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Results for “Ventricular Dysfunction, Right”

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At least 1,531 records · Page 85Linked to original sources
PubMed2003

Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach.

OBJECTIVE: To determine the prevalence of systemic sclerosis associated pulmonary arterial hypertension (SScPAH), evaluate outcome, and identify predictors of mortality in a large patient cohort. METHODS: A prospective four year follow up study of 794 patients (722 from our own unit and 72 referrals). All patients screened for PAH using a combination of echocardiography, lung function testing, and clinical assessment. Patients with suspected raised pulmonary artery systolic pressures of >35 mm Hg, carbon monoxide transfer factor (TLCO) <50% predicted, or a precipitous fall in TLCO >20% over a one year period with no pulmonary fibrosis, and patients with SSc with breathlessness with no pulmonary fibrosis found were investigated with right heart catheterisation. All patients with SScPAH were treated in accordance with current best practice. RESULTS: The prevalence of PAH was 12% (89/722) by right heart catheter. The survival was 81%, 63%, and 56% at 1, 2, and 3 years from the diagnosis (in 89 patients from our own cohort and 59/72 referrals). Haemodynamic indices of right ventricular failure--raised mRAP (hazard ratio 21), raised mPAP (hazard ratio 20), and low CI (hazard ratio 11) predicted an adverse outcome There was no significant difference in survival between patients with SScPAH with (n=40) and without (n=108) pulmonary fibrosis (p=0.3). CONCLUSIONS: The prevalence of SScPAH in this cohort was similar to that of other catheter based studies and lower than that of previous echo based studies. The 148 patients with SScPAH actively treated had comparable outcomes to those of the cohorts with primary pulmonary hypertension. A high mRAP was the strongest haemodynamic predictor of mortality. To improve prognosis, future treatments need to be implemented at an earlier disease stage to prevent right ventricular decompensation.

Aged↗
PubMedDate not supplied

Echocardiographic detection of reversible right ventricular strain in patients with acute pulmonary embolism: report of 2 cases.

This report presents serial echocardiographic changes recorded before and after anticoagulant therapy was administered to 2 patients with acute pulmonary embolism. Dilatation of the right ventricle, abnormal motion of the interventricular septum and mild tricuspid regurgitation were noted in both patients. The results of the echocardiogram suggested that the patients had right ventricular pressure overload resulting from pulmonary hypertension caused by an acute pulmonary embolism. Echocardiograms performed after the patients had received anticoagulant therapy revealed a normalization of the echocardiographic parameters in both patients. The reversal of the right ventricular strain pattern revealed by an echocardiogram occurred as the result of the regression of pulmonary hypertension after anticoagulant therapy. In conclusion, echocardiographic detection of right ventricular strain in patients who present acute cardiopulmonary manifestations with no previous history of severe pulmonary disease may indicate the possibility of a pulmonary embolism.

Acute Disease↗
PubMed2005

Heart involvement and systemic sclerosis.

Scleroderma heart involvement (SHI) is often manifest, and virtually always present when accurately searched and holds a significant prognostic value. Myocardial involvement by patchy fibrosis (secondary to both repeated ischaemia and immunoinflammatory damage) leads to ventricular diastolic dysfunction, whereas right ventricle overload and failure may complicate pulmonary hypertension. Left ventricular systolic dysfunction is present in a minority of patients, namely those presenting atherosclerotic coronary artery disease and/or arterial hypertension, sometimes triggered by sclerodermic renal involvement. Dysrhythmias and conduction disturbances are considered an hallmark of SHI, facilitated by autonomic dysfunction. SHI is frequently linked to parenchimal and/or vascular lung disease; they determine symptom occurrence, particularly dyspnoea, fatigue, palpitations and chest pain when pericardium is affected. Accurate cardiologic baseline screening and subsequent follow-up are mandatory in all patients, initially consisting in some noninvasive diagnostic procedures: visit, electrocardiogram (EKG), chest X-ray, Doppler-echocardiography. When needed, these examinations should be integrated by EKG Holter-monitoring, cardiopulmonary stress tests, cardiac magnetic resonance imaging, nuclear studies of myocardial function and perfusion, cardiac catheterization to better estimate pulmonary hypertension, and cardiac natriuretic hormone evaluation. Several vasodilator approaches (prostacycline or NO/endothelin) may counteract the microvascular dysfunction at peripheral and cardiopulmonary level, and fight the sequelae of pulmonary hypertension.

Fibrosis↗
PubMed1996

Progressive ECG changes in arrhythmogenic right ventricular disease. Evidence for an evolving disease.

Electrocardiography results were used to assess diagnosis and evolution of arrhythmogenic right ventricular disease. The initial ECG presentation and long-term changes were analysed in 74 consecutive patients with symptomatic ventricular tachycardia and arrhythmogenic right ventricular disease. On first available tracings, a left axis deviation of the QRS was found in 18 patients. The QRS length in V1 was > or = 110 ms in 39 patients, an epsilon wave was present in 17, and a complete right bundle branch block in four patients. The T wave was negative in V1-V3 in 37 patients (50%). In 36 patients, long-term electrocardiographic follow-up of 9.5 +/- 3.2 years was available. During this period, ECG changes were observed in 20 patients (56%): negative T waves in 11 patients, a new left axis deviation in three, QRS enlargement in 13 (including eight right bundle branch block), right atrial hypertrophy in three, and paroxysmal or established atrial fibrillation in three. On studying all 110 ECG tracings (74 initial recordings +36 follow-up ECGs), we found a strong correlation between QRS or T wave changes and the length of follow-up after the first symptom; mean time interval between first ventricular tachycardia and ECG recording was significantly longer in patients with negative T waves in the right precordial leads, QRS enlargement, or left axis deviation, than in patients without such abnormalities. ECG abnormalities were more frequent at 10 year and 5 year follow-up than on initial tracings. A normal ECG was found in 40% of patients during the first year of follow-up, 8% at 5 years, and never later than the 6th year. In conclusion, electrocardiographic diagnosis of arrhythmogenic right ventricular disease may be difficult in the initial stage of the disease, since a normal ECG is found in up to 40% of patients. During the follow-up, progressive and characteristic ECG changes will occur. Arrhythmogenic right ventricular disease can be excluded if the ECG is found to be normal 6 years or later after a first ventricular tachycardia attack.

Adolescent↗
PubMed2000

Three-dimensional motion reconstruction and analysis of the right ventricle using tagged MRI.

Right ventricular (RV) dysfunction can serve as an indicator of heart and lung disease and can adversely affect the left ventricle. However, normal RV function must be characterized before abnormal states can be detected. We describe a method for reconstructing the 3D motion of the RV by fitting a deformable model to tag and contour data extracted from multiview tagged magnetic resonance images. The deformable model is a biventricular finite element mesh built directly from segmented contours. Our approach accommodates the geometrically complex RV by using the entire lengths of the tags, localized degrees of freedom, and finite elements for geometric modeling. Also, we outline methods for converting the 3D motion reconstruction results into potentially useful motion variables, such as strains and displacements. The technique was applied to synthetic data, two normal hearts, and two hearts with right ventricular hypertrophy (RVH). Noticeable differences were found between the motion variables calculated for normal volunteers and RVH patients.

Humans↗
PubMed2004

[Cardiogenic shock due to acute mitral dysfunction after deep venous thrombosis].

Open surgical embolectomy may be life-saving in massive pulmonary embolism. Up to now there are no studies concerning the question whether the foramen ovale should be examined routinely during surgery and whether an open foramen ovale should be closed routinely in the same session. Even case reports regarding this question are missing. We report on a 74-year old female patient who developed pulmonary embolism due to deep venous thrombosis. Six days after successful surgical embolectomy the patient developed cardiogenic shock due to a huge thrombus from the right atrium through the foramen ovale into the left atrium and the left ventricle. Immediate surgical embolectomy of a 40-50 cm huge thrombus was successful. Immediately after surgery upon the cardiac mass the patient showed symptoms of acute right leg ischemia. Thus a second embolectomy was necessary, the surgeon removed a 10 cm thrombus from the right external iliacal artery. There was no evidence of another pulmonary embolism timely related to the paradoxical embolism.

Acute Disease↗
PubMed1995

Risk factors of cardiac arrest in arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia is an important cause of ventricular arrhythmia with a potential risk of sudden cardiac death in a young population. In order to define risk factors of cardiac arrest, angiographic and electrophysiological data from 60 patients with angiographically documented arrhythmogenic right ventricular dysplasia (of whom 20 also had spontaneous non-sustained ventricular arrhythmias, 27 sustained ventricular tachycardia and 13 suffered cardiac arrest with documented ventricular fibrillation before resuscitation) were analysed. There were no statistically significant differences in right ventricular volume, global right ventricular ejection fraction (RVEF), right ventricular structure, mean age at the time of diagnosis and angiographic left ventricular contraction abnormalities in the subgroups of patients with different forms of spontaneous arrhythmias. Only in a subgroup of patients with cardiac arrest and inducible sustained ventricular tachycardia did right ventricular volume (P < 0.05), ejection fraction (P < 0.001) and the amount of structural changes (P < 0.01) reveal significant results. A subgroup of patients with structural alterations and a low level of right ventricular function is at a high risk of cardiac arrest, although strenuous exercise and sport remain most important risk factors.

Adolescent↗
PubMed2003

[The use of right ventricular support with a centrifugal pump in a case with right ventricular failure due to intraoperative right ventricular infarction].

The patient was 67-year-old woman with mitral valve restenosis and regurgitation, tricuspid insufficiency, and left atrial dilatation who underwent mitral valve replacement, tricuspid valvuloplasty, and left atrial plication. The patient developed right ventricular (RV) failure due to RV infarction when she was weaned from cardiopulmonary bypass (CPB). Therefore, CPB was resumed to be followed by intra-aorta balloon pumping (IABP). However, complete response was not obtained. Thus, right ventricular support was performed using a centrifugal pump, and the patient could be weaned from CPB. Three days after surgery, the right ventricular support was discontinued, and IABP was removed 7 days after surgery without marked changes in hemodynamics. Although RV failure due to RV infarction is a serious intraoperative complication, favorable results were obtained by combination therapy with IABP and right ventricular support using a centrifugal pump in our patient.

Cardiopulmonary Bypass↗
PubMed1995

[Acute right ventricular insufficiency reversible following anthracycline treatment].

Anthracyclines are very effective antineoplastic agents for the treatment of acute leukemia. Early and late dose-related cardiotoxicity can occur. We present a 33 year old women who developed a reversible right heart failure fifteen days after receiving a treatment with doxorubicine. Severe regional wall motion abnormalities were appreciated through two-dimensional and Doppler-flow echocardiography, there was no evidence of impaired systolic or diastolic left ventricle function. Two weeks later, remission of acute right ventricle failure was obtained, echocardiographic assessment was normal at this time. Incidence of right ventricle abnormalities after treatment is discussed.

Acute Disease↗
PubMed1992

Right ventricular failure after heart transplantation: relationship with preoperative haemodynamic parameters.

The prevalence of right ventricular failure after orthotopic heart transplantation, evaluated in 196 patients, was 11.7%, as assessed by the presence during the first postoperative month of right atrial pressure > 10 mm Hg. Two deaths, related to refractory right ventricular failure, were observed within the first month, both in subjects with preoperative pulmonary arteriolar resistances > 5 Wood Units. The haemodynamic profile after heart transplantation showed a significant decrease (P < 0.01) and an early normalization of pulmonary arterial pressure, pulmonary wedge pressure and pulmonary arteriolar resistances, while right atrial pressure slowly decreased until the third month. In a long-term analysis of survival (death within 1 year) the probability of death was significantly related to the values of right atrial pressure and cardiac index during the first month after heart transplantation. Otherwise, the presence of elevated values of right atrial pressure did not show a significant correlation with the echocardiographic right ventricular end-diastolic diameter nor with the presence of right bundle branch block. The careful selection of patients referred for the cardiac transplantation (mean value of pulmonary arteriolar resistances in the evaluated subjects was 2.5 +/- 1.5 Wood Units) improves the probability of avoiding the appearance of severe right ventricular failure in the postoperative period in most cases. The best predictor of right ventricular failure remains to be clearly identified.

Blood Pressure↗
PubMed1995

Rapid hemodynamic improvement after reperfusion during right ventricular infarction.

OBJECTIVES: This study sought to determine the effects of reperfusion on hemodynamic status and hospital course in patients with right ventricular infarction. BACKGROUND: In contrast to the relatively low risk associated with acute inferior myocardial infarction, right ventricular infarction is associated with higher in-hospital morbidity and mortality. However, the potential benefits of reperfusion in patients with right ventricular infarction are unknown. Consequently, this study evaluated the potential benefits of primary angioplasty in patients with right ventricular infarction. METHODS: Of 141 consecutive patients admitted to the hospital for inferior myocardial infarction, 27 were identified as having right ventricular involvement by electrocardiographic and hemodynamic criteria. Seventeen patients achieved patency of the infarct-related right coronary artery by primary coronary angioplasty within 24 h of hospital admission, but 10 patients did not. All patients had invasive hemodynamic monitoring at the time of hospital admission, and subsequent serial hemodynamic status and clinical events were recorded. RESULTS: Patients with successful reperfusion demonstrated improved right atrial pressure, pulmonary capillary wedge pressure and right atrial/pulmonary capillary wedge pressure ratio as early as 8 h after reperfusion, whereas patients without reperfusion had no hemodynamic improvement over 24 h. Right atrial pressure demonstrated the greatest 8-h improvement after successful reperfusion (15.4 +/- 0.8 to 8.4 +/- 0.8 mm Hg [mean +/- SD], p < 0.05) but was unchanged without reperfusion (13.7 +/- 0.9 to 13.9 +/- 0.8 mm Hg, p = NS). Additionally, persistently elevated right atrial pressure was associated with increased mortality. CONCLUSIONS: Reperfusion in the setting of right ventricular infarction leads to rapid hemodynamic improvement and may result in improved survival.

Aged↗
PubMed1998

Pulmonary impedance and right ventricular-vascular coupling in endotoxin shock.

OBJECTIVE: We tested the hypothesis that right heart failure during endotoxin shock may result from altered ventriculovascular coupling responsible for impeding power transfer to the pulmonary circulation. METHODS: The changes in vascular pulmonary input impedance and right ventricular contractility produced by low-dose endotoxin infusion were studied in 6 intact anesthetized dogs. RESULTS: Endotoxin insult resulted in pulmonary hypertension (from 22 +/- 2 to 33 +/- 3 mmHg) associated with significant decreases in stroke volume (from 26.9 +/- 4 to 20.2 +/- 3 ml) and right ventricular ejection fraction (from 41 +/- 3 to 32 +/- 2%). The first minimum of input impedance spectrum and zero phase were shifted towards higher frequencies. Input resistance and characteristic resistance were dramatically increased. The latter change contributed to a significant increase in the pulsatile component of total right ventricular power output from 13 to 21%, indicating a reduction in the hydraulic right ventricle power output delivered into the main pulmonary artery. Overall changes in input pulmonary impedance were indicative of increased afterload facing the right ventricle leading to depressed performance. In contrast, right ventricular systolic elastance was simultaneously increased from 0.56 to 0.93 mmHg/ml indicating an increase in right heart contractility. CONCLUSION: These data suggest that pulmonary hypertension in the setting of experimental endotoxin shock is accompanied by deleterious changes in the pulmonary impedance spectrum, which are responsible for a mismatch of increased contractile state of the right ventricle to the varying hydraulic load ultimately leading to ventricular-vascular uncoupling.

Analysis of Variance↗
PubMed2001

ST elevation in the anterior precordial leads during right ventricular infarction: lessons learned during primary coronary angioplasty--a case report.

ST elevation in the anterior leads may be due to isolated right ventricular infarction associated with occlusion of a nondominant or codominant right coronary artery. The authors report a case of isolated right ventricular infarction from a dominant right coronary artery's proximal occlusion in the presence of collateral circulation provided by the left coronary artery. Extensive damage occurred owing to compromise of the collateral circulation during primary coronary angioplasty. This is an unusual angiographic pattern for isolated right ventricular infarction. The potential consequences of percutaneous interventions to collateral vessels is discussed.

Adult↗