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PubMed1993

[Evaluation of the right ventricular function in postoperative esophageal cancer patients].

We evaluated the right ventricular function in pre- and post-operative esophageal cancer patients who had no complications after surgery by measurement of cardiopulmonary hemodynamics, right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) using Swan-Ganz catheter and the thermodilution technique. The measurement of RVEF, RVEDVI and other cardiopulmonary hemodynamics were performed from the preoperative day to the 3rd postoperative day. The values of RVEF were stable about 40% from preoperative day to 3rd. RVEDVI was varied at 93.6 +/- 26.3 ml/m2 (preoperative day), 83.6 +/- 15.0 ml/m2 (after surgery), 70.2 +/- 10.6 mg/m2 (morning of the 1st POD), 95.6 +/- 19.4 ml/m2 (evening of the 1st POD), 103.2 +/- 17.9 m/lm2 (morning of the 2nd POD), 1108.3 +/- 14.2 ml/m2 (evening of the 2nd POD) and 112.4 +/- 31.0 ml/m2 (morning of the 3rd POD). The values of RVEDVI on the morning of the 1st POD were statistically lower than those at other times (p < 0.05). The values of RVEDVI were not correlated with mean pulmonary arterial pressure and pulmonary arteriolar resistance which were the afterload of the right ventricle. These data suggest that the right ventricular function of the patients who underwent esophagectomy with no complication does not change and that the changes of RVEDVI are influenced by the preload of the right ventricle.

Cardiac Output↗

PubMed1995

[Assessment of right ventricular function by magnetic resonance imaging of old myocardial infarction].

The usefulness of magnetic resonance imaging (MRI) for estimating right ventricular function and the influence of left ventricular dysfunction on the performance of the right ventricle were assessed in 43 patients with chronic myocardial infarction (MI) and 14 control subjects (N) using electrocardiography-gated MRI and cardiac catheterization. Patients with MI were divided into three groups according to the location of the coronary lesions; 22 patients with left coronary artery lesion (LCA group), 13 with right coronary artery lesion (RCA group), and 8 with both left and right coronary artery lesions (L+R group). The right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF) were measured by Simpson's rule algorithm on transverse images of the right ventricle obtained at the end-systolic and end-diastolic phases. In 34 of the 43 patients, the same parameters of right ventricular function were calculated by the thermodilution method using a Swan-Ganz catheter with rapid response thermistor. Left ventricular ejection fraction (LVEF) and end-diastolic volume were determined from left ventriculography. The intraobserver reproducibility (11 cases, r = 0.97) and interobserver reproducibility (11 cases, r = 0.92) of RVEF measured by MRI were excellent. The RVEF and RVEDV determined from MRI were significantly correlated with those from the thermodilution method (RVEF: r = 0.56, RVEDV: r = 0.52). There was no difference in right ventricular end-diastolic volume index in any patient group. The RVEF was decreased in the L+R (41.0 +/- 4.5%, p < 0.01) and RCA (45.9 +/- 6.6%) groups, but there was no difference between the LCA (50.6 +/- 6.6%) and N (48.9 +/- 4.3%) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1985

Two-dimensional echocardiographic evaluation of right ventricular function during left heart bypass.

Right ventricular (RV) function in terms of hemodynamics and RV wall motion was studied in 14 mongrel dogs during left heart bypass (LHB) using a centrifugal blood pump. The wall motion was analyzed by two-dimensional echocardiography (2D-echo). Incremental changes in LHB flow ratios of 0% (controls), 25%, 50%, 75% and a maximum 85-100% were accompanied by decrements of segmental shortening of the interventricular septum (IVS) by 54 +/- 12%, 43 +/- 5%, 42 +/- 2%, 35 +/- 0% and 0%, respectively. In addition to akinesis of the IVS during maximum flow, a specific part of the RV free wall adjacent to the IVS also had marked depression of contractions and overall RV contraction was nearly dependent on the RV free wall opposite to the IVS. Maximum LHB flow induced complete depression of the left ventricular cavity, a marked increase in RV volume, and depression of the RV ejection fraction on 2D-echo. Excessive or prolonged LHB reduces the RV wall motion capability and may lead to right heart failure. Our results suggest that an LHB ratio of about 75% is optimum to maintain normal cardiac function, particularly that of the right heart.

Animals↗

PubMed1995

[Antegrade or retrograde blood cardioplegic method: comparison of postsurgical right ventricular function and conduction disturbances].

This study was undertaken to compare postsurgical right ventricular function and the occurrence of conduction disturbances after employing cold blood antegrade or retrograde cardioplegia during open heart surgery. Thirty-four patients were divided into AC (antegrade) and RC (retrograde) groups for the difference of route for delivery of cardioplegic solutions. Preoperative evaluation of cardiac and respiratory function revealed to be equal characteristics between the groups. Postoperatively, A-aDO2 and respiratory index (RI) as functional parameters of oxygenation capacity, LVSWI, RVSWI, dosage of dopamine and conduction disturbances were monitored at 0, 3, 6, 12 hours after termination of cardiopulmonary bypass and at extubation period. Although the recovery of respiratory function and left ventricular function were similar in both groups, temporal suppression of right ventricular function was indicated in RC group during early period after surgery, and then recovered to the same values of AC group within 3 hours. In RC group, several type of conduction disturbances were detected in 28 per cent of patients. But none of the persistent conduction disturbances were remained in all patients. We suggest retrograde coronary sinus perfusion may emerge as a valuable alternative to antegrade methods for delivery of cardioplegia.

Blood↗

PubMed1989

[Right ventricular function in retrograde cardioplegia for myocardial protection--an experimental study].

Anterior cardiac veins which are the main drainage vessels of the right ventricle drain directly into the right atrium. Therefore, the right ventricular wall may not be perfused effectively during open heart surgery by the use of retrograde cardioplegic method resulting in postoperative right ventricular dysfunction. Seventeen mongrel dogs were subjected to this study and were placed on cardiopulmonary bypass using a conventional heart-lung machine. Total aortic cross-clamping time was 60 minutes in all dogs. In Group I (n = 6), 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was injected into the aortic root by the use of a syringe. Cardioplegic solution was replenished every 20 minutes with a half of the initial dose (7.5 ml/kg body weight). Group II (n = 6) were the dogs with the retrograde cardioplegia in which 4 degrees C St. Thomas' Hospital solution (15 ml/kg body weight) was given retrogradely from the coronary sinus by the drip method at the height of 60 cm, and the replenishing dose and interval of cardioplegia were the same as Group I. Group III (n = 5) was the dogs treated with retrograde cardioplegia identical to Group II and the combined use of topical cooling with ice-slush. The hearts were resuscitated after 60 minutes of aortic cross-clamping. Right ventricular functions such as cardiac output, right atrial pressure, right ventricular end-diastolic pressure, right ventricular max dp/dt, and shortening fraction of the right ventricle were measured 15, 30, 45, and 60 minutes after cardiac resuscitation respectively. In Group II, right atrial pressure was significantly elevated from the control value 15 and 30 minutes after cardiac resuscitation. On the other hand, all indices of right ventricular functions in Group III showed insignificant changes. The present experimental study demonstrated the retrograde cardioplegic method could produce right ventricular perfusion resulting in right ventricular dysfunction early after cardiac resuscitation. This deleterious effect however could be prevented by the combined use of topical cooling of the right ventricle with ice-slush.

Animals↗

PubMed2002

The usefulness of pulsed tissue Doppler for the clinical assessment of right ventricular function.

Standard Doppler echocardiographic evaluation of the right ventricular (RV) function has several limitations because of a difficult technical approach. The purpose of the present review was to investigate, even in the light of such problems, the usefulness of pulsed tissue Doppler (TD) during the assessment of RV transverse and longitudinal function on the basis of the regional velocities and time intervals. TD-derived (systolic and diastolic) velocities of the RV free wall and of the lateral tricuspid annulus have been used to establish reference values in healthy subjects and in different cardiac diseases. Some studies have shown the usefulness of myocardial systolic velocities for the detection of RV systolic failure at rest and of right coronary artery stenosis during stress. The myocardial early diastolic velocities, combined to Doppler standard tricuspid inflow measurements, represent reliable indexes of right chamber hemodynamics, the ratio between the Doppler tricuspid E velocity and the TD-derived early diastolic velocity of the lateral tricuspid annulus being positively related to the mean right atrial pressure after heart transplantation. Even the assessment of RV regional time intervals may have clinical implications. In particular, the relaxation time of the lateral tricuspid annulus, very short or even absent in healthy subjects increases progressively with the pulmonary systolic artery pressure and its length is strongly influenced also by the increasing RV wall thickness in septal hypertrophic cardiomyopathy and in hypertensive left ventricular hypertrophy. The interaction between the two ventricles is identified by assessing the TD velocities of the RV tricuspid annulus which are often associated with the corresponding velocities of the mitral annulus in different pathologies. On the grounds of these studies, the clinical use of pulsed TD merits consideration. Longitudinal follow-up of TD RV patterns will be useful to evaluate the progression from early RV wall dysfunction until the development of global RV failure and the possible beneficial effect of cardiac drugs on RV function as determined by TD evaluation.

Cardiomyopathy, Hypertrophic↗

PubMed1993

Sevoflurane anaesthesia for one-lung ventilation with PEEP to the dependent lung in sheep: effects on right ventricular function and oxygenation.

This study was undertaken to examine the effect of sevoflurane on right ventricular function, the safety of sevoflurane for one-lung ventilation and the effects of PEEP (positive end-expiratory pressure) to the dependent lung in this model using 12 open-chest sheep. Haemodynamic variables, including cardiac output, mean arterial blood pressure, right ventricular pressure and pulmonary arterial pressure, and right ventricular segment shortening (sonomicrometry) were measured. First, animals received 2.0, 3.0 or 4.0% sevoflurane for 20 min each, respectively, during two-lung ventilation to measure the dose-dependent haemodynamic effects of sevoflurane. Then one-lung ventilation was performed with a randomized sequence of 0 (ZEEP), 5 and 10 cm H2O PEEP to the dependent lung under 2.0% sevoflurane anaesthesia after one-hour stabilization. A decrease in systolic segment shortening along with increases in both the end-diastolic and end-systolic lengths of the right ventricle were observed at 3.0 and 4.0% sevoflurane, while global right ventricular function remained substantially unchanged during two-lung ventilation. During one-lung ventilation the PaO2 was greater with 5 cm H2O PEEP 198 mmHg (+/- 25 SEM) than with ZEEP 138 mmHg (+/- 22) or with 10 cm H2O PEEP 153 mmHg (+/- 23) (P < 0.05). No differences in haemodynamic variables or segment shortening between ZEEP and PEEPs during one-lung ventilation were observed. We conclude that although sevoflurane causes a dose-dependent depression of right ventricular function, sevoflurane anaesthesia can be safely applied to one-lung ventilation, and that 5 cm H2O PEEP to the dependent lung can improve arterial oxygenation without causing changes in right ventricular function.

Anesthesia, Inhalation↗

PubMed1995

MRI complements standard assessment of right ventricular function after lung transplantation.

BACKGROUND: Changes in right ventricular mass and ejection fraction after single-lung transplantation for pulmonary hypertension are poorly understood. METHODS: To complement functional data provided by echocardiography, radionuclide ventriculography, and right heart catheterization, magnetic resonance imaging was used to assess right ventricular function in 5 single-lung transplant recipients with preoperative pulmonary hypertension and right ventricular dysfunction (right ventricular ejection fraction, 0.21 +/- 0.09). The right and left ventricular mass, ejection fraction, and mass ratio (left ventricular mass/right ventricular mass) were calculated from the magnetic resonance images. RESULTS: The mean pulmonary artery pressure fell from 72 +/- 18 to 21 +/- 8 mm Hg after transplantation. At 3 months after transplantation both the left ventricular and right ventricular ejection fractions approached normal values, as shown by both radionuclide ventriculography and magnetic resonance imaging, but the right ventricular mass remained abnormally high with slightly low mass ratios. By 1 year both the left ventricular and right ventricular masses had regressed to normal with near-normal mass ratios. CONCLUSIONS: Right ventricular performance returns to nearly normal early after transplantation, but the right ventricular mass regresses over a more prolonged time. Cine magnetic resonance imaging provides a noninvasive means of assessing changes in right ventricular function and mass after lung transplantation.

Adult↗

PubMed1994

Experimental assessment of right ventricular function in normal pigs with a left ventricular assist device.

Right ventricular (RV) failure during the use of a left ventricular assist device (LVAD) is the leading cause of death in circulatory support patients. Previous work, both experimentally and clinically, has shown the difficulties in predicting the behavior of the right ventricle at the start of LVAD. An experimental study has been designed to evaluate RV functional changes during LVAD and its relation to preload changes. The model used adult mongrel pigs (n = 10). Right ventricular functional parameters were measured with a thermodilution RV ejection fraction catheter. The left ventricle was supported by a Nippon Zeon blood pump. Two groups were studied, the first one was the LVAD-off group (n = 5) and the other was the LVAD-on group (n = 5) which was supported by LVAD at maximum flow. Change of cardiac output, mean pulmonary artery pressure (PAP), RV stroke work, and RV ejection fraction in both groups were not significantly different. However, the relationship between right ventricular end-diastolic pressure (RV-EDP) and right ventricular stroke volume (RVSV) was significantly changed at a high level of RV-EDP. When RV-EDP was over 6.5 mm Hg in the LVAD-off group, RVSV decreased to 52.3 +/- 11.5 ml while in the LVAD-on group, RVSV increased to 97.2 +/- 22.0 ml. The change in PAP in the LVAD-on group was lower than in the LVAD-off group. We conclude that, at the volume overload state, LVAD can reduce the afterload of the right ventricle and maintain Frank-Starling's effect, thus having a beneficial effect on right ventricular performance.

Animals↗

PubMed1992

[Assessment of right ventricular function using gated blood pool single photon emission computed tomography in inferior myocardial infarction with or without hemodynamically significant right ventricular infarction].

Right ventricular function was assessed using gated blood pool single photon emission computed tomography (GSPECT) in 10 normal subjects and 14 patients with inferior myocardial infarction. Three-dimensional background subtraction was achieved by applying an optimal cut off level. The patient group consisted of 6 patients with definite hemodynamic abnormalities indicative of right ventricular infarction (RVI) and 8 other patients with significant obstructive lesion at the proximal portion of right coronary artery without obvious hemodynamic signs of RVI. Right ventricular regional wall motion abnormalities were demonstrated on GSPECT functional images and the indices of right ventricular function (i.e. the right ventricular ejection fraction (RVEF), the right ventricular peak ejection rate (RVPER) and the right ventricular peak filling rate (RVPFR)) were significantly reduced in the patient group, not only in the patients with definite RVI but also in those without hemodynamic signs of RVI. The present study indicates that inferior infarction is frequently associated with RVI, even in the absence of definite hemodynamic signs, when the proximal portion of right coronary artery is obstructed. It is concluded that GSPECT is reliable for the assessment of right ventricular function and regional wall motion, and is also useful for the diagnosis of RVI.

Hemodynamics↗

PubMed2005

Comparison of the Tei index with invasive measurements of right ventricular function.

The Doppler-derived Tei index has been reported to be clinically useful in assessing global right ventricular function. It could increase in response to combinations of increased pulmonary artery pressure and/or ventricular dysfunction. We compared the Tei index with invasive measurements of right ventricular function during acute pulmonary hypertension. Right and left ventricular pressures, pulmonary and aortic pressures, pulmonary flow and right ventricular volume by sonomicrometry were measured in six anaesthetized sheep. Graded pulmonary arterial hypertension was induced by a mechanical occlusion maneuver. Pressure-volume loops were generated during preload reduction through caval occlusion. Epicardial echocardiograms were also performed. Invasive indexes including preload recruitable stroke work, ventricular diastolic time constant and stiffness constant, and cardiac output were assessed, as were noninvasive echocardiographic indexes including Tei index and E/A ratio. The right ventricular pressure-volume loop became rectangular, with well-defined isovolumic phases. The slope of preload recruitable stroke work was increased significantly during pulmonary pressure of 30 mm Hg. The ventricular time constant showed a significant increase with no change of chamber stiffness during pulmonary pressure of 35 mm Hg. Concomitantly, the Tei index increased significantly from 0.06+/-0.03 to 0.31+/-0.06, together with the shortening of the ejection time and a decrease of the E/A ratio (P<0.05). Thus, the right ventricular Tei index was noted to be affected by acute graded afterload increase. The alteration in invasive measurements of systolic and diastolic function makes the Tei index a sensitive indicator of right ventricular dysfunction in the settings of acute pulmonary hypertension.

Acute Disease↗

PubMed1987

Noninvasive evaluation of right ventricular function.

Numerous technologic advances have greatly facilitated the noninvasive analysis of right ventricular function. Nevertheless, important clues continue to be available to the astute clinician by physical examination. The chest x-ray is of rather limited utility. The electrocardiogram can show evidence of right atrial enlargement or right ventricular hypertrophy. Unfortunately, both sensitivity and specificity are deficient. Echocardiography is a widely available and potentially very accurate source of information concerning right ventricular dysfunction. Careful temporal analysis of the M-mode echocardiogram can give information beyond chamber size and wall thickness. Two-dimensional echocardiography allows more accurate determination of chamber size and wall thickness and also permits analysis of segmental wall motion and chamber contour. Doppler echocardiography allows measurement of pressure differences and flow kinetics. Preliminary data indicate that one can accurately assess pulmonary artery pressure and possibly right ventricular diastolic function. Color-flow mapping allows for accurate determination of valvular regurgitation and enhances the accuracy of standard Doppler echocardiographic techniques. Radionuclide analysis of the right ventricle by blood-pool imaging allows accurate determination of ejection fraction and wall motion. In addition, it may be possible to estimate pulmonary artery pressure. Use of short-acting radionuclides allows for serial imaging of the right ventricle after pharmacologic intervention or exercise. Perfusion scanning can show evidence of exercise-induced ischemia, although applicability to the right ventricle is somewhat limited. Avid scanning allows localizing of myocardial injury to the right ventricle. CT scanning of the heart is of limited clinical utility, because cardiac motion occurs too rapidly for accurate imaging. The advent of the cine-CT may overcome this problem and allow evaluation of right ventricular volumes and wall motion. Digital subtraction imaging allows for accurate video densitometric calculation of ejection fractions, but offers no advantage over other currently available techniques. Magnetic resonance imaging may prove to be the methodology of choice for analysis of right ventricular function, because it can give accurate measurement of right ventricular wall motion, ejection fraction, and (similar to Doppler flow studies) some indication of flow within the right-sided chambers. It will soon be possible to generate information concerning the biochemical content of the right ventricular myocardium, perhaps providing early evidence of hypertrophy or myopathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac Output↗

PubMed1987

Right ventricular function in dilated cardiomyopathy.

The right ventricular (RV) function was comprehensively examined in 18 patients with dilated cardiomyopathy (DCMP) and compared with RV function in 10 controls. In most cases of DCMP, the RV function is affected simultaneously with a disturbance of the left ventricular (LV) function. However, the degree of its affection is usually less pronounced and, with less severe LV dysfunction, the right ventricle can work even normally. There can be substantial individual differences in the degree of affection of the right ventricle in DCMP. However, severe LV dysfunction is invariably associated with a marked involvement of the right ventricle. A disturbance of the RV function results (besides the influence of the decreased LV function) from both a decrease in its own contractility and a decrease in RV compliance. There exist significant relations between the RV systolic and diastolic function. The degree of RV disturbance in DCMP both of the systolic and diastolic function) can be approximately estimated from the level of diastolic pressure.

Cardiomyopathy, Dilated↗

PubMed1989

Pulmonary artery counterpulsation to improve right ventricular function after heart transplantation.

The effectiveness of pulmonary artery counterpulsation in improving right ventricular function after heart transplantation was evaluated in a pig model. The balloon catheter was introduced through the anterior wall of the pulmonary artery distal to the pulmonary valve. A Millar catheter with a distal high-fidelity pressure transducer was placed in the right ventricle, where the peak rate of pressure rise, dP/dT, was measured. Pulmonary artery counterpulsation significantly improved right ventricular function, increasing both dP/dT and systolic pressure. A diastolic dip in pulmonary artery pressure and a fall in the early portion of the right ventricular pressure curve were seen. Inflation of the balloon caused a second (suprasystolic) wave in that curve. Improved right ventricular function was also seen when normal pig hearts were counterpulsated after occlusion of the right coronary artery and following increased afterload due to occlusion of a main pulmonary artery. There were no changes in central venous or systemic pressure. The results indicate that pulmonary artery counterpulsation may be valuable when the transplanted heart has a poorly functioning right ventricle.

Animals↗

PubMed2005

[Right ventricular function and pulmonary circulation hemodynamics in patients with vibration disease].

AIM: To study contractile and diastolic function of the right ventricle, mechanic activity of the right heart, hemodynamics of the pulmonary circulation in patients with vibration disease (VD). MATERIAL AND METHODS: The study group consisted of patients in contact with vibration (15 subjects without VD symptoms, 44 patients with VD of the first degree and 10 patients with VD of the second degree). 20 control males had no contact with vibration. RESULTS: VD patients developed right ventricular (RIO dysfunction: disturbed diastolic function, hypodynamic syndrome of the first degree accompanied with reduced ejection fraction, stroke output and cardiac index. In VD, RV dysfunction appears in parallel with left ventricular dysfunction due to high pressure in pulmonary circulation and interventricular interaction. CONCLUSION: VD-specific features of the lesser circulation and RV function give rise to formation of heart failure. Thus, early diagnostic and prophylactic measures should be taken in subjects in contact with vibration.

Disease Progression↗

PubMed1996

Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function.

BACKGROUND: A paucity of data exists as to the relation of mean right atrial pressure (RAP) to Doppler parameters of right atrial and ventricular filling. Furthermore, whether echocardiographic parameters of right atrial and right ventricular function and inferior vena cava improve the relation of Doppler filling dynamics with RAP has not been explored. METHODS AND RESULTS: Doppler and echocardiographic studies were performed simultaneously with measurements of mean RAP in consecutive patients who either had a central venous catheter in the Intensive Care Unit or underwent catheterization of the right side of the heart. The initial population consisted of 35 patients with a mean age (+/-SD) of 60+/-15 years; 34% were on mechanical ventilation. Mean RAP averaged 9+/-5.7 mm Hg (range, 2 to 28 mm Hg). Among tricuspid inflow parameters, the strongest relation with RAP was observed with the ratio of early to late velocity (r=.66). For hepatic venous flow, systolic filling wave indexes had the best relation with atrial pressure, the highest being for systolic filling fraction (r=-.86). Weaker relations were noted with the use of right atrial volumes, right ventricular function, and inferior vena caval diameters. The addition of any of these variables did not improve the relation of systolic filling fraction with RAP. The regression equation (RAP=21.6-24 systolic filling fraction) was tested prospectively in the estimation of atrial pressure 50 patients. The correlation coefficient was .89 in the prospective group and .88 in the total group of 85 patients. The mean difference between predicted and actual pressures in the whole population was -0.2+/-2.6 mm Hg. The sensitivity and specificity for mean RAP>8 mm Hg were 86% and 92%, respectively. CONCLUSIONS: Among echocardiographic and Doppler parameters of right atrial and right ventricular function, hepatic venous flow dynamics relate best to mean atrial pressure and can be used clinically to estimate mean RAP.

Adult↗

PubMed1992

Preoperative and postoperative right ventricular function during exercise in patients with mitral stenosis.

To elucidate the effects of mitral valve surgery on right ventricular function in 11 patients with mitral stenosis, pre- and postoperative right ventricular function were quantified using gated equilibrium blood pool radionuclide ventriculography at rest and during exercise. The preoperative right ventricular ejection fraction was 39 +/- 4% at rest and 36 +/- 9% during exercise, which during exercise was lower than control values (51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction was lower during exercise than at rest, postoperative right ventricular ejection fraction during exercise was lower than normal values (42 +/- 3% versus 51 +/- 5%) (p < 0.01). When the preoperative right ventricular ejection fraction did not decrease during exercise, the postoperative right ventricular ejection fraction was within normal limits during exercise (54 +/- 5%). In addition, postoperative right ventricular ejection fraction during exercise increased to normal values in patients whose preoperative right ventricular ejection fraction during exercise had been 40% or higher. Preoperative peak ejection rate was -1.81 +/- 0.19 EDV/sec at rest and -1.72 +/- 0.39 EDV/sec during exercise, which during exercise was lower than control values (-2.44 +/- 0.53 EDV/sec) (p < 0.01). Postoperatively, peak ejection rate during exercise (-2.50 +/- 0.37 EDV/sec) increased (p < 0.05) to normal levels. Preoperative peak filling rate was 1.61 +/- 0.47 EDV/sec at rest and 1.88 +/- 0.54 EDV/sec during exercise, which during exercise was lower than control values (2.58 +/- 0.62 EDV/sec) (p < 0.01). Postoperatively, peak filling rate during exercise (2.82 +/- 0.62 EDV/sec) increased (p < 0.05) to normal values in all patients. Preoperative changes in both right ventricular ejection fraction and peak ejection rate from rest to exercise inversely correlated with the preoperative pulmonary vascular resistance at rest (right ventricular ejection fraction, r = -0.79, p < 0.005; and peak ejection rate, r = -0.67, p < 0.05). In conclusion, right ventricular systolic function improved in about half of the patients with mitral stenosis, and diastolic function improved in all patients during exercise following surgery. When the preoperative pulmonary vascular resistance was elevated, the right ventricular systolic dysfunction persisted.

Adult↗

PubMed2006

Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension.

OBJECTIVE: To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction. METHODS: The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography. RESULTS: Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0.45, P < 0.05). CONCLUSION: Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.

Adult↗