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At least 757 records · Page 42Linked to original sources
PubMed2006

MDCT assessment of right ventricular systolic function.

OBJECTIVE: The objective of our study was to validate using MDCT for the assessment of right ventricular (RV) function. MDCT with retrospective ECG gating was performed in 15 patients being evaluated for suspected cardiovascular disease. Echocardiography was performed for comparison. The MDCT images were reconstructed at 20 phase points over the cardiac cycle. The end-diastolic and end-systolic volumes of both ventricles were measured. Stroke volumes and ejection fractions were calculated from these data. CONCLUSION: RV volumes can be accurately assessed using MDCT.

Electrocardiography↗
PubMed1994

[Change in right ventricular diastolic function in children and adolescents with mucoviscidosis--a Doppler echocardiographic study].

The present study investigated the right ventricular filling pattern with Dopplerechocardiography in childhood and adolescent patients (n = 31) with cystic fibrosis and in normal subjects. The results show that, as the pulmonary pressure increases (RPEP/AT > or = 1.0), the peak flow velocity during atrial contraction and the triangle under the atrial velocity are significantly increased while the acceleration half-time is significantly decreased. These are sensitive parameters for right ventricular diastolic dysfunction.

Adolescent↗
PubMed1996

Left ventricular contributions to right ventricular systolic function during LVAD support.

BACKGROUND: In patients with postcardiotomy low cardiac output syndromes, right ventricular (RV) failure develops in approximately 25% of patients receiving left ventricular (LV) assist device support. Depressed RV function have been attributed to abnormalities of the RV myocardium, excessive load imposed on the RV during systole or diastole, or obstruction to RV inflow. However, recent studies also suggest that LV function may significantly affect RV function through ventricular interdependence. METHODS: We reviewed the data showing the importance of systolic ventricular interaction. We then related these observations to the RV response during LV assist device support, and present our ideas regarding the mechanisms responsible for this RV failure. RESULTS: Using an electrically isolated right heart preparation, Damiano observed double-peaked waveforms for RV pressure, and pulmonary artery blood flow occurred over a wide range (0 to 300 ms) of pacing intervals between the LV and RV. Numeric analysis indicated that RV systolic pressure and pulmonary artery blood flow were composed of both RV and LV components, with the LV component dominating (63.5% versus 36.5%). CONCLUSIONS: The experimental studies indicate a very consistent RV response during LV assist device support: a decrease in RV afterload, increased compliance, and decreased contractility. In normal hearts, the net effect is an increase or no change in cardiac output. With a preexisting pathologic condition, the RV responses is qualitatively the same, but anatomic ventricular interaction is accentuated, leading to a greater decrease in RV contractility. The net effect is a decrease in cardiac output, which may require inotropic or RV mechanical support.

Animals↗
PubMed1987

[Equilibrium angioscintigraphic evaluation of sequential changes in right ventricle function in patients with lower myocardial infarct and ischemic co-involvement of the right ventricle: long-term study].

The purpose of this study was to define the sequential changes in global and regional right ventricular function, using equilibrium gated radionuclide angiography, following transmural inferior myocardial infarction (IMI) and associated ischemic right ventricular involvement. 24 patients with IMI underwent radionuclide angiography within 72 hours of onset of chest pain; subsequent studies were done at 13 +/- 5 days and at 6 +/- 2 months. Scintigraphic evidence of ischemic right ventricular involvement was defined by depression of right ventricular ejection fraction (less than 40%) and regional wall motion abnormalities (hypo-a-dyskinesia of right ventricular free wall). Significant improvement of global right ventricular ejection fraction was observed in 15 patients at the second study, and in 21 patients at the third study. Right ventricular regional wall motion showed similar improvement from the initial to the final studies. Significant changes in right ventricular function occurred without concurrent changes in global and regional left ventricular ejection fraction. We concluded that patients with IMI and ischemic right ventricular involvement show frequently improvement of global and regional right ventricular function over time. This changes tend to occur early and without significant modifications in left ventricular function. The good prognosis observed in our patients, despite the high incidence of in hospital complications, might be related to the improvement of right ventricular function.

Adult↗
PubMed2002

Right ventricular ejection function assessed by cineangiography--Importance of bellows action.

The right ventricular ejection fraction (RVEF) can be shown theoretically as a mathematical function of the percent shortening in the 3 axial dimensions of the right ventricular cavity (the septum-free wall dimension (SF), the anterior-posterior dimension (AP), and the tricuspid valve-apex dimension (TA) or the long axis dimension (LA)). There is a need to decide which mechanism is the most important for the RVEF in cases with neither obvious regional wall motion abnormalities of the left ventricle nor right ventricular overload. Forty-four consecutive subjects (34 males/10 females) were enrolled: 16 had normal hemodynamic parameters without significant coronary artery stenosis, 15 had hypertrophic cardiomyopathy and 13 had dilated cardiomyopathy. Biplane right ventricular cineangiography was performed and the percent shortening of the SF, AP, and TA or LA were measured. The percent shortening in the SF (34.8+/-14.7%) was larger than that of the AP, TA, and LA (23.2+/-8.5, 21.0+/-8.3 and 18.3+/-7.0, respectively; all p<0.001). There was a linear correlation between the percent shortening of each dimension and the RVEF. The 95% confidence interval of the regression equation from the percent shortening of the SF and RVEF was located above those from the other percent shortenings, except for a lower RVEF. These results indicate that systolic shortening of the SF (ie, bellows action) plays an important role in the RVEF except for a lower ejection fraction.

Adolescent↗
PubMed1990

Right ventricular diastolic function during exercise: effect of ischemia.

The effects of exercise on right ventricular diastolic function were evaluated in 14 patients who underwent supine rest and exercise right ventricular angiography. On the basis of coronary anatomy and exercise left ventricular regional wall motion analysis, these patients were classified into two groups: Group 1 (n = 7) had no or only mild coronary artery disease and Group 2 (n = 7) had significant coronary disease and exercise-induced left ventricular wall motion abnormalities suggesting ischemia. Chamber stiffness at rest was higher in Group 2 (48 x 10(-3) ml-1/m2) than in Group 1 (18 x 10(-3) ml-1/m2, p = 0.006). During exercise, right ventricular filling rate in the second half of diastole was significantly lower in Group 2 (126 versus 276 ml/m2 per s, p less than 0.03). The time constant of right ventricular pressure decay decreased significantly in both groups with exercise; however, both groups displayed a parallel upward shift of the pressure-volume curve with exercise. Because ischemia could not be demonstrated in Group 1, it is an unlikely explanation for this shift. Septal shifting was not a significant factor with exercise. Because of an increase in left ventricular end-diastolic volume with exercise and a close correlation between right and left ventricular end-diastolic pressures (r = 0.96 for Group 1 and r = 0.76 for Group 2), pericardial constraint is the most likely cause for this upward shift of the pressure-volume curve. Therefore, an increase in right ventricular end-diastolic pressure may not be a reliable indicator of ischemia during exercise because this pressure is coupled to changes in left ventricular volume and pericardial constraint.

Angiocardiography↗
PubMed1981

Right ventricular performance in essential hypertension after beta-blockade.

Recent studies indicate that right ventricular performance is impaired even in uncomplicated systemic hypertension. Because of widespread use of beta-blockade in essentially hypertension, it is possible that such treatment often further depresses right ventricular contractility. To test this premise, and to evaluate the changes induced by different beta-adrenoceptor blocking agents on the contractility of right ventricular myocardium, 20 patients with essential hypertension were divided into two groups on a double-blind randomised basis, and maintained on oral oxprenolol or propranolol for five weeks. Cardiac catheterisation and right ventricular cineangiography were performed at the beginning and again at the end of the five week period. Right ventricular end-diastolic volume index did not change significantly in either group. In contrast, right ventricular end-systolic volume index increased, and right ventricular ejection fraction significantly decreased after chronic beta-blockade. Cardiac index decreased in both groups, but these changes were not statistically significant. When the intergroup differences were compared for all measured indices none of the changes between the two groups was statistically significant. Despite its intrinsic sympathomimetic activity, oxprenolol therefore impairs right ventricular performance to an extent nearly equal to that of propranolol. Moreover, right ventricular contractility is clearly diminished after the institution of beta-blockade in hypertensive patients--an effect that has until now been thought to be limited to the left side of the heart. Great caution must therefore be exercised when beta-blockade is initiated in patients with severely abnormal right ventricular function, because frank right ventricular decompensation may result.

Clinical Trials as Topic↗
PubMed1991

Left and right ventricular systolic function and exercise capacity with coronary artery disease.

This prospective study of symptom-limited supine ergometry was conducted to determine the contributions of right ventricular (RV) and left ventricular (LV) systolic function to the exercise capacity of a cohort of patients with coronary artery disease (CAD). Patients with unstable angina, angiographically proven CAD (n = 53) and stable symptoms after medical therapy or angioplasty were included. Documented myocardial infarction (greater than or equal to 2 weeks before exercise) was present in 43 of 53 patients. Angina was the limiting symptom in 11 of 53; the other 42 stopped exercise with dyspnea or fatigue, or both. Oxygen consumption was measured on-line during exercise with a metabolic cart. RV ejection fraction and LV ejection fraction were measured by validated methods from gated blood pool radionuclide ventriculography. There were weak but statistically significant correlations between exercise oxygen consumption and exercise RV ejection fraction (r = 0.30, p less than 0.05) and between exercise oxygen consumption and exercise LV ejection fraction (r = 0.38, p less than 0.01). Multivariate regression analysis, including exercise RV ejection fraction, exercise LV ejection fraction and exercise heart rate versus exercise oxygen consumption revealed a better relation (r = 0.48, p less than 0.005) than any variable in univariate regression. The values of RV and LV ejection fraction at rest did not correlate significantly (r = 0.2, difference not significant), but the exercise values did correlate weakly (r = 0.41, p less than 0.01). The reserve of LV ejection fraction, defined as exercise minus rest value, correlated weakly with exercise oxygen consumption (r = 0.32, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed2003

Assessment of right ventricular morphology and function.

The assessment of right ventricular morphology and function is of clinical importance in patients with pulmonary disease. Until recently the evaluation of the right ventricle was difficult because of the unusual geometry of the right ventricle. This chapter discusses the various diagnostic modalities available for assessment of right ventricular morphology and function. Although echocardiography is widely used because of its common availability, nuclear magnetic resonance imaging and radionuclide angiocardiography should be considered the gold standards and are preferred when reliable and accurate measures of right ventricular function and morphology are needed.

Journal Article↗
PubMed2004

Myocardial acceleration during isovolumic contraction as a new index of right ventricular contractile function and its relation to pulmonary regurgitation in patients after repair of tetralogy of Fallot.

BACKGROUND: Myocardial acceleration during isovolumic contraction (IVA) by Doppler tissue imaging has been proposed to be a new index of right ventricular contractile function that is unaffected by ventricular shape or loading conditions. OBJECTIVES: We sought to assess the use of IVA to evaluate right ventricular contractile function. METHODS: In all, 22 pediatric patients with pulmonary regurgitation (PR) after repair of tetralogy of Fallot (TOF) (8 +/- 3 years) and 27 age-matched children were examined. The degree of PR (mild, moderate, and severe) for patients with TOF was on the basis of pulsed and color Doppler findings. Using Doppler tissue imaging, the peak myocardial velocities during early diastole, late diastole, systole, and isovolumic contraction were recorded. RESULTS: Compared with healthy children, Doppler tissue imaging velocities for patients with TOF showed decreased myocardial velocities during early diastole (P =.007), late diastole (P <.0001), systole (P <.0001), and isovolumic contraction (P <.0001). Patients with TOF had a lower IVA when compared with healthy children (P <.0001). There was a stepwise decrease in the IVA from mild to severe PR. We found a significant relationship between the IVA and the degree of PR (r = -0.86, P <.0001). CONCLUSION: The analysis of IVA allows the assessment of right ventricular contractile function for patients with repaired TOF and various degrees of PR.

Acceleration↗
PubMed1988

The right ventricle and critical illness: a review of anatomy, physiology, and clinical evaluation of its function.

This paper reviews right ventricular anatomy and physiology in the critically ill patient. The role of right ventricular function during acute pulmonary artery hypertension and the effect of acute myocardial injury upon right ventricular performance are examined. Clinical methods of assessing right ventricular function at the bedside in acutely ill patients are critically reviewed.

Acute Disease↗
PubMed1988

Right ventricular performance and pulmonary haemodynamics in adolescent and adult patients with cystic fibrosis.

A combined haemodynamic and radionuclide approach was used to evaluate right ventricular performance in 16 adolescent and adult patients with cystic fibrosis (CF). There were nine patients with mild arterial hypoxaemia (PaO2 greater than 80% of predicted) and normal resting pulmonary artery pressure and seven patients with severe arterial hypoxaemia (PaO2 less than 70% of predicted) and resting pulmonary arterial hypertension (PH). The right ventricular ejection fraction (RVEF) by equilibrium angiocardiography using krypton 81m as a tracer and stroke volume index (SVI) by thermodilution techniques were measured simultaneously and right ventricular end-diastolic and end-systolic volumes were derived. RVEF was normal in CF patients without PH (58.9 +/- 7.2%) but was reduced in those with PH (45.4 +/- 2.6%). There was a statistically significant inverse linear correlation between RVEF and afterload as assessed by mean pulmonary artery pressure (Pap: r = -0.76) and pulmonary vascular resistance (PVR: r = -0.78), indicating that RVEF ist afterload-dependent. Right ventricular function, however, as assessed by right ventricular end-systolic pressure-volume relations was even higher in CF patients with PH, indicating preserved or even increased right ventricular function in the face of an increased afterload stress.

Adolescent↗
PubMedDate not supplied

Quantitative angiographic analysis of right ventricular global function in normal incidences and in patients with coronary artery disease.

At present right ventriculography data cannot be accurately estimated owing to the absence of software for quantitative analysis of the right ventricle (RV) volumes and function. The aim of this study was to use existing software for left ventriculography analysis to estimate right ventricular volumes and function in patients without coronary lesions and in those with coronary artery disease (CAD). Thirty-two patients without significant lesions of coronary arteries and 20 patients with CAD were examined with left ventriculography and right atriography. Each examination was performed in 2 projections: 30 degrees right anterior oblique (RAO 30 degrees) and 60 degrees left anterior oblique (LAO 60 degrees) projections. Correction factor (CF) was obtained by finding the ratio between stroke volumes of the left and right ventricles. The mean CF was 0.9243+/-0.2887 for patients without CAD and 0.8758+/-0.2232 for patients with CAD. Such calculation is the easiest and quite accurate method of determining RV volumes and function by using existing software of quantitative angiographic analysis.

Adult↗
PubMed1996

Importance of the right ventricle in valvular heart disease.

The importance of the right ventricle as a determinant of clinical symptoms, exercise capacity, peri-operative survival and postoperative outcome has been underestimated for a long time. Right ventricular ejection fraction has been used as a measure of right ventricular function but has been found to be dependent on loading conditions, ventricular interaction as well as on myocardial structure. Altered left ventricular function in patients with valvular disease influences right ventricular performance mainly by changes in afterload but also by ventricular interaction. Right ventricular function and regional wall motion can be determined with right ventricular angiography, radionuclide ventriculography, two-dimensional echocardiography or magnetic resonance imaging. However, the complex structure of the right ventricle and its pronounced translational movements render quantification difficult. True regional wall motion analysis is, however, possible with myocardial tagging based on magnetic resonance techniques. With this technique a baso-apical shear motion of the right ventricle was observed which was enhanced in patients with aortic stenosis.

Aortic Valve↗
PubMed2006

Physiopathology of right ventricular failure.

The physiopathology of right ventricular failure after repair of tetralogy of Fallot is complex. While primarily reflecting chronic volume overload resulting from pulmonary regurgitation, its determinants reflect a varied contribution of different boundary conditions. The competence of the outflow tract, right ventricular afterload, and the integrity of right ventricular diastolic performance are all crucial elements to the long-term responses of the right ventricle. When adverse, chronic right ventricular volume overload may lead to exercise intolerance, congestive cardiac failure, and both atrial and ventricular arrhythmia. Indeed, there appears to be a close relationship between the mechanical properties of the right ventricle and its electrical stability. In this chapter the determinants of pulmonary incompetence and its secondary effects on right ventricular function and performance, and mechano-electric interactions will be discussed.

Adult↗
PubMed1996

[Right ventricular failure in terminale cardiac failure: prognostic value and evaluation before transplantation assessment].

Right ventricular failure occurs as a late complication of cardiomyopathy; the observation of biventricular failure usually reduces survival to less than 2 years. Right ventricular dysfunction is related mainly to the important increase of the afterload and also to parietal ischaemia in ischaemic heart disease or direct dysfunction of the contractility in pure myocardial disease, giving rise to the dilated cardiomyopathies. The prognostic value of the right ventricular ejection, fraction has been demonstrated in all forms of cardiomyopathy leading up to cardiac transplantation. Right ventricular function must therefore be taken into account in pretransplantation investigations.

Follow-Up Studies↗
PubMed2006

Right ventricular systolic function is not the sole determinant of tricuspid annular motion.

Maximal tricuspid annular plane systolic excursion (TAPSE) correlates well with right ventricular (RV) function; however, little is known regarding the impact of left ventricular (LV) systolic function on TAPSE. Consequently, TAPSE was examined in 206 patients (105 men; mean age 56 +/- 17 years), and the data were analyzed with respect to RV (RV fractional area change 45 +/- 19%) and LV (56 +/- 17%) systolic function. The mean TAPSE for the population studied was 1.97 +/- 0.72 cm. Although a strong linear correlation was noted between RV fractional area change and TAPSE (r = 0.73, p <0.0001), relative differences with regard to TAPSE were also found. First, the greatest TAPSE was noted only when RV and LV systolic function were normal (2.46 +/- 0.50 cm). Second, patients with reduced RV systolic function had the smallest TAPSE (1.28 +/- 0.48 cm, p <0.0001). Third, patients with normal RV function but reduced LV systolic function had TAPSE (1.91 +/- 0.54 cm, p <0.0001) that was intermediate between that of patients with normal RV and LV systolic function and those with abnormal RV systolic function. Fourth, patients with reduced biventricular function had the smallest TAPSE (1.16 +/- 0.41 cm, p <0.0001). In conclusion, TAPSE is not only determined by RV systolic function but also appears to depend on LV systolic function. TAPSE <2.0 cm is associated with some degree of either RV or LV dysfunction, whereas a value >2.0 cm suggests normal biventricular systolic function.

Adult↗