Biomedical subjects

Kathy Edelman

Publications and source records attributed to Kathy Edelman.

8 recordsLinked to original sources

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↗

PubMed2006

Right ventricular dyssynchrony in heart failure: a tissue Doppler imaging study.

BACKGROUND: The development of right ventricular dysfunction is a poor prognostic sign in patients with heart failure (HF). Although left ventricular dyssynchrony has been well described, it is not known whether right ventricular dyssynchrony coexists in HF. We used tissue Doppler imaging to determine whether right ventricular dyssynchrony is also present in HF patients. METHODS AND RESULTS: In 34 HF patients (mean age 56 +/- 13 years), we measured longitudinal strain at the right ventricular free wall, interventricular septum, and left ventricular lateral wall. Right ventricular and left ventricular dyssynchrony were defined as the difference in time to peak strain between the right ventricular free wall and the septum and between the left ventricular lateral wall and septum, respectively. Mean right ventricular dyssynchrony was 59 +/- 45 ms and the mean left ventricular dyssynchrony was 80 +/- 62 ms. We found a strong correlation between right ventricular dyssynchrony and pulmonary artery systolic pressure (r = 0.73; P < .001) and a negative correlation between right ventricular dyssynchrony and right ventricular fractional area change (r = -0.43; P < .02). CONCLUSION: HF patients exhibit right ventricular dyssynchrony by strain imaging which correlates with pulmonary hypertension and right ventricular dysfunction.

Adult↗

PubMed2006

An abnormal right ventricular apical angle is indicative of global right ventricular impairment.

The presence of right ventricular (RV) dysfunction is an adverse prognostic indicator but current echocardiographic methods have some limitations. RV apical angles in systole and diastole were correlated with known parameters of RV function in patients without pulmonary hypertension (Group 1) and in patients with pulmonary hypertension (Group 2). RV apical angles were significantly smaller in both systole (22 +/- 7 degrees) and diastole (33 +/- 6 degrees) in Group 1 patients when compared to Group 2 (54 +/- 18 degrees, p < 0.0001 and 59 +/- 17 degrees, p < 0.0001, respectively). RV apical angles, both in systole and diastole, were strongly correlated with RV end-systolic area (R = 0.89, p < 0.0001) and end-diastolic area (R = 0.81, p < 0.0001), respectively. Similarly, the apical systolic and diastolic angle correlated well with decreased tricuspid annular plane systolic excursion (TAPSE, R = -0.76 and R = -0.73, p < 0.001) as well as with decreased RV fractional area change (R = -0.81 and R = -0.77, p < 0.001). Therefore, we conclude that this new measurement of RV apical angle is simple and useful to quantify RV apical structural and functional abnormalities that are well correlated with global RV impairment in patients with chronic pulmonary hypertension.

Adult↗

PubMed2006

Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures.

Assessment of right ventricular (RV) systolic function can be somewhat difficult, particularly in pulmonary hypertension (PH). RV fractional area change (FAC) and tricuspid valve annular motion (TAPSE) although useful in the assessment of RV performance, their use can be sometimes limited and tedious. Thus, a quicker but yet reliable alternative is needed. Accordingly, we compared peak tricuspid annulus systolic (TA Sa) velocities derived from Doppler tissue imaging (DTI) with both RVFAC and TAPSE to estimate RV function in 52 patients (53 +/- 16 years) with varying degrees of PH. In this group, mean was RVFAC 49 +/- 20, TAPSE was 2.3 +/- 0.7 cm, peak TA Sa velocity by DTI was 10.4 +/- 3.8 cm/s, left ventricular systolic function was 57 +/- 18%, and pulmonary artery systolic pressure was 47 +/- 28 mmHg. An excellent correlation was noted between TAPSE and RVFAC (r = 0.91, P < 0.001). Similar correlations were noted between peak TA Sa velocity and RVFAC (r = 0.84, P < 0.001) and between peak TA Sa velocity and TAPSE (r = 0.90, P < 0.001). A TA Sa >10.5 cm/s identified individuals with both a normal RV function and without significant PH. Therefore, we conclude that TA Sa velocity, an easily obtainable DTI measure, that has an excellent correlation with more time-consuming methods to assess RV systolic function regardless of the degree of PH should be routinely assessed during the initial evaluation and eventual follow-up of patients either at risk or with documented PH.

Adult↗

PubMed2005

Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class.

BACKGROUND: Abnormalities in right ventricular function are known to occur in patients with pulmonary arterial hypertension. OBJECTIVE: Test the hypothesis that chronic elevation in pulmonary artery systolic pressure delays mechanical activation of the right ventricle, termed dyssynchrony, and is associated with both symptoms and right ventricular dysfunction. METHODS: Fifty-two patients (mean age 46 +/- 15 years, 24 patients with chronic pulmonary hypertension) were prospectively evaluated using several echocardiographic parameters to assess right ventricular size and function. In addition, tissue Doppler imaging was also obtained to assess longitudinal strain of the right ventricular wall, interventricular septum, and lateral wall of the left ventricle and examined with regards to right ventricular size and function as well as clinical variables. RESULTS: In this study, patients with chronic pulmonary hypertension had statistically different right ventricular fractional area change (35 +/- 13 percent), right ventricular end-systolic area (21 +/- 10 cm2), right ventricular Myocardial Performance Index (0.72 +/- 0.34), and Eccentricity Index (1.34 +/- 0.37) than individuals without pulmonary hypertension (51 +/- 5 percent, 9 +/- 2 cm2, 0.27 +/- 0.09, and 0.97 +/- 0.06, p < 0.005, respectively). Furthermore, peak longitudinal right ventricular wall strain in chronic pulmonary hypertension was also different -20.8 +/- 9.0 percent versus -28.0 +/- 4.1 percent, p < 0.01). Right ventricular dyssynchrony correlated very well with right ventricular end-systolic area (r = 0.79, p < 0.001) and Eccentricity Index (r = 0.83, p < 0.001). Furthermore, right ventricular dyssynchrony correlates with pulmonary hypertension severity index (p < 0.0001), World Health Organization class (p < 0.0001), and number of hospitalizations (p < 0.0001). CONCLUSION: Lower peak longitudinal right ventricular wall strain and significantly delayed time-to-peak strain values, consistent with right ventricular dyssynchrony, were found in a small heterogeneous group of patients with chronic pulmonary hypertension when compared to individuals without pulmonary hypertension. Furthermore, right ventricular dyssynchrony was associated with disease severity and compromised functional class.

Echocardiography↗

PubMed2005

Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging.

Several well-established echocardiographic parameters used in the assessment of right ventricular (RV) performance, as well as tissue Doppler imaging (TDI) to investigate RV free wall mechanical events, were prospectively obtained from a heterogenous group of 20 patients with varying degrees of pulmonary hypertension (mean age 51 +/- 13 years; World Health Organization class average 2.8, mean pulmonary systolic pressure 78 +/- 24 mm Hg) and compared with similar data retrospectively obtained from 20 healthy volunteers (mean age 45 +/- 15 years). Patients with varying degrees of pulmonary hypertension had worse RV performance parameters than healthy volunteers (RV fractional area change 37 +/- 13% vs 52 +/- 5%, p < 0.0001; RV myocardial performance index 0.76 +/- 0.31 vs 0.29 +/- 0.11, p < 0.0001; and eccentricity index 1.41 +/- 0.57 vs 0.98 +/- 0.06, p < 0.005). Similarly, in these patients with abnormal RV performance, TDI showed statistically significant smaller peak longitudinal RV free wall strain (-21.5 +/- 9.0% vs -28.0 +/- 4.1%, p < 0.01) and significantly delayed time to peak strain (459 +/- 76 vs 388 +/- 29 ms, p < 0.0005) values than in healthy volunteers; a very strong correlation between RV mechanical delay and RV fractional area change (r = -0.89) was noted.

Adult↗

PubMed2005

Usefulness of angle corrected tissue Doppler to assess segmental left ventricular function during dobutamine stress echocardiography in patients with and without coronary artery disease.

The application of angle correction to tissue Doppler (TD) during dobutamine stress echocardiography (DSE) extends the application of TD to all left ventricular segments, improves the differentiation of abnormal from normal segmental responses to stress, and has promise to improve its clinical utility for objectively evaluating wall motion during DSE.

Adult↗

PubMed2003

Normal values of left ventricular systolic and diastolic function derived from signal-averaged acoustic quantification waveforms: a multicenter study.

Automated border-detection techniques such as acoustic quantification have proven accurate and useful for quantifying left ventricular (LV) function. We acquired LV acoustic quantification waveforms from the parasternal short-axis window in 140 healthy patients in the age range of 16 to 78 years. Signal-averaged waveforms were analyzed for parameters of systolic and diastolic performance. The average fractional area change was 54 +/- 12%, and there were no significant changes in LV systolic function in the age range studied. There were significant changes in diastolic parameters with aging. The percentage of contribution to total LV filling occurring during atrial filling nearly tripled during the 6 decades studied, from 13% in the youngest cohort to 36% in the eighth decade of life. This study provides normal reference values for systolic and diastolic parameters of LV function determined from signal-averaged acoustic quantification waveforms acquired from the parasternal short-axis view in adult and adolescent patients over a wide age range.

Adolescent↗