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PubMed1988

Right ventricular function in cor pulmonale.

Traditionally the right ventricle has been thought to function poorly in the presence of an increased afterload. Indeed, the presence of pulmonary arterial hypertension, or cor pulmonale, has been associated with a poor prognosis in patients with hypoxic chronic obstructive pulmonary disease (COPD). Recent data suggest that right ventricular contractility as measured by the right ventricular end-systolic pressure/volume relationship is relatively normal in patients with COPD, despite the presence of pulmonary arterial hypertension if the patients are studied when clinically stable, but reduced when the patients present with oedema. Continuous oxygen therapy is the only treatment which has been shown to improve survival in patients with COPD and cor pulmonale. However, the effects of oxygen therapy may not be directly related to an improvement in cardiac function.

Heart Failure↗
PubMed1995

Quantification of right ventricular function with magnetic resonance imaging in children with normal hearts and with congenital heart disease.

In clinical treatment of children with congenital heart disease (CHD) assessment of right ventricular (RV) function is important. Available imaging techniques have been of limited value because of technical factors and the complex geometry of the right ventricle. To validate magnetic resonance (MR) imaging measurements of RV function in children, gradient echo MR imaging of both ventricles and MR flow mapping of great vessel and tricuspid flow was performed in 20 children with CHD affecting the right ventricle and in 22 healthy children ranging in age from 5 to 16 years. Close correlation between RV versus LV stroke volumes (r = 0.96) and RV stroke volume versus great artery (r = 0.97) or tricuspid flow (r = 0.97) was observed with small interobserver and intraobserver variability. Results of healthy children were end-diastolic volume: 70 +/- 9 ml/m2, end-systolic volume: 21 +/- 5 ml/m2, and ejection fraction: 70% +/- 4%. In the patient groups clinically important differences were noted. We conclude that MR imaging provides accurate noninvasive measurements of RV function in healthy children and patients with (operated) CHD.

Adolescent↗
PubMed1982

[Effects of ouabain and furosemide on right ventricular function, pulmonary and renal circulation ].

Digitalis glycosides are often used in the treatment of cor pulmonale. However, several investigators have shown that these drugs produce an increase of pulmonary vascular resistance. Combination of other drugs which could reduce this unfavorable effects is to be explored. The purpose of this study is to observe the effects of ouabain on the systemic, pulmonary and renal hemodynamics and right ventricular function with special emphasis on modification of its effects in combination with furosemide. Normal open-chest dogs anesthetized with pentobarbital sodium were used under artificial ventilation. Isolated dog lung lobes were also examined in which perfusion was maintained with heparinized autologous blood at a constant flow rate by a pulsatile pump. In normal dogs, intravenous ouabain administration (0.03 mg/kg) resulted in rise of systemic, pulmonary and renal vascular resistance. However, furosemide (5 mg/kg), when given 3 minutes after ouabain administration, suppressed the vasoconstrictive effect of ouabain. Right ventricular tension (measured by strain gauge arch) was increased after ouabain administration, but this increase was not altered by the combination with furosemide. In the isolated lung lobe, ventilated with normal alveolar gas (14.7% O2, 5.4% CO2) and hypoxic gas (5% O2, 5.4% CO2), ouabain (0.48 mg) caused significant rise of pulmonary inflow pressure (P less than 0.05) which was suppressed significantly by furosemide administration (40 mg) given 3 minutes before and after ouabain administration (P less than 0.05). These results suggest that furosemide may be used rationally with ouabain, because of its effects to eliminate the pulmonary vasoconstriction caused by ouabain and to preserve its positive intropic action.

Animals↗
PubMed2000

Analysis of the right ventricular function in the exercising horse: use of the Fourier Transform.

The objective of this study was to develop and test a technique to allow dynamic cardiac function to be studied during exercise in the horse. Blood pressure waveforms in the exercising horse are difficult to interpret because of the large influence of stride and respiration. A method has been devised to study dynamic right ventricular variables during high-speed exercise in the horse. A Fast Fourier Transform was performed on the digitised pressure waveforms and the frequency components associated with stride and respiration were removed. An inverse Fourier Transform was then performed to generate a time-domain pressure signal. Several dynamic right ventricular variables were calculated using the derived signal. Various parameters associated with removing frequencies from the frequency-domain pressure signal were changed to determine their influence on the variables. Most of the variables were not sensitive to these parameters. When compared during separate exercise bouts, some variables differed among runs, while others were not significantly different. Using the signal separation technique described here, right ventricular function of an exercising horse can be critically analysed.

Animals↗
PubMed1995

Evaluation of hepatic venous flow using transesophageal echocardiography in coronary artery bypass surgery: an index of right ventricular function.

Hepatic venous flows (HVFs) were evaluated to assess right-heart function by transesophageal Doppler echocardiography in 45 patients undergoing coronary artery bypass graft (CABG) surgery. Peak velocity and time velocity integral of A-wave (reverse flow in end diastole), S-wave (forward flow in systole), V-wave (reverse flow in late systole), and D-wave (forward flow in diastole) of biphasic HVF were examined. Peak systolic-diastolic ratio (S/D) of biphasic HVF and reverse flow ratio (% reversal flow/forward flow [RF/FF]) of both biphasic and monophasic HVF also were examined. Tricuspid regurgitation (TR) was assessed by color Doppler image. All data were obtained after performing the following: induction of anesthesia (stage 1); pericardiectomy (stage 2); cardiopulmonary bypass (CPB) (stage 3); and closure of sternum (stage 4). HVFs at stage 1 were obtained in all 45 patients, and the peak S/D in patients with a history of inferior wall myocardial infarction (MI) was significantly less than that in patients without a history of MI (p < 0.05). HVFs of 35 patients were recorded successfully at all stages. In 5 of these 35 patients, HVF patterns became monophasic after CPB, and only one of those patients had severe TR. In the rest of the 30 patients with biphasic patterns throughout the operation, peak A and D velocities increased (p < 0.01), whereas peak S and V velocities decreased (p < 0.01) after CPB compared with those before CPB. Consequently, peak S/D was reduced (p < 0.01), and %RF/FF increased (p < 0.05). These post-CPB changes were associated with increased (p < 0.01) pulmonary artery diastolic and right atrial pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

Carcinoid heart disease: impact of pulmonary valve replacement in right ventricular function and remodeling.

BACKGROUND: Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. METHODS AND RESULTS: We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n=12), to those who underwent TV replacement and excision of the PV (n=10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2+/-0.8 [no PVR]versus 2.7+/-0.6 [with PVR], P=0.15), RV dysfunction (0.9+/-0.9 [no PVR]versus 1.4+/-0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7+/-0.6 to 1.7+/-1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2+/-0.8 to 2.3+/-0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4+/-0.7 to 1.8+/-0.9 with PVR (P=0.26) and 0.9+/-0.9 to 1.6+/-0.9 without PVR (P=0.07). CONCLUSIONS: PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.

Adult↗
PubMed1983

Right ventricular function in valvular heart disease: relation to pulmonary artery pressure.

Right ventricular angiography was performed in 46 patients with acquired valvular heart disease and 8 normal subjects. Right ventricular ejection fraction (RVEF) correlated highly only with right ventricular peak systolic pressure (RVPSP) and mean pulmonary artery pressure, both in patients with and without tricuspid insufficiency. For the group, RVEF = -0.33 RVPSP + 63 (correlation coefficient [r] = -0.76, probability [p] less than 0.001). Of 20 patients with moderate or severe elevation of pulmonary artery pressure, 17 (85%) had an abnormally low ejection fraction (less than 47%), while 19 (73%) of 26 patients with normal or mildly elevated pulmonary artery pressure had a normal right ventricular ejection fraction. In seven patients with elevated pulmonary artery pressure, a second ventriculogram was performed during intravenous nitroglycerin administration. Nitroglycerin produced a significant decrease in right ventricular peak systolic pressure (59 +/- 22 to 49 +/- 18 mm Hg, mean +/- standard deviation) (p less than 0.05) and in end-systolic volume (71 +/- 16 to 59 +/- 11 m1/m2) (p less than 0.05), and an increase in ejection fraction (43 +/- 9 to 48 +/- 7%) (p less than 0.05). Thus, at least part of the depression of ejection fraction in patients with elevated pulmonary pressure is reversible with a decrease in pulmonary artery pressure.

Adult↗
PubMed1996

Automatic Border Detection to Assess Right Ventricular Function Following Surgical Treatment of Thromboembolic Pulmonary Hypertension.

Automatic border detection (ABD) has been developed as a potentially useful means for evaluating ventricular function on line in an automatic fashion. Its success with tracking left ventricular function is established, but little is known about its ability to assess right ventricular (RV) function. Accordingly, 20 patients with severe pulmonary hypertension due to chronic thromboembolic disease underwent standard two-dimensional echocardiography and imaging with ABD before and after pulmonary thromboendarterectomy to correct pulmonary hypertension. ABD-derived results were compared to manually planimetered RV areas calculated from the apical four-chamber view. Doppler tricuspid regurgitant velocity fell significantly with surgery from 4.4 +/- 0.6 to 2.9 +/- 0.7 m/sec (P < 0.001). The mean values for RV areas derived by manual planimetry and ABD were similar, as was fractional area shortening, which improved significantly with surgery (manual 0.24 +/- 0.01 preoperative vs 0.31 +/- 0.11 postoperative, P < 0.05; and ABD 0.19 +/- 0.05 preoperative vs 0.32 +/- 0.15 postoperative, P < 0.001). There was, however, very little correlation between the individual values for ABD versus manually derived RV areas and fractional area shortening, with the best correlation being the RV end-diastolic areas after surgery (y = 0.684x + 7.9, r = 0.564, P = 0.01). These results demonstrate that both manually planimetered RV areas and those determined by ABD can adequately follow changes in ventricular function over time. However, variability within each technique may prevent direct comparison of the absolute values of the two techniques. (ECHOCARDIOGRAPHY, Volume 13, March 1996)

Journal Article↗
PubMed1980

Acute response of pulmonary blood flow and right ventricular function to Dirofilaria immitis adults and microfilaria.

Pulmonary arterial pressures, right ventricular pressures, and right ventricular force of contraction (max dP/dt) were measured before and after the surgical addition of Dirofilaria immitis adults and microfilaria. Six adult anesthetized and heparinized dogs were studied during thoracotomy to compare these pressure measurements with left caudal pulmonary arterial flow. Diversion of pulmonary flow was performed to obtain incremental increases in pulmonary flow through the left caudal lobar artery and to increase right ventricular afterload. The addition of adult heartworm disease, microfilaria, or both did not produce either pulmonary arterial hypertension or increase right ventricular pressure and force of contraction.

Animals↗
PubMed1989

[Left ventricular function in right ventricular overload: asymmetry of the left ventricular ejection].

This study clarified regional and global functions of the distorted left ventricle due to right ventricular overload by means of gated radionuclide ventriculography (RNV). Cardiac catheterization and RNV were performed in 13 cases of atrial septal defect (ASD), 13 of pure mitral stenosis (MS), 10 of primary pulmonary hypertension (PPH), and 10 of normal subjects (NL). Right ventricular systolic pressure (RVSP) was 32.9 +/- 13.9, 45.0 +/- 12.2, 88.3 +/- 17.1, and 21.2 +/- 4.5 mmHg, respectively. RNV was performed with a 99mTc-red blood cell in a vivo labeling technique. The end-systolic LAO view of the left ventricle was halved into septal and free-wall sides. The end-diastolic halves were determined in the same plane. Ejection fractions of the global left ventricle (LVEF), global right ventricle (RVEF), the septal half of the left ventricle (SEPEF), and the free-wall half of the left ventricle (FWEF) were obtained. LVEF was 56.8 +/- 9.8% in NL, 52.8 +/- 10.5% in ASD, and 49.5 +/- 12.9% in PPH. In MS, LVEF (47.0 +/- 13.0%) was smaller than those in the other groups. RVEF was 37.0 +/- 5.2% in NL, 43.7 +/- 15.5% in ASD, and 32.8 +/- 11.5% in MS. In PPH, RVEF (25.0 +/- 10.6%) was smaller than those in the other groups. SEPEF was smaller in AS D (42.5 +/- 13.2%), MS (40.4 +/- 13.1%), PPH (40.5 +/- 12.5%) than in NL (53.5 +/- 8.5%). Systolic function of the septal half of the left ventricle was disturbed by right ventricular overload. RVEF (r = -0.35, p less than 0.05) and SEPEF (r = -0.51, p less than 0.01) had negative correlations with RVSP. As RVSP rose, systolic function of the septal half of the left ventricle was more severely disturbed. FWEF was the same among the four groups; NL (57.0 +/- 12.6%), ASD (48.6 +/- 15.2%), MS (50.5 +/- 12.0%), and PPH (51.1 +/- 12.3%). Right ventricular overload does not affect systolic function of FWLV. There was a good correlation between SEPEF and LVEF in NL (r = 0.81), though in PPH this correlation was poor (r = 0.64). In patients with PPH the septal side of the left ventricle does not act as a part of the global left ventricle. Systolic function of the septal side of the left ventricle is disturbed due to the distortion of the ventricular septum, but systolic function of the free-wall side is maintained within a normal range, when the left ventricular myocardium is kept normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2004

Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study.

BACKGROUND: Decreased right ventricular (RV) function is a known echocardiographic finding after coronary artery bypass grafting (CABG). For patients with heart failure, RV dysfunction is a predictor of poor exercise capacity. The significance and time course of RV dysfunction and its relation to exercise capacity after CABG have not been elucidated, however. OBJECTIVES: In this prospective study, we assessed RV function measured from echocardiographic tricuspid annular motion (TAM) before and after CABG and its relation to exercise capacity. METHODS: In 99 patients accepted for CABG, we did a baseline echocardiographic investigation before operation, followed by repeated echocardiograms 3 months and 1 year after CABG. RV function was assessed using the magnitude of TAM measured at the RV free wall. An exercise stress test and coronary angiography were performed before and 3 months after CABG. RESULTS: RV function assessed by TAM was significantly reduced 3 months after CABG (22.4 vs 14.5 mm, P <.001) compared with preoperative measurements and remained so after 1 year (14.7 mm, P <.001). Left ventricular systolic function was unchanged 3 months after CABG. The 1-year echocardiographic follow-up showed paradoxical septal movement in 96% of the patients. Exercise capacity improved significantly 3 months after CABG compared with before (1.6 vs 1.83 W/kg, P <.001). These finding are independent of the state of the right coronary artery. CONCLUSIONS: One year after CABG, RV function remained depressed and septal motion remained paradoxical compared with the preoperative investigation, suggesting that these postoperative findings might be permanent in the majority of patients. Despite the reduced RV function, exercise performance 3 months after CABG was improved. The depressed RV function, measured from TAM after CABG, probably lacks clinical significance.

Aged↗
PubMed2005

The determinants of right ventricular function in patients with atrial septal defect.

OBJECTIVE: The purpose of this study was to ascertain the determinants of right ventricular (RV) systolic and diastolic functions in patients with atrial septal defect. METHODS: Thirty-three patients with atrial septal defect having left to right shunt were enrolled in this study. RV function parameters were assessed echocardiographically. RV systolic function was assessed using tricuspid tissue Doppler S velocity (St). With regard to RV diastolic function parameters, E/A ratio, deceleration time (DT), E/Et ratio (Et = tissue Doppler E velocity), RV isovolumetric relaxation time (RVIVRT) were assessed. RV myocardial performance index (MPI) was calculated as an index of both systolic and diastolic function. Pulmonary artery stiffness (PAS) was also calculated. After echocardiography, right and left heart catheterization was performed. Mean pulmonary artery pressure (MPAP), mean right atrial pressure (MRAP), systemic flow (Qs), pulmonary flow (Qp), systemic vascular resistance (SVR), and pulmonary vascular resistance (PVR) were obtained using the data of invasive measurements. RESULTS: In multivariate analysis, MPAP was found to be the parameter closest related to RVIVRT (r = 0.73, p < 0.001) and E/Et (r = 0.66, p < 0.001), while PAS was found to be the parameter closest related to MPI (r = 0.53, p = 0.002). In addition, St velocity was found the only parameter related to PVR (r = -0.39) in univariate analysis. There was no relationship between QP/QS and any of the RV function parameters. CONCLUSION: The pulmonary vascular bed appears to be the predictor of the RV functions in patients with atrial left to right shunts, and the amount of the shunt seems to have no direct adverse influence on the RV functions.

Adult↗
PubMed1988

Changes of right ventricular function with positive end-expiratory pressure (PEEP) in man.

The side effects of positive pressure ventilation on cardiovascular function are well known. However, in most clinical studies its influence on left ventricular function was examined. In the present study right ventricular (RV) performance was studied in 13 patients undergoing coronary artery bypass grafting during mechanical ventilation with and without positive end-expiratory pressure (PEEP). In the majority of patients (10/13), PEEP caused a decrease in RV end-diastolic volume (by 18%) whereas RV ejection fraction did not change. In the remaining 3 patients, end-diastolic and end-systolic RV volumes increased by 25% and 50% respectively and ejection fraction decreased by 29%. These results suggest that PEEP can affect RV function in two different ways: first, in the majority of patients studied, PEEP exerted an unloading effect on the RV whereas second, in 3 patients RV dilatation and a decrease in ejection fraction was observed.

Aged↗
PubMed2006

Characterization of right ventricular function after monocrotaline-induced pulmonary hypertension in the intact rat.

We characterized hemodynamics and systolic and diastolic right ventricular (RV) function in relation to structural changes in the rat model of monocrotaline (MCT)-induced pulmonary hypertension. Rats were treated with MCT at 30 mg/kg body wt (MCT30, n = 15) and 80 mg/kg body wt (MCT80, n = 16) to induce compensated RV hypertrophy and RV failure, respectively. Saline-treated rats served as control (Cont, n = 13). After 4 wk, a pressure-conductance catheter was introduced into the RV to assess pressure-volume relations. Subsequently, rats were killed, hearts and lungs were rapidly dissected, and RV, left ventricle (LV), and interventricular septum (IVS) were weighed and analyzed histochemically. RV-to-(LV + IVS) weight ratio was 0.29 +/- 0.05 in Cont, 0.35 +/- 0.05 in MCT30, and 0.49 +/- 0.10 in MCT80 (P < 0.001 vs. Cont and MCT30) rats, confirming MCT-induced RV hypertrophy. RV ejection fraction was 49 +/- 6% in Cont, 40 +/- 12% in MCT30 (P < 0.05 vs. Cont), and 26 +/- 6% in MCT80 (P < 0.05 vs. Cont and MCT30) rats. In MCT30 rats, cardiac output was maintained, but RV volumes and filling pressures were significantly increased compared with Cont (all P < 0.05), indicating RV remodeling. In MCT80 rats, RV systolic pressure, volumes, and peak wall stress were further increased, and cardiac output was significantly decreased (all P < 0.05). However, RV end-systolic and end-diastolic stiffness were unchanged, consistent with the absence of interstitial fibrosis. MCT-induced pressure overload was associated with a dose-dependent development of RV hypertrophy. The most pronounced response to MCT was an overload-dependent increase of RV end-systolic and end-diastolic volumes, even under nonfailing conditions.

Animals↗
PubMed1982

Comparison of single-plane and biplane contrast analyses of right ventricular function and size.

To evaluate the utility of single and biplane right ventricular (RV) contrast angiograms, we evaluated 25 canine RV casts and 31 cineangiograms performed in patients during standard contrast ventriculograms. Both standard single and biplane formulae were utilized. In the 25 canine RVs, absolute volume was determined by water displacement. Both biplane (r = 0.96) and single-plane (r = 0.86) volumes correlated well with cast data. These formulae were then applied to contrast ventriculograms in the 31 patients (30-degree right anterior oblique and 60-degree left anterior oblique projections). The ejection fractions (EFs) calculated from the single-plane technique provided fair correlation with EFs derived from the biplane data (r = 0.81, y = 0.81X + 0.05). Similar correlations were noted when end-diastolic volume results were compared (r - 0.78, y - 0.57X + 56.4). However, while single-plane contrast right ventriculograms correlate with estimates of global RV function and size by biplane methods, considerable scatter of the data may limit its application in individual cases.

Aged↗
PubMed1999

Quantitative assessment of regional right ventricular function with color kinesis.

We used color kinesis, a recent echocardiographic technique that provides regional information on the magnitude and timing of endocardial wall motion, to quantitatively assess regional right ventricular (RV) systolic and diastolic properties in 76 subjects who were divided into five groups, as follows: normal (n = 20), heart failure (n = 15), pressure/volume overload (n = 14), pressure overload (n = 12), and RV hypertrophy (n = 15). Quantitative segmental analysis of color kinesis images was used to obtain regional fractional area change (RFAC), which was displayed in the form of stacked histograms to determine patterns of endocardial wall motion. Time curves of integrated RFAC were used to objectively identify asynchrony of diastolic endocardial motion. When compared with normal subjects, patients with pressure overload or heart failure exhibited significantly decreased endocardial motion along the RV free wall. In the presence of mixed pressure/volume overload, the markedly increased ventricular septal motion compensated for decreased RV free wall motion. Diastolic endocardial wall motion was delayed in 17 of 72 segments (24%) in patients with RV pressure overload, and in 31 of 90 segments (34%) in patients with RV hypertrophy. Asynchrony of diastolic endocardial wall motion was greater in the latter group than in normal subjects (16% versus 10%: p < 0.01). Segmental analysis of color kinesis images allows quantitative assessment of regional RV systolic and diastolic properties.

Adult↗
PubMed1983

Right ventricular function in acute disease states: pathophysiologic considerations.

In critically ill patients, alterations in pulmonary vasomotor tone profoundly influence right ventricular (RV) function. An increase in end-diastolic volume (EDV) follows elevations in the RV afterload, this increase in preload probably subserving the increased RV stroke work (SW) required to ensure unchanged RV pump function. The maintenance of a normal left ventricular (LV) preload is essential in the cardiovascular adaptation to an acute illness. With volume overload of the RV consequent upon pulmonary artery hypertension (PAH), leftward septal shift occurs and reduces LV diastolic compliance. With extremely high levels of RV loading conditions, a depression in RV contractility and reduced RV pump function are eventually seen, both of which then become partially responsible for LV pump failure. Hence, abnormalities in RV function will have a marked clinical influence on the circulatory response seen in critically ill patients. Future investigation should be directed toward the effects of augmenting or improving RV function with pharmacologic agents in this patient population.

Blood Pressure↗
PubMed1986

Biventricular function during volume loading in porcine E. coli septic shock, with emphasis on right ventricular function.

In 14 anesthesized pigs, the effect of E. coli (2 X 10(8)/kg) and volume loading on hemodynamics and right and left ventricular performance were studied. Autologous red cells were labeled in vitro with 99mTC (15-20 mCi). Gated blood pool studies and hemodynamics were performed simultaneously. E. coli infusion resulted in an abrupt increase in pulmonary artery pressure, whereas systemic blood pressure fell gradually. Gated studies showed a transient increase in right ventricular end-diastolic volume (RVEDV) after 1 hour; left ventricular end-diastolic volume (LVEDV) declined gradually during sepsis. During volume loading, RVEDV and LVEDV both increased. As estimated from the altered Frank Starling relation between preload and SW, a depressed performance of both left and right ventricle was found. We conclude that volume expansion in porcine E. coli septic shock results in a uniform increase of left and right preload despite a substantial increase in pulmonary vascular resistance.

Animals↗