Longitudinal systolic ventricular interaction in pediatric and young adult patients with TOF: a cardiac magnetic resonance and M-mode echocardiographic study

Aim of this prospective study was to evaluate longitudinal systolic left ventricular (LV)–right ventricular (RV) interaction using M-mode compared to magnetic resonance imaging (MRI) data in 146 pediatric and adults with operated tetralogy of Fallot (TOF). We determined biventricular measures of longitudinal M-mode echocardiography [i.e. tricuspid annular plane systolic excursion (TAPSE); the mitral annular plane systolic excursion (MAPSE)] compared to longitudinal function parameters using MRI. M-mode data were compared to established normal z-score values. We found a good correlation between MAPSE and LVEF values (r = 0.788; p < 0.001). Correlations between MRI derived MAPSE and M-mode guided MAPSE (r = 0.879, p < 0.001), and between MRI derived TAPSE and M-mode guided TAPSE were significant (r = 0.780, p < 0.001). While the LVEF was normal in patients with a normal RVEF, the LVEF was decreased in patients with significantly reduced RVEF. Patients with a significantly dilated RV (RVEDVi > 150 ml/m²) showed a significantly reduced mean MAPSE of 1.30 ± 0.26 cm. LV longitudinal function decreases below ?2 SD of normal MAPSE z-score values after a mean of 22 postoperative years. Our data confirm progressive adverse RV–LV interaction in the long-term follow-up of TOF. We show that simple M-mode measurement of the longitudinal LV function (i.e. MAPSE) is a sufficient surrogate for estimation of LVEF. Therefore determination of the MAPSE is a helpful additional tool for LV systolic function assessment late after TOF repair.     

Tricuspid annular plane systolic excursion and right ventricular ejection fraction in pediatric and adolescent patients with tetralogy of Fallot,patients with atrial septal defect,and age-matched normal subjects

Aims  

To determine whether TAPSE is an accurate marker of right ventricular (RV) systolic function in patients with tetralogy of Fallot (TOF) and patients with small atrial septal defect (ASD). The tricuspid annular plane systolic excursion (TAPSE) values were measured and compared with RV ejection fraction (EF).     

Angiocardiographic Pressure Volume Loops in the Analysis of Right Ventricular Function after Repair of Tetralogy of Fallot

Objective: The objective of the study was to estimate the capacity of pressure volume (PV) loop analysis to assess right ventricular (RV) function after Fallot (TOF) repair.Patients: Fifty six patients were examined after TOF repair. PV loops were constructed from RV angiocardiography and simultaneous pressure measurement. Patients were divided in three groups according to RV size and pressure (Group I: normal RV size and pressure; group II: enlarged RV, near normal pressure; group III: normal RV size, elevated pressure).Main outcome measures: Systolic stroke work corrected for body surface area (W/BSA) and for RV enddiastolic volume (W/EDV), peak RV filling (PFR) and emptying rates (PER) corrected for RV stroke volume, cycle efficiency (CE), RV ejection fraction (RVEF).Results: W/BSA was significantly higher in group II than in group I (0.19 ± 0.05 vs. 0.11 ± 0.04 J/m², p < 0.001) and was similar between groups II and III (0.19 ± 0.05 vs. 0.17 ± 0.05 J/m² ; NS). W/EDV was similar in groups I and II (12.4 ± 5.4 vs. 12.4 ± 2.9 mmHg; NS). CE was smallest in group II. The difference was significant between groups II and III (0.62 ± 0.08 vs. 0.73 ± 0.09; p < 0.05). RVEF was negatively correlated to RV end systolic volume (RVESV) in the patients of groups I and II (r = −0.32, p < 0.05). A similar correlation was found between PFR and RVESV (r = −0.28, p < 0.05).Conclusions: Analysis of a single PV loop allows quantification of RV load after TOF repair. W/BSA is increased to the same extent under volume and pressure load. The lack of decrease in W/EDV in patients with enlarged RV indicates that RV is capable to perform adequate work in a wide range. RVESV is a useful measure for estimating RV function after TOF repair depicting parameters of systolic and diastolic RV function.     

Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension

Background

Longitudinal wall motion of the right ventricle (RV), generally quantified as tricuspid annular systolic excursion (TAPSE), has been well studied in pulmonary hypertension (PH). In contrast, transverse wall motion has been examined less. Therefore, the aim of this study was to evaluate regional RV transverse wall motion in PH, and its relation to global RV pump function, quantified as RV ejection fraction (RVEF).

Methods

In 101 PH patients and 29 control subjects cardiovascular magnetic resonance was performed. From four-chamber cine imaging, RV transverse motion was quantified as the change of the septum-free-wall (SF) distance between end-diastole and end-systole at seven levels along an apex-to-base axis. For each level, regional absolute and fractional transverse distance change (SFD and fractional-SFD) were computed and related to RVEF. Longitudinal measures, including TAPSE and fractional tricuspid-annulus-apex distance change (fractional-TAAD) were evaluated for comparison.

Results

Transverse wall motion was significantly reduced at all levels compared to control subjects (p < 0.001). For all levels, fractional-SFD and SFD were related to RVEF, with the strongest relation at mid RV (R² = 0.70, p < 0.001 and R² = 0.62, p < 0.001). For TAPSE and fractional-TAAD, weaker relations with RVEF were found (R² = 0.21, p < 0.001 and R² = 0.27, p < 0.001).

Conclusions

Regional transverse wall movements provide important information of RV function in PH. Compared to longitudinal motion, transverse motion at mid RV reveals a significantly stronger relationship with RVEF and thereby might be a better predictor for RV function.     

Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

The present study examined whether tricuspid annular plane systolic excursion (TAPSE) can simply predict right ventricular ejection fraction (RVEF) in patients with pulmonary hypertension (PH). The TAPSE cut-off value to predict reduced RVEF was also evaluated. The association between TAPSE and cardiac magnetic resonance imaging (CMRI)-derived RVEF was examined in 53 PH patients. The accuracy of the prediction equation to calculate RVEF using TAPSE was also evaluated. In PH patients, TAPSE was strongly correlated with CMRI-derived RVEF in PH patients (r = 0.86, p < 0.0001). We then examined the accuracy of the two equations: the original regression equation (RVEF = 2.01 × TAPSE + 0.6) and the simplified prediction equation (RVEF = 2 × TAPSE). Bland–Altman plot showed that the mean difference ± limits of agreement was 0.0 ± 10.6 for the original equation and ?0.6 ± 10.6 for the simplified equation. Intraclass correlation coefficient was 0.84 for the original and 0.82 for the simplified equation. Normal RVEF was considered to be ≥40 % based on the data from 53 matched controls, and the best TAPSE cut-off value to determine reduced RVEF (<40 %) was calculated to be 19.7 mm (sensitivity 88.9 %, specificity 84.6 %). A simple equation of RVEF = 2 × TAPSE enables easy prediction of RVEF using TAPSE, an easily measurable M-mode index of echocardiography. TAPSE of 19.7 mm predicts reduced RVEF in PH patients with clinically acceptable sensitivity and specificity.     

Doppler Tissue Imaging Evaluation of Right Ventricular Function at Rest and During Dobutamine Infusion in Patients After Repair of Tetralogy of Fallot

Background Reliable, non-invasive evaluation of right ventricular function, especially in congenital heart disease, is challenging. Objectives The aim of this study was to evaluate Doppler tissue imaging (DTI) parameters of lateral tricuspid annular motion, mean rate of pressure rise during RV contraction (mean dP/dt) and indexed right ventricular (RV) stroke volume (RVSVi) as RV function indices in repaired tetralogy of Fallot (TOF). Methods DTI evaluation was performed in 25 repaired-TOF patients, aged 11 ± 6, at rest and during dobutamine infusion and 20 controls at rest. Results TOF patients had lower (P < 0.05) peak systolic velocity (Sa) (11.4 ± 4 vs. 13.7 ± 3.1 cm/s), early diastolic velocity (Ea) (11 ± 3.1 vs. 16.3 ± 3.5 cm/s) and Sa/time from onset of QRS to Sa (Sa/Q–Sa)␣(68.8 ± 26.4 vs.␣92.3 ± 29.4 cm/s²) versus controls. Dobutamine increased (P < 0.01) Sa (11.4 ± 2.8–17.7 ± 4.7 cm/s), Ea (11 ± 3.1–15.6 ± 3.9 cm/s), late diastolic velocity (Aa) (8.4 ± 2–14.8 ± 5 cm/s), Sa/Q–Sa (68.8 ± 26.4–17 6.8 ± 84.5 cm/s²), mean dP/dt (180 ± 74–537 ± 37 2 mmHg/s), and RVSVi (7.8 ± 3.9–11.9 ± 5.6 L/min/m²). RVSVi increase correlated (P < 0.01) with that in Sa (r = 0.6), Ea (r = 0.5), Sa/Q–Sa (r = 0.71), and mean dP/dt (r = 0.57) while mean dP/dt increase correlated strongly with Sa/Q–Sa increase (r = 0.88). Conclusion DTI evaluation of tricuspid annular motion during dobutamine infusion in repaired TOF correlates with dP/dt and RV stroke volume and may help in assessing RV function and reserve.     

Optimizing right ventricular focused four-chamber views using three-dimensional imaging,a comparative magnetic resonance based study

Obtaining focused right ventricular (RV) apical view remains challenging using conventional two-dimensional (2D) echocardiography. This study main objective was to determine whether measurements from RV focused views derived from three-dimensional (3D) echocardiography (3D-RV-focused) are closely related to measurements from magnetic resonance (CMR). A first cohort of 47 patients underwent 3D echocardiography and CMR imaging within 2 h of each other. A second cohort of 25 patients had repeat 3D echocardiography to determine the test–retest characteristics; and evaluate the bias associated with unfocused RV views. Tomographic views were extracted from the 3D dataset: RV focused views were obtained using the maximal RV diameter in the transverse plane, and unfocused views from a smaller transverse diameter enabling visualization of the tricuspid valve opening. Measures derived using the 3D-RV-focused view were strongly associated with CMR measurements. Among functional metrics, the strongest association was between RV fractional area change (RVFAC) and ejection fraction (RVEF) (r?=?0.92) while tricuspid annular plane systolic excursion moderately correlated with RVEF (r?=?0.47), all p?<?0.001. Among RV size measures, the strongest association was found between RV end-systolic area (RVESA) and volume (r?=?0.87, p?<?0.001). RV unfocused views led on average to 10% underestimation of RVESA. The 3D-RV-focused method had acceptable test–retest characteristics with a coefficient of variation of 10% for RVESA and 11% for RVFAC. Deriving standardized RV focused views using 3D echocardiography strongly relates to CMR-derived measures and may improve reproducibility in RV 2D measurements.     

二维斑点追踪技术评价心力衰竭患者右心室功能

目的 采用二维斑点追踪成像（2D-STI）评估心力衰竭（HF）患者右心室（RV）功能。方法 对31例射血分数下降型HF患者（HFREF组）、41例射血分数保留型HF患者（HFPEF组）及26名健康志愿者（对照组）行彩色多普勒超声检查,于心尖四腔心切面图像获得常规超声参数：RV壁厚度、RV基底段内径（RVD1）、RV收缩末期面积（RVESA）、RV舒张末期面积（RVEDA）、面积变化分数（RVFAC）、三尖瓣环收缩峰值速度（S''）、心肌做功指数（MPI）、三尖瓣环收缩期位移（TAPSE）及左心室射血分数（LVEF）;应用2D-STI技术获得RV游离壁基底段应变（RVLSbas）、中间段应变（RVLSmid）、心尖段应变（RVLSapi）及整体应变（RVLSfw）。比较3组间二维应变参数,分析RVLSfw与常规超声参数的相关性。结果 3组间RV壁厚度、RVD1、MPI、RVFAC、TAPSE及LVEF差异均有统计学意义（P均<0.01）。对照组、HFPEF组及HFREF组间RVLSbas、RVLSmid、RVLSfw均逐渐降低（P均<0.05）。HF患者RVLSfw与LVEF、TAPSE、MPI及RV壁厚度均呈强相关（r=-0.68、-0.53、0.52、0.51,P均<0.01）,与RVD1、FAC、S''均呈弱相关（r=0.42、-0.46、-0.39,P均<0.01）。结论 二维应变参数可用于评估HF患者RV功能。     

实时三维超声心动图评价系统性红斑狼疮并发肺动脉高压患者右心功能

目的 采用实时三维超声心动图(RT-3DE)和传统二维超声心动图综合评价系统性红斑狼疮(SLE)并发肺动脉高压(PAH)患者右心结构和功能.方法 获得60例SLE患者(无PAH亚组、轻度PAH亚组、中重度PAH亚组)和28名健康对照者(对照组)右心常规超声和三维全容积超声动态图像,测量常规右心结构、功能和血流动力学参数;采用三维分析软件获得右心室舒张末期容积指数(RVEDVI-3D)和收缩末期容积指数(RVESVI-3D),射血量(RVSV-3D)、射血分数(RVEF-3D),比较其在各组间的差异,分析各参数间的相关性.结果 中重度PAH亚组RA长短轴内径、RV乳头肌部和基底部内径明显增大,RVEDVI-2D和RVESVI-2D明显增大,RVEF-2D明显降低,差异均有统计学意义(P均 <0.05);不同组间RVFAC、RVTei指数、RV e/a差异均有统计学意义(P均 <0.05);中重度PAH亚组TAPSE、s明显降低,E/e明显增大,差异均有统计学意义(P均 <0.05).中重度PAH亚组RVEDVI-3D和RVESVI-3D明显增大,RVEF-3D和RVSV-3D明显降低,差异均有统计学意义(P均 <0.05).三尖瓣环收缩期位移(TAPSE)、s、RVFAC分别与肺动脉收缩压呈负相关(P均 <0.001).RV Tei指数分别与PVR、肺动脉收缩压、平均压呈正相关(P均 <0.001).RVEDVI-3D、RVESVI-3D分别与PVR、肺动脉收缩压、平均压呈正相关(P均 <0.05).RVEF-3D与s、TAPSE分别呈正相关(P均 <0.001).RVEDVI-3D、RVESVI-3D分别与RVTei指数呈正相关(P均 <0.001).RVEDVI-3D、RVESVI-3D分别与s呈负相关(P均 <0.05).结论 RT-3DE可在机、快速、定量分析SLE患者RV容积和功能,适于临床应用.     

Three-dimensional assessment of two-dimensional technique for evaluation of right ventricular function by tricuspid annulus motion

Background: Measurement of tricuspid annulus motion (TAM) is an easy way to estimate right ventricular ejection fraction (RVEF). However the accuracy of two-dimensional (2-D) methods for analyzing the three-dimensional (3-D) structure of the tricuspid annulus has not been evaluated. Objective: This study evaluated the accuracy with which 2-D measurements of TAM reflect RVEF using 3-D reconstructions of the heart at end diastole (ED) and end systole (ES). Methods: 2-D echocardiographic studies were performed on 12 subjects and used to reconstruct the RV and tricuspid annulus in 3-D at ED and ES. Measurements of TAM from medial and lateral positions on the annulus were selected from the standard echocardiographic apical four-chamber view. The minimum and maximum possible TAM values, RV volumes, and movement of the apex of the heart along the trajectory of TAM were calculated from the 3-D reconstructions. Results: TAM correlated highly with RVEF (r 0.90). Values found by 2-D and 3-D techniques were not significantly different. Correcting TAM for apex motion did not improve correlation. Summation of medial and lateral TAM data increased correlation values slightly relative to lateral TAM alone. Regional aberrant contractility degraded the predictive value of TAM. Conclusion: Estimation of RVEF from 2-D echo measurement of TAM is accurate, especially when medial and lateral TAM are summed, except in patients with severe apical RV dysfunction.     

Right ventricular peak systolic longitudinal strain is a sensitive marker for right ventricular deterioration in adult patients with tetralogy of Fallot

The aim of this study was to evaluate the feasibility of right ventricular (RV) longitudinal peak systolic strain (LPSS) assessment for the follow-up of adult patients with corrected tetralogy of Fallot (TOF). Adult patients (n = 18) with corrected TOF underwent echocardiography and CMR twice with a time interval of 4.2 ± 1.7 years. RV performance was derived from CMR, and included RV volumes and ejection fraction (EF). LPSS was calculated globally (GLPSS) and in the RV free wall (LPSS FW), with echocardiographic speckle-tracking strain-analysis. Baseline (G)LPSS values were compared between patients and healthy controls; the relation between (G)LPSS and CMR parameters was evaluated and the changes in (G)LPSS and CMR parameters during follow-up were compared. GLPSS and LPSS FW were significantly reduced in patients as compared to controls (−14.9 ± 0.7% vs. −21.6 ± 0.9% and −15.5 ± 0.9% vs. −22.7 ± 1.5%, P < 0.01). Moderate agreement between LPSS and CMR parameters was observed. RV EF remained unchanged during follow-up, whereas GLPSS and LPSS FW demonstrated a significant reduction. RVEF showed a 1% increase, whereas GLPSS decreased by 14%, and LPSS FW by 27%. RV LPSS is reduced in TOF patients as compared to controls; during follow-up RV EF remained unchanged whereas LPSS decreased suggesting that RV LPSS may be a sensitive marker to detect early deterioration in RV performance.     

Tricuspid Annular Plane Systolic Excursion (TAPSE) for Risk Stratification and Prognostication of Patients with Pulmonary Embolism

BackgroundThe categorization of pulmonary embolism (PE) as non-massive, sub-massive, and massive helps guide acute management. The presence of right ventricular (RV) strain differentiates sub-massive from non-massive PEs. Unlike laboratory markers and electrocardiogram changes, the classic parameters used in the echocardiographic diagnosis of RV strain have a technical component that is operator-dependent.ObjectiveThis narrative review will describe the physiologic effects of a PE on the RV and how this affects prognosis. It will summarize the literature evaluating the accuracy and prognostic ability of tricuspid annular plane systolic excursion (TAPSE) in the echocardiographic assessment of RVfunction. The review will describe the appeal of TAPSE for this purpose, provide cutoff measurements, and then illustrate how to perform the technique itself, while offering associated pearls and pitfalls in this bedside evaluation.DiscussionRV function and dynamics undergo acute changes in the setting of a PE. RV dysfunction predicts poor outcomes in both the short and long term. However, RV strain is difficult to capture on echocardiography due to the chamber's complex geometric shape and contraction. From the apical four-chamber window, TAPSE offers a quantitative measure that is more easily performed with high interobserver reliability for evaluating systolic RV contraction. This measurement carries prognostic value in patients diagnosed with PE.ConclusionsAlong with other more qualitative echocardiographic parameters, TAPSE can be used as a simple quantitative measure of RV dysfunction for differentiating sub-massive from non-massive PEs. This categorization helps guide acute management and disposition.     

Prevalence of ventricular discordance and its relation to functional capacity in idiopathic dilated cardiomyopathy

Introduction  Although left ventricular (LV) dilatation is the most distinguishing morphologic feature of idiopathic dilated cardiomyopathy (IDC), right ventricular (RV) dilatation may variably contribute to total cardiac enlargement. The prevalence and functional importance of the relative degree of left and right ventricular dilatation has not been comprehensively studied using cardiac magnetic resonance imaging (MRI). Methods  Our prospective study included 58 consecutive IDC patients with a LV ejection fraction <40% and NYHA functional class ≥2. MRI was performed with a 1.5 Tesla scanner for RV and LV dimensional and functional analysis. Cardiopulmonary exercise testing was used for evaluation of exercise capacity. Patients were grouped into tertiles based on the distribution of LV end-diastolic volume. Results  Compared to control subjects a considerable heterogeneity in the relative degree of left and right ventricular dilatation was noted in IDC patients. Within the entire patient group, a strong correlation between the degree of ventricular volume discordance and the extent of LV enlargement was observed (r = 0.8; P < 0.001). Tertile analysis revealed that the LV/RV volume ratio significantly differed in the three subgroups of patients (1.0 ± 0.3 vs. 1.5 ± 0.4 vs. 2.1 ± 0.9; P < 0.001). Only weak correlations between MRI data and patients’ functional capacity were found. LV ejection fraction was identified as the only independent predictor of maximum oxygen consumption in our setting. Conclusion  In IDC patients the degree of ventricular volume discordance is strongly related to the extent of left ventricular enlargement. However, comprehensive biventricular assessment of cardiac function by MRI adds little to our understanding of the cardiac mechanisms limiting exercise tolerance when compared to exclusive left ventricular measurements.     

Improving the role of echocardiography in studying the right ventricle of repaired tetralogy of Fallot patients: comparison with cardiac magnetic resonance

Right ventricular (RV) evaluation represents one of the major clinical tasks in the follow-up of repaired tetralogy of Fallot patients (rToF) with pulmonary valve regurgitation, as both severe RV dilatation and dysfunction are key factors in defining the need of pulmonary valve replacement. The aim of our study was to report the diagnostic accuracy of echocardiography in the identification of rToF patients with severely dilated and/or depressed RV as compared to cardiac magnetic resonance (CMR). Among our patients with rToF, a subgroup of 95 (17.6?±?6.8 years; 60% male), who underwent right ventricular qualitative and quantitative evaluation with CMR following echocardiographic suspicion of severe dilation/dysfunction, were included in the analysis. When comparing echocardiographic RV functional parameters to CMR findings, we found no association between CMR-ejection fraction (EF) and either tricuspid annulus plane systolic excursion (TAPSe) nor tissue Doppler systolic tricuspid excursion velocity (all p?=?ns). In contrast RVFAC was strongly associated with CMR-EF (r?=?0.44; p?<?0.01) as well as to longitudinal components of RV mechanics including tissue Doppler s′ (r?=?0.40; p?<?0.01) and TAPSE (r?=?0.36; p?<?0.01). When comparing echocardiographic and CMR structural parameters of the RV, we found that CMR RV volume was strongly related to echocardiographic measurements of RV end diastolic area (from the 4 chamber apical view) and with proximal parasternal short axis right ventricle outflow-dimension. Accordingly a regression model was derived from multiple regression analysis, which allows a more accurate estimate of CMR RV volume from echocardiography (r²?=?0.59, p?<?0.001). Our study demonstrates a significant, although imperfect, correlation between echocardiographic and CMR RV functional and geometrical parameters. Combining echocardiographic measures of RV inflow and RV outflow, we deliver a simple formula to estimate CMR-RV volume, improving the echocardiographic accuracy in RV volume quantification.     

Right ventricular echocardiographic parameters and prediction of stroke volume in ischemic cardiogenic shock: A retrospective study

PurposeThis study investigated which commonly used right ventricular (RV) echocardiographic parameter correlates best with stroke volume (SV) estimated by Doppler echocardiography in ischemic cardiogenic shock (CS).Materials and methodsWe retrospectively reviewed the records of 100 patients admitted to the ICU over 34 months with CS. Tricuspid annular plane systolic excursion (TAPSE), Tricuspid annulus systolic velocity (RV S′), Tricuspid regurgitation maximum velocity (TR Vmax), and RV outflow tract velocity time integral (RVOT VTI) were correlated to SV.ResultsMean age was 62.6 ± 12.7 years and 78% were male. The mean SV, TAPSE, RV S′, TR Vmax, and RVOT VTI were 47 ± 16 ml, 16 ± 5 mm, 11 ± 4 mm/s, 1.97 ± 0.73 m/s, and 12.7 ± 5 cm, respectively. RVOT VTI correlated best to SV (r = 0.39 p = 0.01) compared to TAPSE, RV S′, and TR Vmax (r = 0.26 p = 0.01, r = 0.15 p = 0.21, r = 0.03 p = 0.78). RVOT VTI independently predicted SV. Univariate analysis demonstrated that only RVOT VTI predicted SV (OD = 1.18 p = 0.04) and had the best area under the curve (0.70, p = 0.03).ConclusionRVOT VTI correlated better (albeit weakly) to and best predicted SV compared to TAPSE, RV S′, and TR Vmax in patients admitted to intensive care with CS. This study suggests that RVOT VTI has the potential as a therapeutic target to optimize SV in CS.     

Tricuspid valve magnetic resonance imaging phase contrast velocity-encoded flow quantification for follow up of tetralogy of Fallot

Our purpose was to identify E- and A-wave flow patterns across the tricuspid valve in tetralogy of Fallot (TOF) patients following repair using magnetic resonance imaging phase contrast velocity-encoded flow quantification and to correlate them with measurements of right ventricle enlargement. The study included 33 children following TOF repair who had MRI examinations that included cine imaging to quantify ventricle size and function and flow analysis across the atria-ventricular valves to evaluate ventricle in-flow patterns. The E:A ratio was calculated for each patient and the population separated into α (E:A ratio ≥ 1.4) and β (E:A ratio < 1.4) groups. Significant association was present between the β group and right ventricle end diastolic volume index ≥140 ml/m² (P = 0.046), right ventricle end systolic volume index ≥70 ml/m² (P = 0.02), and end diastolic volume right ventricle to left ventricle ≥ 2.0 (P = 0.003). A reduction in the E:A wave ratio across the tricuspid valve is associated with right ventricle diastolic dysfunction and correlated well in our study with right ventricle enlargement. This may be a useful criterion for determining the timing of valved pulmonary conduit surgery in children following TOF repair.     

Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease

Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac surgery in these patients. Adult CHD patients operated between January 2008 and December 2009 in the Academic Medical Centre in Amsterdam were studied. Clinical characteristics, laboratory tests, surgical data and intensive care unit outcome were obtained from medical records. RVF was measured by trans-thoracic echocardiography (TTE) and expressed by tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (RV S’) and myocardial performance index (MPI) pre-operatively and direct, at intermediate and late follow up. Of a total of 185 operated, 86 patients (mean age 39?±?13?years, 54% male) had echo data available. There was a significant fall in RVF after cardiac surgery. TAPSE and RV S’ were significantly higher and MPI was significantly lower pre-operatively compared to direct post-operative values (TAPSE 22?±?5 versus 13?±?3?mm (P?<?0.01), RV S’ 11?±?4 versus 8?±?2?cm/s (P?<?0.01) and MPI 0.36?±?0.14 vs 0.62?±?0.25; P?<?0.01). There were no significant differences in left ventricular function pre-operatively compared to post-operative values. Right-sided surgery was performed in 33, left-sided surgery in 37 and both sided surgery in 16 patients. Decline in RVF was equal for those groups. Patients with severe decline in RVF, were patients who underwent tricuspid valve surgery. Decline in RVF was associated with post-operative myocardial creatine kinase level and maximal troponin T level. There was no association between decline in RVF and clinical outcome on the intensive care unit. 18?months post-operatively, most RVF parameters had recovered to pre-operative values, but TAPSE which remained still lower (P?<?0.01). CHD patients have a decline in RVF directly after cardiac surgery, regardless the side of surgery. Although a gradual improvement was observed, complete recovery was not seen 18?months post-operatively.     

实时三维超声心动图评价酒精性心肌病患者右心室收缩功能

目的 应用实时三维超声心动图(RT-3DE)评价酒精性心肌病(ACM)患者右心室收缩功能的变化。方法 对30例ACM患者(ACM组)和30名正常人(对照组)分别进行常规超声及RT-3DE检查。常规超声测量参数包括左心室射血分数(LVEF)、右心室舒张末期面积(RVEDA)和收缩末期面积(RVESA),计算右心室面积变化分数(RVFAC);运用M型超声测量三尖瓣环收缩期位移(TAPSE);RT-3DE测量参数包括右心室舒张末期容积(RVEDV)、收缩末期容积(RVESV)、每搏量(RVSV)、射血分数(RVEF)。比较两组上述参数的差异,分析RVFAC、TAPSE与RVEF的相关性。结果 常规超声中,ACM组RVEDA和RVESA高于对照组,LVEF、RVFAC和TAPSE低于对照组(P均<0.05);RT-3DE中,ACM组RVEDV和RVESV高于对照组,RVEF低于对照组(P均<0.05),两组RVSV无明显差异(P>0.05)。RVFAC、TAPSE均与RVEF呈正相关(r=0.610、0.822,P均<0.05)。结论 RT-3DE能准确评价右心室收缩功能,具有一定临床应用价值。     

TAPSE联合Tei指数评价Ebstein畸形手术前后右室功能

目的:阐明三尖瓣环收缩期位移(TAPSE)联合Tei指数对Ebstein畸形(EA)患者手术前后右心功能评价的可行性。方法:本研究中人选的40例EA患者和20名健康对照者均完成了超声心动图(UCG)检查评估右心功能,其中EA患者分别于术前、术后I周、术后3月进行UCG。于四腔心切面测量常规超声心动指标,测量三尖瓣环收缩期位移(TAPSE),留取组织多普勒(TDI)四腔心切面,并计算出右心室心肌做功(RVTei)指数。结果:术前反映右心室收缩功能的TAPSE、右心室面积变化分数(RVFAC)指标降低,同时反映右心室收缩和舒张功能的RVTei指数升高。EA患者矫治术后1周、3月时TAPSE值高于术前(P<0.01),而RVTei指数低于术前(P<0.05),研究结果表明可通过TAPSE、RVTei评估EA矫治术后右心功能。TAPSE与RVFAC有一定的相关性,RVFAC在用于EA矫治手术前后右心功能的评估中,不适于术后与术前的比较,仅适于术后不同阶段之间的比较。结论;利用TAPSERVTei指数,可评估EA患者术前术后右心室功能,并认识到三尖瓣修复对右心功能改善的积极作用,为右心功能的评估积累经验。     

Regional motion of the AV-plane is related to the cardiac anatomy and deformation of the AV-plane. Data from the HUNT study

The study examines global and regional systolic shortening of the left (LV) and right ventricle (RV) in 1266 individuals without evidence of heart disease in the third wave of the HUNT study. Regional mitral annular systolic displacement (mitral annular plane systolic excursion [MAPSE]) was 1.5 cm in the septum and anterior walls, 1.6 cm in the lateral wall and 1.7 cm in the inferior wall, global mean 1.6 cm. Peak systolic velocity S' was 8.0, 8.3, 8.8 and 8.6 cm/s in the same walls (global mean 8.7 cm/s). All measures of LV longitudinal shortening correlated, mean MAPSE and S' also correlated with stroke volume (SV) and ejection fraction (EF). Global longitudinal strain by either method correlated with MAPSE, S' and EF, but not with SV, reflecting a systematic difference. S' and MAPSE correlated with early annular diastolic velocity (e'), reflecting that e' is the recoil from systole. Mean displacement was 2.8 (0.5) cm in the tricuspid annulus (tricuspid annular plane systolic excursion [TAPSE]). Normal values by age and sex are provided. Both TAPSE and S' were lower in women, where body size explained the sex difference. Normalisation of MAPSE and S' for wall length reduced intra-individual variation of displacement and velocity by 80%–90%, showing regional MAPSE to be related to LV wall length, and that longitudinal wall strain was relatively uniform. Displacement and S' were lowest in the septum and highest in the left and right free walls, shows systolic bending of the AV-plane into a U-shape, relating to the total cardiac volume changes during the heart cycle.