The Significance of Ventricular Interdependence in Patients with Right Ventricular Hypertrophy and Normal Left Ventricular Function

Abstract

The aim of the study is to quantify ventricular interactions by comparing tissue and spectral systolic echocardiographic parameters to allow the early identification of ventricular dysfunction. Clinical, paraclinical, electrocardiographic and echocardiographic evaluations were performed. Right ventricular hypertrophy was diagnosed in the M mode subcostal echocardiographic section. RV hypertrophy was defined by a right ventricular free wall thickness of ] 5 mm in diastole. We assessed the following RV and LV tissue and spectral systolic indices: apical systolic excursion of the lateral mitral ring (MAPSE), apical systolic excursion of the lateral tricuspid ring (TAPSE), left (Svs) and right (Svd) ventricular tissue systolic velocities, and RV and LV ejection times. We calculated the following to assess systolic ventricular interdependence: MAPSE/TAPSE, the normal value of which was considered as 0.66 � 0.14, and Svs/Svd, the normal value of which was considered as 0.76 � 0.21. The study group was compared to a control group with the same clinical features but without ventricular hypertrophy. Twenty-one patients were included in the study: 13 men (62%) and eight women (38%) with a mean age of 56 � 3.8 years. We compared the values between the study group and control group, with the following results: TAPSE = 20.4 � 0.9 vs. 24.1 � 0.76 and MAPSE/TAPSE = 0.74 � 0.06 vs. 0.75 � 0.04. MAPSE was comparable between the groups. Svs was comparable between the groups (0.09 � 0.01 vs. 0.12 � 0.02), whereas Svd was different between the groups (0.11 � 0.03 vs 0.16 � 0.03). Svs/Svd was 0.81 � 0.05 in the study group and 0.75 � 0.08 in the control group. LV ejection time was comparable between the two groups (299.8 � 23.6 ms vs. 303.3 � 28 ms), whereas, RV ejection time differed between the groups (275 � 17 ms vs. 245.5 � 28.5). Changes in TAPSE and MAPSE/TAPSE, in addition to Svd and Svs/Svd, are related to right ventricular dysfunction and suggest pathological changes in the interdependence mechanism of the ventricles in patients with RV hypertrophy. In addition, RV free wall thickness was strongly correlated with ventricular interdependence parameters, with the exception of MAPSE. Assessing these parameters and proportions in clinical practice will facilitate the early detection and appropriate treatment of right ventricular dysfunction.

The Acute Hemodynamic Effects of Caffeine During Different Body Positions in Normotensive Young Adults

“…To take into account the postural, gravitationally induced effects on BP, it should be mentioned that the head-down Trendelenburg position leads to a temporary increase of venous return and preload, cardiac output and perfusion index [28]. Certainly, the stroke volume variation is subjected to the body posture [29,30], but the pressure hemodynamic effects, especially in people with hypotension, heart failure or aortic stenosis are the subject of dispute between various authors [31][32][33]. In clinical practice, the Trendelenburg position is used mainly with small or medium angles of inclination, in which there is no significant influence in the dominant parasympathetic cardiac control [34].…”

Diagnostic Accuracy of Electrocardiography (Ecg) for the Diagnosis of Left Ventricular Hypertrophy, Taking Echocardiography as Gold Standard

“…The introduction of the practice of ECG in diagnosing left ventricular hypertrophy has proven its benefits when compared to ECHO as the gold standard for the validation of ECG as a tool to diagnose LVH would benefit centers that lack access to echocardiography. Moreover, in developing countries, echocardiography can't be prescribed to screen each patient with hypertension, starting assessment utilizing ECG can help in choosing the individuals who require echocardiography 6,7 . In an Indian study, the sensitivity of ECG was 43.5% and specificity was 88.9 when it was used for diagnosis of LVH keeping ECHO as a gold standard, 8 while another recent study recorded these findings as to the sensitivity of 86% and specificity of 81% .…”