Comparison of echocardiographic and cardiac magnetic resonance imaging for assessing right ventricular function in adults with repaired tetralogy of fallot

Adults with repaired tetralogy of Fallot and significant chronic pulmonary regurgitation are at risk for progressive right ventricular (RV) dilatation and dysfunction. The assessment of RV function is important in the management in these patients. There is still a lack of an adequate geometric model to quantify RV function by echocardiography. The myocardial performance index (MPI) is a nonvolumetric method to quantify global ventricular function. In this study, the accuracy of MPI obtained by echocardiography to quantify RV function was assessed in 57 adults with repaired tetralogy of Fallot. The MPI measurement was compared with the RV ejection fraction (EF) derived by cardiac magnetic resonance imaging. There was a negative linear correlation between the MPI and the RVEF (r = 0.73, p <0.001). A MPI cutoff of > or =0.40 had a sensitivity of 81% and a specificity of 85% to diagnose a RVEF <35%. A MPI cutoff of <0.25 had a sensitivity of 70% and a specificity of 89% to identify patients with RVEFs > or =0.50. In a multivariate regression model, the MPI was not affected by the degree of pulmonary regurgitation, the presence of tricuspid regurgitation, or the QRS duration. In conclusion, the Doppler-derived MPI is a simple and reliable method for the evaluation of RV systolic function in adults with repaired tetralogy of Fallot.     

Comparison of Echocardiography with Technetium 99m-Gated Single Photon Emission Computed Tomography as Diagnostic Tools for Left Ventricular Ejection Fraction

Left ventricular ejection fractions (LVEF) are routinely measured and result in critical decision-making algorithms in cardiology. This study was conducted to compare the accepted standard two-dimensional (2-D) echocardiogram ejection fraction (EF(ECHO)) with single photon emission computed tomography rest ejection fraction (EF(SPECT)). Data were acquired and analyzed from 51 inpatients. EF(ECHO) was obtained using modified Simpson's rule in the four-chamber apical view, and gated EF(SPECT) was computed by an automated method (Siemens ICON software). Comparison between EF(ECHO) and EF(SPECT) was done by linear regression, Bland-Altman, and receiver operator characteristic (ROC) analyses. Linear regression analysis revealed EF(SPECT) = 1.12 x EF(ECHO) - 3.6%, r = 0.93, n = 51, P < 0.0001. Bland-Altman analysis showed that the limits of 95% confidence for the difference between EF(SPECT) and EF(ECHO) were - 12% to 18%. Ninety-eight percent of the datapoints were within the limits of confidence. The ROC analysis showed that the sensitivity and specificity for detecting abnormal EF (< or = 50%) were 85% and 86% with EF(SPECT), and 91% and 90% with EF(ECHO). This study showed good correlation as well as agreement between SPECT and two-dimensional echocardiograms in measuring EF.     

Systolic time ratio by impedance cardiography to distinguish preserved vs impaired left ventricular systolic function in heart failure

Left ventricular ejection fraction (EF) is used to assess patients with heart failure (HF); however, frequent measurements are not cost-effective. Impedance cardiography (ICG) is a low-cost, noninvasive test that measures systolic time intervals and may be a method for detecting impaired vs intact EF. This study evaluated the relationship between EF by echocardiography or gated nuclear ventriculography and systolic time ratio (STR) by ICG in outpatients with chronic HF. A retrospective chart review identified 52 patients with EF and STR measured within 2 weeks. There was an inverse correlation between STR and EF (r=-0.54; P<.001). The area under the receiver operating characteristic curve for STR to identify reduced EF was 0.86. An EF < or =50% and STR > or =0.50 demonstrated 93% sensitivity and 85% specificity. STR was able to distinguish intact (>50%) from impaired EF (< or =50%). STR by ICG has the potential to be a reliable method to monitor ventricular function in chronic HF.     

Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension: a comparison with 3D echo-derived right ventricular ejection fraction

While right ventricular (RV) function and size are important clinical markers in several cardiac conditions, the assessment of RV function by two-dimensional (2D) echocardiography remains challenging, due to the complexity of RV geometry. We therefore sought to compare an easily-measured parameter, peak systolic velocity of tricuspid annulus (TAPSV) obtained by tissue Doppler imaging (TDI), to right ventricular ejection fraction (RVEF) measured by real time three-dimensional echocardiography (RT3DE) and to explore what TAPSV cutoff values would be useful in detecting global RV dysfunction. We enrolled 20 patients affected by primary pulmonary hypertension and 30 consecutive healthy volunteers, who underwent transthoracic echocardiography, RT3DE and tissue Doppler evaluation. TAPSV had a statistically significant correlation with RVEF (r = 0.66, P < 0.001). With RV dysfunction defined as RVEF <40%, a TAPSV cutoff value of 9.5 cm/sec yielded the best compromise between sensitivity, specificity, and positive predictive value and negative predictive value. In conclusion, a TAPSV cutoff value of 9.5 cm/sec yields significantly high sensitivity and specificity and appears to be a valid compromise in detecting RV dysfunction, TAPSV values however are not useful in evaluating the severity of RV dysfunction.     

Prognostic Value of Computed Tomography Versus Echocardiography Derived Right to Left Ventricular Diameter Ratio in Acute Pulmonary Embolism

BackgroundComputed Tomography (CT) Pulmonary Angiography is the most commonly used diagnostic study for acute pulmonary embolism (PE). Echocardiogram (ECHO) is also used for risk stratification in acute PE, however the diagnostic performance of CT versus ECHO for risk stratification remains unclear.MethodsCT and ECHO right ventricle (RV) and left ventricle (LV) diameters were measured in a retrospective cohort of patients with acute PE. RV:LV diameter ratios were calculated and correlation between CT and ECHO RV:LV ratio was assessed. Sensitivity and specificity for the composite adverse events endpoint of mortality, respiratory failure requiring intubation, cardiac arrest, or shock requiring vasopressors within 30 days of admission were assessed for CT or ECHO derived RV:LV ratio alone and in combination with biomarkers (troponin or B-type natriuretic peptide).ResultsA total of 74 subjects met the inclusion criteria and had a mean age of 62±18 years. The proportion of patients with RV:LV >1 was similar when comparing CT (37.8%) versus ECHO (33.8%) (P = 0.61). A statistically significant correlation was found between CT derived and ECHO derived RV:LV diameter ratio (r = 0.832, P < 0.001). The sensitivity and specificity to predict 30-day composite adverse events for CT versus ECHO derived RV:LV diameter ratio >1 together with positive biomarker status was similar with sensitivity and specificity of 87% and 41% versus 87% and 42%, respectively.ConclusionsIn patients with acute PE, CT and ECHO RV:LV diameter ratio correlate well and identify similar proportion of PE patients at risk for early adverse events. These findings may streamline risk stratification of patients with acute PE.     

Sensitivity and specificity of left ventricular ejection fraction by echocardiographic automated border detection: Comparison with radionuclide ventriculography

Background: Echocardiographic automated border detection (ABD) provides on-line, beat-to-beat estimation of left ventricular (LV) ejection fraction (EF). Sensitivity and specificity of using ABD-EF for diagnosing LV dysfunction in routine clinical situations have not been previously studied. Hypothesis: Analysis of ABD-EF data based on receiver operating characteristic (ROC) should provide useful information about sensitivity and specificity for clinical diagnosis of LV function based on ABD-EF. Methods: The study group included 50 consecutive patients with EF measured by both ABD and radionuclide ventriculography (RVG). ABD-EF was recorded for 25 consecutive heart beats in the apical four-chamber view. Data were analyzed statistically by linear regression, Bland-Altman plot, and ROC. In ROC analysis, abnormal LV function was defined RVG-EF ≤ 40%. Results: ABD and RVG showed a moderate correlation in the EF measurements: slope=0.93, intercept=17%, r=0.79 (n = 50). Interbeat variability in ABD was diminished by averaging consecutive beats; standard error of estimate (SEE) decreased from 15.6% without averaging to 12.5% with 25-beat averaging. Bland-Altman analysis indicated that ABD-EF compared unfavorably with RVG-EF, with limits of agreement from -11% to 39%. ABD-EF showed a systematic overestimation (p<0.005), which was compensated by increasing the threshold for abnormal ABD-EF to 56%. With the optimized threshold, ABD-EF provided 89% sensitivity and 89% specificity (85% overall diagnostic accuracy) for diagnosing abnormal LV function. Conclusion: This study explored the limitations of on-line echocardiographic measurement of EF in a clinical setting and provided useful data for assessing interbeat variability, sensitivity, and specificit.     

Rest and exercise right and left ventricular function late after the mustard operation: Assessment by radionuclide ventriculography

To evaluate ventricular function late after atrial repair of transposition of the great arteries (TGA), 26 asymptomatic patients had rest and exercise radionuclide ventriculography performed a mean of 9 years (range 5 to 15) after undergoing the Mustard operation. The mean resting right (systemic) ventricular (RV) ejection fraction (EF) was 0.50 ± 0.10 (±1 standard deviation); the RVEF was <0.45 in 8 patients. With exercise the RVEF increased in 9 patients and either failed to increase or decreased in 15 (including all 8 patients with resting values <0.45). The weight-adjusted work load performed was a first predictor of RV exercise response (sensitivity 87%, specificity 92%); patients whose RVEF increased did more work.The mean resting left (pulmonary) ventricular (LV) EF was 0.58 ± 0.09; the LVEF was <0.50 in 3 patients. With exercise the LVEF increased in 14 patients and did not increase in 10 (including all 3 with resting values <0.50). The presence of complex ventricular arrhythmia documented on Holter monitoring was a first predictor of failure of the LVEF to increase with exercise (sensitivity 84%, specificity 71%).The patient's age, operative age, postoperative interval, residual arterial desaturation, preoperative large ventricular septal defect or pulmonary stenosis, postoperative pulmonary stenosis or superior vena caval obstruction, or performance of a second open-heart procedure was predictive of the rest or exercise EF of either ventricle.     

Estimation of global left ventricular function from the velocity of longitudinal shortening

AIMS: To determine if global ventricular function can be assessed from the long-axis contraction of the left ventricle, we compared pulsed-wave Doppler myocardial imaging of mitral annular motion to radionuclide ventriculography. METHODS AND RESULTS: We studied 51 patients (56 +/- 10 years, 11 women) with a radionuclide ejection fraction of 52 +/- 13% (15%-70%). Peak systolic velocities of medial and lateral mitral annular motion correlated with ejection fraction (0.55 and 0.54, respectively; P < 0.001), as did the time-velocity integrals (0.57 and 0.58, respectively; P < 0.001). Correlations were higher in normal ventricles (0.62-0.69) than in patients with previous myocardial infarction (0.39-0.64). Patients with anterior myocardial infarction had the lowest correlations (0.39-0.46). The best differentiation of normal (> or = 50%) from abnormal (< 50%) ejection fraction was provided by peak systolic velocity > or = 8 cm/sec for the medial (sensitivity 80%, specificity 89%) or lateral (sensitivity 80%, specificity 92%) mitral annulus. CONCLUSION: Global left ventricular function can be estimated by recording mitral annular velocity. The implementation of a cutoff limit of 8 cm/sec gave a simple guide for differentiating between normal and abnormal left ventricular systolic function that might be useful clinically in patients without regional wall-motion abnormalities. However, in patients with important segmental wall-motion abnormalities during systole, left ventricular longitudinal shortening is an imperfect surrogate for ejection fraction.     

Relation of brain natriuretic peptide to myocardial performance index in adults with congenital heart disease

Myocardial performance index (MPI) is an echocardiographic Doppler-derived measure of ventricular function previously validated in patients with congenital heart disease. It may be preferred over conventional noninvasive measures of ventricular function in patients with complex anatomy because it is dependent on neither geometric shape nor heart rate. Brain natriuretic peptide (BNP) is a predictor of systolic and diastolic dysfunction in anatomically correct hearts. The correlation of BNP to MPI in patients with congenital heart disease was determined. Fifty-four adults with congenital heart disease were evaluated. BNP was measured using standardized assays. Doppler echocardiography was performed within 6 months of BNP assay. There were no changes in clinical status during this interval. An experienced observer was blinded and evaluated all echocardiographic images, and MPI and ejection fraction (EF) were determined. Left ventricular (LV) or univentricular MPI was calculated in 34 patients and right ventricular (RV) MPI was calculated in 23 patients. Pearson's correlation coefficient test showed that BNP significantly correlated with LV/univentricular MPI (r = 0.461, p = 0.006) and RV MPI (r = 0.748, p <0.0001), whereas LV/univentricular EF and RVEF had no significant correlation with BNP (r = -0.189, p = 0.172; r = 0.066, p = 0.729, respectively). In patients with congenital heart disease, BNP correlated significantly with MPI, but not with LV, RV, or univentricular EF. This is particularly true in patients with geometrically variable right ventricles in which EF may be more difficult to assess. In conclusion, these findings emphasize the unique ability of both BNP and MPI to assess global ventricular function in geometrically complex hearts.     

Digoxin withdrawal in patients with dilated cardiomyopathy following normalization of ejection fraction with beta blockers.

BACKGROUND: The effect of withdrawal of digoxin on left ventricular function in patients with a history of idiopathic dilated cardiomyopathy (IDCM) following normalization of left ventricular ejection fraction (LVEF) with beta blockers remains unknown. HYPOTHESIS: This study was undertaken to determine the effect of digoxin withdrawal on left ventricular function in patients with IDCM. METHODS: In 8 consecutive patients with IDCM (5 men, 3 women) who had normalization of LVEF following beta-blocker treatment, digoxin was withdrawn as part of an office protocol. and LVEF was followed. Baseline EF prior to beta blocker initiation (carvedilol = 6, atenolol = 1, metoprolol 1) was measured with isotope ventriculography (IVG), echocardiography, or left ventriculography. Post beta blocker ejection fraction (post BB EF) was measured in all patients with IVG at a mean of 17.25 +/- 5.38 months. Follow-up EF was measured using IVG after digoxin withdrawal at a mean of 6.99 +/- 4.34 months. RESULTS: An experienced blinded reader interpreted the IVG scans. Baseline EF was 28.5 +/- 8.26; post BB EF and follow-up EF were 56.1 +/- 4.65 and 51.0 +/- 7.35, respectively (p = 0.05). CONCLUSION: These data provide potential evidence that digoxin withdrawal can result in a small but significant reduction in LVEF in patients with IDCM who had normalization of LVEF after treatment with beta blockers. Mean LVEF, however, remained within normal (> 50%) on beta-blocker therapy and without digitalis. Large, randomized controlled trials are needed to confirm these findings.     

Podemos Acreditar no Ecocardiograma de Rotina para Avaliar o Ventrículo Direito e a Insuficiência Pulmonar? Um Estudo Comparativo com Ressonância Magnética Cardíaca

BackgroundCardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI).ObjectivesTo assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings.MethodsWe compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant.ResultsWe included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI.ConclusionsThe 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.     

Assessment of left ventricular systolic function by velocity vector imaging

ObjectivesTo study the usefulness of a novel echocardiographic technique, velocity vector imaging (VVI) in the measurement of left ventricular ejection fraction (LVEF).BackgroundEjection fraction measured by echocardiography forms the cornerstone in the assessment of LV systolic function. Errors in measurement of EF by routine two-dimensional echocardiography (2D ECHO) limit its utility. The VVI is a new technology which uses speckle tracking and other algorithms to track the endocardial border. This may help in more accurate assessment of EF.MethodsGlobal and regional LVEF was measured in 49 patients using VVI, 2D ECHO and radionuclide-gated single photon emission computed tomography (SPECT). Results were categorised as normal, mild, moderate, or severe LV systolic dysfunction based on American Society of ECHO classification. The results were analysed by appropriate statistical tests for correlations.ResultsThe mean EF was 35 ± 12.08% by VVI, 54.2 ± 19.51% by SPECT (P< 0.001 vs VVI) and 50.3 ± 8.92% by 2D ECHO (P < 0.001 vs VVI). There was weak linear positive correlation between EF measured by VVI and the other modalities (Pearson's correlation coefficient 0.577 for SPECT and 0.573 for 2D; P=0.01). The VVI systematically underestimated the EF compared to SPECT. Greater number of patients had moderate or severe LV systolic dysfunction by VVI (37; 74.5%) than by SPECT (17; 34.7%; P=0.037). We derived a correction factor to calculate SPECT EF from VVI EF as follows: EF (SPECT) = EF (VVI) × 0.9 + 21 or approximately VVI (EF) + 20.ConclusionMeasurement of EF by VVI is feasible. The VVI underestimated the EF when compared to nuclear-gated SPECT in this study. The accuracy of this technology and the need for a correction factor needs to be assessed in future studies.     

Usefulness of tissue Doppler parameters for identifying pulmonary embolism in patients with signs of pulmonary hypertension

The objective of this study was to use tissue Doppler parameters to identify pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary hypertension. One hundred fifty patients with echocardiographic signs of pulmonary hypertension were enrolled, 50 of whom had PE on multidetector row computed tomography of the chest. Another 150 patients without cardiopulmonary distress or echocardiographic signs of pulmonary hypertension served as a control group. All patients were in sinus rhythm. Routine echocardiography and tissue Doppler imaging were performed. The right ventricular (RV) myocardial performance index (MPI) was obtained during tissue Doppler imaging over the lateral tricuspid annulus. The M index was measured and defined as the peak early diastolic mitral inflow velocity divided by the RV MPI. Statistical analysis was preformed using receiver-operating characteristic curves. Peak early diastolic mitral inflow velocity was significantly less and the RV MPI was significantly greater in patients with PE than in patients without PE (both p values < 0.0001). The RV MPI and the M index were useful in identifying PE in patients with echocardiographic signs of pulmonary hypertension. On statistical analysis, a RV MPI > 0.55 identified PE with a sensitivity of 85% and a specificity of 78%. A M index < 112 had a sensitivity of 92% and a specificity of 92%. In conclusion, the sensitivity and specificity of the RV MPI and the M index to identify PE were excellent. Echocardiography is a useful method to screen for PE.     

Usefulness of coronary angiography for assessing left ventricular systolic function

OBJECTIVE: In previous echocardiographic studies, a correlation between ejection fraction of the left ventricle and change in the movement of the mitral annular ring was found. In the light of these studies, we planned to investigate the relationship between systolic shortening (SS) and percent of systolic shortening (PSS), calculated from the long axis frame in coronary angiography and left ventricular systolic function. METHODS AND RESULTS: One hundred and thirty-eight patients (40 men and 98 women; mean age 58 +/- 10 years) who had been referred for coronary angiography and left ventriculography were included in the study. Ejection fraction (EF) was calculated from left ventriculography obtained from 30 degrees right anterior oblique projection. Distance from the lower border of the ostium of the left coronary artery to the most apical border of the left anterior descending (LAD) artery was measured at end-systole (ES) and end-diastole (ED) using coronary angiography obtained from the same projection. SS as ED-ES and PSS as SS/ED were calculated. Correlation of SS and PSS with EF was calculated (EF = 13.7 + 4.8 x SS, r = 0.91, p < 0.001 and EF = 14.2 + 6.5 x PSS, r = 0.90, p < 0.01). SS < 7 mm (criterion A) and PSS < 6% (criterion B) suggested that left ventricle EF was less than 50%, with a sensitivity, specificity and diagnostic accuracy of 83%, 100%, 95%; 95%, 86% and 88%, respectively. CONCLUSION: SS and PSS highly significantly correlate with left ventricular EF. Therefore, left ventriculography could be omitted in selected patients undergoing coronary angiography if it is not necessary to define the anatomic structure of the left ventricle.     

Cardiac transplantation: role of echocardiography in the diagnosis of rejection

Sixteen patients surviving orthotopic cardiac transplantation were studied by M-Mode and two dimensional echocardiography (ECHO) on the same day of cardiac biopsy during (n = 138) a mean follow-up of 6.2 +/- 4 months (range 1-4 months). The following parameters were measured: right ventricular end diastolic internal diameter (RVdD) left ventricular end diastolic internal diameter (LVdD), interventricular septum (IVS) and posterior wall (PW) diastolic thickness, myocardial mass (MM); LV cross sectional area (CSA) and ejection fraction (EF). LV and RV wall motion, pericardial effusion and myocardial echogenicity (brightness) were evaluated by inspection. Every ECHO was compared with the previous one for qualitative and quantitative changes. In the absence of rejection, analysis of the data during the first postoperative week showed the following results: mean EF = 51 +/- 6.8%, dilated overloaded RV (30.4 +/- 4.8 mm), various amount of pericardial effusion; FE increased significantly (55.3 +/- 4%; p less than 0.001) and RVdD decreased (26.6 +/- 5mm; p less than 0.001) after the 2nd week and remained stable thereafter, while pericardial effusion decreased or disappeared. The mean values of the remaining ECHO parameters did not very significantly during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)     

Feasibility of a New Image Processing (4D Auto LVQ) to Assessing Right Ventricular Function in Patients with Chronic Obstructive Pulmonary Disease

A new single-beat three-dimensional (3D) real time echocardiographic semi-automatic images processing (4D Auto LVQ) allows accurate assessment of left ventricular function, but whether it is suitable for the evaluation of right ventricular function remains unknown. To evaluate the feasibility of this procedure for assessing right ventricular volumes and function, right ventricular end-diastolic volumes (RVEDV), end-systolic volumes (RVESV) and ejection fraction (RVEF), stroke volumes (SV) and cardiac output (CO) were computed in 49 patients with chronic obstructive pulmonary disease (COPD) using 4D Auto LVQ. The myocardial performance index (MPI) was obtained by Doppler tissue imaging. The RV function parameters were compared with MPI by linear correlation analysis. A comparison of the performance of these RV function parameters in discrimination between MPI at a value of >0.45 or not was done. Compared with normal subjects, patients with COPD had significantly greater RVEDV, RVESV, MPI and significantly lower RVEF. Significant correlations were found between RVEF and MPI (r = –0.67, p < 0.001). The areas under the receiver operating characteristic curve for RVEF in discrimination between MPI at a value of >0.45 or not were 0.72, while they were 0.55 for SV and 0.57 for CO, respectively. The overall sensitivity, specificity and accuracy for RVEF analysis in predicting a >0.45 MPI in patients with COPD was 78.57%, 66.67% and 73.46%, respectively. These data suggest that 4D Auto LVQ is a feasible method for right ventricular volumes and function quantification in patients with COPD. Further studies are needed to improve the accuracy of the measurements.     

Comparison of echocardiography and radionuclide ventriculography in the follow-up of left ventricular systolic function in adult lymphoma patients during doxorubicin therapy

OBJECTIVES: To compare echocardiography (ECHO) and radionuclide ventriculography (RVG) in the monitoring of left ventricular systolic function during doxorubicin therapy in adult lymphoma patients. DESIGN: Prospective study. SETTINGS: University hospital. SUBJECTS: A total of 28 adult patients who received doxorubicin to a cumulative dose of 400-500 mg m(-2). MAIN OUTCOME MEASURES: ECHO and RVG were performed at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg m(-2). RESULTS: At baseline, the mean (+/-SE) left ventricular ejection fractions (LVEF) were 58 +/- 1.3, 71 +/- 1.8 and 58 +/- 1.7% as determined by RVG, M-mode ECHO and two-dimensional (2D) ECHO, respectively. After the cumulative doxorubicin dose of 500 mg m(-2) LVEF decreased to 49.6 +/- 1.7% (RVG) (P < 0.001), 62 +/- 1.6% (M-mode) (P=0.006) and 52.5 +/- 1.3% (2D ECHO) (P=0.036). Although a significant correlation between LVEF determined by RVG and M-mode ECHO (r=0.615, P=0.002) and a trend between RVG and 2D ECHO (r=0.364, P=0.096) were observed, there were substantial differences in the results of individual patients. In the agreement analysis using the method of Bland and Altman there was a mean difference of 12% units with the upper limit of agreement +26% units and the lower limit of agreement -2.1% units for LVEF determinations with M-mode ECHO and RVG, and a mean difference of 3.3% units with upper and lower limits of agreement +19.6 and -13.1% units for LVEF determinations with 2D ECHO and RVG, respectively. CONCLUSION: We found only a moderate agreement between left ventricular systolic function determined by ECHO and RVG methods. Thus, in the follow-up of left ventricular function in adult patients during doxorubicin therapy, the guidelines based on LVEF measurement by RVG cannot be applied to ECHO. Consequently, RVG remains the method of choice in this context.     

The influence of extreme mixed exertion load on the right ventricular dimensions and function in elite athletes: a tissue Doppler study

Aims: The athlete's heart is a widely discussed topic regarding the adaptation of the left ventricle (LV) to regular training. The data on the morphology and—even more—the function of the right ventricle (RV) are less well studied. The aim of the study was to assess the influence of prolonged exertion on morphology and function of the RV. Methods and Results: We examined 38 elite athletes, members of the Polish Olympic Team and a control group of 41 age and sex‐matched healthy volunteers. Specifically, we assessed the details of RV size and function including: RV enlargement, transtricuspid systolic gradient, and dilatation of main pulmonary artery (PA) as compared with the values derived from the control group. There was no significant difference in the function of the RV assessed using tissue Doppler echocardiography (TDE) between the athletes and controls (S’: 15.0 cm/sec vs. 14.0 cm/sec; E’: 15.8 cm/sec vs. 15.7 cm/sec; A’: 9.9 cm/sec vs. 10.4 cm/sec), but the athletes had a higher transtricuspid systolic gradient (23.6 mm Hg vs. 19.0 mm Hg, P = 0.004). There were no significant differences in TDE velocities in athletes with dilated RV or PA. However, those with elevated tricuspid regurgitation velocity had lower systolic velocities of the tricuspid annulus then the rest (S’: 12.3 cm/sec vs. 15.5 cm/sec, P = 0.01). Conclusions: RV enlargement in professional athletes is not connected with deterioration of diastolic or systolic RV function. Athletes with elevated pulmonary systolic pressure at rest, however, present with lower longitudinal systolic velocities of RV assessed using TDE. (Echocardiography 2011;28:753‐760)     

A delayed time of the peak tricuspid regurgitation signal: marker of right ventricular dysfunction

BACKGROUND:: Worsening degrees of tricuspid regurgitation (TR) have been associated with worse outcomes. We investigated the time it takes for the TR jet to attain its maximum peak (tmpTR) with measures of right ventricular (RV) function. METHODS:: Several echocardiographic variables of RV size and function and tmpTR corrected for heart rate were collected from 140 patients (mean age 57 +/- 20 years). RESULTS:: Mean RV end systolic (15 +/- 9 cm) and end diastolic (25 +/- 9 cm) areas, RV fractional area change (44 +/- 19%), maximal tricuspid annular motion (1.98 +/- 0.71 cm), pulmonary artery systolic pressure (57 +/- 33 mm Hg) and tmpTR (248 +/- 75 ms). A negative correlation was seen between tmpTR and RV fractional area change (r = -0.74; P < 0.0001) and between tmpTR and maximal tricuspid annular excursion (r = -0.69; P < 0.0001). On a multiple stepwise linear regression analysis tmpTR was better than pulmonary artery systolic pressure in predicting RV dysfunction (P < 0.001). Receiver operating characteristic curve analysis demonstrated that a tmpTR value >240 ms identified RV systolic dysfunction (sensitivity 79% and specificity 94%, areas under the curves 0.923, P = 0.0001). The longest tmpTR values were seen in patients with both RV systolic dysfunction and pulmonary hypertension (310 +/- 30 ms, P < 0.0001). CONCLUSION:: A delayed time to peak of the maximum TR jet correlates with RV dysfunction. Patients with normal RV function and no pulmonary hypertension had abnormal tmpTR values (243 +/- 57 ms) implying an underlying RV mechanical abnormality that requires further investigation.     

Evaluation of the degree of mitral stenosis : reassessment of the M mode echocardiographic index

Fifty consecutive patients (32 female and 18 male) with mitral stenosis aged 11 to 60 years underwent cardiac catheterisation and echocardiography to determine the value of M mode in assessing the degree of stenosis. Mitral stenosis was pure in 47 cases; isolated in 31 cases; associated with minimal aortic regurgitation in 11 cases, with mild mitral incompetence in 3 cases and with tricuspid incompetence in 5 cases (all patients underwent aortography and left ventriculography). Mitral valve surface area (MSA) calculated from the Gorlin formula correlated well with the anatomical mitral valve area (r = 0.88) in the 30 operated patients and enabled the patients to be divided into three subgroups : Group I : 36 patients with severe mitral stenosis; MS less than 1.3 cm2 including 29 with very severe stenosis : MS less than 1.0 cm2; Group II : 9 cases of moderate stenosis (1.3 cm2 less than MS less than or equal to 1.8 cm2), and Group III : 8 cases of mild mitral stenosis (MS greater than 1.8 cm2). The indices correlating with haemodynamic MSA were, in decreasing order of significance : EF slope of early diastolic closure of the anterior leaflet (r = 0.74); maximal EE' diastolic separation of the two leaflets (r = 0.57); the ratio of left atrium/aortic root dimensions (r = 0.39) and the Q-mitral closure interval (r = 0.31). The left atrial emptying index, the mitral valve closure index and changes in the rapid phase of left ventricular filling did not correlate with the degree of stenosis. An EF slope of less than 15 mm/sec had a sensitivity of 77% and a specificity of 93% and was a satisfactory method for distinguishing patients in Group I from those in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)