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Results for “Ventricular Dysfunction, Right”

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At least 1,333 records · Page 74Linked to original sources
PubMed2005

Three-dimensional electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia.

BACKGROUND: Three-dimensional electroanatomic voltage mapping offers the potential to identify low-voltage areas that correspond to regions of right ventricular (RV) myocardial loss and fibrofatty replacement in patients with arrhythmogenic RV cardiomyopathy/dysplasia (ARVC/D). METHODS AND RESULTS: Thirty-one consecutive patients (22 men and 9 women; mean age, 30.8+/-7 years) who fulfilled the criteria of the Task Force of the European Society of Cardiology and International Society and Federation of Cardiology (ESC/ISFC) for ARVC/D diagnosis after noninvasive clinical evaluation underwent further invasive study including RV electroanatomic voltage mapping and endomyocardial biopsy (EMB) to validate the diagnosis. Multiple RV endocardial, bipolar electrograms (175+/-23) were sampled during sinus rhythm. Twenty patients (group A; 65%) had an abnormal RV electroanatomic voltage mapping showing > or =1 area (mean 2.25+/-0.7) with low-voltage values (bipolar electrogram amplitude <0.5 mV), surrounded by a border zone (0.5 to 1.5 mV) that transitioned into normal myocardium (>1.5 mV). Low-voltage electrograms appeared fractionated with significantly prolonged duration and delayed activation. In 11 patients (group B; 35%), electroanatomic voltage mapping was normal, with preserved electrogram voltage (4.4+/-0.7 mV) and duration (37.2+/-0.9 ms) throughout the RV. Low-voltage areas in patients from group A corresponded to echocardiographic/angiographic RV wall motion abnormalities and were significantly associated with myocyte loss and fibrofatty replacement at EMB (P<0.0001) and familial ARVC/D (P<0.0001). Patients from group B had sporadic disease and histopathological evidence of inflammatory cardiomyopathy (P<0.0001). During the time interval from onset of symptoms to the invasive study, 11 patients (55%) with electroanatomic low-voltage regions received an implantable cardioverter/defibrillator because of life-threatening ventricular arrhythmias, whereas all but 1 patient with a normal voltage map remained stable on antiarrhythmic drug therapy (P=0.02). CONCLUSIONS: Three-dimensional electroanatomic voltage mapping enhanced accuracy for diagnosing ARVC/D (1) by demonstrating low-voltage areas that were associated with fibrofatty myocardial replacement and (2) by identifying a subset of patients who fulfilled ESC/ISFC Task Force diagnostic criteria but showed a preserved electrogram voltage, an inflammatory cardiomyopathy mimicking ARVC/D, and a better arrhythmic outcome.

Adult↗
PubMed1996

[Is the presence of right ventricular high intensity signals sufficient for the diagnosis of right ventricular dysplasia?].

The aim of this study was to assess "morphological" MRI data (spin-echo) compared with cine-MRI in 10 patients with documented right ventricular dysplasia and 10 normal controls. Data was acquired with a 0.5 Tesla superconductor magnet associating sequences of spin-echo and gradient echo (cine-MRI). An abnormal high intensity signal was observed in spin-echo in 9 out of the 10 patients. They were present on the anterior and sub-tricuspid walls of the right ventricle (8/10) and in the pulmonary infundibulum (8/10). A dyskinetic zone corresponding to the abnormal signals was detected in 8 patients. In the control group, only one subject had an abnormal high intensity signal and no dyskinesis could be detected. The association of high intensity signals and dyskinesis would seem to be very specific of right ventricular dysplasia. On the other hand, a high intensity signal alone may be observed in apparently normal subjects and would seem to be less specific.

Aged↗
PubMed2000

Isolated right ventricular infarction.

Rare occurrence of isolated right ventricular infarction is reported in four patients, three of whom were elderly. The causes of infarction were due to pulmonary thromboembolism and dissection of non-dominant right coronary artery. None of the hearts had right ventricular hypertrophy and significant coronary atherosclerosis.

Adult↗
PubMed1998

Estimation of Right Atrial Volume and Function by an Online Echocardiographic Edge Detection System.

To define the accuracy of real-time two-dimensional echocardiographic imaging with automatic border detection (ABD) for the assessment of right atrial volume and function, we studied with ABD echocardiography 29 healthy subjects and 43 patients with sinus rhythm and various forms of heart disease. Twenty-three patients had right ventricular (RV) dysfunction (fractional area change < 45%), and 20 had RV hypertrophy from pressure overload. Doppler color flow imaging disclosed moderate-to-severe tricuspid regurgitation (TR) in 20 patients and trivial or no TR in 23. The ABD-derived end-diastolic (EDV) and end-systolic (ESV) volumes by the method of discs were used to compute fractional indexes of right atrial (RA) volume changes. Right atrial emptying fraction (RAEF) percent [(ESV - EDV)/ESV x 100] was calculated. The ABD-derived EDV and ESV correlated well with conventional offline measurements of two-dimensional echocardiographic images in the 43 patients (r = 0.94 for the end-diastolic values; r = 0.93 for the end-systolic values). Intraobserver and interobserver variability showed a high correlation between different measurements (r = 0.97 and 0.90, respectively). RA volumes were significantly higher in the patient population than in the control subjects (148.9 +/- 66.7 ml vs 43.1 +/- 9.2 ml, P < 0.0001). The right atrial emptying fraction (RAEF) was higher in patients with RV pressure overload than in normal subjects (61% +/- 11% vs 46% +/- 9%, P < 0.05) and lower in those with RV dysfunction than in the control subjects (29% +/- 7% vs 46% +/- 9%, P < 0.01). In both groups (RV pressure overload and RV dysfunction), RAEF was higher in patients without or with trivial TR compared with those with significant TR (29% +/- 7% vs 23% +/- 6%; 61% +/- 11% vs 42% +/- 7%; P < 0.05). Thus, changes in right atrial volume and function can be measured noninvasively by the ABD method. This imaging technique may prove to be useful for assessing right atrial size and function under different physiological and pathological conditions and for identifying factors that influence atrial function in right ventricular diseases.

Journal Article↗
PubMed2005

Usefulness of electroanatomical mapping to differentiate between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia.

Differentiation between the different right ventricular rhythm disorders and specifically between arrhythmogenic right ventricular dysplasia (ARVD) and right ventricular outflow tract (RVOT) tachycardias has important clinical implications but remains a clinical challenge. We tested the hypothesis that the spatial association of local electrographic parameters may be used to discriminate between these 2 entities. Electroanatomic mapping of the right ventricle was performed in 3 groups: patients who had typical RVOT tachycardia, a control group of patients who had no ventricular arrhythmias, and patients who had a diagnosis of ARVD based on clinical, electrocardiographic, and structural findings. Electroanatomic mapping in the RVOT tachycardia group showed normal electrographic parameters throughout the right ventricle (unipolar electrographic amplitude 9.9 +/- 0.9 mV, duration 55 +/- 1 ms, amplitude/duration 0.193 +/- 0.022) that were no different from those in the control group. In contrast, dysplastic regions in the ARVD group were characterized by significantly lower amplitude (unipolar 3.6 +/- 0.4 mV), prolonged electrographic duration (unipolar 73 +/- 4 ms), and a decreased amplitude/duration ratio (unipolar 0.054 +/- 0.008) compared with the unaffected zones in the same hearts and with all regions in the RVOT and control groups. Thus, endocardial electrographic parameters do not differ between patients who have RVOT and control patients. RVOT tachycardia can be differentiated from ARVD by the absence of abnormal right ventricular electrographic findings. This ability may have important clinical implications and supports the concept of different underlying mechanisms for these 2 entities.

Adult↗
PubMed2000

[Idiopathic right ventricular tachycardia or arrhythmogenic right ventricular tachycardia?].

HISTORY: While cycling a 38-year-old man suddenly experienced palpitations associated with marked weakness. 90 min later his general practitioner, having diagnosed a ventricular tachycardia (VT) with a rate of 218/min, terminated it by a drug injection. INVESTIGATIONS: Electrocardiography (ECG), echocardiography and biventricular cardiac catheterization with right ventricular contrast injection failed to provide any evidence of structural abnormality. However, ergometry and EPS with programmed ventricular stimulation induced VT of identical morphology (left bundle branch bloc [LBBB] with right axis deviation [RAD]). TREATMENT AND COURSE: Idiopathic right-ventricular outflow tract tachycardia (IRVT) having been diagnosed, the patient was put on a maintenance dose of 50 mg/d atenolol. After 6 months without symptoms he again experienced several attacks of tachycardia. Resting ECG merely revealed an epsilon potential and negative T waves in V1-V3. Right ventricular contrast injection revealed inferolateral dyskinesia. EPS demonstrated both the known VT and a second, morphologically different one (LBBB with LAD). These findings indicated arrhythmogenic right-ventricular cardiomyopathy (ARCV). A cardioverter/defibrillator was implanted (ICD) and over the subsequent 8 months he had six episodes of VT which were quickly terminated by the ICD. CONCLUSION: At first presentation of right-ventricular outflow tract tachycardia it is often not possible to differentiate between IRVT and arrhythmogenic RV cardiomyopathy. The two being significantly different in prognosis and treatment, follow-up monitoring is essential to establish the definitive diagnosis.

Adult↗