Importance of the right ventricle in valvular heart disease

Nagel, Eike; Stuber, Matthias; Hess, Otto M.

doi:10.1093/oxfordjournals.eurheartj.a014963

Cited by 106 publications

(77 citation statements)

References 52 publications

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“…RV long axis function correlated closely with the estimated radionuclide ejection fraction, as well as with the right-sided pressures. This is in accordance with previous reports describing afterload dependence of the RV systolic function, mostly represented by ejection fraction [36][37][38]. Although the myocardial deformation rate and ejection fraction are two different measurements, the current study shows a significant correlation between the peak systolic SR and the RV ejection fraction.…”

Section: Right Ventricular Function By Tissue/strain Dopplersupporting

confidence: 93%

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease

et al. 2006

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The purpose of the current study was to compare right ventricular (RV) myocardial wall velocities (tissue Doppler imaging) and strain rate imaging (SRI) parameters with conventional echocardiographic indices evaluating RV function in chronic obstructive pulmonary disease (COPD) patients.In total, 39 patients with COPD and 22 healthy subjects were included in the current study. Seventeen patients had pulmonary artery pressure ,35 mmHg (group I) and 22 patients had pulmonary artery pressure .35 mmHg (group II). Tissue Doppler imaging, strain and strain rate (SR) values were obtained from RV free wall (FW) and interventricular septum. Respiratory function tests were performed (forced expiratory volume in one second/vital capacity (FEV1/VC) and carbon monoxide diffusion lung capacity per unit of alveolar volume (DL,CO/VA)).Strain/SR values were reduced in all segments of group II patients compared with group I patients and controls with lowest values at basal FW site. A significant relationship was shown between peak systolic SR at basal FW site and radionuclide RV ejection fraction. A significant relationship was shown between peak systolic SR at basal FW site and DL,CO/VA and FEV1/VC.In conclusion, in chronic obstructive pulmonary disease patients, strain rate imaging parameters can determine right ventricular dysfunction that is complementary to conventional echocardiographic indices and is correlated with pulmonary hypertension and respiratory function tests.

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Section: Right Ventricular Function By Tissue/strain Dopplersupporting

confidence: 93%

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease

et al. 2006

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“…[1][2][3][4][5] Survival in pulmonary hypertension (PH) patients depends on the capability of the RV to adapt to chronically elevated pulmonary artery pressures. 6 Therefore, an accurate evaluation of RV pump function is crucial for screening, diagnosis, and follow-up assessment in PH.…”

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confidence: 99%

“…11 Exercise-induced changes in radionuclide RV ejection fraction seemed to be inversely related to pulmonary artery pressure changes in patients with valvular left heart disease. 3 The objectives of this study were to prospectively assess exercise-induced increase in pulmonary arterial systolic pressure (PASP) as a possible measure of the RV contractile reserve using exercise stress echocardiography in patients with invasively confirmed manifest PH and to analyze the prognostic impact of exercise-induced PASP increase in context with other prognostically relevant parameters.…”

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confidence: 99%

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

et al. 2013

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R ight ventricular (RV) pump function is of essential clinical and prognostic importance in a variety of heart and lung diseases and in pulmonary arterial hypertension (PAH). [1][2][3][4][5] Survival in pulmonary hypertension (PH) patients depends on the capability of the RV to adapt to chronically elevated pulmonary artery pressures. 6 Therefore, an accurate evaluation of RV pump function is crucial for screening, diagnosis, and follow-up assessment in PH. 7 However, it is difficult to assess RV function because of its complex geometry and load dependence and because of inadequate standardization of the assessment. 8 This is true for both noninvasive and invasive techniques.Evaluation of RV performance in PH patients has been recommended to be obtained at rest. 9 It is unknown whether assessment of RV function during exercise may be of additional benefit or even preferable. According to clinical experience, some PH patients with a severely enlarged right side of the heart and impaired RV pump function at rest do much better in their exercise capacity, World Health Organization functional class, and quality of life than others. They might differ in their RV reserve, defined as the ability of the ventricle to increase ejection fraction and stroke volume during exercise or pharmacological stress.10,11 RV and left ventricular (LV) contractileBackground-This study sought to analyze a new approach to assess exercise-induced pulmonary artery systolic pressure (PASP) increase by means of stress Doppler echocardiography as a possible measure of right ventricular contractile reserve in patients with severe pulmonary hypertension and right heart failure. Methods and Results-In this prospective study, patients with invasively diagnosed pulmonary arterial hypertension or inoperable chronic thromboembolic pulmonary hypertension and impaired right ventricular pump function despite a stable targeted pulmonary arterial hypertension medication underwent a broad panel of noninvasive assessments, including stress echocardiography and cardiopulmonary exercise testing. On the basis of the assumption that exerciseinduced PASP is a measure of right ventricular contractile reserve, patients were classified into 2 groups according to an exercise-induced PASP increase above or below the median. Patients were followed up for 3.0±1.8 years. Univariate and multivariate analyses were used for factors predicting survival. Of 124 patients, 66 were below the median exerciseinduced PASP increase of 30 mm Hg (low PASP), and 58 patients were above the median (high PASP). These groups were not significantly different in terms of medication and resting hemodynamics. Low PASP was associated with a significantly lower 6-minute walking distance, peak Vo 2 per kilogram, and 1-, 3-, and 4-year survival rates (92%, 69%, and 48%, respectively, versus 96%, 92%, and 89%). In the multivariate Cox model analysis adjusted for age and sex, PASP increase during exercise and peak Vo 2 per kilogram remained independent prognostic markers (hazard ratio, 2.56 for pea...

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“…Our study has demonstrated that RV Tei index is a feasible approach to estimate RV function in dogs and is not influenced by heart rate, body weight, and aging. Right ventricular (RV) function plays an important role in determining cardiac output and functional capacity in humans [1,28]. RV dysfunction has been observed in various cardiac disorders such as pulmonary hypertension (PH) [17,37], idiopathic dilated cardiomyopathy (DCM) [22], and heart failure [7,8,27].…”

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confidence: 99%

Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

Teshima

Asano

Iwanaga

et al. 2006

The Journal of Veterinary Medical Science

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ABSTRACT. Right ventricular (RV) Tei index (index of myocardial performance) has been demonstrated to be clinically useful in estimating RV function in various human cardiac diseases. The purposes of this study were to validate the correlation between RV Tei index and RV function obtained by cardiac catheterization in healthy dogs, and to evaluate the RV Tei index in dogs with tricuspid regurgitation (TR). In healthy dogs, the RV Tei index significantly correlated with the RV peak +dP/dt (r=-0.80, p<0.0001) and -dP/dt (r=0.69, p=0.0001). In normal dogs, the RV Tei index was not significantly correlated with heart rate, body weight, and age. The RV Tei index significantly increased in dogs with moderate to severe TR (0.39 ± 0.35, p=0.0015), filariasis (0.46 ± 0.16, p=0.0131), and trivial to mild TR and severe mitral regurgitation (MR; 0.61 ± 0.14, p=0.0017) when compared with the normal dogs (0.17 ± 0.10). In addition, the RV Tei index in dogs with TR significantly increased in association with pulmonary hypertension [PH(-), 0.19 ± 0.09; PH(+), 0.65 ± 0.14; respectively p<0.0001]. Our study has demonstrated that RV Tei index is a feasible approach to estimate RV function in dogs and is not influenced by heart rate, body weight, and aging. Right ventricular (RV) function plays an important role in determining cardiac output and functional capacity in humans [1,28]. RV dysfunction has been observed in various cardiac disorders such as pulmonary hypertension (PH) [17,37], idiopathic dilated cardiomyopathy (DCM) [22], and heart failure [7,8,27].RV function can be evaluated by cardiac catheterization with RV peak +/-dP/dt, Tau and RV ejection fraction. However, this method is invasive, and it is difficult to evaluate the RV function due to the complex structural geometry, mechanical properties, and contraction pattern of the right ventricle [12,16].A decade ago, the Tei index (index of myocardial performance) derived from pulsed Doppler echocardiography was proposed in human medicine [36,39]. The Tei index is defined as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), and it has been reported to reflect comprehensive cardiac function, including systolic and diastolic performances, in humans [36,39]. The Tei index is a simple and reproducible technique, and is relatively independent of heart rate [4,39] and age [19]. In addition, the Tei index has been demonstrated to be clinically useful in estimating the prognosis in human patients with primary PH [37,44], DCM [9], cardiac amyloidosis [38], and myocardial infarction [32]. It could be used for evaluating the RV function as well as the left ventricular function that is unrelated to the complex RV geometric structure [10, 11, 19, 24, 33-35, 37, 44].In small animal medicine, RV dysfunction is suspected in dogs with various cardiac diseases such as left-sided heart failure, pulmonary stenosis, tricuspid dysplasia, dirofilariasis, idiopathic cardiomyopathy, cor pulmonale, and idiopathic or secondary PH...

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Importance of the right ventricle in valvular heart disease

Cited by 106 publications

References 52 publications

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease

Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

Evaluation of Right Ventricular Tei Index (Index of Myocardial Performance) in Healthy Dogs and Dogs with Tricuspid Regurgitation

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