Doppler assessment of right ventricular filling in a normal population. Comparison with left ventricular filling dynamics.

Abstract

To examine whether alterations in right ventricular filling dynamics occur with increasing age and to compare right and left ventricular filling in normal subjects, pulsed Doppler echocardiographic studies were performed at the tricuspid and mitral anuli in 50 normal volunteers (23 males and 27 females) with an age range of 5-66 years. An age-related decrease in peak early filling velocity, increase in peak late velocity, and augmentation in the late/early ratio of peak velocities at the tricuspid anulus were observed (r= -0.68, 0.63, and 0.84, respectively). Significant correlations were also found between age and first third, first half, and atrial filling fractions (r=-0.60, -0.72, and 0.69, respectively Methods Subject PopulationThe population consisted of 50 normal volunteers (23 males and 27 females) with an age range of 5-66 years (mean, 37+15 years) who met all the following criteria: the individuals were asymptomatic, had no risk factors for coronary artery disease, and had neither history nor evidence of systemic hypertension or cardiovascular, pulmonary, or systemic disease. All subjects had a supine blood pressure below 150/90 mm Hg and normal physical examination, electrocardiogram, and two-dimensional and Doppler echocardiographic studies. Echocardiographic and Doppler StudiesTwo-dimensional and Doppler echocardiographic studies were performed by using an ultrasound system (model 77020AC, Hewlett-Packard Co., Palo Alto, Calif., or Ultramark 8, Advanced Technology Laboratories, Bothell, Wash.) equipped with 3.5-, 2.5-, or 2.25-MHz transducers and recorded on 1/2-in. videotape. Echocardiographic images were obtained from the parasternal and apical windows, with the patient in the left lateral recumbent position.Pulsed Doppler studies were performed by using the parasternal and apical windows.

Effect of Age, Heart Rate and Tricuspid Regurgitation on the Doppler Echocardiographic Evaluation of Right Ventricular Diastolic Function

“…This is particularly problematic, as subjects with RV pathology might be expected to have compensatory higher heart rates than subjects with normal RV performance. The heart rate dependency of tricuspid Doppler parameters includes a rate-related increase in peak A wave velocity and atrial filling fraction, which is consistent with prior reports in normal subjects [2, 3, 4]. The current study extends the observation of heart rate dependency to patients with a variety of RV pathological states.…”

“…In normal subjects, the age dependency of the tricuspid peak E velocity, E/A ratios and atrial filling fraction has been previously described in some reports [1, 2, 3, 4]but not in others [5, 6]. This study has shown that this age dependency is also present in subjects with a variety of RV pathologic findings.…”

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography

“…A relação E/A diminui cerca de 0,1 pontos por década. 117,141,149,150 A inspiração causa um aumento da onda E, e, portanto, um aumento da relação E/A. A taquicardia causa um aumento da onda E, porém um aumento relativamente maior na onda A, e consequentemente uma diminuição da relação E/A.…”

“…A taquicardia causa um aumento da onda E, porém um aumento relativamente maior na onda A, e consequentemente uma diminuição da relação E/A. 141,150,15 Quando comparamos os parâmetros do Doppler entre pacientes ou no mesmo paciente, o efeito das variáveis hemodinâmicas sobre os parâmetros estudados deve ser levado em conta. Em função das suas paredes muito finas, o VD é extremamente sensível a elevações da pós carga (estresse de parede), especialmente na presença de doenças que afetem o miocárdio do VD, como isquemia e infarto do miocárdio.…”

Abnormalities of left ventricular long-axis function predict the onset of hypertension independent of blood pressure: a 7-year prospective study

“…Categorical variables were compared using the w 2 -test. Because the parameters of systolic and diastolic function are in a great degree influenced by age, [12][13][14] for purposes of univariate analysis these parameters were adjusted to an age of 45 years according to the formula adjusted parameter ¼ measured parameter-b (age-45), where b is the coefficient of the linear regression between measured parameter and age. The ability of MAVPD À1 mitral E/A ratio À1 and LV mass index to discriminate between subjects who developed HTN and those who remained normotensive at follow-up was evaluated by receiver operating characteristic (ROC) curves with calculation of areas under the curves (AUC) of sensitivity plotted vs 1-specificity.…”