Left ventricular function and exercise capacity in patients with slow coronary flow

Background: Endothelial and microvascular dysfunction have been implicated in slow coronary flow (SCF). How and to what extent do these etiological factors affect left ventricular (LV) function and exercise capacity? Aim: The aim of the study was to evaluate LV systolic and diastolic function by pulsed tissue Doppler imaging (TDI) in SCF patients and their effects on exercise capacity. Subjects and methods: Sixty SCF patients and 20 control subjects were included in the study. Echocardiographic examination, treadmill exercise test, and TDI were performed. Isovolumic myocardial acceleration (IVA) and myocardial performance index (MPI) were measured. Results: TDI mean parameters for systolic and diastolic LV function were significantly impaired in SCF group with decreased Sa, IVA, Ea/Aa, and increased MPI (0.31 ± 0.06 vs. 0.26 ± 0.04, P < 0.01) compared to control. There was significant correlation between thrombolysis in myocardial infarction (TIMI) frame count and TDI mean parameters for LV systolic function (Sa & IVA, r =?0.53, P < 0.01 & r =?0.36, P < 0.05, respectively). Mean TIMI frame count was correlated with MPI and E/Ea. SCF patients had poorer peak exercise capacity than the controls (9.9 ± 1.9 METs vs. 12.7 ± 2.3, P < 0.01) with significant negative correlation with mean TIMI frame count (r =?0.46, P < 0.01). Conclusion: There is impairment of LV systolic and diastolic function in SCF patients with clinical impact on exercise capacity which emphasizes the importance of close follow‐up of these patients for risk stratification. (Echocardiography 2012;29:158‐164)     

Assessment of Left Ventricular Function and Tei Index by Tissue Doppler Imaging in Patients with Slow Coronary Flow

Background: The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of thrombolysis in myocardial infarction (TIMI) frame count (TFC) with the Tei index and LV function in patients with slow coronary flow (SCF). Methods: We prospectively evaluated 50 patients with SCF and 27 control subjects. Diagnosis of SCF was made by TFC. LV systolic and diastolic function was assessed by conventional echocardiography and TDI. Results: Early diastolic mitral annular velocity (Em), Em/Am, and peak systolic mitral annular velocity (Sm) were lower in patients with SCF than those in controls (13±2.8 cm/sec vs 15.2±2.8 cm/sec, P = 0.002; 0.88±0.22 vs 1±0.23, P = 0.03; and 14.1±3.51 vs 16.5±3.31, P = 0.005, respectively). In patients with SCF, the Tei index was significantly higher than that in controls (0.34±9.6 vs 0.29±9.5, P = 0.02, respectively). Mean TFC and RCA TFC were positively correlated with the Tei index (r = 0.3, P = 0.02 and r = 0.329, P = 0.02). Left circumflex (LCX) TFC was negatively correlated with Em/Am (r =–0.310, P = 0.03) only in patients with SCF. Conclusion: LV systolic and diastolic function is impaired in patients with SCF. TDI analysis of mitral annular velocities such as the Tei index, Em, Em/Am, and Sm is useful to assess LV systolic and diastolic dysfunction in patients with SCF. Mean TFC and RCA TFC were positively correlated with the Tei index and LCX TFC was negatively correlated with Em/Am. TDI may be better than conventional echocardiography in assessing LV function in patients with SCF. (ECHOCARDIOGRAPHY, Volume 26, November 2009)     

Ventricular Function in Patients with End‐Stage Renal Disease Starting Dialysis Therapy: A Tissue Doppler Imaging Study

Background: Heart failure is prevalent in end‐stage renal disease (ESRD) patients on long‐term dialysis. Detection of right ventricular (RV) dysfunction before starting dialysis may help to identify patients at a higher risk of developing heart failure. Aim: To assess RV function in predialysis patients using tissue Doppler imaging (TDI) derived myocardial performance index of RV (MPI‐RV). Methods: Echocardiography including pulsed TDI of lateral tricuspid annulus was performed in 41 patients with ESRD before starting dialysis therapy and 12 age and gender matched healthy controls. RV dysfunction was defined as MPI > 0.4; a value above the median MPI in controls. Results: Compared to controls, ESRD patients had significantly higher blood pressure and lower hemoglobin level. MPI‐RV was significantly impaired in ESRD patients compared to control (0.6 vs. 0.4, P < 0.001). RV dysfunction was identified in 23 ESRD patients (56%). ESRD patients had significantly lower e’ velocity and e’/a’ ratio as compared with controls. Pulmonary hypertension was detected in 15 (36.5%) patients. Among ESRD patients, no correlation was detected between MPI‐RV and calculated mean pulmonary artery pressure (r =–0.13, P = 0.47), pulmonary artery systolic pressure (r =–0.12, P = 0.6), left ventricular ejection fraction (r = 0.294, P = 0.06), or MPI of left ventricle (r = 0.3, P = 0.065). ESRD patients with and without pulmonary hypertension had similar MPI‐RV (0.6 vs.0.62, P = 0.32). Conclusion: Subclinical RV dysfunction—as estimated by TDI derived MPI—is highly prevalent among ESRD patients even before starting dialysis therapy. Pulmonary hypertension is not significantly associated with RV dysfunction in these patients.     

The mechanics of left ventricular dysfunction in patients with Churg-Strauss syndrome

Background: Heart is frequently involved in Churg‐Strauss syndrome (CSS). However, the mechanics of left ventricular (LV) dysfunction in CSS has not been studied. Objective: To assess the mechanics of LV function and to characterize the contribution of longitudinal, circumferential and rotational deformation to LV dysfunction in CSS. Methods: We enrolled 22 CSS patients (eight males, mean age 43.2 ± 9.5 years) in remission of their disease and 22 sex‐ and age‐matched healthy subjects. All patients underwent conventional and two‐dimensional speckle‐tracking echocardiography. Global longitudinal, circumferential and rotational deformation parameters were calculated. Results: CSS subjects demonstrated lower LV ejection fraction (EF) than controls (56.6 ± 15.0% vs 63.8 ± 3.4%; P < 0.05). When compared to those with LVEF ≥ 50% (n = 14), CSS patients with LVEF < 50% (n = 7) had decreased global peak‐systolic longitudinal and circumferential strain/strain rate (all P < 0.001) and tended to have lower global peak‐systolic radial strain (P = 0.05). There were no differences between these two subgroups in global peak‐systolic radial strain rate and LV twist/torsion. When comparing individual systolic and diastolic parameters early diastolic longitudinal and circumferential strain rate demonstrated the highest correlation with corresponding global longitudinal and circumferential peak‐systolic strain/strain rate (r < ?0.80, P < 0.001 for all correlations). Conclusions: In CSS LV systolic dysfunction strongly correlates with longitudinal and circumferential, but not radial or rotational systolic components, indicating that impaired LV systolic function may result predominantly from impaired contraction of inner and middle, but not outer myocardial fiber layers. The spatial correspondence between systolic and diastolic deformation parameters suggests the similar impact of pathologic process on systolic and diastolic function in CSS. (Echocardiography 2012;29:568‐578)     

Chronic pulmonary hypertension causes significant interventricular spatiotemporal dyssynchrony when onset of diastolic flow signals are assessed by color m-mode

Background: Color M‐mode (CMM) has been useful in characterizing left ventricular (LV) relaxation as well as providing information regarding right ventricular (RV) filling dynamics and pressure gradients. The spatiotemporal resolution of CMM offers a unique opportunity to study the effect of chronic pulmonary hypertension (cPH) on biventricular diastolic function. Methods: Propagation velocities of LV and RV diastolic flows were obtained from 20 individuals with normal pulmonary artery systolic pressures, designated Group I (mean age 50 ± 12 years and 32 ± 6 mmHg) and from 30 patients with cPH, designated Group II (mean age 55 ± 14 years and 81 ± 25 mmHg). Results: Group II patients not only had a significant difference between RV and LV onset of early (13 ± 55 vs. ?223 ± 333 msec; P < 0.003) and late (?494 ± 467 vs. ?125 ± 258 msec; P < 0.001) diastolic flows; but also had lower propagation velocities of the main RV (40 ± 10 vs. 28 ± 10 cm/sec; P < 0.0001) and LV (52 ± 11 vs. 37 ± 15 cm/sec; P < 0.0003) diastolic flows than Group I individuals. Conclusions: It appears that cPH disrupts not only RV and LV diastolic signal distribution but also their temporal occurrence as well as reducing the propagation velocities of the main diastolic signals in both ventricles. These results seem to imply that cPH causes significant interventricular diastolic dyssynchrony and further studies are now needed to correlate these findings with regard to symptoms and patient clinical outcomes. (Echocardiography 2012;29:653–660)     

Right Ventricular Adaptations Along with Left Ventricular Remodeling in Older Athletes

Background: Afterload changes and anatomic interaction between the ventricles cause right ventricle (RV) adaptation along with left ventricle (LV) remodeling. This study was designed to evaluate RV adaptations along with LV remodeling and to determine the effect of aging on both ventricles in a population of older athletes. Methods: Echocardiographic characteristics of 48 endurance trained older athletes were examined by tissue Doppler imaging (TDI) and integrated backscatter (IBS). Results: Mean LV mass index was calculated as 107.8 ± 17.0 g/m² . Twenty-two athletes were > 55 years old. Age was found to be a risk factor for diastolic dysfunction regarding lateral TDI velocities (E_m < A_m) (r = 0.385, P < 0.001). RV long-axis (LAX) diameters were associated with LA volumes and LV masses (r = 0.380, P < 0.01 and r = 0.307, P < 0.05). RV LAX diameters were correlated with RV TDI E-wave (r =−0.285, P < 0.05), RV LAX average, and peak IBS values (r = 0.36, P < 0.05 and r = 0.348, P < 0.05). Conclusions: TDI and IBS are applicable methods to evaluate the relationship between the two ventricles in athletes' heart. Increased RV LAX IBS values indicate increased LV mass and LA volume as a result of RV changes along with LV remodeling. Our data suggest that RV TDI E-wave and average RV IBS values reflect cardiac adaptations of both RV and LV in older athletes.     

Echocardiographic Evaluation of Right Ventricular Function in Patients with Acute Pulmonary Embolism: A Study Using Tricuspid Annular Motion

Assessment of right ventricular (RV) function is a challenge due to complex anatomy. We studied systolic and diastolic tricuspid annular excursion and longitudinal RV fractional shortening as geometry‐independent measures in patients with acute pulmonary embolism (PE). Forty patients with PE were studied within 24 hours after admission and after 3 months, and compared to 23 healthy subjects used as controls. We recorded tricuspid annular plane systolic (TAPSE) and diastolic (TAPDE) excursion from the four‐chamber view and calculated RV fractional shortening as TAPSE/RV diastolic length. The diastolic RV function was defined as the ratio of the amplitude of tricuspid annular plane excursion during atrial systole to total tricuspid annular plane diastolic excursion (atrial/total TAPDE). In the acute stage, the TAPSE was decreased in PE compared to healthy subjects (19 ± 5 vs. 26 ± 4 mm, P < 0.001), with greater reduction in patients with increased, compared to normal, RV pressure (16.6 ± 5 vs. 20.5 ± 5 mm, P < 0.05). The atrial/total TAPDE was increased in patients compared to healthy subjects (47 ± 13% vs. 38 ± 7%, P < 0.001) and normalized during the follow‐up. Although the patients were asymptomatic after 3 months, the TAPSE recovered incompletely as compared to healthy subjects (21.4 ± 4 vs. 26 ± 4 mm, P < 0.001). Both systolic and diastolic RV function are impaired in acute PE. Diastolic function recovers faster than systolic; therefore, the atrial contribution to RV filling may be a useful measure to follow changes in diastolic function in PE. (Echocardiography 2010;27:286‐293)     

Evaluation of Left Ventricular Circumferential Contraction Functions in Obese Patients

Background: We aim to evaluate left ventricular (LV) function abnormalities, especially circumferential contraction functions, in obese patients. Method: Cases without coronary artery disease (CAD) were divided into two groups according to their body mass indexes (BMI). Results: Female predominance (P = 0.002), systolic blood pressure (BP) (P = 0.001), diastolic BP (P = 0.001), waist circumference (P < 0.001), left atrium (P < 0.001), LV end‐diastolic diameter (P = 0.046), LV mass index (P = 0.001), and LV stroke volume (P = 0.016) were prominent in obese patients (BMI ≥ 27). In obese patients, transmitral late velocity (P = 0.005) was prominent, and pulmonary vein antegrade diastolic velocity (PV‐D) (P = 0.002) and mitral annular early diastolic pulsed‐wave tissue Doppler imaging (pw‐TDI) velocity (annular Ea) (P = 0.032) were lower. Transmitral late velocity was positively correlate with stroke volume (P = 0.029) and systolic BP (P < 0.001). Negatively correlation between PV‐D and diastolic BP (P = 0.046) was found. And also, annular Ea velocity was negatively correlate with systolic BP (P = 0.017) and diastolic BP (P = 0.031). These findings may reflect LV longitudinal contraction abnormalities (LVLCA) and underlying mechanism that is responsible for LVLCA, may be volume and afterload alterations. However, LV circumferential contraction functions that evaluate by using pw‐TDI, were not different among the groups. Conclusion: In obese patients without CAD, it was clearly said that while LVLCA were evident, LV circumferential contraction abnormalities were not. This differentiation may be explained by subepicardial myocardial fiber that is responsible for LV circumferential contractions is supplied by coronary arteries, subendocardial myocardial fiber that is responsible for LV longitudinal contractions, is supplied by systemic circulation via LV cavity penetration. (ECHOCARDIOGRAPHY 2010;27:378‐383)     

Preoperative Right Ventricular Function in Patients with Organic Mitral Regurgitation

Aims: To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. Methods: RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 ± 10 years). Mean NYHA class was 2.6 ± 0.4, LVEF was 55.3 ± 12%, RV end‐diastolic diameter was 28.7 ± 4.7, left ventricular end‐systolic diameter (LVESD) was 44.6 ± 12.6 mm, and LV end‐diastolic volume (Simpson) was 160.6 ± 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. Results: Mean preoperative TAPSE and Sa were 19.4 ± 4.3 mm and 10.3 ± 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end‐diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 ± 2 cm/sec (P < 0.001), and TAPSE 8.7 ± 3.2mm (P < 0.001). Twenty‐one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end‐diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. Conclusion: The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR. (Echocardiography 2010;27:282‐285)     

Myocardial fibrosis is associated with biventricular dysfunction in patients with hypertrophic cardiomyopathy

Aims: To assess left (LV) and right ventricular (RV) function by two‐dimensional (2D) speckle tracking echocardiography and its relation to myocardial fibrosis in hypertrophic cardiomyopathy (HCM). Methods: We enrolled 50 HCM patients (30 male; 47.3 ± 9.9 years) in our study. Each patient received echocardiography with modern high‐end scanners. For speckle tracking analysis of LV and RV function the dedicated software was used. The presence of myocardial fibrosis was detected by cardiac magnetic resonance imaging (MRI). Results: For intraobserver variability of RV global longitudinal strain, we found a correlation of r = 0.89 (p < 0.001) with a minor bias of 4.9 ± 2.9%. On cardiac MRI 30 patients (60%) demonstrated late gadolinium‐enhancement (LGE) of the LV. Of these patients only 7% showed LGE of the RV. HCM patients with myocardial fibrosis had less global longitudinal LV strain in comparison to patients without myocardial fibrosis (?12.8 ± 2.2 vs ?21.1 ± 2.6, P < 0.001), thicker interventricular septums (23.7 ± 4.0 vs 19.2 ± 5.1, P < 0.001), larger left atria (34.9 ± 7.1 vs 23.9 ± 5.1, P < 0.001), and impaired diastolic function (E/A‐ratio: 1.02 ± 0.22 vs 1.15 ± 0.18, P < 0.01). Comparable results were found for RV function. LV and RV strain correlated with r = 0.85 (p < 0.001). Conclusions: HCM is not only a disease of the LV. LGE in HCM is associated with both LV and RV dysfunction. Although RV LGE occurs only in a minority of patients with HCM and LV fibrosis, speckle tracking echocardiography is feasible for evaluating LV and RV dysfunction in these patients. (Echocardiography 2012;29:438‐444)     

Doppler echocardiographic evaluation of ventricular function in patients with rheumatoid arthritis

 Cardiac involvement in rheumatoid arthritis (RA) has been reported previously. However, evaluation of ventricular function in this disease by the use of recently proposed Doppler echocardiographic methods has not been reported before. Thus, the aim of this study was to evaluate ventricular function by measurement of myocardial performance index (MPI) and transmitral flow propagation velocity (TFPV). Thirty-two patients with long-standing RA and 32 control subjects (mean ages 52 ± 11 and 50 ± 10 years, respectively) participated in this study. Systolic function was assessed by subjective evaluation of wall motion for both ventricles and by fractional shortening for the left ventricle (LV). LV diastolic function was evaluated by standard pulsed-wave Doppler echocardiography, MPI and TFPV. Right ventricular (RV) function was evaluated by MPI. No subject had signs or symptoms of clinically overt heart failure. Systolic function was normal in all subjects. Among the echocardiographic indices of LV diastolic function the peak E velocity, E velocity/A velocity ratio, isovolumetric relaxation time, MPI and TFPV in the RA group were significantly different from those of the controls (P < 0.05). However, we did not observe a significant difference in RV echocardiographic indices between the two groups. Our results show that there is LV diastolic dysfunction in patients with long-standing RA. The lack of a history of cardiotoxic antirheumatic drug use among our patients suggests that this abnormality is due to RA itself. Received: 11 March 2002 / Accepted: 2 October 2002     

Feasibility of three-dimensional transthoracic echocardiography to evaluate right ventricular volumes in children and comparison to left ventricular values

Background: Three‐dimensional echocardiography (3DE) allows accurate estimation of left ventricular (LV) volumes and function in children. Because of the peculiar morphology of the right ventricle (RV), RV volumes and function assessment remain challenging. 3D software adapted for RV morphology is a promising noninvasive method. Aims: The aims of this study were to evaluate the feasibility of 3D RV analysis in a normal pediatric population and to compare 3D RV to 3D LV measurements. Patients and methods: 3D transthoracic echocardiography was performed in 50 patients (mean age 9.5 years ± 5.1) with normal cardiac anatomy and function. Measurements were performed with the X3‐1 or the X7‐2 matrix probe (iE33, Philips Medical Systems, Andover, MA, USA). Ventricular volumes were analyzed with dedicated analysis software (TomTec Imaging Systems, Munich, Germany). Results: Measurements were possible in 100% of LVs and 94% of RVs. The stroke volumes of the two ventricles correlated well (r = 0.81 [95% CI, 0.68–0.89], P < 0.0001) with a mean difference of 3.6 mL (±9.2). Compared to the LV, the RV had higher mean end‐diastolic volume (53 mL [±29] versus 46 mL [±46], P = 0.020) and end‐systolic volume (29 mL [±17] versus 17 mL [±12], P < 0.0001) but lower mean ejection fraction (49%[±8] versus 67%[±10], P < 0.0001). Conclusion: 3DE using dedicated software is a feasible and reproducible method for RV volume quantification in children with normal hearts. Further studies are needed to validate the accuracy of the measurements. (Echocardiography 2012;29:492‐501)     

Myocardial performance index for detection of subclinical abnormalities in patients with sarcoidosis

Aim

The aim of this study was to evaluate ventricular functions in patients with sarcoidosis without an obvious heart disease by using tissue Doppler-derived left and right ventricular myocardial performance index (MPI).

Methods

The study population included 45 patient with sarcoidosis (29 men, 16 women; mean age, 44±10 years, mean disease duration, 4.2±2.7 years) and 45 healthy control subjects (31 men, 14 women; mean age, 41±8 years). Cardiac functions were determined using echocardiography, consisting of standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Myocardial tissue Doppler velocities [peak systolic (Sa), early diastolic (Ea), and late diastolic velocities (Aa)] were recorded using spectral pulsed Doppler from the LV free wall, septum, and RV free wall from the apical four chamber view. MPI was also calculated by TDI.

Results

The conventional echocardiographic parameters and tissue Doppler measurements were similar between the patients and controls. Left ventricular MPI (0.490±0.092 vs. 0.396±0.088, P=0.010) and right ventricular MPI (0.482±0.132 vs. 0.368±0.090, P=0.006) were significantly higher in patients with sarcoidosis than the control subjects. There was a correlation between the disease duration and right and left ventricular MPI (r=0.418, P=0.005; r=0.366, P=0.013, respectively). There was also a correlation between the systolic pulmonary arterial pressure and right ventricular MPI but not left ventricular MPI (r=0.370, P=0.012; r=0.248, P=0.109, respectively). In receiver operating characteristics curve analysis, the cutoff value of left ventricular MPI >0.46 had 92% sensitivity and 64% specificity in predicting left ventricular diastolic dysfunction.

Conclusions

We have demonstrated that tissue Doppler-derived myocardial left and right ventricular MPI were impaired in sarcoidosis patients, although systolic function parameters were comparable in the patients and controls, showed a subclinic impaired ventricular functions in patients with sarcoidosis.     

New Annular Tissue Doppler Markers of Pulmonary Hypertension

Background: Tissue Doppler imaging (TDI) of mitral (MA) and tricuspid annulus (TA) events characterizes systolic and diastolic properties of each respective ventricle. However, the effect of chronic pulmonary hypertension (cPH) on these TDI annular events has not been well described. Methods: Measurements of right ventricular (RV) performance with TDI of the lateral mitral and tricuspid annuli, to measure isovolumic contraction (IVC) and systolic (S) signals were recorded from 50 individuals without PH and from 50 patients with cPH. To avoid confounding variables, all patients had normal left ventricular ejection fraction and were in normal sinus rhythm at the time of the examination. Results: As expected, markers of RV systolic performance were markedly reduced while LV systolic function remained largely unaffected in cPH patients when compared to patients without PH. TDI interrogation of the MA revealed lengthening of the time interval between IVC and systolic signal (70 ± 17 msec) when compared to individuals without PH (43 ± 8 msec; P < 0.0001). In contrast, cPH markedly shortened the time interval between IVC and the TA systolic signal (34 ± 12 msec) when compared to individuals without PH (65 ± 17 msec; P < 0.0001). Conclusions: cPH lengthens time interval between the IVC and the MA systolic signal while shortening this same interval when the TA is interrogated with TDI; reflecting the potential influence that cPH exerts in biventricular performance. Whether measuring these intervals be routinely used in the follow‐up of cPH patients will require further study. (Echocardiography 2010;27:969‐976)     

Impact of bronchiectasis on right and left ventricular functions

Diffuse systemic-pulmonary anastomoses and chronic hypoxemia may result in increase in ventricular work in bronchiectasis. We aimed to assess right ventricular (RV) and left ventricular (LV) functions in patients with bronchiectasis by using tissue Doppler-derived myocardial performance index (MPI), which is a novel and more sensitive parameter than conventional ventricular function parameters. To assess the possibility of RV and LV dysfunctions occurring in bronchiectasis, we studied 25 patients with bronchiectasis, and compared them with 22 age- and gender-matched control subjects. MPI, which is a combined index of both systolic and diastolic ventricular function, was calculated for both ventricles. RV and LV MPIs were also significantly different in patients and the controls. RV MPI was associated with the number of involved lobe, arterial blood oxygen pressure, and acceleration time/ejection time of pulmonary flow. LV MPI was not related to any clinical parameter, but it was correlated only with RV MPI. Ventricular functions are impaired in bronchiectasis. The impairment of RV function is related to involved lung lobe number, arterial oxygen pressure, and acceleration time/ejection time of pulmonary flow. LV dysfunction was correlated only with RV function.     

Echocardiographic Determinants of the Clinical Condition in Patients with a Systemic Right Ventricle

Background: Ventricular systolic and diastolic function, as measured by echocardiography, are diminished in patients with a systemic right ventricle (RV). As the clinical implications of these finding remained unknown, we aimed to identify echocardiographic parameters of systolic and diastolic ventricular function that are independent determinants of the clinical condition in these patients. Methods: Forty‐six adult patients (61% male; mean age 33 [range 18–69] years) with a systemic RV underwent echocardiography to assess qualitative and quantitative systolic and diastolic function of the systemic RV and the subpulmonary left ventricle (LV). Uni‐ and multivariate linear regression analyses were performed to identify independent echocardiographic determinants for NYHA class, maximal exercise capacity (V’O_2peak) and NT‐proBNP levels. Results: We found qualitative assessment of RV and LV function to be significantly associated with NYHA class (RV: β= 0.26; P = 0.05 and LV: β= 0.82; P < 0.01), V’O_2peak (RV: β=?10.4; P < 0.05 and LV: β=?18.4; P < 0.05) and NT‐proBNP levels (RV: β= 0.58; P < 0.01 and LV: β= 1.40; P < 0.001). Tricuspid annulus plane systolic excursion (TAPSE) was significantly associated with NYHA class (β=?0.92; P = 0.001), V’O_2peak (β= 18.5; P = 0.05), and serum NT‐proBNP levels (β=?1.00; P < 0.05). Associations between quantitative parameters of systolic subpulmonary LV function and clinical parameters were less distinct. We found no associations between RV and LV diastolic function and clinical parameters. Conclusions: Qualitative function of the systemic RV and the subpulmonary LV, and TAPSE, are determinants of clinical condition in patients with a systemic RV. These patients’ clinical condition could not be determined by echocardiographically measured diastolic RV function, and systolic and diastolic LV function. (Echocardiography 2010;27:1247‐1255)     

Tissue doppler imaging and NT-proBNP levels show the early impairment of ventricular function in patients with beta-thalassaemia major

Beta-thalassaemia major is a chronic haemolytic anaemia, and congestive heart failure (CHF) is the most common cause of death in this disease. N terminal pro B type natriuretic peptide (NT-proBNP) increases with the severity of CHF and predicts the prognosis. The aim of this study was to investigate the relation between left ventricular systolic and diastolic function determined by standard pulsed wave Doppler (PWD), tissue Doppler imaging (TDI) and NT-proBNP in patients with beta-thalassaemia major. Thirty-four patients with beta-thalassaemia major and 34 healthy individuals were included in the study. Blood samples were taken for NT-proBNP. All patients and controls underwent echocardiographic examination. All cardiac chambers were significantly increased in the patient group. Left and right ventricular (LV, RV) ejection fractions and all diastolic parameters were normal in the patients and controls. Tissue Doppler imaging (TDI) showed a significant decrease in LV and RV Sm velocities in patients compared to the controls. NT-proBNP levels were also significantly higher in the patient group. There was a negative correlation between serum NT-proBNP levels and LV Sm and RV Sm velocities in patients (r = -0.426, P = 0.006 and r = -0.409, P = 0.009, respectively). Linear regression analysis showed that LV Sm and RV Sm were independent predictors for NT-proBNP. Our findings suggest that although iron overload in patients with beta-thalassaemia major impairs the systolic and diastolic functions of both ventricles, it impairs the systolic function earlier than diastolic function. Tissue Doppler imaging is an easy and reliable method in the early determination of ventricular dysfunction in these patients.     

Cardiac involvement in systemic sclerosis assessed by tissue-doppler echocardiography during routine care: A controlled study of 100 consecutive patients

OBJECTIVE: To assess the prevalence of primary cardiac complications in a large population of patients with systemic sclerosis (SSc), using recently developed echocardiographic techniques. METHODS: We prospectively studied 100 consecutive patients (mean +/- SD age 54 +/- 14 years; 86 women) presenting with SSc without pulmonary arterial hypertension or clinical manifestations of heart failure. All patients underwent standard echocardiography, along with measurements of longitudinal velocities by tissue Doppler imaging (TDI) to assess left ventricular (LV) and right ventricular (RV) contractility and LV diastolic function. Results were compared with those in 26 age- and sex-matched healthy controls. RESULTS: Patients with SSc had a wider mean left atrial diameter and impaired relaxation compared with the controls. A trend was observed toward a smaller LV ejection fraction (EF) in the patients (mean +/- SD 64.9 +/- 0.6%) than in the controls (67.2 +/- 0.7%), as well as higher pulmonary artery pressure (mean +/- SD 33.3 +/- 0.6 mm Hg versus 30.8 +/- 1.0 mm Hg). LVEF was <55% in 7 patients versus none of the controls. Peak systolic mitral annular velocity as measured by TDI was <7.5 cm/second in 14 patients versus none of the controls (P = 0.040). Mitral annulus early diastolic velocity was <10 cm/second in 30 patients versus 2 of the controls (P = 0.022). Fifteen patients and none of the controls had reduced peak systolic tricuspid annular velocity (P = 0.039). The TDI results correlated with each other, but not with lung abnormalities or other disease characteristics. CONCLUSION: Depression of LV and RV systolic and LV diastolic function is common in patients with SSc and is due to primary myocardial involvement. Considering the major contributions of TDI, the addition of this simple technique to standard measurements may improve the detection of heart involvement in patients with SSc.     

Myocardial performance index and atrial ejection force in patients with Duchenne's muscular dystrophy

Background: Progressive movement limitation in patients with Duchenne's muscular dystrophy (DMD) may mask the onset of cardiac involvement. We aimed to determine whether myocardial performance index (MPI), either by conventional Doppler (CD) or tissue Doppler imaging (TDI), could detect subclinical myocardial dysfunction in DMD patients. Furthermore, we assessed the atrial ejection force (AEF) to evaluate possible existence of latent diastolic dysfunction. Method: Twenty DMD patients without signs and symptoms of cardiac impairment and 20 age matched control group enrolled into the study. MPI for right ventricle and left ventricle (LV) was assessed with CD and TDI for comparison. Results: No significant difference was detected in ejection fraction, fractional shortening, and AEF between two groups. CD derived MPI was higher for both ventricles in the patients (P < 0.0001). Moreover, the TDI derived MPI were significantly higher in the patients in mitral, tricuspid, and septal views (P < 0.0001). A significant decrease of mitral myocardial systolic wave velocity was detected in the patients, in favor of early involvement of the posterobasal LV myocardium. All acceleration and deceleration times’ values for the late mitral inflow were higher whereas the rates were significantly lower in the patients. There was no significant difference between AEF of both groups. Conclusion: MPI might be a useful parameter for early detection of occult cardiac dysfunction in DMD patients when other simple and standard echocardiographic parameters are within the normal limits. Lack of atrial contribution in LV filling due to atrial contractile dysfunction may play a role in DMD cardiac dysfunction. (Echocardiography 2011;28:1088‐1094)     

Clinical Asthma Phenotypes: Is There an Impact on Myocardial Performance?

Background: Asthma is a systemic disease, which affects various body systems. We aimed to assess the impact of clinical asthma phenotypes on myocardial performance in asthmatic children using tissue Doppler imaging (TDI). Methods: We enrolled 58 children with moderate persistent asthma and 62 age‐ and sex‐matched healthy controls. Asthmatic children were classified according to clinical asthma phenotypes into shortness of breath group (n = 26) and wheezy group (n = 32). Pulmonary function tests, and conventional and TDI echocardiography were performed. Results: TDI echocardiography assessment of the studied groups showed that asthmatic children as a group had significant left and right ventricular dysfunction when compared with healthy controls. Children in the shortness of breath group had a significant diastolic dysfunction of both ventricles in the form of lower tricuspid and mitral annular early myocardial diastolic velocity (Em), early to late myocardial diastolic velocity (Em/Am) ratio, and prolonged isovolumetric relaxation time when compared with wheezy group (P < 0.001). In the shortness of breath group, TDI‐derived myocardial performance index (MPI) of both ventricles was significantly higher when compared with wheezy group (P < 0.001) reflecting global myocardial dysfunction. Conventional echocardiography of both ventricles showed RV diastolic dysfunction in the form of a significantly lower tricuspid E/A ratio in the shortness of breath group when compared with wheezy group. Conclusion: Clinical asthma phenotypes have an impact on myocardial function especially those presented with shortness of breath. Thus, measurement of MPI by TDI can detect subclinical changes in the cardiac performance in asthmatic children. (Echocardiography 2012;29:528‐534)