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PubMed1996

Value of perioperative Doppler echocardiography in patients undergoing major lung resection.

BACKGROUND: The effects of major lung resection on right heart function have not been well established. Our goal was to evaluate these effects using serial Doppler echocardiography in the perioperative period. METHODS: In 86 patients undergoing lobectomy (n = 47) and pneumonectomy (n = 39), we examined the effects of pulmonary resection on perioperative changes in right heart function by transthoracic echocardiography. Serial echocardiograms were performed preoperatively, on postoperative day 1, and again between postoperative days 2 and 6 (median, 3 days) to evaluate cardiovascular function and to estimate right ventricular systolic pressure by the tricuspid regurgitation jet Doppler velocity method. RESULTS: Right or left atrial size, right atrial pressure, and estimated right ventricular systolic pressure did not differ between groups on the preoperative or postoperative day 1 examinations. However, on postoperative days 2 through 6 patients who underwent pneumonectomy had higher (mean +/- standard deviation) right ventricular systolic pressure values than lobectomy patients (31 +/- 15 versus 25 +/- 10 mm Hg, respectively; p < 0.05 by analysis of variance). In the subset of patients with percent predicted forced expiratory volume in 1 second less than 60% undergoing pneumonectomy (9/39), preoperative right ventricular systolic pressure was inversely correlated with percent predicted forced expiratory volume in 1 second values (r = -0.78; p < 0.04). This correlation was not significant in corresponding lobectomy patients. Postoperative right ventricular enlargement determined by echocardiography occurred with similar frequency in both groups and was associated with poor short-term prognosis in patients in whom severe respiratory failure developed. CONCLUSIONS: Preoperative indices of right heart function were within the normal range in both groups. Pneumonectomy but not lobectomy was associated with mild postoperative pulmonary hypertension that was not accompanied by significant right ventricular systolic dysfunction. Postoperative echocardiography may be useful to evaluate right heart function in critically ill patients after lung resection.

Adult↗
PubMed1998

[Right ventricular infarction].

Right ventricle infarction (RVI) is not a rare clinical entity. It complicates approximately half of inferolateral myocardial infarctions. Under the term RVI we can find mild, asymptomatic dysfunction of right ventricle and cardiogenic shock as well. RVI is associated with increased mortality and its presence obliged us to qualify patient to a high risk group. Diagnosis is based on clinical signs, electrocardiographic findings, hemodynamic measurements and echographic evaluations. The proper treatment of RVI requires support of right ventricle preload with fluid administration, maintainance of atrio-ventricular synchrony, reduction of right ventricle afterload. Early reperfusion with fibrinolytic therapy and coronary angioplasty should be regarded as the prior methods of treatment RVI. Patients who survive RVI have complete resolution of hemodynamic abnormalities with restoration of proper right ventricle function.

Hemodynamics↗
PubMed1992

Utility of various radionuclide techniques for distinguishing ischemic from nonischemic dilated cardiomyopathy.

BACKGROUND: Clinically, ischemic and nonischemic (idiopathic) dilated cardiomyopathy may be difficult to distinguish. Radionuclide ventriculography and exercise testing with thallium-201 scintigraphy are often used in an attempt to differentiate them noninvasively. With these techniques, the presence of (1) left ventricular (LV) regional asynergy, (2) depressed LV systolic function with normal right ventricular function, and/or (3) thallium-201 perfusion abnormalities traditionally has been regarded as evidence of ischemic heart disease. We assessed the incidence with which these abnormalities occur in patients with nonischemic-dilated cardiomyopathy. METHODS: Seventy-six patients (45 men, 31 women, aged 18 to 75 years) with invasively proven nonischemic-dilated cardiomyopathy underwent radionuclide ventriculography (n = 75) and provocative thallium-201 perfusion imaging (n = 17). RESULTS: Regional LV wall motion abnormalities were noted in 48% of patients, and 54% had LV systolic dysfunction without concomitant right ventricular dysfunction. Reversible and/or fixed exercise-induced thallium-201 perfusion abnormalities occurred in 94% of the patients studied. CONCLUSIONS: Radionuclide ventriculography and exercise testing with thallium perfusion imaging cannot be used reliably to differentiate ischemic from nonischemic dilated cardiomyopathy, since many patients with the latter have radionuclide evidence of LV segmental wall motion abnormalities, selective LV systolic dysfunction, and segmental perfusion abnormalities.

Adolescent↗
PubMed1993

Interpretation of cardiac pathophysiology from pressure waveform analysis: simultaneous left and right ventricular pressure measurements.

In addition to demonstrating constrictive and restrictive cardiac physiology, simultaneous right and left ventricular pressure measurements can be helpful to identify various aspects of myocardial dysfunction. Intracardiac conduction defects will displace the right ventricular pressure under the left ventricular pressure upstroke and identify differences in the timing of ventricular contraction. Right ventricular dysfunction will also produce abnormal right ventricular pressure waveforms which may overlap left ventricular pressure and contribute to abnormalities in right atrial and ventricular pressure waveforms.

Adult↗
PubMed2006

Usefulness of pulsed-wave tissue Doppler echocardiography for the assessment of the left and right ventricular function in patients with clinical hypothyroidism.

Clinical hypothyroidism (HT) is often associated with cardiovascular disorders, such as endothelial and myocardial dysfunction. Previous studies have explored left ventricular (LV) function using pulsed-wave tissue Doppler echocardiography (TDE) in HT. However, no study has utilized this technique in the assessment of right ventricular (RV) function in HT. Accordingly, we investigated the effects of clinical HT on LV and RV function by TDE. The study subjects included 35 newly diagnosed HT patients and 32 healthy normal controls. For each subject, serum FT3, FT4, TT3, TT4, and thyroid stimulating hormone (TSH) levels were measured, and standard echocardiography and TDE were performed. No statistically significant difference was found between patients and controls with regard to age, gender, body mass index, heart rate, and blood pressure. Compared to controls, TSH levels were significantly higher, and TT4 and FT4 levels were significantly lower. TDE showed that patients had significantly lower early diastolic tricuspid annular velocity (Ea) and early/late (Ea/Aa) diastolic tricuspid annular velocity ratio (P < 0.001 and P < 0.001, respectively), and significantly longer isovolumetric relaxation time (P < 0.001) than those of the controls. Aa, Sa, isovolumetric contraction time, and ejection time did not significantly differ. In addition, a significant relationship between some TDE indexes, and thyroid hormones (TT4 and FT4) and TSH was observed. We showed that patients with clinical HT are associated with impaired RV diastolic function, in addition to impaired LV diastolic function using TDE.

Adult↗
PubMedDate not supplied

Extracorporeal life support as a post left ventricular assist device implant supplement.

Extracorporeal life support (ECLS) is indicated following left ventricular assist device (LVAD) implant for right heart failure or pulmonary dysfunction. From December 1991 to December 1996, 100 patients were supported with the implantable HeartMate LVAD. Of these, 12 patients were supported with ECLS post LVAD implant. Pre-operatively, 10 patients (83%) were on an intra-aortic balloon pump, 9 patients (75%) were intubated, and 8 patients (67%) required ECLS bridge to LVAD implant. Six patients (50%) were men, and patient age ranged from 28 to 63 years (mean 46 +/- 10 years). Duration of ECLS averaged 3 +/- 2 days (range, 1-9 days). Eight patients (67%) required a right ventricular assist device (RVAD) with an ECLS circuit, three patients (25%) required peripheral veno-venous ECLS, and one patient peripheral veno-arterial ECLS. Forty-five percent supported with ECLS post LVAD survived to transplant compared with the 81% supported with LVAD only. Early in this experience, three patients had RVAD support only and all three patients died. RVAD support (with or without ECLS) was 11% overall and declined from 14% in the first 50 patients to 8% in the second 50. ECLS post LVAD is relatively uncommon and its use is associated with reduced survival, but helps salvage these critically ill patients.

Adult↗
PubMed2006

Cardiovascular magnetic resonance imaging for the assessment of right heart involvement in cardiac and pulmonary disease.

In most patients with heart disease left ventricular dysfunction is the principle physiologic disorder leading to heart failure and is an important prognostic factor. Various imaging methods have been developed for the evaluation of left ventricular function and a substantial body of literature is available describing these methods. The right ventricle (RV) may be predominantly involved in certain cardiac or pulmonary pathological conditions such as arrhythmogenic right ventricular cardiomyopathy or pulmonary hypertension. Also in many congenital or acquired cardiac diseases primarily affecting the left ventricle (LV), right heart involvement has an important role in disease prognosis. The RV is difficult to evaluate using two-dimensional (2D) cross-sectional imaging modalities due to its complex shape and orientation. Cardiovascular magnetic resonance imaging (CMR) is a virtually three-dimensional (3D) tomographic technique which has entered the mainstream of clinical cardiovascular imaging over the last decade. Compared to other imaging methods CMR allows the accurate quantification of RV volumes, myocardial mass, and transvalvular flow with the added benefit of tissue characterisation and without the use of ionising radiation. The manuscript presents a review of the contemporary use of CMR for the evaluation of right heart involvement in various cardio-pulmonary diseases.

Diagnostic Techniques, Cardiovascular↗
PubMedDate not supplied

[Influence of the pericardium in the pathophysiology of ventricular dysfunction in acute infarct of the right ventricle. Experimental study] .

UNLABELLED: To obtain more information about the role of the pericardium in the setting of acute right ventricular infarction (ARVI) we studied the behaviour of the ventricular function curves (VFC) and the relationship of the ventricular end-diastolic pressures (R-VEDP-RV:LV) in two groups of dogs. Group A. (n = 12) Control (C), ARVI, Pericardiectomy (P). A parabolic behaviour of the C VFC was noted (r2 = 071) and it's flexion point (FP) was found in 13. +/- 2 mmHg. After the ARVI the right (R) VFC was shifted downwards and to the right and the FP was documented in 18 +/- 2 mmHg (p < 0.05) in relation to C VFC. After P the RVFC was displaced upwards and to the left in relation to ARVIC RVFC (p < 0.05). The C R-VEDP-RV:LV = 0.75 and only a trend to equalization after the ARVI and after P were noted (0.91, 0.84, respectively) (p = ns). Group B (n = 12). Control (C), P, ARVI. The RVFC after P was shifted up and to the left in relation to the C RVFC (p < 0.05) and the FP = 10 +/- 2 mmHg. After P in the setting of ARVI the RVFC was shifted downward and to the right in relation to P RVFC (p < 0.05). After P the R-VEDP-RV:LV = 0.45 and statistical significant equalized in the condition of ARVI without pericardium (0.95, p < 0.05). CONCLUSION: Ours results support a partial restrictive role of the pericardium in the origin of the low cardiac output (LCO) in ARVI. Because, equalization of the R-VEDP-RV:LV is not only due to the restraining pericardial effect but is also due to right ventricular myocardial ischemia. The FP (18. +/- 2 mmHg) found seems to be the top value of RVEDP for volume infusion in experimental ARVI. Hemodynamic finding that could be useful in the preload volume management for humans with ARVI and LCO or systemic hypotension.

Animals↗
PubMed2006

Pulmonary embolism and right heart function: insights from myocardial Doppler tissue imaging.

BACKGROUND: Acute pulmonary embolism (PE) has significant impact in right heart function. We assess the difference of Doppler tissue parameters among control subjects, patients with pulmonary hypertension, and patients with acute PE. After optimal treatment, the changes of Doppler tissue parameters in patients with PE were assessed. METHODS: A total of 50 patients with acute PE, confirmed by multidetector-row chest computed tomography, were enrolled. Another 70 patients with pulmonary hypertension, but no evidence of PE found by computed tomography, were also enrolled. A total of 100 healthy people without signs of cardiopulmonary dysfunction served as a control group. We assessed left and right ventricular (RV) ejection fraction by Simpson's rule. Doppler tissue parameters were obtained from lateral sides of tricuspid and mitral annulus, and interventricular septum. Myocardial performance index (MPI) of RV was estimated from lateral tricuspid annulus by Doppler tissue imaging, MPI of left ventricle from lateral mitral annulus. RESULTS: The left ventricular and RV ejection fractions in patients with pulmonary hypertension were lower than for the control group and patients with PE. But the RV-MPI in patients with PE was the lowest as a result of significant prolongation of isovolumic relaxation time (IVRT). One month after anticoagulant treatment, the IVRT and RV-MPI recovered in patients with PE. There was no significant correlation between IVRT and pulmonary artery systolic pressure. By bivariate correlation analysis, the most significant factor correlated to pulmonary artery systolic pressure was peak late diastolic velocity of tricuspid annulus with r 0.67, r(2) 0.45, and P less than .0001. CONCLUSIONS: Acute PE has significant impact in systolic and diastolic function of RV. The higher RV-MPI implies that condition. However, optimal anticoagulant treatment corrects RV dysfunction in patients with PE. After a 1-month course of anticoagulant treatment, RV-MPI diminishes as the result of RV-IVRT reduction.

Adult↗
PubMed2006

Pulsed tissue Doppler identifies subclinical myocardial biventricular dysfunction in active acromegaly.

OBJECTIVE: The aim of this study was to assess the role of pulsed tissue Doppler (TD) to identify left (LV) and right ventricular (RV) myocardial regional involvement in acromegaly. PATIENTS AND MEASUREMENTS: Thirty active acromegaly patients, free of diabetes mellitus, thyroid dysfunction, valvular and coronary heart disease, clinically overt heart failure, and 30 sex- and age-matched healthy controls underwent standard Doppler echocardiography and pulsed TD, by placing the sample volume at the level of basal posterior septum, LV lateral mitral annulus and RV lateral tricuspid annulus. Myocardial systolic (S(m)) and diastolic velocities (E(m)/A(m) ratio) and time-intervals of relaxation (RT(m)), precontraction (PCT(m)) and contraction (CT(m)) and the PCT(m)/CT(m) ratio were measured at each level. RESULTS: The two groups had similar heart rate, whereas acromegaly patients had higher body mass index, systolic and diastolic blood pressure, LV mass and impaired Doppler indexes of LV and RV diastolic function, without any difference in the global systolic function. At TD, acromegaly patients showed significantly delayed RT(m) and PCT(m,) reduced E(m)/A(m), S(m) and increased PCT(m)/CT(m) of posterior septum, mitral annulus and tricuspid annulus in comparison with controls. By separate multilinear regression analyses, after adjusting for body mass index, heart rate, diastolic blood pressure and LV mass index, age was the main independent determinant of tissue Doppler diastolic but not of systolic indexes. CONCLUSIONS: In active acromegaly, pulsed TD confirms LV and RV diastolic abnormalities detectable by standard Doppler, additionally identifying subclinical biventricular impairment of systolic function.

Acromegaly↗
PubMedDate not supplied

[Dynamics of ultrastructural changes in guinea pig cardiomyocytes in experimental diphtheria intoxication].

Electron microscopy of the left and right ventricles from guinea pigs was made 24, 72, and 120 hours after they were administered diphtheria toxin, 0.3 DLM/kg. The important pathogenetic mechanism responsible for dysfunction of the "diphtheritic heart" was found to be left and right ventricular cardiomyocytic lesion discordance developing in the mid-process, by causing serious intracardiac hemodynamic disorders. The lysosomal system influencing the ultrastructure of the two ventricles may exist in the heart. In diphtheritic intoxication, cardiomyocytic lysosomes exert mainly a damaging effect on their ultrastructure.

Animals↗
PubMed2002

Arrhythmogenic right ventricular cardiomyopathy and atrial right-to-left shunt.

A 47-year-old woman diagnosed with arrhythmogenic right ventricular cardiomyopathy, was studied at our institution with palpitations, progressive dyspnoea and cyanosis over a 3-year period. Her haemoglobin saturation was 76.1%. The transthoracic echocardiogram showed that both right atrium and ventricle were dilated, with diffuse akinetic and hypokinetic areas. Radionuclide scintigraphy, angiography and magnetic resonance imaging showed dilated and severe dysfunction of the right ventricle, with depressed ejection fraction (0.16), and bulging at the level of the right ventricular anterior wall areas. Doppler examination revealed a right-to-left interatrial shunt through a patent foramen ovale. Contrast transoesophageal echocardiography confirmed the right-to-left shunting. Considering the clinical symptoms were severe and refractory to medical treatment, she was referred for cardiac transplantation. Unfortunately the patient died suddenly a few weeks later.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMed2006

Right ventricular abnormalities in sickle cell anemia: evidence of a progressive increase in pulmonary vascular resistance.

OBJECTIVE: To assess the effects of sickle cell anemia (SCA) on the right ventricle (RV). STUDY DESIGN: Echocardiograms of 32 children with SCA were compared with age-matched healthy controls. RV measurements included diastolic area index, fractional area change, free-wall mass index, ejection time corrected for heart rate (ET(c)), and tricuspid regurgitation (TR) gradient. RESULTS: SCA subjects had elevated RV ETc (mean +/- standard deviation, 0.369 +/- 0.030 sec vs 0.351 +/- 0.022 sec; P < .01), diastolic area index (19.9 +/- 2.4 cm(2)/m(2) vs 13.2 +/- 2.1 cm(2)/m(2); P < .01) and free-wall mass index (33.2 +/- 4.4 g/m(2) vs 23.9 +/- 4.3 g/m(2); P < .01), whereas RV fractional area change (37 +/- 8% vs 36 +/- 4%) was not different from controls. Although RV diastolic area index in SCA paralleled the normal range over time, RV free-wall mass index continued to gradually rise throughout childhood (r = .42; P < .05). TR gradients > 2.5 m/sec, consistent with pulmonary hypertension, were found in 5 (16%) of SCA subjects, all older than 9 years. CONCLUSIONS: RV preload and systolic function do not worsen during childhood in SCA; however, RV mass index and the prevalence of pulmonary hypertension increase consistent with rising pulmonary vascular resistance.

Adolescent↗
PubMed2006

Early diastolic impairment of diabetic heart: the significance of right ventricle.

BACKGROUND: Left ventricular diastolic dysfunction represents the earliest preclinical manifestation of diabetic cardiomyopathy. Right ventricular function has not been studied in depth yet in diabetic patients, although the right ventricle has an important contribution to the overall cardiac function. This study was designed to assess diastolic and systolic ventricular function in both ventricles, in patients with type 1 diabetes, free from coronary artery disease and hypertension. METHODS: We studied 66 type 1 diabetic patients and 66 age- and sex-matched normal subjects by conventional and tissue Doppler echocardiography. A possible correlation was examined for age, diabetes duration and echocardiographic measurements of left ventricular and right ventricular functions with univariate analysis. RESULTS: Type 1 diabetic patients were found to have impaired diastolic function in both ventricles with either conventional or tissue Doppler echocardiography. On the contrary, systolic function in both ventricles was preserved in our diabetic population. The measured indexes showed an expected correlation with age and diabetes duration except from systolic velocity in tricuspid annulus determined by color tissue Doppler. Moreover, significant correlations were found among parameters of left and right ventricular function. CONCLUSIONS: Patients with type 1 diabetes mellitus have impaired diastolic function, and particularly relaxation, in both ventricles before the development of myocardial systolic dysfunction. These alterations in myocardial function may be attributed to ventricular interdependence as well as to the uniform effect of diabetes to cardiac function.

Adult↗
PubMed1991

Acute positive inotropic intervention: the phosphodiesterase inhibitors.

Phosphodiesterase inhibitors that are selective for cAMP-specific cardiac and vascular PDE III comprise a new group of agents for the treatment of heart failure, which at present are limited to clinical shortterm intravenous use and research uses only. Although both intravenous amrinone and milrinone are FDA approved, only amrinone is available for general clinical use. Selective phosphodiesterase inhibition produces beneficial actions of positive inotropy and peripheral vasodilation that result from increased cardiac and vascular muscle concentrations of intracellular cAMP and ionic calcium. In addition, a positive lusitropic action (enhancement of cardiac relaxation) has been observed. Neither beta-adrenergic agonist activity nor inhibition of the sodium-potassium ATPase is produced by these agents. The magnitude of hemodynamic improvement generally exceeds that of the cardiac glycosides and is comparable with that of intravenous catecholamines such as dobutamine. The different pharmacodynamic profile of the PDE inhibitors is additive to the effects of cardiac glycosides, complementary and synergistic to the actions of catecholamines, and has been shown to have favorable effects on coronary hemodynamics. As a result there is continued enthusiasm for the short-term intravenous use of amrinone and potentially milrinone in the setting of acute heart failure resulting from systolic dysfunction (after myocardial infarction, open heart surgery, or infectious or toxic myocarditis), heart failure resulting from right ventricular systolic dysfunction, and when patients with severe heart failure await cardiac transplantation. Initiation of treatment with an intravenous bolus followed by a maintenance infusion provides prompt increases in stroke volume and cardiac output and simultaneous reductions in right and left ventricular filling pressures and systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Amrinone↗
PubMed2006

The deleterious consequences of right ventricular apical pacing: time to seek alternate site pacing.

BACKGROUND: The purpose of this article is to critically review the data accumulated to date from studies evaluating the hemodynamic and clinical effects of right ventricular apical pacing during conventional permanent cardiac pacing. The data from studies comparing the effects of right ventricular apical pacing and alternate site ventricular pacing are also reviewed. METHODS: We conducted a MEDLINE and journal search of English-language reports published in the last decade and searched relevant papers. RESULTS: Although intraventricular conduction delay in the form of left bundle branch block (LBBB) has traditionally been viewed as an electrophysiologic abnormality, it has now become abundantly clear that it has profound hemodynamic effects due to ventricular dyssynchrony, especially in patients with heart failure. These deleterious effects can be significantly ameliorated by cardiac resynchronization therapy effected by biventricular or left ventricular pacing. However, not only is spontaneous LBBB harmful, but the iatrogenic variety produced by right ventricular apical pacing in patients with permanent pacemakers may be equally deleterious. In this review new evidence from recent studies is presented, which strongly suggests a harmful effect of our long-standing practice of producing an iatrogenic LBBB by conventional right ventricular apical pacing in patients receiving permanent pacemakers. This emerging strong new evidence about the adverse hemodynamic and clinical effects of right ventricular apical pacing would dictate a reassessment of our traditional approach to permanent cardiac pacing and direct our attention to alternate sites of pacing, such as the left ventricle and/or the right ventricular outflow tract or septum, if not for all patients, at least for those with left ventricular dysfunction. Indeed, current convincing data on alternate site ventricular pacing are encouraging and this approach should be actively pursued and further investigated in future studies. CONCLUSIONS: Not only is spontaneous permanent LBBB harmful to our patients, but the iatrogenic variety produced by right ventricular apical pacing during conventional permanent pacing may also be deleterious to some patients. The compelling evidence presented herein cannot be ignored; it may dictate a change of attitude toward right ventricular apical pacing directing our attention to alternate sites of ventricular pacing and avoidance of the right ventricular apex.

Bundle-Branch Block↗