Humans ; Hypertension, Pulmonary ; complications ; physiopathology ; Ventricular Dysfunction, Right ; etiology

Objective: To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography (2-D STE) and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis. Methods: All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022. The clinical information of patients such as general data, arterial blood gas analysis and pulmonary function test were collected. The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain (RVFWLS) and conventional echocardiographic-derived parameters, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'), respectively. Based on their RVFWLS, the patients were divided into right ventricular dysfunction group and normal right ventricular function group. Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis. Results: A total of 104 silicosis patients were enrolled, with aneverage age (65.52±11.18) years old, among whom including 57 cases diagnosed with stage Ⅰ/Ⅱ silicosis and 47 cases diagnosed with stage Ⅲ silicosis. 26 (25.00%) patients concurrent right ventricular dysfunction. The abnormal rates of RVFAC, TAPSE and S' in patients were 16.35% (17 cases), 21.15% (22 cases) and 6.73% (7 cases), respectively. The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group, and the incidence of pulmonary arterial systolic pressure ≥36 mmHg was higher than that in normal right ventricular function group (P<0.05). Logistic regression analysis showed that arterial partial pressure of oxygen (OR=0.932, 95%CI: 0.885-0.981, P=0.007) was the protective factor, and the forced expiratory volume in 1 second (FEV(1)) /forced vital capacity (FVC) ratio<70% (OR=5.484, 95%CI: 1.049-28.662, P=0.044) and stage Ⅲ silicosis (OR=6.343, 95%CI: 1.698-23.697, P=0.007) were the risk factors for silicosis patients concurrent right ventricular dysfunction. Conclusion: The incidence of right ventricular dysfunction is higher in patients with stage Ⅲ silicosis than that in patients with stage Ⅰ/Ⅱ silicosis. Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction. Hypoxemia, airflow limitation and the stage Ⅲ silicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.
Humans ; Middle Aged ; Aged ; Ventricular Dysfunction, Right/etiology* ; Ventricular Function, Right ; Echocardiography ; Risk Factors ; Silicosis/diagnostic imaging*

BACKGROUNDTissue Doppler imaging (TDI) has provided an objective means to quantify global and regional left ventricular (LV) and right ventricular (RV) function with improved accuracy and greater reproducibility than conventional echocardiography. This study was conducted to assess RV myocardial systolic activation by TDI in subjects with pulmonary arterial hypertension (PAH).

METHODSA total of 30 patients with PAH and 30 healthy volunteers, all comparable in age and sex, underwent standard Doppler echo and TDI. Using pulsed Doppler echocardiography combined with TDI, the following regional parameters were evaluated in three different myocardial segments (RV basal lateral wall, basal septal, and LV basal lateral) on apical 4-chamber view: systolic (Sm), early- and late-diastolic (Em and Am) peak velocities. RV myocardial systolic activation delay was defined as the difference in time to peak TDI systolic velocities between the RV basal lateral wall and basal septal. In addition, RV end-diastolic and end-systolic areas were measured to calculate RV fractional area change from the same apical 4-chamber view.

RESULTSCompared with the control group, patients with PAH showed increased RA and RV end-diastolic diameter (RA: (4.5 +/- 1.2) cm vs (3.0 +/- 0.8) cm, P < 0.05 and RV: (4.8 +/- 1.9) cm vs (3.4 +/- 0.5) cm, P < 0.05) and reduced RV fractional area change; (35 +/- 14)% vs (56 +/- 9)%, P < 0.05. These PAH patients showed lower myocardial peak velocities and a significant activation delay compared with controls (P < 0.05). Moreover, a strong correlation between RV myocardial systolic activation delay and RV fractional area change was shown in patients with pulmonary arterial hypertension (r = -0.82).

CONCLUSIONSIn PAH, RV myocardial systolic activation was markedly delayed, which was directly related to the RV fractional area change. RV myocardial systolic activation delay assessed by TDI could offer a unique approach to predict RV dysfunction.

Adolescent ; Adult ; Diastole ; Echocardiography, Doppler ; Female ; Humans ; Hypertension, Pulmonary ; physiopathology ; Male ; Middle Aged ; Systole ; Ventricular Dysfunction, Right ; etiology ; Ventricular Function, Right

OBJECTIVETo observe the relationship between preoperative pulmonary artery pressure and postoperative right ventricular function in heart transplant patients.

METHODA total of 54 heart transplant patients were divided to two groups: group I (n = 34): preoperative pulmonary arterial systolic pressure (sPAP) > or = 45 mm Hg (1 mm Hg = 0.133 kPa) [(60 +/- 12) mm Hg]; group II (n = 20): sPAP < 45 mm Hg [(25 +/- 9) mm Hg]. Cardiac index (CI), pulmonary circulation resistance (PVR) and CVP were measured preoperatively and up to 60 hours post operation by Swan-Ganz catheter. The extent of tricuspid regurgitation at preoperation and 3, 7, 14, 21, 30 days post operation was evaluated by bedside echocardiography. Postoperative pulmonary hypertension was treated by diuresis, nitrates, Ilomedin 20 and hemofiltration (CRRT).

RESULTAll patients survived the operation. Preoperative PVR was significantly higher in group I patients than that of group II patients [(358 +/- 150) dyn x s(-1) x cm(-5) vs. (140 +/- 68) dyn x s(-1) x cm(-5), P < 0.01]. Right heart insufficiency early post operation was more often in group I patients than that in group II patients (70.6% vs. 35.0%, P < 0.05). The PVR was higher and tricuspid regurgitation extent severer in group II than group I early post operation and were similar 30 days post operation.

CONCLUSIONPost operative right heart insufficiency was associated to preoperative pulmonary hypertension in heart transplant patients.

Adult ; Female ; Heart Transplantation ; Humans ; Hypertension, Pulmonary ; complications ; etiology ; physiopathology ; Male ; Middle Aged ; Tricuspid Valve Insufficiency ; etiology ; physiopathology ; Ventricular Dysfunction, Right ; etiology ; physiopathology

Foramen Ovale, Patent ; pathology ; Humans ; Hypoxia ; complications ; etiology ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; etiology ; physiopathology ; Singapore ; Ventricular Dysfunction, Right ; physiopathology

OBJECTIVE: To explore the alteration and the clinical significance of QT dispersion in acute pulmonary embolism (PE). METHODS: From May 2011 to April 2012, 42 hospitalized PE patients in Xiangya Hospital of Central South University were enrolled, and divided into a high-risk group and a non-high-risk group according to the clinic state on admission. Another 30 healthy subjects with matched age and genders were enrolled as a normal control group. QT interval was measured manually in 12- lead conventional electrocardiogram within 24 hours on admission and after the treatment. QT dispersion (QTd) and heart rate-corrected QT dispersion (QTcd) were also calculated. All patients were followed up during hospitalization, and were divided to a death group and a survival group. RESULTS: QTd and QTcd in the high-risk group [(70.2±34.0), (88.1±43.3) ms] and the non-high-risk group [(49.3±21.8), (59.1±26.2) ms] were significantly higher than those in the normal control group[(33.2±12.4), (36.7±14.2) ms] (P<0.05), while QTd and QTcd in the high-risk group were significantly higher than those in the non-high-risk group (P<0.05). The interval of electrocardiogram was (5.6±2.5) days between 24 hours on admission and after the treatment (ECG). QTd and QTcd were reduced significantly after the treatment in the survival group [(41.0±16.4), (47.4±18.0)ms] compared with those on admission [(54.0±33.0), (67.2±40.5)ms] (P<0.05), but the QTd and QTcd after the treatment were also significantly higher than those in the normal control group (P<0.05). There was no significant difference in the QTd and QTcd between 24 hours on admission and after the treatment in the death group (P>0.05). Logistic regression showed that high-risk of PE, right ventricular dysfunction and high QTcd after the treatment were the main risk factors of hospital death. CONCLUSION QTd and QTcd are increased in PE. PE patients with right ventricular dysfunction, high-risk of PE, and high QTcd after the treatment suggest weak prognosis.
Adolescent ; Adult ; Aged ; Case-Control Studies ; Electrocardiography ; Female ; Heart Conduction System ; physiopathology ; Humans ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism ; complications ; physiopathology ; Ventricular Dysfunction, Right ; etiology ; physiopathology ; Young Adult

OBJECTIVE: We wanted to assess the relationship between measurements of the right ventricular (RV) function and mass, with using cardiac multi-detector computed tomography (MDCT) and the severity of chronic obstructive pulmonary disease (COPD) as determined by the pulmonary function test (PFT). MATERIALS AND METHODS: Measurements of PFT and cardiac MDCT were obtained in 33 COPD patients. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the patients were divided into three groups according to the severity of the disease: stage I (mild, n = 4), stage II (moderate, n = 15) and stage III (severe, n = 14). The RV function and the wall mass were obtained by cardiac MDCT. The results were compared among the groups using the Student-Newman-Keuls method. Pearson's correlation was used to evaluate the relationship between the right ventricular ejection fraction (RVEF) and the wall mass results with the PFT results. P-values less than 0.05 were considered statistically significant. RESULTS: The RVEF and mass were 47+/-3% and 41+/-2 g in stage I, 46+/-6% and 46+/-5 g in stage II, and 35+/-5% and 55+/-6 g in stage III, respectively. The RVEF was significantly lower in stage III than in stage I and II (p < 0.01). The RV mass was significantly different among the three stages, according to the disease severity of COPD (p < 0.05). The correlation was excellent between the MDCT results and forced expiratory volume in 1 sec (r = 0.797 for RVEF and r = -0.769 for RV mass) and forced expiratory volume in 1 sec to the forced vital capacity (r = 0.745 for RVEF and r = -0.718 for RV mass). CONCLUSION: Our study shows that the mean RV wall mass as measured by cardiac MDCT correlates well with the COPD disease severity as determined by PFT.
Ventricular Dysfunction, Right/*etiology/physiopathology/*radiography ; Tomography, X-Ray Computed/*methods ; Statistics, Nonparametric ; Respiratory Function Tests ; Pulmonary Disease, Chronic Obstructive/*complications/physiopathology ; Middle Aged ; Male ; Humans ; Female ; Analysis of Variance ; Aged