组织多普勒评价重叠综合征患者右心功能的临床研究

目的通过组织多普勒(TDI)检查评价轻中度慢性阻塞性肺疾病(慢阻肺)合并重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)重叠综合征(OS)患者的右心功能变化。方法选取来我院呼吸内科就诊的轻中度慢阻肺缓解期患者120名,行多导睡眠监测(PSG),根据PSG监测结果选定单纯慢阻肺组、OS组及正常对照组各30名。对各组进行心脏多普勒及同步心电图检查,记录三尖瓣瓣环十字交叉处测三尖瓣环舒张早期峰值速度(Em)及舒张晚期峰值速度(Am);同时测量三尖瓣瓣环右心室游离壁处舒张早期峰值速度(Em’)及舒张晚期峰值速度(Am’),并计算心肌运动指数(Tei),Em/Am及Em’/Am’。结果正常对照组、单纯慢阻肺组及OS组三尖瓣环Em/Am比值1的比例分别为42.6%、76.3%、88.9%,与正常对照组比较,慢阻肺组及OS组三尖瓣环十字交叉处及右室游离壁侧Em/Am及Em’/Am’下降,且有统计学差异(P0.05),以OS组变化更为显著。慢阻肺组、OS组三尖瓣环十字交叉处、右室游离壁侧Tei指数均大于正常组且有统计学差异(P0.05),与单纯慢阻肺组比较,OS组Tei指数增高,有统计学差异(P0.05)。结论重叠综合征患者右心功能受累较单纯慢阻肺组更加明显,组织多普勒检测及Tei指数可作为临床评价指标。     

急性下壁心肌梗死患者右心室功能变化的探讨

目的 应用组织多普勒(TDI)结合M型超声技术评价急性下壁心肌梗死(心梗)患者右心室功能变化. 方法 急性下壁心梗患者50例,男34例、女16例;正常对照组50例,男30例,女20例.急性心梗第4～7天行超声心动图检查,采用M型超声记录三尖瓣环右心室游离壁处运动曲线,测量收缩期、舒张早期和舒张晚期运动幅度(SD、DED和DAD)及DED/DAD比值;并应用TDI技术,记录该处速度曲线,测量右室收缩期、舒张早期和晚期最大运动速度Sm、Em和Am及Em/Am比值. 结果 急性下壁心梗患者三尖瓣环右室游离壁处SD、DED运动幅度、DED/DAD比值均较对照组显著降低[分别为(18.7±5.5)mm和(24.9±2.8)mm、(10.9±3.4)mm和(16.6±3.4)mm、1.5±0.6和2.3±0.9,t值分别为18.711、19.055、6.068,均P＜0.01]Sm、Em和Em/Am明显下降[分别为(12.9±2.8)cm/s和(15.9±2.7)cm/s、(12.3±3.4)cm/s和(16.7±4.7)cm/s、0.9±0.4和1.1±0.3,t值分别为11.851、14.781、2.127,P＜0.01或P＜0.05]. 结论 急性下壁心梗损害右室舒缩功能,表现为既有运动幅度下降又有最大运动速度下降,舒张功能降低以舒张早期性能下降为主.     

超声心动图在老年女性继发肺动脉高压的类风湿关节炎患者右心室功能检测中的应用

目的探讨超声心动图在老年女性继发肺动脉高压(PAH)的类风湿关节炎(RA)患者右心室功能检测中的应用价值。方法回顾性分析RA老年女性患者超声心动图检查结果。其中,继发PAH 36例,无PAH 34例,测定两组患者的右室舒张末横径(RVDD)、右室游离壁舒张末厚度(RVDT)、三尖瓣环收缩期位移(TAPSE)、主肺动脉内径(MPA)、右室收缩末期面积(RVESA)和右室舒张末期面积(RVEDA),并计算右室面积变化率(RVFAC);测量三尖瓣舒张期血流峰值流速E/A比值;测量血流加速时间(AT)和肺动脉瓣收缩期血流最大频移(MFS),计算肺动脉僵硬度(PAS);通过三尖瓣反流峰值估测肺动脉收缩压(SPAP);采用组织多普勒成像技术(DTI)测量舒张早期、晚期峰值速度(Em、Am),并计算Em/Am,测量三尖瓣前叶瓣环处组织运动收缩期峰值速度(Sm)和右室肌射血时间(ET)、等容收缩(ICT)、舒张时间(IRT),计算右室Tei指数。结果 PAH组与无PAH组相比,RVDD和RVDT明显增大,TAPSE下降,RVFAC降低;MPA及PAS明显增大;三尖瓣舒张期血流峰值流速E/A比值下降;右室肌运动速度Em/Am、Sm降低,右室肌ET缩短,ICT+IRT延长,Tei指数增加(P<0.01)。结论患有RA的老年女性PAH患者,右心室功能显著下降,超声心动图对其具有良好的诊断价值。     

组织多普勒技术评估血栓抽吸治疗对急性下壁心肌梗死患者右室功能的影响

目的 探讨组织多普勒(TDI)技术评估血栓抽吸治疗对急性下壁心肌梗死(AIMI)患者右室功能的影响.方法 将46例AIMI患者随机分为两组,对照组27例行急诊经皮冠脉介入(PCI)治疗,观察组19例行PCI+血栓抽吸治疗.两组均于PCI后1周行超声心动图检查,在胸骨旁长轴用M型超声检测左室舒张末内径(LVEDD)、左房前后径(LAD)、右室舒张末内径(RVEDD)、左室射血分数(LVEF);在标准心尖四腔心切面转换为TDI频谱多普勒形式,检测三尖瓣环收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、心房收缩期峰值运动速度(Am)及Em/Am比值;并计算右室Tei指数.结果 与对照组比较,观察组三尖瓣环的Sm、Em、Am及Em/Am比值升高,右室Tei指数下降(P均＜0.05),LVEDD、LAD、RVEDD、LVEF均无明显变化(P均＞0.05).结论 TDI技术能检测到AIMI患者的右室功能变化,血栓抽吸治疗可改善其右室功能.     

超声心动图评价红斑狼疮患者右心功能损伤的可行性研究

目的探讨超声心动图评价系统性红斑狼疮（SLE）患者右心功能损伤的可行性和敏感性。方法将57例研究对象分为4组,即Ⅰ组（对照组）:超声心动图及查体均正常的体检者18例;Ⅱ组:左室收缩、舒张功能均正常的SLE患者18例;Ⅲ组:左室收缩功能正常、舒张功能减低的SLE患者13例;Ⅳ组:SLE并发肺动脉高压的患者8例。用脉冲多普勒采集三尖瓣口舒张期血流频谱,计算舒张早期和晚期速度的比值（TrE/A）;用组织多普勒采集三尖瓣环右室游离壁舒张早期峰值速度（Em）、舒张晚期峰值速度（Am）,并计算Em/Am值。根据公式（ICT+IRT）/ET计算右心Tei指数,并测量右室射血分数（RVEF）。结果Ⅰ、Ⅱ、Ⅲ、Ⅳ组的右心Tei指数依次增大,分别为0.25±0.062、0.29±0.087、0.41±0.15及0.53±0.21。Ⅳ组患者的各项心功能指标与其他组的差异均有显著性意义（P<0.05）。Ⅲ组患者的右心Tei指数、Em和Em/Ea的比值较Ⅰ组和Ⅱ组减低（P<0.05）,而Ⅲ组患者的RVEF和TrE/A的比值与Ⅱ组和对照组的差异未见显著性意义。结论右心Tei指数和三尖瓣环组织多普勒频谱能评估SLE患者右心功能的损害,较RVEF和TrE/A更为敏感。     

右室功能异常对左室功能和收缩同步性的影响

目的:通过无创性超声心动图评价右室功能异常对左室功能和收缩同步性的影响。方法:以三尖瓣环收缩期位移16mm为标准界定右室功能不全。连续收录肺源性肺动脉高压、结缔组织病性肺动脉高压和不明原因三尖瓣反流的患者54例,无左心室受累且左室射血分数(LVEF)正常,并经超声心动图检查证实右室功能不全(RVSD组,32例)或右室功能正常(NRVF组,22例);另选取年龄匹配的健康体检者26例为对照组。采集病史及基础临床资料并行详细的超声心动图检查。结果:1NRVF和RVSD组右室舒张末期内径(RVEDD)和室间隔厚度(IVSD)高于对照组,RVSD组更明显;RVSD组LVEDD、E峰、E/A比值低于对照组和NRVF组(均P0.05);2NRVF组和RVSD组的Tei指数均大于对照组,且以RVSD组更显著(均P0.05);3RVSD组中所有反应右室功能的指标均显著低于对照组和NRVF组(均P0.05);4NRVF组左室游离壁舒张早期峰值速度(Em)及舒张早期峰值速度/舒张晚期峰值速度(Em/Am),RVSD组室间隔的收缩期峰值速度(Sm)、Em、Am和左室游离壁的Sm、Em和Em/Am低于对照组,而E/Em高于对照组(均P0.05);5NRVF组和RVSD组中左、右室壁的达峰时间较对照组明显延长。两组左室游离壁-室间隔、左室游离壁-右室游离壁和右室游离壁-室间隔的达峰时间(TTP)差值明显延长。结论:右室收缩功能不全可能通过心室间的交互作用影响左室功能和收缩同步性,且以左室舒张功能异常的发生早于收缩功能异常为特点。     

定量组织速度成像在检测急性下壁合并右室心肌梗死中的应用价值

目的评价定量组织速度成像技术测定三尖瓣环的运动速度在检测下壁合并右室梗死中的应用价值.方法研究对象分为初次急性下壁合并右室心肌梗死组(Ⅰ组)18例、初次急性单纯下壁心肌梗死不合并右室心肌梗死组(Ⅱ组)20例和正常对照组(Ⅲ组)20例.在标准心尖四腔心切面二维图像指引下,用M型超声记录三尖瓣环右室游离壁处运动曲线,测量右室收缩期、舒张早期与晚期室壁运动幅度;应用定量组织速度成像(QTVI)技术,记录该处运动速度曲线,测量右室收缩期、舒张早期与晚期的运动峰速度.结果下壁合并右室心肌梗死组右室游离壁三尖瓣环处的收缩期位移(SD)、舒张期早期位移(DED)及收缩期峰速度(VS)、舒张早期峰速度(VE)、VE/VA(舒张晚期峰速度)均显著低于对照组,其中VS和VE也显著低于单纯下壁心肌梗死组;单纯下壁心肌梗死组的SD、DED及VS显著低于对照组;VA在三组间无显著差异.结论应用定量组织速度成像技术测量右室游离壁三尖瓣环运动速度可作为评价下壁心肌梗死是否合并右室心肌梗死的一项新指标,同时能测定右室收缩和舒张功能,有助于指导治疗和随访观察.     

老年慢性阻塞性肺疾病患者右心室功能的评价

目的探讨老年性慢性阻塞性肺疾病(COPD)缓解期患者右心室功能的改变。方法应用辛普森(Simp-son)法、彩色多普勒血流显像及组织多普勒速度显像,测定COPD组及对照组的右心室射血分数(RVEF);三尖瓣血流峰值速度E峰(E)、A峰(A)、E/A比值;三尖瓣环收缩期S波的峰速度(Sm),舒张早期负向E波的峰速度(Em),舒张期负向A波的峰速度(Am)及Em/Am比值;右心室Tei指数。结果COPD组及正常组之间的RVEF、E峰、A峰、E/A比值无统计学差异,Sm、Em、Am、Em/Am比值、右心室Tei指数有显著性差异(P<0.05)。结论COPD缓解期患者右心室功能下降;三尖瓣环Sm、Em、Am、Em/Am比值及右心室Tei指数能敏感地反映右心室功能的变化。     

001 三尖瓣环运动及其速度评价首次下壁心肌梗死病人的右室功能

由于形状复杂,超声心动图难以估测右室功能。心肌梗死后右室功能尚未被深入研究。作者采用脉冲波多普勒组织显象,研究了首次下壁心肌梗死病人的右室功能。 前瞻性入选38例首次下壁急性心肌梗死病人、33例首次前壁心肌梗死病人和24名匹配的健康对照者。下壁心肌梗死合并右室梗死的定义是：下壁心肌梗死加右心前导联V4R ST段抬高＞1mm。全部病人均无左束支传导阻滞和房颤。于心尖四腔切面,在二维超声的指导下,将取样标本置于右室游离壁侧,用M型超声心动图记录三尖瓣环收缩期运动。同时用脉冲波多普勒组织显象,记录三尖瓣环峰收缩和峰舒张早期及晚期速度。     

阻塞性睡眠呼吸暂停综合征患者左心室结构及功能变化研究

目的探讨阻塞性睡眠呼吸暂停综合征(Obstructivesleepapneahypopneasyndrome,OSAHS)对患者左心室结构和心功能造成的变化及影响。方法本次研究对象为我院收治的70例阻塞性睡眠呼吸暂停综合征患者,同时与我院45名健康志愿者进行彩色多普勒超声诊断仪检查,通过检查结果比较分析两组对象的左心室结构、左心室收缩功能、左心室舒张功能的变化情况。结果健康组的左心室结构各项指标数据显著低于病例组(P0.05);病例组LVEF(%)、EF(%)、FS(%)、室间隔Sm(cm/s)、二尖瓣环Sm(cm/s)和左室后壁Sm(cm/s)指标显著低于健康组,且差异具有统计学意义(P0.05);病例组患者E/A峰、室间隔Em(cm/s)、室间隔Em/Am、二尖瓣环Em(cm/s)、二尖瓣环Em/Am、左室后壁Em(cm/s)和左室后壁Em/Am指数显著低于健康组,室间隔Am(cm/s)和左室后壁Am(cm/s)则显著高于健康组,差异具有统计学意义(P0.05);病例组二尖瓣环则壁侧Sm指标显著低于健康组,差异具有统计学意义(P0.05),病例组二尖瓣环室间隔侧Sm、Em和Em/Am显著低于健康组,差异具有统计学意义(P0.05)。结论阻塞性睡眠呼吸暂停综合征患者的左心室结构明显发生变化,呈现了向心性肥厚,同时左心室的收缩和舒张功能受到影响。     

Colour tissue Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction

OBJECTIVE: This study was undertaken to determine right ventricular (RV) function as assessed by colour Doppler tissue imaging (DTI) in patients with RV infarction. METHODS: During the study period, 35 patients were evaluated: 14 patients had an inferior myocardial infarction (MI) with RV infarction and 21 patients had an inferior MI without RV involvement. Twenty age-matched healthy subjects served as controls. The diagnosis of RV infarction was defined by ST segment elevation >0.1 mV in lead V4R. Systolic and early and late diastolic velocities were acquired from the apical four-chamber view at the lateral tricuspid annulus, the septal side of the tricuspid annulus and the RV free mid-wall using colour DTI. RESULTS: Systolic and early diastolic velocities at the lateral tricuspid annulus were significantly reduced in patients with inferior MI with RV infarction compared with those in healthy individuals (7.8 +/- 1 vs. 11 +/- 2 cm/s, p < 0.002) and patients with inferior MI without RV infarction (7.8 +/- 1 vs. 10 +/- 1 cm/s, p < 0.002). The late diastolic lateral annular velocity did not differ between the groups. Systolic and early diastolic RV free wall velocities were also significantly decreased in patients with RV infarction compared with those in healthy individuals (7 +/- 1 vs. 8.7 +/- 1 cm/s, p < 0.01; 6.3 +/- 2 vs. 8.7 +/- 2 cm/s, p < 0.05, respectively) and patients with inferior MI without RV infarction (7 +/- 1 vs. 9 +/- 2 cm/s, p < 0.01; 6.3 +/- 2 vs. 8.3 +/- 2 cm/s, p < 0.05, respectively). CONCLUSION: The evaluation of tricuspid annular and RV free wall velocities using colour DTI provides a rapid and noninvasive tool for assessing RV function in patients with RV infarction.     

Assessment of Right Ventricular Diastolic Function by Tissue Doppler Imaging in Patients with Acute Right Ventricular Myocardial Infarction

Background: It is known that right ventricular systolic parameters as assessed by color tissue Doppler imaging (TDI) are abnormal in patients with inferior wall ST elevation myocardial infarction (IWMI) with right ventricular myocardial infarction (RVMI). This study was undertaken to determine right ventricular diastolic function as assessed by TDI in patients with acute RVMI. Methods: Thirty‐five patients with first IWMI were studied and compared with 20 age‐matched healthy controls, and categorized into those with (14 patients) and without (21 patients) RVMI based on standard ECG criteria. Peak systolic, peak early and late diastolic velocities (Sm, Em, and Am), Em/Am ratio along with time to Sm (ECG Q‐Sm) and time to Em (ECG Q‐Em) were acquired from the apical 4‐chamber view at the lateral side of tricuspid annulus using TDI. Results: Sm, Em, and Em/Am ratio was reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm [11.1 ± 2.9] vs. [14 ± 1.9] and [14.5 ± 2.1] cm/sec, P < 0.01; Em [9.2 ± 3.5] vs. [12.9 ± 3] and [14.0 ± 2.0] cm/sec, P < 0.01; Em/Am ratio 0.53 ± 0.2 vs. 0.78 ± 0.19 and 0.8 ± 0.3 [P < 0.0001]). Among the intervals, there was significant prolongation of Q‐Em (558 ± 14.8 vs. 507 ± 16.2 and 480 ± 20 ms [P < 0.0001]) but Q‐Sm and Am were not statistically different between the groups. Conclusion: Right ventricular TDI diastolic parameters are abnormal in patients with RVMI. The method of recording the velocities and time intervals are simple and can be used to assess right ventricular diastolic function in patients with RVMI. (Echocardiography 2010;27:539‐543)     

New parameters in identification of right ventricular myocardial infarction and proximal right coronary artery lesion

OBJECTIVE: The diagnosis of right ventricular myocardial infarction (RVMI) accompanied by acute inferior myocardial infarction (MI) is still a problem that we encounter. This study was designed to find out the usefulness both of peak myocardial systolic velocity (Sm) and of the myocardial performance index (MPI) of the right ventricle measured by pulsed-wave tissue Doppler imaging (TDI) in assessing right ventricular function. METHODS: Sixty patients who experienced a first acute inferior MI (mean [+/- SD] age, 57 +/- 9 years) were prospectively assessed. An ST-segment elevation of >or= 0.1 mV in V(4)-V(6)R lead derivations was defined as an RVMI. From the echocardiographic apical four-chamber view, the Sm, the peak early diastolic velocity, peak late diastolic velocity, the ejection time, the isovolumetric relaxation time, and the contraction time of the right ventricle were recorded at the level of the tricuspid annulus by using TDI. Then, the MPI was calculated. The patients were classified into the following three groups, according to the localization of the infarct-related artery (IRA) detected using coronary angiography: group I, proximal right coronary artery; group II, distal right coronary artery; and group III, circumflex coronary artery. RESULTS: RVMIs were detected in sixteen patients, and the IRA in 27 patients was the proximal right coronary artery. The right ventricular Sm was observed to be significantly low in patients with RVMIs and those in group I compared to those without RVMIs and those in groups II and III (10.9 +/- 1.3 vs 14.3 +/- 3.2 cm/s, respectively [p < 0.001]; 11.5 +/- 2.5 vs 15.1 +/- 3 cm/s, respectively; and 14.9 +/- 2.6 cm/s, respectively [p < 0.001]). In the diagnosis of RVMI, the values for sensitivity, specificity, negative predictive value, and positive predictive value of Sm < 12 cm/s were 81%, 82%, 92%, and 62% respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 63%, 88%, 74%, and 81%, respectively. The MPI was high in the same patient groups (0.83 +/- 0.12 vs 0.57 +/- 0.11 in those patients without RVMI, respectively, [p < 0.001]; 0.74 +/- 0.13 vs 0.56 +/- 0.15 in group II and 0.54 +/- 0.07 in group III, respectively [p < 0.001]). The sensitivity, specificity, negative predictive value, and positive predictive value of an MPI of > 0.70 in the diagnosis of RVMI were calculated as 94%, 80%, 97%, and 63%, respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 78%, 91%, 83%, and 88% respectively. CONCLUSIONS: An Sm <12 cm/s and an MPI > 0.70 obtained by TDI may define RVMI concomitant with acute inferior MI, and the IRA.     

单纯急性下壁心肌梗死及其合并右心室心肌梗死对右心长轴功能的影响

目的应用心肌组织多普勒技术结合M型超声心动图,评价单纯急性下壁心肌梗死及其合并右心室心肌梗死对右心室长轴功能的影响。方法选择首次急性下壁心肌梗死患者28例,分为单纯急性下壁心肌梗死18例(Ⅰ组),急性下壁心肌梗死伴右心室心肌梗死10例(Ⅱ组),另选健康体检者20例(Ⅲ组)。在标准心尖四腔心切面二维图像指引下,应用M型超声记录右心房室环右心室游离壁及中心纤维支架处运动曲线,测量收缩期、舒张早期、舒张晚期最大运动幅度(SD,DED,DAD)及收缩期、舒张早期、舒张晚期平均运动速度(SMV,DEMV,DAMV),计算DED/DAD比值。心肌组织多普勒记录该处运动速度曲线,测量上述各期最大运动速度(Sm、Em、Am)及Em/Am比值。结果与Ⅲ组比较,Ⅰ组和Ⅱ组右心房室环右心室游离壁处SD、DED、DED/DAD、SMV、DEMV、Sm及Em均明显下降。DAD、DAMV、Am虽有下降,但差异无统计学意义。结论急性下壁心肌梗死无论是否合并右心室心肌梗死均可影响右心室长轴功能,导致右心室整体功能降低。     

Pseudonormalized Doppler total ejection isovolume (Tei) index in patients with right ventricular acute myocardial infarction

The Doppler total ejection isovolume (Tei) index is useful for estimating global cardiac function. However, the relation between the right ventricular (RV) Tei index and RV infarction has not been investigated. The relation between the RV Tei index and severity of RV infarction was evaluated in 25 patients with inferior wall acute myocardial infarction (13 with and 12 without RV infarction). RV infarction was diagnosed when right atrial pressure was > or = 10 mm Hg or when right atrial pressure/pulmonary capillary wedge pressure was >0.8 by catheterization. The RV Tei index was significantly increased in patients with RV infarction compared with those without (0.53 +/- 0.15 vs 0.38 +/- 0.14, p <0.05). The RV Tei index in patients with severe RV infarction (right atrial pressure > or = 15 mm Hg) was significantly smaller compared with those with mild/moderate RV infarction (right atrial pressure <15 mm Hg) and showed no significant difference in patients with myocardial infarction but without RV infarction (0.44 +/- 0.09 vs 0.61 +/- 0.16 vs 0.38 +/- 0.14, severe RV infarction vs mild/moderate RV infarction vs no RV infarction, p <0.01). The RV Tei index is generally increased in patients with RV infarction; however, severe RV infarction can be manifested with limited or no increase in the Tei index (pseudonormalization).     

Right ventricular function following cardiac resynchronization therapy

The effect of cardiac resynchronization therapy (CRT) on right ventricular (RV) function has not been well described. The purpose of this study was to use tissue Doppler imaging to assess changes in RV function after CRT. Thirty-five patients with heart failure (age 65 +/- 10 years; 26 men) who underwent color tissue Doppler imaging of the right ventricle both immediately before CRT and >3 months (mean 6 +/- 3) after were studied. Myocardial systolic velocity was measured at the tricuspid annulus and basal and midventricular segments of the right ventricle free wall and averaged to obtain a measure of global RV function (RV S(m)). Left ventricular ejection fraction was also measured using biplane Simpson's method before and after CRT. RV S(m) significantly improved after CRT (5.4 +/- 1.9 to 7.1 +/- 2.6 cm/s; p <0.001), as did left ventricular ejection fraction (26 +/- 6% to 34 +/- 10%; p <0.001). Twenty-one of 35 patients (60%) showed an increase in RV S(m) > or =1 cm/s, with an increase > or =2 cm/s in 13 of those patients (37%). Improvement was seen in both ischemic and nonischemic patients and was independent of improvement in left ventricular ejection fraction and baseline left ventricular dyssynchrony. In conclusion, CRT resulted in improved RV function measured as RV S(m). CRT had beneficial effects on RV function independent of improvement in left ventricular ejection fraction.     

Right ventricular myocardial activation delay in adult patients with right bundle branch block late after repair of Tetralogy of Fallot.

Electromechanical interaction, with prolonged QRS duration due to right ventricular (RV) overload, has been described as a predictor of unfavorable outcome in patients late after correction of Tetralogy of Fallot (TOF). Aim of our study was to evaluate myocardial function and activation delay of both left and right ventricles in TOF patients. Doppler echo, treadmill test and pulsed Tissue Doppler (TD) were performed in 25 healthy subjects and in 30 adult patients who had undergone surgery for TOF, all with right bundle branch block on ECG. Exclusion criteria were evidence of residual pulmonary either stenosis or regurgitation. By use of TD, the level of both LV mitral and RV tricuspid annulus were measured: systolic (Sm), early- and late-diastolic (Em and Am) regional peak velocities. The indexes of myocardial systolic activation were calculated: precontraction time (PCTm) and interventricular activation delay (InterV-del) (difference of PCTm between RV and LV segments). The two groups were comparable for LV diameters and for Doppler indexes, while QRS duration was prolonged and RV end-diastolic diameter was increased in TOF. By TD analysis, only at the level of tricuspid annulus TOF patients had lower Sm and Em, and increased RV PCTm ( p<0.001 ) and InterV-del ( p<0.0001 ), even after adjustment for heart rate (HR) and QRS duration. By treadmill test, TOF showed reduced cardiac functional reserve. In seven patients non-sustained ventricular tachycardia was documented during physical effort. By multivariate analysis, RV Em ( p<0.001 ), and InterV-del ( p<0.01 ) were independently associated to maximal workload at peak effort. The same InterV-del was an independent determinant of risk of ventricular arrhythmias during effort ( p<0.01 ). A cut-off point of Em peak velocity of tricuspid annulus <0.13 m/s at rest showed a sensitivity of 91% and a specificity of 88% in identifying TOF patients with submaximal exercise test. A cut-off point of InterV-del >55 ms showed 87% sensitivity and 88% specificity to detect increased risk of ventricular arrhythmias during effort. In TOF patients, TD analysis at rest may be taken into account as a non-invasive and easy-repeatable tool to predict cardiac performance during physical effort, and to select subgroups of patients at increased risk of ventricular arrhythmias.     

Restrictive right ventricular physiology: its presence and symptomatic contribution in patients with pulmonary valvular stenosis.

OBJECTIVES: The aim of this study was to examine whether restrictive right ventricular (RV) physiology (the presence of antegrade pulmonary arterial flow in late diastole) occurred in patients with moderate to severe isolated pulmonary valvular stenosis (PVS) and to estimate its prevalence and relationship to RV function and patient symptoms. BACKGROUND: Little is published about RV diastolic performance in adult patients with PVS. METHODS: A total of 43 consecutive patients (age 44 +/- 10 years) with moderate to severe PVS referred to Royal Brompton Hospital from 2002 to 2005 were retrospectively studied. Patient New York Heart Association (NYHA) functional class was recorded. The RV (lateral tricuspid annulus motion) long-axis movement was measured by M-mode and pulsed-wave (PW) tissue Doppler imaging (TDI). Restrictive RV physiology was assessed by PW Doppler echocardiography. RESULTS: Eighteen patients (42%) had restrictive RV physiology. They were more symptomatic (NYHA functional class 1.8 +/- 0.5 vs. 1.3 +/- 0.5; p < 0.001) and had poorer RV long-axis function (TDI peak systolic velocity 7.3 +/- 2.1 cm/s vs. 9.7 +/- 2.7 cm/s; TDI early diastolic velocity 6.6 +/- 1.6 cm/s vs. 8.5 +/- 2.4 cm/s; RV long-axis systolic amplitude 1.3 +/- 0.2 cm vs. 1.5 +/- 0.3 cm; p < 0.01 for all) compared with other PVS patients despite similar RV ejection fraction, myocardial performance index, and RV systolic pressure. The presence of restrictive RV physiology (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.45 to 10.29; p = 0.01) and peak pulmonary valve pressure gradient (OR 1.07, 95% CI 1.01 to 1.13; p = 0.04) were the 2 independent echocardiographic predictors for decreased exercise tolerance in patients on multivariate analysis. CONCLUSIONS: Restrictive RV physiology is common in PVS patients. Its presence is related to a worse deterioration in RV long-axis function and decreased exercise tolerance in patients.     

Myocardial tissue Doppler-based indexes to distinguish right ventricular volume overload from right ventricular pressure overload

The objective of this study was to develop tissue Doppler parameters that could be used to differentiate right ventricular (RV) volume overload from RV pressure overload. The RV-pressure-overload group consisted of 40 patients with severe pulmonary hypertension, and the RV-volume-overload group consisted of 40 patients who had an atrial septal defect without evidence of right-to-left shunt, significant pulmonary hypertension, or Eisenmenger's complex. Another 40 healthy subjects were enrolled and served as a control group. Routine echocardiography and tissue Doppler imaging were performed. RV myocardial performance index was determined based on data collected during tissue Doppler imaging over the lateral tricuspid annulus. In patients with RV pressure overload, tissue Doppler parameters showed characteristically lower systolic velocity over the tricuspid annulus (RV myocardial systolic wave [Sm]) and longer isovolumic relaxation time (RV-IVRT). Nevertheless, in patients with RV volume overload, RV-Sm increased significantly, but early-diastolic velocity over tricuspid annulus was relatively low. In conclusion, RV-MPI, RV-Sm/early-diastolic velocity over tricuspid annulus, and RV-IVRT/RV-Sm were all useful to differentiate RV pressure overload from volume overload, although RV-IVRT/RV-Sm was the best parameter, with excellent sensitivity and specificity.