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At least 163 records · Page 9Linked to original sources
PubMed1999

Cardioversion of atrial fibrillation and its effect on right ventricular function as assessed by tricuspid annular motion.

In patients with atrial fibrillation, the reduced right ventricular function determined by tricuspid annular motion before cardioversion returns to normal 1 month after successful cardioversion to sinus rhythm. The simplicity of recording the tricuspid annular motion provides an easy opportunity to assess right ventricular function following electroconversion of atrial fibrillation to sinus rhythm.

Aged↗
PubMed2000

[The effects of enalapril on exercise capacity and right ventricular function in patients with chronic cor pulmonale].

BACKGROUND: Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC. METHODS: Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study. RESULTS: At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10). CONCLUSIONS: Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.

Aged↗
PubMed2001

Right ventricular function in the human fetus.

Fetal RV function is critical for survival and normal cardiovascular development. Doppler can be used to assess function. Combined with wise use of imaging techniques, the cause of abnormalities can be assessed. Both congenital heart defects and other cardiovascular defects can lead to hydrops and death. Serial semi-quantitation of fetal heart failure can be done with a Cardiovascular Profile score.

Female↗
PubMed1986

Protamine: does it alter right ventricular function?

Protamine administration has been associated with cardiac decompensation secondary to acute pulmonary vasoconstriction and subsequent right ventricular failure. To determine whether protamine infusion produced alterations in right ventricular performance, we evaluated both right and left ventricular function in patients receiving protamine infusion. The dose of protamine administered was calculated as adequate to reverse heparin as measured by the activated clotting time (ACT). Indices of right and left ventricular function obtained included right atrial pressure, right ventricular pressure, right ventricular ejection fraction, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, blood pressure, and heart rate. These measurements were obtained prior to protamine administration, at 1/2 total protamine dose, at completion of protamine infusion, and prior to sternal closure. No significant changes in right ventricular ejection fraction, right ventricular end-diastolic pressure, mean pulmonary artery pressure, or pulmonary vascular resistance were seen at any point during the study. Left ventricular function remained unchanged. Even in patients who are possibly at an increased risk (pulmonary artery hypertension, PAP greater than 25 mm Hg), no deterioration in right or left ventricular function could be demonstrated following protamine administration. These data suggest that protamine does not consistently exert a significant detrimental effect on right ventricular performance.

Blood Pressure↗
PubMed1997

Effects of epinephrine on right ventricular function in patients with severe septic shock and right ventricular failure: a preliminary descriptive study.

OBJECTIVE: To recognize patients with unresponsive septic shock and right ventricular (RV) failure and to evaluate the effects of epinephrine on RV performance in these patients. DESIGN: Prospective descriptive study. SETTING: Medical intensive care unit. SUBJECTS: 14 consecutive patients in septic shock unresponsive to fluid loading, dopamine, and dobutamine. INTERVENTIONS: Evaluation of RV function by thermodilution with a pulmonary artery catheter equipped with a rapid-response thermistor. Measurements were obtained before and during epinephrine infusion to achieve a systolic arterial pressure > or = 90 mmHg or a mean arterial pressure (MAP) > or = 70 mmHg. RESULTS: At the time of inclusion in the study the hemodynamic pattern in the 14 patients was as follows: (MAP) 58 +/- 14 mmHg, systemic vascular resistance (SVR) 1046 +/- 437 dyne.s.cm-5.m-2, pulmonary artery occlusion pressure (PAOP) 14 +/- 4 mmHg, mean pulmonary artery pressure (MPAP) 24 +/- 4 mmHg, right arterial pressure (RAP) 11 +/- 4 mmHg, cardiac index (CI) 4 +/- 1.7 l/min per m2. During epinephrine infusion, MAP, CI and stroke volume index (SVI) were increased (27%, p < 0.01; 20%, p < 0.01; 15%, p < 0.05, respectively). There was no change in PAOP, SVR or heart rate. Seven patients (group A) had marked RV failure defined by both RV dilation [RV end-diastolic volume index (RVEDVI) > 92 ml/m2] and low RV ejection factor (RVEF) (< 52%) and 7 did not (group B). Group A had a lower baseline RVEF than group B (24 +/- 7 vs 45 +/- 9%, p < 0.05), a higher RVEDVI (134 +/- 28 vs 79 +/- 17 ml/ m2, p < 0.01), and a higher RVES (systolic) VI (103 +/- 30 vs 43 +/- 11 ml/ m2, p < 0.01). The other hemodynamics, especially RAP and RV stroke work index (RVSWI) were no different in the two groups and did not predict RV dysfunction. In group A, epinephrine infusion improved RVEF (25%, p < 0.05) by a reduction in RVESVI (-8%, p < 0.05) without any change in RVEDVI or in RAP, in spite of a rise in MPAP (11%, p < 0.05). A rise in RVSWI (76%, p < 0.05), SVI (23%, p < 0.05), and CI (24%, p < 0.05) was also achieved. An upward vertical shift of the Frank-Starling relationship RVSWI/ RVEDVI and an upward shift to the left of the pressure volume relationship pulmonary artery peak pressure/RVESVI was observed only in the group with RV failure following treatment with epinephrine. In group B (without RV failure), RV parameters were not modified by epinephrine. CONCLUSION: In patients with severe septic shock, RV dysfunction was identified by the use of an RVEF pulmonary artery catheter and was improved by epinephrine by means of an improvement in RV contractility.

Adult↗
PubMed1993

Effect of continuous positive airway pressure applied by face mask on right ventricular function after cardiac surgery.

The effect of respiratory therapy with continuous positive airway pressure (CPAP) on right ventricular function 24 hours after elective cardiac surgery was evaluated in patients with or without severe coronary artery disease. The first group included 10 patients following coronary artery bypass graft (CABG) surgery, and the second group included 10 patients following aortic valve replacement (AVR) without preexisting coronary artery disease. Patients of both groups had preoperative left ventricular ejection fractions above 40%. CPAP was applied by face mask at a flow rate of 20 L/min with 40% oxygen in nitrogen and with a positive end-expiratory pressure of 12 cmH2O. Right ventricular function was estimated at end-expiration by a fast-response thermodilution cardiac output catheter. The results demonstrate that in both groups of patients, CPAP did not significantly modify right ventricular indices, ejection fraction, end-systolic and end-diastolic volume indices, and stroke volume index, indicating that CPAP can safely be applied after elective cardiac surgery in patients with or without severe coronary artery disease and preoperative left ventricular ejection fractions above 40%. Furthermore, the concomitant postoperative intravenous infusion of nitroglycerin (to all 10 patients of the CABG group and to 4 patients of the AVR group) counteracted the expected beneficial effect of CPAP therapy on arterial oxygenation.

Adult↗
PubMedDate not supplied

Effect of bisoprolol on right ventricular function and brain natriuretic peptide in patients with heart failure.

Beta-blocker use improves left ventricular ejection fraction (LVEF) in patients with heart failure. A similar effect of b blockers on right ventricular function has been proposed, although the effect of bisoprolol, a highly selective b-1 blocker, on right ventricular function has not been assessed. This study investigated the short-term effect of bisoprolol on right ventricular function in chronic heart failure patients. A cohort of 30 heart failure patients who were not taking b blockers at baseline was studied prospectively. Right ventricular ejection fraction (RVEF) and LVEF were measured at both baseline and 4 months by radionuclide angiography. Bisoprolol was up-titrated during four monthly visits by a preestablished protocol to a target dose of 10 mg/d. The dose of vasodilators was not changed. Quality of life and brain natriuretic peptide level were assessed. Mean age was 62.7+/-14.3 years. Baseline RVEF was 30.7%+/-6.3% and baseline LVEF was 21.7%+/-9.4%. Mean bisoprolol dose reached was 5.3+/-3.9 mg daily. At 4 months, RVEF significantly increased by 7.1% (95% confidence interval, 3.9-10.2; p=0.0001) and LVEF also increased significantly by 7.9% (95% confidence interval, 4.0%-11.9%; p=0.0003). Quality-of-life score improved from 42.8 to 30.8 (p=0.047). No correlation was found between brain natriuretic peptide levels and RVEF. Bisoprolol treatment for 4 months resulted in a significant improvement of RVEF, which paralleled the improvement of LVEF.

Adrenergic beta-Antagonists↗
PubMed1992

The effect of calcium on pulmonary vascular resistance and right ventricular function.

Calcium chloride is frequently administered to patients immediately after separation from cardiopulmonary bypass to improve the contractile state of the myocardium. Animal studies suggest that calcium chloride may produce increases in pulmonary vascular resistance, which can precipitate right ventricular failure. In an attempt to determine the effect of calcium chloride administration after cardiopulmonary bypass on right ventricular function, this study was designed to evaluate patients with normal and elevated pulmonary vascular resistance. Fifty patients scheduled for elective cardiac surgery were prospectively studied for changes in ionized calcium levels before and after bypass. The impact of calcium administration on right ventricular function was assessed by a pulmonary artery catheter modified for the measurement of right ventricular ejection fraction. In all patients the level of ionized calcium decreased during bypass from a mean of 4.91 to 4.29 mg.dl-1. However, the infusion of calcium chloride (10 mg.kg-1) after bypass resulted in increasing the ionized calcium levels to prebypass levels. Administration of calcium chloride after bypass to patients with normal right ventricular function resulted in a transient increase in both cardiac output and right ventricular ejection fraction without any change in pulmonary vascular resistance. Eight patients with both elevated pulmonary vascular resistance and depressed right ventricular function were evaluated to determine the effect of calcium chloride after bypass on pulmonary vascular resistance and right ventricular ejection fraction. Administration of calcium chloride (10 mg.dl-1) to these patients did not result in any significant increase in pulmonary vascular resistance or depression of right ventricular performance. More important, in these patients, right ventricular ejection fraction and cardiac output were significantly increased after calcium chloride administration. In summary, the results of this study fail to demonstrate any increase in pulmonary vascular resistance or deterioration of right ventricular function with the administration of calcium chloride (10 mg.kg-1) after bypass in patients with elevated pulmonary vascular resistance.

Aged↗
PubMed1997

Nitric oxide has little effect on acute pulmonary hypertension and right ventricular function during acute respiratory distress syndrome.

OBJECTIVE: To evaluate the effect of nitric oxide (NO) on acute pulmonary hypertension and right ventricular function in patients with acute respiratory distress syndrome. DESIGN: A prospective clinical study. PATIENTS: Ten patients in the respiratory and surgical intensive care units were used. They met the criteria for acute respiratory distress syndrome and were significantly hypoxic. They were all ventilator-dependent at the time of the study. INTERVENTION: NO was delivered to the patients in 5, 10, 20 and 30 ppm doses for 30 minutes at each concentration. The dosing was not randomised. MEASUREMENTS AND RESULTS: The general and central haemodynamics were measured. Right ventricular function and interaction with the pulmonary artery impedance (Ea) were quantified with the ratio of right ventricular stroke work index/Ea. NO did not decrease the raised pulmonary artery pressure found in all of the patients. Right ventricular coupling to the circulation did not improve during the administration of NO. CONCLUSION: NO did not relieve the acute pulmonary artery hypertension associated with acute respiratory distress syndrome. As a consequence of this, right ventricular function failed to improve during the administration of NO.

Acute Disease↗
PubMed1990

Assessment of right ventricular function with nonimaging first pass ventriculography and comparison of results with gamma camera studies.

A new technique has been developed for measuring right ventricular function by nonimaging first pass ventriculography. The right ventricular ejection fraction (RVEF) obtained by non-imaging first pass ventriculography was compared with that obtained by gamma camera first pass and equilibrium ventriculography. The data has demonstrated that the correlation of RVEFs obtained by the nonimaging nuclear cardiac probe and by gamma camera first pass ventriculography in 15 subjects was comparable (r = 0.93). There was also a good correlation between RVEFs obtained by the nonimaging nuclear probe and by equilibrium gated blood pool studies in 33 subjects (r = 0.89). RVEF was significantly reduced in 15 patients with right ventricular and/or inferior myocardial infarction compared to normal subjects (28 +/- 9% v. 45 +/- 9%). The data suggests that nonimaging probes may be used for assessing right ventricular function accurately.

Adult↗
PubMed2000

Response of right ventricular function to prostaglandin E1 infusion predicts outcome for severe chronic heart failure patients awaiting urgent transplantation.

BACKGROUND: Selection of patients for urgent heart transplantation who have end-stage heart failure requires objective criteria to distinguish between subjects who may deteriorate clinically and those who can be stabilized. This population appears to differ in terms of right ventricular function, and right ventricular changes in loading may provide prognostic information. To investigate predictive parameters of patients admitted for urgent heart transplantation, we prospectively studied the mechanical performance of the right ventricle during acute afterload reduction. PATIENTS AND METHODS: We studied 68 heart failure patients hospitalized for bridge-to-transplant. The patients underwent right heart catherization at baseline and during prostaglandin E1 infusion. We stratified patients according to clinical outcome: Group A comprised patients who could be weaned from bridging therapy or who were electively transplanted after at least 90 days, and Group B comprised patients who died or who remained unstable and required transplant under urgent conditions. RESULTS: Right ventricular hemodynamics at baseline were comparable in both groups. However, during maximal vasodilatation, with prostaglandin E1 infusion, the right ventricular end-diastolic volume index (EDVI) was significantly reduced in Group A, (-23 ml/m(2) (p < 0.01) vs +12 ml/m(2) (p = n.s. DeltaEDVI in Group B. Reduction of EDVI by less than 10% during prostaglandin E1 infusion has a sensitivity of 89% and a specificity of 70% for clinical deterioration. CONCLUSIONS: The response of right ventricular volumes to prostaglandin E1 may predict the outcome of patients with severe congestive heart failure listed for urgent heart transplantation.

Aged↗
PubMed1991

Monitoring right ventricular function.

A new catheter developed by Edwards Critical-Care Division measures right ventricular ejection fraction and calculates right ventricular stroke volume, end-systolic volume, and end-diastolic volume. The nurse can thus assess a patient's right ventricular function curves using the relationship between stroke volume and end-diastolic volume. This article critiques a study that used this new technology and discusses implications for clinical practice and nursing research.

Catheterization, Swan-Ganz↗
PubMed1987

[Right ventricular function in patients with chronic obstructive pulmonary disease measured by krypton-81m].

Right ventricular function was assessed at rest and during exercise in patients with chronic obstructive pulmonary disease (COPD). Right ventricular ejection fraction (RVEF) was measured by first-pass radionuclide angiography using ultrashort-lived radionuclide krypton-81m. The half-life of this nuclide is only 13 sec, and it is completely expired from the lungs. These properties allow measurement of RVEF without correcting for background activity. In 30 patients with cardiac or pulmonary disease, RVEF was first measured by krypton-81 m scintigraphy (Kr-RVEF), then by technetium-99m (Tc-RVEF), without changing the patients' positions. In eight of the 30 cases, right ventricular cineangiography (RVG) was performed within 72 hrs after the radionuclide study, and RVEF was measured according to the Chapman's rule (RVG-RVEF). Kr-RVEF correlated significantly with Tc-RVEF (r = 0.87), and also with RVG-RVEF (r = 0.80). In 10 patients with stable COPD, who had severe hypoxemia (PaO2 less than or equal to 60 mmHg) and pulmonary hypertension [mean pulmonary arterial pressure (mean PAP) greater than or equal to 20 mmHg], and in seven normal control subjects, radionuclide angiographic and hemodynamic monitoring were performed at rest and during supine ergometer exercise. Kr-RVEF at rest was 47.6 +/- 5.4% (mean +/- SD) in patients with COPD and was 54.1 +/- 4.8% in normal subjects. Kr-RVEF during exercise was 51.8 +/- 7.3% in the patients, and 62.3 +/- 3.2% in the normal subjects. Hemodynamically, mean PAP and pulmonary vascular resistance (PVR) increased significantly during exercise, but the RV end-diastolic volume index (RVEDVI) did not change. There was inverse correlation between Kr-RVEF and mean PAP (r = -0.51) or PVR (r = -0.47) as an index of RV afterload. However, there was no correlation between Kr-RVEF and RVEDVI as an expression of RV preload. These findings suggest that a poor response by RVEF during exercise in patients with COPD is associated with elevation of afterload. Thus, right ventricular imaging techniques using the ultrashort-lived nuclide krypton-81 m allow noninvasive, serial and accurate assessments of right ventricular function in patients with COPD.

Aged↗
PubMed2006

Use of noninvasive tools in primary pulmonary hypertension to assess the correlation of right ventricular function with functional capacity and to predict outcome.

UNLABELLED: Most patients with Primary Pulmonary Hypertension (PPH) have severe exertional limitation which ultimately leads to right heart failure and death. The purpose of the study was to assess the correlation between right ventricular (RV) systolic and diastolic noninvasive variables and exercise tolerance, as well as the predictors of adverse outcome in treated patients. METHODS: We prospectively studied 29 patients, 17 with PPH and 12 with PPH due to collagen disease. RV parameters were assessed by echocardiography and Radionuclide ventriculography. Pulmonary function and clinical profile were assessed by 6 min walk test and NYHA class. The patients were followed-up during 2 years for cardiac death and cardiac deterioration. RESULTS: Mean age was 51 +/- 15 years, 22 (78%) women. NYHA class1 in 2 pts, class 2 in 17, class 3 in 8 and class 4 in 2 pts. Pulmonary function (DLCO) was low in 25 (86%) pts, mean 22 +/- 48%. Six minutes walk distance was 358 +/- 132 m, RVEF was 34 +/- 11% (range 16-51%). Among RV variables, RVEF, RA area and TR were independently correlated to 6 min walk. Within follow up of 2 years, there were 10 patients with adverse outcome (4 deaths and 6 deteriorated to NYHA class 3 and 4). Among all clinical and noninvasive variables, RVEF only was correlated to adverse outcome. CONCLUSION: The noninvasive tests of RVEF, RA size and TR were closely correlated to exercise tolerance. However, among the various clinical, functional and RV variables, RVEF was the only variable correlated with adverse outcome in pts with PPH.

Adult↗
PubMed1993

Right ventricular function at rest and during exercise in chronic obstructive pulmonary disease. Comparison of two radionuclide techniques.

Right ventricular function was assessed in 24 patients with COPD, at rest and during submaximal exercise, using both technetium-99m (99mTc) blood-pool and krypton-81m (81mKr) equilibrium ventriculography. Technetium-99m right ventricular ejection fraction (RVEF) at rest was lower than 81mKr RVEF (0.39 +/- 0.12 and 0.54 +/- 0.08, respectively; p < 0.001). During submaximal exercise, there was no increase in RVEF using either imaging technique. This observation contrasted with an increase in RVEF in a group of age-comparable normal subjects during modest submaximal exercise. An inability to obtain spatial separation of right heart structures using 99mTc imaging leads to a value for RVEF that is consistently lower than that measured using 81mKr ventriculography. Resting RVEF is well preserved at rest in most patients with COPD. In contrast to normal subjects, many show an inability to augment right ventricular function during exercise that may contribute to the reduced exercise capacity observed in these patients.

Aged↗
PubMed1989

Assessment of right ventricular function in acute inferior myocardial infarction using 133-xenon imaging.

UNLABELLED: The detection of right ventricular dysfunction in acute inferior myocardial infarction is important because of its potentially serious consequences which may be remediable with the appropriate therapeutic manoeuvres. A technique has been developed to assess right ventricular function using 133-xenon. This technique was applied to 26 patients who had sustained an acute inferior myocardial infarction. Right ventricular ejection fractions ranged from 7-54%, mean 30 +/- 11%, which was significantly lower than values obtained from normal volunteers (n = 21), mean 43 +/- 5%, and patients with arteriographically proven coronary artery disease without previous myocardial infarction (n = 12), mean 39 +/- 9%, P less than 0.001, and P less than 0.001, respectively. In the patients with acute inferior myocardial infarction 18 patients (69%) had evidence of right ventricular dysfunction (right ventricular ejection fraction less than 35%). 13/26 patients (50%) had clinical evidence of right ventricular dysfunction with a mean right ventricular ejection fraction 26 +/- 11% (range 7-54%) which was significantly lower than the patients without evidence of right ventricular dysfunction, mean 35 +/- 9% (range 16-49%), P less than 0.001. The clinical signs had a sensitivity of 72% (13/18), a specificity of 87.5% (7/8) and a predictive accuracy of 76% (20/26) when compared to the imaging data. IN CONCLUSION: (1) gated 133-xenon imaging provides a method for assessing right ventricular function in the setting of acute myocardial infarction; (2) a wide spectrum of right ventricular dysfunction occurs following inferior myocardial infarction which may not manifest itself clinically.

Adult↗
PubMed1986

Gated xenon scans for right ventricular function.

The complex geometry of the right ventricle makes the use of radionuclides an attractive method for assessing right ventricular function. The use of the gated 133Xe technique for this purpose offers several advantages. A short i.v. infusion over 20 sec of 133Xe permits scans to be obtained, gated to the electrocardiogram at rest and during maximal exercise using a standard gamma camera. The method is both reproducible (3.5%) and repeatable (2.8%), and because of the short half-life within the patient with most of the radioisotope being excreted by the lungs, scans may be repeated within a few minutes and the radiation dose to the patient is small. Right ventricular ejection fraction obtained from gated xenon scans is shown to correlate well with measurements obtained from both standard gated technetium scans and first-pass studies.

Female↗