Right atrial spontaneous echo contrast and thrombi in atrial fibrillation: a transesophageal echocardiography study.

BACKGROUND: Previous studies have reported the clinical and echocardiographic findings of patients with left atrial spontaneous echo contrast (SEC) and thrombi. We sought to study these characteristics in patients with right atrial SEC and thrombi. METHODS: We reviewed 580 consecutive patients from the ACUTE (Assessment of Cardioversion Using Transesophageal Echocardiography) Registry and found 79 patients (14%, aged 67 +/-13 years, 67 male) with transesophageal echocardiography (TEE) findings of right atrial SEC or thrombi (group 1). This group was compared with a control group of 75 consecutive patients (group 2) (aged 68 +/- 13 years, P = not significant; 49 male, P <.005) from the registry with no TEE findings of SEC or thrombi in the left or right atrium. RESULTS: Atrial fibrillation was present in 60 of 79 group 1 patients (76%). Five right atrial (6%) and 11 left atrial (14%) thrombi were identified. Both left ventricular ejection fraction (39% +/- 16% versus 47% +/- 14%; P =.0005) and presence of right ventricular dysfunction (n = 44 versus 18; P =.0001) differed significantly between groups 1 and 2, respectively. Right atrial area (24 +/- 6 cm(2) versus 22 +/- 6 cm(2); P = .02) was larger in patients in group 1. Left atrial SEC was present in 68 of 79 group 1 patients (86%). Patients with right atrial thrombi and right atrial SEC had a longer duration of arrhythmia (524 +/-812 days versus 147 +/-368 days, P <.05) than patients with right atrial SEC only. CONCLUSIONS: Right atrial SEC has a prevalence of 14% in patients with atrial arrhythmia who undergo TEE-guided cardioversion. Right atrial thrombi are a rare finding and were seen in fewer than 1% (5/580) of patients with atrial arrhythmia. Right atrial thrombi among patients on anticoagulation therapy were not associated with clinically significant pulmonary embolism.     

Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension

This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC?=?0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.     

Prospective Evaluation of Two-dimensional Transthoracic Echocardiography in Emergency Department Patients with Suspected Pulmonary Embolism

OBJECTIVE: To prospectively examine the diagnostic accuracy of two-dimensional transthoracic echocardiography (2-D echo) in emergency department (ED) patients being evaluated for acute pulmonary embolism (PE). METHODS: This was a 14-month prospective observational trial of a convenience sample of ED patients undergoing evaluation for suspected PE at a suburban teaching hospital. The 2-D echo was defined as positive if any two of the following were noted: right ventricular dilation, abnormal septal motion, loss of right ventricular contractility, elevated pulmonary artery or right ventricular pressures, moderate to severe tricuspid regurgitation, or visualization of a clot seen in the right ventricle or pulmonary artery. The patient was considered to have a PE if one of the following was positive: a pulmonary angiogram, contrast helical computed tomography, a magnetic resonance angiogram, a high-probability ventilation/perfusion (V/Q) scan without contradictory evidence, or an intermediate-probability V/Q scan with ultrasonic evidence of deep venous thrombosis. RESULTS: Of 225 cases identified, 39 met the defined criteria for PE (17%). A 2-D echo was performed on 124 patients (55%), of whom 27 (22%) had PE. In 20 patients the 2-D echo had at least two indicators of right ventricular strain; however, only 11 of these patients had confirmed pulmonary embolus. The 2-D echo had a sensitivity of 0.41 (95% CI = 0.32 to 0.49) and a specificity of 0.91 (95% CI = 0.86 to 0.96). The likelihood ratio positive was a moderately strong 4.4, with a weak likelihood ratio negative of 0.6. CONCLUSIONS: Bedside 2-D echo is not a sensitive test for the diagnosis of PE in ED patients. Positive findings moderately increase the suspicion for PE but are not diagnostic.     

Echocardiographic prediction of left-to-right shunt with atrial septal defects.

We investigated the ability of transthoracic echocardiography to predict a ratio of pulmonary to systemic flow (Qp/Qs) > or = 1.5 in patients with secundum atrial septal defects. The 44 study patients included 31 patients undergoing catheterization for device closure of atrial septal defects and 13 additional control patients with normal echocardiograms (median age 7.8 years, mean age 15.9 years, range 1.5 to 69 years). Right atrial end-systolic area, right ventricular end-diastolic volume, and the ratio of pulmonary annulus diameter to aortic annulus diameter were determined from standard transthoracic echocardiographic views. The 26 subjects in the shunt group had Qp/Qs between 1.5 and 3.0. The control subjects included the 5 catheterization patients with Qp/Qs between 0.9 and 1.2 and the 13 patients that did not undergo catheterization with assumed Qp/Qs = 1. The shunt patients had significantly increased median-indexed right atrial area (13.8 versus 8.5 cm(2)/M(2), P <. 0001), median-indexed right ventricular volume (85 versus 39 mL/M(2), P <.0001), and median ratio of pulmonary valve annulus to aortic valve annulus (1.26 versus 1.13, P =.008) compared with controls. Indexed right ventricular volume was the best predictor of significant shunt. A combination of right ventricular volume and right atrial area identified subjects with Qp/Qs >1.5 with 96% sensitivity, 94% specificity, and 96% positive and 94% negative predictive value. We conclude that quantitative transthoracic echocardiography can be used to screen for a significant shunt in patients with atrial septal defects.     

Highly mobile pedunculated left atrial appendage thrombus falling into the mitral valve orifice

We treated two patients with atrial fibrillation and stringlike left atrial appendage thrombus: a 66 year-old man who had apical hypertrophic cardiomyopathy and a 86 year-old woman with no underlying heart disease. In the patient with hypertrophic cardiomyopathy, transesophageal echocardiography showed a highly mobile stringlike echo protruding from the left atrial appendage and sometimes falling into the mitral orifice. Pathologic examination after excision proved the stringlike echo to be a pedunculated structure composed of red and white thrombi. Excision of thrombus was also planned for the woman, who had a history of recurrent cerebral embolism. Because her cerebral CT showed infarction with bleeding, however, surgery was postponed. The stringlike mobile thrombus was not detected by transesophageal echocardiography 1 month later, when a new embolic episode affected a foot. Clinical outcomes of these two patients differed remarkably. The critical findings by transesophageal echocardiography which facilitated differential diagnosis from cardiac tumors were: spontaneous contrast echo accompanying mural thrombuslike echo, and low flow velocity in the left atrial appendage. However, the differential diagnosis may be quite difficult in cases of tumors associated with atrial fibrillation.     

Cor triatriatum: echocardiograhic findings.

The echocardiographic findings in a patient with cor triatriatum are presented. The preoperative echocardiogram demonstrated an unusual structure behind the mitral valve that moved anteriorly during atrial systole. There was also echocardiographic evidence of abnormalities of mitral valve motion, right ventricular and left atrial enlargement, and pulmonary hypertension. Postoperatively, the unusual echo behind the mitral valve had disappeared and the mitral valve appeared more normal. Left atrial and right ventricular dimension had decreased and the pulmonary valve appeared more normal. Fine diastolic mitral valve fluttering, an abnormal echo behind the anterior mitral valve leaflet moving anteriorly with atrial systole, an abnormal pulmonary valve echogram suggesting pulmonary hypertension, and marked right ventricular and left atrial enlargement were the main echocardiographic findings in our patient.     

致心律失常性右室心肌病的临床及超声心动图特点

目的探讨致心律失常性右室心肌病（ARVC）的临床和超声心动图特点。 方法收集、查阅1993年～2005年我院心内科7例诊断为ARVC的入院病例资料,分析其临床资料及超声心动图特点。 结果7例ARVC患者中6例以室性心律失常发病,1例为家系检查时发现。1例猝死,1例心力衰竭,4例晕厥,1例无症状。所有患者均做了心电图、二维超声心动图,部分患者做了动态心电图、心室核素造影、右心室造影。二维超声心动图检查：所有患者均有右心室扩大,4例右室流出道扩张,1例左室略大;5例右室壁运动弥漫性减弱,2例局限性减弱,2例右室室壁瘤形成,3例室间隔运动异常;所有患者三尖瓣、肺动脉瓣口前向血流速度均减慢,右房内均见反流束,反流压差均较低。 结论（1）ARVC患者的临床表现较为复杂多样,典型者常以反复发作性室性心动过速、晕厥、猝死为其首发症状;部分呈家族遗传倾向;（2）超声心动图显示有右心室扩大、右室流出道扩张伴右心室壁弥漫性或局限性变薄、动度减弱,部分患者左心室受累;（3）超声心动图简便、易行,但在诊断ARVC时需除外其他致右室扩大的病变。     

超声心动图在肺心病分级中的应用价值

目的探讨超声心动图在肺心病分级中的应用价值。方法2007年1月～2008年5月在我院就诊的肺心病患者86例，将其超声心动图结构和功能参数与临床心肺功能分级相比较。结果肺心病患者右心室流出道内径、主肺动脉宽度及肺动脉收缩压随着心肺功能降低而增大：右心输出量和右心射血分数随着心肺功能降低而减小，且组间比较差异有统计学意义（P〈0.05）；而在心肺功能Ⅲ级患者右心室壁反而变薄、收缩运动减弱。结论超声心动图对肺心病患者心肺功能分级有一临床指导意义，超声心动图各参数可以作为肺心病分级的指标之一。     

超声心动图评价系统性硬化病肺动脉高压的临床研究

目的 探讨超声心动图评价系统性硬化病(SSc)患者肺动脉高压的临床价值.方法 连续选择23例SSc患者及29名年龄和性别匹配的健康志愿者.常规二维超声测量各房室内径,主肺动脉内径(MPA);多普勒超声测定肺动脉前向血流速度(Vpa)、右心室射血前期(RPEP)、右心室射血期(RVET)、肺动脉血流加速时间(AcT),并计算其比值:AcT/RVET、AcT/RPEP、RPEP/RVET;利用三尖瓣反流压差估测肺动脉收缩压.结果 SSc患者右心房上下径(Rad)、左右心室内径比值(LVdd/RVdd)分别为(41.74±5.19)mm、(2.04±0.27),对照组分别为(36.89±3.22)mm、(2.18±0.15),两组比较差异有统计学意义(t=4.122、-2.312,P=0.000、0.025).SSc患者MPA为(22.23±3.04)mm,对照组为(19.34±1.70)mm,两组比较差异有统计学意义(t=4.308,P=0.000).SSc患者Vpa、AcT分别为(0.88±0.17)m/s、(118.26±30.87)ms,对照组分别为(0.85±0.15)m/s、(145.44±6.28)ms,两组比较差异有统计学意义(t=0.851、-3.365,P=0.393、0.002).SSc患者RVET、RPEP分别为(330.78±54.31)ms、(96.26±26.11)ms,对照组的分别为(340.10±27.05)ms、(87.52±20.44)ms,两组比较差异无统计学意义(t=-0.808、1.317,P=0.423、0.195).SSc患者AcT/RVET、AcT/PREP、RPEP/RVET比值分别为(0.37±0.11)、(1.29±0.43)、(0.31±0.74),对照组的分别为(0.43±0.70)、(1.74±0.47)、(0.26±0.69),差异有统计学意义(t=-2.466、-3.611、2.678,P=0.017、0.001、0.000).SSc组8例(34.8%,8/23)发生肺动脉高压(PAH).结论 超声心动图可作为评价SSc患者肺动脉压力的重要方法.     

Crossing atrial thrombus in a patient with recurrent pulmonary embolism

OBJECTIVES: To report the detection of a thrombus entrapped in a patent foramen ovale by echocardiography in a patient with recurrent pulmonary embolism. DESIGN: Case report. SETTING: Intensive care unit of a university hospital. PATIENT: A 62-yr-old man with initial deep venous thrombosis and recurrent minor pulmonary embolism followed by a severe embolic event with transitory hemiparesis 10 days after prostatectomy. INTERVENTION: Systemic anticoagulation, surgical removal of a crossing atrial thrombus, closure of a patent foramen ovale, and venous thrombectomy. MEASUREMENTS AND MAIN RESULTS: Transesophageal echocardiography revealed a large thrombus entrapped in a patent foramen ovale with portions in all four heart chambers. Intraoperatively, a 19-cm-long thrombus, shaped like the pelvic veins, was found. The patient was successfully weaned from cardiopulmonary bypass, requiring temporary positive inotropic support because of right ventricular dysfunction. Within 24 hrs of the operation, the patient was discharged to the intermediate care unit. CONCLUSIONS: Recurrent pulmonary embolism can potentially result in paradoxic embolism in patients with a patent foramen ovale. In such patients, it may be crucial to monitor right ventricular function and exclude right-to-left shunts by transesophageal echocardiography, regardless of clinical symptoms. The patent foramen ovale should be closed. This case emphasizes an important indication for transesophageal echocardiography in critically ill patients.     

超声心动图检测右心功能与急性肺栓塞患者预后相关分析

目的 探讨超声心动图检测右心功能对急性肺栓塞（APE）患者预后评价的价值。方法2001年11月至2005年6月40所医院入选，随机对照研究资料完整、符合APE诊断的患者502例。根据右心功能减低和CT肺动脉造影（CTPA）栓塞部位≥2个肺叶或≥7个肺段分为大面积、次大面积和非大面积APE。大面积、次大面积APE进入溶栓组，非大面积APE进入抗凝组。超声心动图检测右心功能参数。结果 治疗后近期（30d内）预后分析，溶栓组超声检测右心功能不全224例（死亡和恶化占2．7％），抗凝组超声检测右心功能正常278例（死亡和恶化占0．7％），二者之间差异无统计学意义（P〉0．05）。超声心动图右心功能参数与CTPA行一致性检验，并比较与预后的关系，显示三尖瓣反流压差（TRPG）〉25mmHg（1mmHg=0．133kPa）＋右室前后径（RVTD）／左室前后径（LVTD）〉1．0的敏感性和特异性均为100％。结论超声心动图检测APE患者右心功能可较好地预测预后，与CTPA一致性较好，与临床预后相关。联合指标TRPG〉25mmHg＋RVTD／LVTD〉1．0是提示大面积和次大面积APE的最佳参数。     

超声心动图急性肺栓塞溶栓治疗的评估

目的应用超声心动图技术观察急性肺栓塞患者溶栓抗凝治疗前后肺动脉栓子、右心结构及收缩功能的改变。方法前瞻性非随机对照研究,对2002年12月至2006年4月间经肺动脉CT或肺血管造影证实的30例急性肺栓塞患者行溶栓治疗,应用经胸超声心动图观察治疗前、治疗后24～30h、1个月的肺动脉栓子、主肺动脉及其分支内径、右房室内径,右室前壁运动幅度、右室舒张末期容积、右室射血分数,三尖瓣返流、肺动脉收缩压等指标。结果30例急性肺动脉栓塞患者溶栓治疗24～30h后右房室结构明显改善,表现为右房长径及横径、右室前后径及横径、主肺及右肺动脉内径、右室舒张末期容积与治疗前比较明显回缩(P<0.01),右室前壁运动幅度、右室射血分数有所增加(P<0.01),肺动脉收缩压明显下降(P<0.01);治疗后1个月后右房室大小、主肺及右肺动脉内径、右室舒张末期容积、右室前壁运动幅度及肺动脉收缩压等仍有恢复(P<0.05或P<0.01)。5例患者主肺动脉和/或右、左肺动脉内检出栓子,溶栓后栓子逐渐消失。结论超声心动图可动态、实时、无创评价急性肺动脉栓塞溶栓治疗效果,尤对血栓的溶解、右房室结构、右室超负荷及肺动脉高压的变化有独到的价值。     

Surrogate markers for adverse outcomes in normotensive patients with pulmonary embolism

BACKGROUND: Although echocardiography has proven utility in risk stratifying normotensive patients with pulmonary embolism, echocardiography is not always available. OBJECTIVE: Test if a novel panel consisting of pulse oximetry, 12-lead electrocardiography, and serum troponin T would have prognostic equivalence to echocardiography and to examine the prognostic performance of age, previous cardiopulmonary disease, D-dimer, brain natriuretic peptide, and percentage of pulmonary vascular occlusion on chest computed tomography. DESIGN: Prospective cohort study. PATIENTS AND SETTING: Normotensive (systolic blood pressure of >100 mm Hg) emergency department and hospital inpatients with diagnosed pulmonary embolism who underwent cardiologist-interpreted echocardiography and other measurements within 15 hrs of anticoagulation. MEASUREMENTS AND MAIN RESULTS: End points were in-hospital circulatory shock or intubation, or death, recurrent pulmonary embolism, or severe cardiopulmonary disability (defined as echocardiographic evidence of severe right ventricular dysfunction with New York Heart Association class III dyspnea or 6-min walk test of <330 m) at 6-month follow-up. The two-one-sided test tested the hypothesis of equivalence with one-tailed alpha = 0.05 and Delta = 5%. Of 200 patients enrolled, data were complete for 181 (88%); 51 of 181 patients (28%) had an adverse outcome, including in-hospital complication (n = 18), death (n = 11), recurrent pulmonary embolism (n = 2), or cardiopulmonary disability (n = 20). Right ventricular dysfunction on initial echocardiogram was 61% sensitive (95% confidence interval, 46-74%) and 57% specific (48-66%). The panel was 71% sensitive (56-83%) and 62% specific (53-71%). The two-one-sided procedure demonstrated superiority of the panel to echocardiography for both sensitivity and noninferiority for specificity. No other biomarker demonstrated equivalence, noninferiority, or superiority for sensitivity and specificity. CONCLUSION: Normotensive patients with pulmonary embolism have a high rate of severe adverse outcomes during 6-month follow-up. A panel of three widely available tests can be used to risk stratify patients with pulmonary embolism when formal echocardiography is not available.     

室间隔完整的肺动脉闭锁的产前超声诊断

目的探讨室间隔完整的肺动脉闭锁的胎儿期超声诊断声像特征、检测技巧及其鉴别诊断,提高此类畸形的产前检出率。 方法对33200例胎儿均采取胎儿心脏四腔心切面加胎儿头侧偏转法获得四腔心切面及左右心室流出道及主、肺动脉长轴切面快速筛查胎儿心脏畸形,对疑有胎儿心脏畸形者则更行详细的胎儿彩色多普勒超声心脏检查。分析8例产前及产后诊断的室间隔完整的肺动脉闭锁的声像特征和病理特征。 结果产前共诊断室间隔完整的肺动脉闭锁8例,其主要声像特征是8例均有肺动脉内径细小,彩色多普勒于三血管气管平面显示7例动脉导管内血流反向,7例右室右房扩大,6例右室壁厚,7例中重度三尖瓣反流,1例三尖瓣下移畸形,1例三尖瓣狭窄并右室小。 结论肺动脉内径细小、不同程度的右房右室扩大、三尖瓣畸形、右室发育不良、动脉导管内血流反向是肺动脉闭锁的主要声像特征,三血管气管平面是产前超声诊断室间隔完整的肺动脉闭锁的关键切面,需注意与主动脉闭锁、永存动脉干进行鉴别。     

A case of arrhythmogenic right ventricular cardiomyopathy in sinus rhythm associated with thrombus in the right atrium.

We describe a patient with arrhythmogenic right ventricular cardiomyopathy (ARCV) in sinus rhythm associated with thrombus in the right atrium. The occurrence of a right heart thrombus in ARCV is extremely rare and, to our knowledge, has been previously reported only in the right ventricle. In our case, ARCV most probably led to right atrial spontaneous echo contrast, and later, right atrial thrombus formation by blood stasis caused by right ventricular systolic dysfunction. In conclusion, our case suggests that right atrial thrombus may occur in ARCV, even in sinus rhythm.     

成人动脉导管未闭的超声心动图特点及声学造影在诊断中的作用

目的：通过分析以重度肺动脉高压为主要表现的成人动脉导管未闭(PDA)的超声心动图特点，探讨超声心动图确诊此类PDA的有效方法。方法：12例伴重度肺动脉高压的PDA患者，分别采用Philips Sonos 5500及GE Vivid7型超声心动图仪进行检查，用维生素B6注射液5ml与碳酸氢钠注射液5ml等比混合进行静脉超声造影，根据降主动脉内有无造影剂出现判定有无PDA。结果：常规超声诊断此类PDA的难度很高和容易漏诊，而注射超声造影剂后所有患者降主动脉内均出现较多造影气泡，提示主动脉与肺动脉间存在交通。结论：以重度肺动脉高压为主要表现的成人PDA的超声心动图特点包括：(1)以右房室大为主要表现，左心大小多在正常范围；(2)肺动脉显著扩张，肺动脉收缩压多在100mmHg以上；(3)用超声造影观察降主动脉的方法有助于迅速确诊PDA。     

Transesophageal echocardiographic evaluation of left atrial mass lesions

Transesophageal echocardiography with color flow Doppler studies was performed on 12 consecutive patients who had left atrial mass identified by transthoracic echocardiography. In two patients with atrial myxoma, transesophageal study identified the tumor by its attachment to the atrial septum. In all instances, the tumors were larger and more mobile by transesophageal study and influenced the decision to operate early on an asymptomatic patient. In six instances the masses in the atria were deemed to be thrombi because of associated spontaneous echo contrast, location in the left atrial appendage, mitral valvular disease or prosthesis, atrial fibrillation, congestive heart failure, and enlarged left atrial chamber. In two patients the left atrial masses on transesophageal imaging were large vegetations attached to the mitral valve with ruptured chordae tendineae. In two patients, because of superior quality images obtained by transesophageal imaging, the atrial mass lesions were deemed to be a prominent muscle band between the left atrial appendage and left upper pulmonary vein. In conclusion, transesophageal echocardiography is superior to transthoracic imaging in elucidating the cause and significance of atrial mass lesions and helps in guiding appropriate therapy.     

The spectrum of left ventricular filling in severe aortic stenosis

To assess left ventricular diastolic filling in valvular aortic stenosis, pulsed Doppler echocardiography was used prospectively in 35 patients with severe aortic stenosis (valve area < 1 cm²) and in 38 age-matched normal subjects. Twenty-seven patients had a normal left ventricular systolic function at rest (ejection fraction > 0.50) and a normal or only slightly increased mean pulmonary capillary wedge pressure (mean 11±4 mm Hg). Eight patients had a poor left ventricular systolic function (ejection fraction: 0.28±0.10) and an elevated mean pulmonary capillary wedge pressure (mean: 36±9 mm Hg). The Doppler derived filling parameters were correlated with hemodynamic data, left ventricular wall thickness derived from M-mode echocardiograms, heart rate and atrio-ventricular (A-V) conduction delay using stepwise multiple correlation. The data of this study suggest that left ventricular filling is significantly impaired in patients with severe aortic stenosis and left ventricular hypertrophy with an increase in late diastolic (A-wave) velocity, an increase in the A/E ratio, a decrease in the first one-half filling fraction and a prolongation of early diastolic deceleration time. These changes in filling hemodynamics are associated with alterations in mean pulmonary capillary wedge pressure, left ventricular wall thickness, heart rate and A-V conduction delay. When heart failure develops as a result of impaired left ventricular systolic function, an increase in left atrial filling pressure is associated with a shift of left ventricular filling towards early diastole with a ‘normalisation’ of the transmitral flow velocity curve. In extreme cases, a progression towards a ‘restrictive’ filling pattern is found with a marked shortening of the left ventricular early diastolic deceleration time. In the presence of high filling pressures, increased left atrial driving pressure (derived from the mean pulmonary capillary wedge pressure) is associated with changes in the left ventricular filling pattern irrespective of the presence and the degree of myocardial hypertrophy.     

Doppler echocardiographic findings in patients with right ventricular infarction.

Doppler Echocardiographic Findings in Patients with Right Ventricular Infarction Transthoracic Doppler echocardiography was performed in 96 consecutive patients with right ventricular infarction treated with thrombolysis. The bedside examination was performed before and 2 to 3 hours after thrombolytic therapy, and a subsequent follow-up examination was scheduled for 7 days later. The in-hospital and long-term course was determined for all patients. Significant differences were found in echocardiographic findings after the thrombolytic therapy: the right ventricular diameter decreased from 28.8 mm+/-5.8 to 22.5 mm +/- 4.3 (P < 0.001), tricuspid regurgitant flow peak velocity was reduced from 2.9 m/s +/- 0.3 to 2.0 m/s +/- 0.5 (P < 0.001). The analysis of interatrial septal motion and interventricular septal motion showed a normalization in many patients. Major complications and deaths were more frequent in patients with echocardiographic findings of pulmonary hypertension persisting after thrombolytic therapy. Echocardiographic findings involving the right side of the heart are frequent in patients with right ventricular infarction. The presence of a severe tricuspid regurgitation and of an abnormal septal motion in patients with acute myocardial infarction indicates involvement of the right ventricle.     

Right heart function and haemodynamics in pulmonary hypertension

The primary challenge in the care of the patient with advanced pulmonary arterial hypertension (PAH) is right ventricular dysfunction with concomitant right heart failure. Right heart function is closely tied to survival in this disease, and there is a growing interest in the study of this unique structure. While echocardiography and cardiac magnetic resonance (CMR) have augmented our ability to image the right ventricle (RV), the primary means of assessing right heart function remains right heart catheterisation. Several of the currently available treatments for PAH have been shown to have effects on the RV, not just the pulmonary vasculature, and, in future, therapies aimed at optimizing right ventricular function may allow better outcomes in this challenging disease. New directions in right ventricular assessment including measurement of pulmonary vascular impedance and more widespread availability of CMR may allow greater knowledge about this little studied, yet highly important, right side of the heart.