resistance, and had a positive inotropic effect on the left ventricle and increased left ventricular mechanical efficiency. Moreover, levosimendan increased right ventricular contractility and hydraulic power. However, total pulmonary vascular resistance and characteristic impedance did not change throughout the protocol, and right ventricular mechanical efficiency decreased slightly at the highest concentration of levosimendan. CONCLUSIONS: At clinical concentrations in the present model, levosimendan increases right ventricular contractility and performance without significantly influencing pulmonary vascular tone. Further studies are required in a model of pulmonary vasoconstriction to disclose possible pulmonary vasodilator effects of levosimendan.

Animals↗
PubMed1996

Pulmonary vascular resistance and right ventricular function in morbid obesity in relation to gastric bypass surgery.

STUDY OBJECTIVE: To investigate right ventricular function (RVF) during gastric bypass surgery in morbidly obese patients. To study the influence of obstructive sleep apnea syndrome on hemodynamics and RVF as a preoperative evaluation in morbidly obese patients. DESIGN: Prospective study. SETTING: Surgical patients at a university hospital. PATIENTS: 14 morbidly obese patients undergoing gastric bypass surgery. INTERVENTIONS: Hemodynamic changes and RVF were investigated using a thermodilution ejection fraction volumetric catheter and the REF-1 computer. MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters and RVF were measured: (1) before induction of anesthesia, awake, (2) after induction of anesthesia, (3) after opening the abdomen, and (4) after closing the abdomen. Esophageal pressure was measured in the midesophagus after induction of anesthesia with a camino catheter and its device. Morbidly obese patients with obstructive sleep apnea syndrome had significantly lower PaO2, higher PaCO2, and higher pulmonary artery (PA) pressure and pulmonary vascular resistance (PVR) compared with patients without sleep apnea (p < 0.05). However, there were no significant differences in heart rate, mean blood pressure, pulmonary capillary wedge pressure (PCWP), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume. During gastric bypass procedure, PA pressure, PCWP, and PVR decreased significantly after opening the abdomen (p < 0.05). There were no significant changes in RVEF and cardiac index during gastric bypass procedure. CONCLUSION: The presence of chronic hypoxemia and hypercarbia in our morbidly obese patients with obstructive sleep apnea syndrome while awake, causes significant increases in PA pressure and PVR. We also demonstrated that RVEF did not change significantly during gastric bypass procedure despite significant decreases in PA pressure, PCWP, and PVR after opening the abdomen. This decrease in PA pressure and PVR may be caused by decreases in pleural pressure reflected by a concomitant decrease in esophageal pressure.

Adult↗
PubMed1989

Exercise first-pass radionuclide assessment of left and right ventricular function and valvular regurgitation in symptomatic mitral valve prolapse.

The changes in right ventricular (RV) and left ventricular (LV) function and in regurgitant fractions on first-pass exercise radionuclide angiography (RNA) were assessed in 29 consecutive patients with symptomatic mitral valve prolapse (MVP). The mean right ventricular ejection fraction (RVEF) was 35 +/- 8% at rest and 46 +/- 15% after exercise (p less than 0.001). The mean left ventricular ejection fraction (LVEF) was 62 +/- 11% at rest and 74 +/- 13% after exercise (p less than 0.001). Seven of 29 patients had an abnormal RV response and 6 had an abnormal LV response. Eight had abnormal wall motion after exercise. A total of 12/29 patients (41%) had one or more abnormalities. The mean left-sided regurgitant fraction before exercise was 27 +/- 17% in 21/29 patients (72%) and 31 +/- 21% after exercise (p = ns). An additional 5 patients (17%) developed left-sided regurgitation after exercise. These findings indicate that wall motion abnormalities and abnormal RVEF and LVEF responses to exercise occur in symptomatic MVP patients. In addition, 26/29 (89.6%) had left-sided regurgitation after exercise. Since the presence of a murmur did not correlate with the presence of mitral regurgitation by RNA, then symptomatic patients with MVP should have first-pass exercise RNA to assess the presence of regurgitation at rest and after exercise. Antibiotic prophylaxis is recommended in MVP patients with systolic murmurs or with regurgitation. Since patients without murmurs can have regurgitation, further study is necessary to determine the need for endocarditis prophylaxis in these patients.

Adult↗
PubMed2000

[The effect of myocardial revascularization on global and regional systolic and diastolic left and right ventricular function].

UNLABELLED: The objective of the study was to evaluate the effect of myocardial revascularization (PTCA, CABG) on right and left ventricular systolic and diastolic function, and segmental wall motion in patients with coronary artery disease. The study population consisted of 27 patients, ranging in age from 36 to 67 years (mean age 51.1 +/- 8.8). CABG and PTCA were performed in 17 and 10 patients, respectively. All patients underwent radionuclide angiocardiography at baseline and 3 months after the procedure. The following parameters were measured: ejection fraction (EF), 1/3EF, maximal emptying rate (MER), maximal filling rate (MFR), 1/3 filling fraction (1/3FF), and segmental wall motion in segments S1 to S9. Increased left ventricular EF was observed in 29.4% of patients after CABG and in 40% of patients after PTCA. Segmental wall motion in the revascularized area also improved except for septal segments in the left ventricle in patients after CABG. Global right ventricular function remained practically unchanged both after CABG and PTCA. However, EF of right ventricular septal segments increased after CABG: S1--24.58 +/- 11.7% vs 33.4 +/- 14.7%, S9--35.52 +/- 13.7% vs 46.8 +/- 15.9%. CONCLUSION: Myocardial revascularization improves left ventricular systolic and diastolic function with no effect on global right ventricular performance. After CABG the ejection fraction of septal segments was altered. Successful PTCA of LAD improves EF of septal segments in the left ventricle.

Adult↗
PubMed1999

Evaluation of Global and Regional Right Ventricular Function Using Automated Border Detection Techniques.

Quantitative evaluation of right ventricular (RV) function remains challenging due to the complex geometry of this chamber, which precludes the use of simple geometric assumptions. Automated border detection (ABD) techniques, which provide online changes in cardiac chamber dimensions, have been predominantly used for quantitative assessment of global as well as regional left ventricular function. Recently, acoustic quantification has been validated for quantitative evaluation of global RV function, and color kinesis has been used to objectively assess systolic and diastolic regional RV function. In this article, the main studies validating ABD for the objective assessment of global RV function and the current clinical uses of this technique are reviewed. In addition, technical guidelines and limitations of ABD techniques are described, and potential applications of color kinesis for quantitative assessment of regional systolic and diastolic RV performance are detailed. ABD techniques provide new insights into right atrial and RV systolic and diastolic properties. The clinical value of these techniques in the diagnosis, prognosis, and potential guidance of therapeutic management of RV dysfunction remains to be determined.

Journal Article↗
PubMed2006

A single open sea air dive increases pulmonary artery pressure and reduces right ventricular function in professional divers.

After decompression from dives, bubbles are frequently observed in the right ventricular outflow tract and may lead to vascular damage, pulmonary arterial hypertension and right ventricular overload. No data exist on the effect of open sea diving on the pulmonary artery pressure (PAP). Eight professional divers performed an open sea air dive to 30 msw. Before and postdive a Doppler echocardiographic study was undertaken. Systolic pulmonary artery pressure (SPAP) was estimated from measurement of peak flow velocity of the tricuspid regurgitant jet; the ratio between pulmonary artery acceleration times (AccT) and right ventricular ejection time (RVET) was used as an estimate of the mean PAP. No evidence of either patent foramen ovale or intra-pulmonary shunt was found in any subject postdive after performing a Valsalva maneuver. SPAP increased from 25 +/- 3 to 33 +/- 2 mmHg and AccT/RVET ratio decreased from 0.44 +/- 0.04 to 0.3 +/- 0.02 20 min after the dive, respectively. Pulmonary vascular resistance increased from 1.2 +/- 0.1 to 1.4 +/- 0.1 Woods Units. Postdive right ventricle end-diastolic and end-systolic volumes were increased for about 19% (P = 0.001) and 33% (P = 0.001) and right ejection fraction decreased about for 6% (P = 0.001). Cardiac output decreased from 4.8 +/- 0.9 (l min(-1)) to 4.0 +/- 0.6 at 40 min postdive due to decreases in heart rate and stroke volume. This study shows that a single open sea dive may be associated with right heart overload due to increased pressure in the pulmonary artery.

Adult↗
PubMedDate not supplied

Automatic quantification of right ventricular function with gated blood pool SPECT.

BACKGROUND: Quantification of right ventricular (RV) function is clinically relevant for the risk stratification and follow-up of patients with a wide spectrum of disease. This can be achieved with electrocardiography-gated blood pool single photon emission computed tomography (GBPS). We aimed to evaluate the accuracy of the completely automatic QBS GBPS processing software as compared with equilibrium planar radionuclide angiography (RNA) and with a GBPS manual segmentation method (GBPS(35%)) for the measurement of global RV ejection fraction (EF), taking the first-pass RNA (FP-RNA) as the gold standard. In parallel, we compared the RVEF, RV end-diastolic volume (EDV), and RV end-systolic volume (ESV) provided by QBS and GBPS(35%). METHODS AND RESULTS: The population included 85 patients with chronic post-embolic pulmonary hypertension. Twenty-one patients were excluded because of unsuccessful FP-RNA. Intraobserver and interobserver RVEF, RVEDV, and RVESV reproducibilities encountered with planar RNA, QBS, and GBPS(35%) were similar and compared favorably with those calculated with FP-RNA for RVEF. Mean RVEF was different between all methods. RVEF calculated with FP-RNA was better correlated to QBS (r = 0.68) and GBPS(35%) (r = 0.70) than to planar RNA (r = 0.59). RVEDV and RVESV with QBS were lower than with GBPS(35%), by 29% +/- 14% and 36% +/- 13%, respectively. RVEDV and RVESV with QBS were highly correlated to corresponding GBPS(35%) values: r = 0.88 and r = 0.91, respectively. CONCLUSION: As opposed to FP-RNA, GBPS is highly successful for the quantification of RV function. Both QBS and GBPS(35%) provide RVEF values similarly well correlated to FP-RNA and performed better than planar RNA. RVEF, RVEDV, and RVESV provided by QBS and GBPS(35%) are highly correlated. All of these RV functional measurements require further validation versus a better gold standard before their accuracy can be established.

Algorithms↗
PubMed2001

[Pulmonary hemodynamics and right ventricular function].

Measurement of continuous blood flow by thermodilution catheter takes into account measures that are intermittent, though the estimation of mean pressures is satisfactory. Natural pulsatile pulmonary circulation would remain unknown. To evaluate pulsatile pulmonary hemodynamics and its importance in right ventricular function, the calculation of impedance based on spectral analysis of pressure and flow waves would allow their respective contributions to resistance, elastance and wave reflection upon after right ventricle loading. Computerization allows bedside monitoring of this sophisticated assessment of right ventricle after loading.

Cardiac Catheterization↗
PubMed2002

Analysis of right ventricular function in healthy mice and a murine model of heart failure by in vivo MRI.

Because of its complex geometry, assessment of right ventricular (RV) function is more difficult than it is for the left ventricle (LV). Because gene-targeted mouse models of cardiomyopathy may involve remodeling of the right heart, the purpose of this study was to develop high-resolution functional magnetic resonance imaging (MRI) for in vivo quantification of RV volumes and global function in mice. Thirty-three mice of various age were studied under isoflurane anesthesia by electrocardiogram-triggered cine-MRI at 7 T. MRI revealed close correlations between RV and LV stroke volume and cardiac output (r = 0.97, P < 0.0001 each). Consistent with human physiology, murine RV end-diastolic and end-systolic volumes were significantly higher compared with LV volumes (P < 0.05 each). MRI in mice with LV heart failure due to myocardial infarction revealed significant structural and functional changes of the RV, indicating RV dysfunction. Hence, MRI allows for the quantification of RV volumes and global systolic function with high accuracy and bears the potential to evaluate mechanisms of RV remodeling in mouse models of heart failure.

Animals↗
PubMed2005

[Sildenafil improves right ventricular function in a cardiac transplant recipient].

We report the case of a male patient who underwent orthotopic cardiac transplantation. A marginal donor was used, because the recipient's clinical condition was critical. He experienced cardiogenic shock due to right ventricular dysfunction secondary to pulmonary hypertension associated with vasoplegia. After the introduction of sildenafil, the patient recovered hemodynamically, his pulmonary vascular resistance decreased, the vasoactive drugs were withdrawn, and his right ventricular function improved.

Adult↗
PubMed2003

Right ventricular function before and after an uncomplicated coronary artery bypass graft as assessed by pulsed wave Doppler tissue imaging of the tricuspid annulus.

BACKGROUND: Right ventricular (RV) function using myocardial velocities before and after a coronary artery bypass graft (CABG) is not known. METHODS: Using pulsed wave Doppler tissue imaging, RV function was studied in 35 patients before and after CABG. Patients were followed-up for 1 year after the CABG. Myocardial velocities at the tricuspid annulus at the RV free wall were recorded from the apical 4-chamber views. RESULTS: Both the systolic and early diastolic tricuspid annular velocities (TAV) were significantly reduced 1 month after CABG (P <.001 for both). During the follow-up period, there was no improvement in the diastolic TAV. The systolic TAV showed no improvement 3 months after CABG but recovered partially 1 year after the CABG (systolic velocities were 11.8, 8.7, 8.7 and 9.7 cm/s, the early diastolic velocities were 11.0, 8.1, 8.1 and 8.2 cm/s before and 1 month, 3 months and 1 year after the CABG, respectively). The systolic and early diastolic velocities of the interventricular septum were unchanged during the follow-up period. Unlike the right ventricle, the mitral annular systolic velocity was unchanged shortly after CABG and showed signs of improvement after 1 year (6.4, 6.9, 6.8 and 7.3 cm/s respectively before and after CABG). Patients underwent dobutamine stress echocardiography (DSE) before and 3 months after the CABG. The systolic TAV increased significantly during the DSE before CABG (11.8 vs 15.8 cm/s, P <.001). However, the increase in systolic TAV was limited during DSE 3 months after CABG (8.7 vs 9.9 cm/s, P <.05). CONCLUSION: RV function, as assessed by TAV, decreased significantly after CABG and the changes were still evident after 1 year. The response of systolic TAV during DSE was more pronounced before CABG than after CABG.

Aged↗
PubMed1986

[Angiographic study of left and right ventricular function in patients with alcoholic lesions of the heart and dilatational cardiomyopathy].

An angiographic study of left- and right-ventricular function in 57 patients with alcoholic heart and dilatation cardiomyopathy demonstrated preclinical disorders of left-ventricular myocardial contractility and more marked right-ventricular changes in patients with second-stage chronic alcoholism. In cases of dilatation cardiomyopathy, left-ventricular dysfunction was predominant, while right-ventricular changes were less pronounced.

Adult↗
PubMed1994

Right ventricular function during weaning from respirator after coronary artery bypass grafting. Comparison of two different weaning techniques.

The purpose of this investigation was to determine right ventricular function during weaning from controlled ventilation comparing a biphasic positive airway pressure ventilatory support system (BiPAP [Respironics]) with pressure support ventilation (PSV). In 22 patients following coronary artery bypass grafting, both weaning techniques were used in randomized chronological order for 60 min each. Right ventricular end-systolic (RVESV) and end-diastolic volume (RVEDV) and ejection fraction (RVEF) were evaluated using the fast-response Swan-Ganz catheter. In comparison to PSV, the BiPAP system resulted in a significantly higher mean pulmonary artery pressure (20.6 +/- 5.0 vs 19.3 +/- 4.2 mm Hg, p = 0.0158), pulmonary vascular resistance index (206 +/- 55 vs 181 +/- 61 dyn.s.cm-5.m2, p = 0.0355), RVESV (92.2 +/- 36.3 vs 77.2 +/- 30.4 ml, p = 0.0017), and RVEDV (176.4 +/- 48.5 vs 161.8 +/- 43.3 ml, p = 0.0061), while the RVEF was significantly lower (46.0 +/- 11.9 vs 51.8 +/- 12.4 percent, p = 0.0012). No differences in left ventricular function or arterial blood gas analyses were measured during both study periods. In summary, the RV afterload was higher with the BiPAP system compared with PSV which suggested that this was due to differences in the respiratory support between both weaning modes. Because of the Frank-Starling mechanism, this higher afterload did cause a small but significant increase in RV volumes and a significant decrease in RV ejection fraction with the BiPAP system.

Aged↗
PubMed1994

[Right ventricular function and postural changes during surgery of the lumbar spine].

The aim of the study was to assess the effects of the sitting prone position on right ventricular function in a group of patients requiring low back surgery with using of right heart catheterization with a low fast response thermodilution technique. This posture involves moderated hemodynamic effects. A discrete right ventricle impairment characterised by a decreased compliance was observed and may be due to a moderate compression by the sternum and was improved by fluid challenge. Thus, the sitting prone position appears a safe position.

Humans↗