BACKGROUND: The potential impact of pre-existing coronary artery stenosis (CAS) on right ventricular (RV) function during acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and RV dysfunction in patients with acute PE. METHODS: In this multicenter, case-control study, 89 cases and 176 controls matched for age were enrolled at three study centers (Peking Union Medical College Hospital, Fuwai Hospital, and the Second Affiliated Hospital of Harbin Medical University) from January 2016 to December 2020. The cases were patients with acute PE with CAS, and the controls were patients with acute PE without CAS. Coronary artery assessment was performed using coronary computed tomographic angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0 mm in diameter. Conditional logistic regression analysis was used to evaluate the association between CAS and RV dysfunction. RESULTS: The percentages of RV dysfunction (19.1% [17/89] vs. 44.6% [78/176], P <0.001) and elevated systolic pulmonary artery pressure (sPAP) (19.3% [17/89] vs. 39.5% [68/176], P = 0.001) were significantly lower in the case group than those in the control group. In the multivariable logistic regression model, CAS was independently and negatively associated with RV dysfunction (adjusted odds ratio [OR]: 0.367; 95% confidence interval [CI]: 0.185-0.728; P = 0.004), and elevated sPAP (OR: 0.490; 95% CI: 0.252-0.980; P = 0.035), respectively. CONCLUSIONS Pre-existing CAS was significantly and negatively associated with RV dysfunction and elevated sPAP in patients with acute PE. This finding provides new insights into RV dysfunction in patients with acute PE with pre-existing CAS.
Humans ; Pulmonary Embolism/complications* ; Case-Control Studies ; Male ; Ventricular Dysfunction, Right/physiopathology* ; Female ; Middle Aged ; Aged ; Coronary Stenosis/complications* ; Logistic Models ; Adult

OBJECTIVES: To evaluate the short-term outcomes of transcatheter pulmonary valve replacement (TPVR) using the Venus-P valve in patients with moderate-to-severe pulmonary regurgitation and right ventricular systolic dysfunction (RVSD) following surgical repair of complex congenital heart disease. METHODS: A retrospective analysis was conducted on patients undergoing Venus-P valve implantation (TPVR group, n=28) or surgical pulmonary valve replacement (SPVR group, n=19) at Fuwai Hospital between February 2014 and February 2024. All patients had moderate-to-severe pulmonary regurgitation with right ventricular ejection fraction less than 45% preoperatively. Postoperative pulmonary valve function and ventricular parameters were assessed at discharge and during a 6-month follow-up. RESULTS: All procedures were successfully completed with no early mortality. At 6 months, the TPVR group demonstrated significantly lower pulmonary valve transvalvular pressure gradients compared to the SPVR group (P<0.05). Both groups exhibited significant improvements from baseline in New York Heart Association (NYHA) functional class, biventricular ejection fractions, and right ventricular end-diastolic volume index (all P<0.05). The reduction in right ventricular end-diastolic diameter differed between the two groups (P<0.01). However, multivariable analysis revealed no association between this difference and surgical approach (β=4.4, P>0.05). In the TPVR group, QRS duration was significantly shortened postoperatively (P<0.01), with improvements in left ventricular end-diastolic volume index and cardiac index (both P<0.01), but these improvements did not differ significantly from the SPVR group (all P>0.05). During the follow-up, one patient in each group developed infective endocarditis within 1-month post-procedure; both were successfully treated with antibiotics. No other major complications were observed. CONCLUSIONS For patients with moderate-to-severe pulmonary regurgitation and RVSD, TPVR using the Venus-P valve effectively improves short-term pulmonary valve function and ventricular performance with a favorable safety profile, demonstrating potential as a minimally invasive alternative to SPVR .
Humans ; Pulmonary Valve Insufficiency/surgery* ; Retrospective Studies ; Pulmonary Valve/surgery* ; Heart Valve Prosthesis Implantation/methods* ; Ventricular Dysfunction, Right/physiopathology* ; Treatment Outcome ; Female ; Male ; Child ; Adult ; Heart Valve Prosthesis ; Adolescent ; Cardiac Catheterization/methods* ; Child, Preschool

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

BACKGROUND/AIMS: Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute pulmonary embolism (APE). Echocardiography and computed tomography (CT)-angiography may be difficult to perform in a serial follow up, unlike electrocardiography (ECG). Many ECG findings specific for APE have been reported, and many studies have found that negative T-waves (NTW) in precordial leads are most frequently observed in patients with APE. We analyzed serial changes in precordial NTW to detect RVD and predict the recovery of RVD in patients with APE. METHODS: We examined 81 consecutive patients diagnosed with APE using CT-angiography or echocardiography. ECG, transthoracic echocardiography, and laboratory tests were performed within 24 hours of admission, and daily ECG follow-up was performed. Precordial NTWs were defined by the new development of pointed and symmetrical inverted T-waves in at least three leads. Recovery of NTW was defined as flattening or upright inverted T-waves in more than two leads. RESULTS: Of the 81 patients with APE, 52 (64%) had RVD according to echocardiography. Among the patients with RVD, 33 (63%) showed precordial NTW. The multivariate logistic regression analysis revealed that NTW was the strongest independent predictor for RVD (odds ratio, 22.8; 95% confidence interval, 2.4 to 221.4; p = 0.007). Time to normalization of NTW was associated with improvement of RVD on echocardiography (r = 0.84, p < 0.01). CONCLUSIONS: Precordial NTW was a reliable finding to identify RVD in patients with APE. Improvements in RVD can be predicted by normalizing precordial NTW.
Acute Disease ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Echocardiography ; *Electrocardiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Pulmonary Embolism/complications/*diagnosis ; Recovery of Function ; Republic of Korea ; Time Factors ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Right/complications/*diagnosis/physiopathology ; *Ventricular Function, Right

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

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

There are many differences between cardiac resynchronization therapy (CRT) and conventional pacing therapy in terms of indications and implant techniques. Generally speaking, CRT requires implanting 3 pacing leads in heart failure patients with ventricular dysynchrony. A left ventricular lead is implanted via intravenous coronary sinus. The pacing site of left ventricle has important influence on therapy response. Sometimes open chest implant or other pacing modes are adopted to compensate the anatomical limitation of coronary sinus and its branches. In addition, the pacing sites and modes of right atrium and right ventricle are also under research to further improve CRT response.
Cardiac Pacing, Artificial ; methods ; Electrodes, Implanted ; Heart Atria ; Heart Failure ; physiopathology ; therapy ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; physiopathology ; Ventricular Dysfunction, Right ; physiopathology

The authors first segment the right ventricle regions from the echocardiographics by introducig a seeded region growth algorithm. Then they reconstrunct the three dimensional data field of right ventricle by using rotary scanning interpolation algorithm. And then, the authors propose a layer-by-layer, row-by-row, and voxel-by-voxel approach based on the interpolation results to estimate the volume of right ventricle. Finally, some right ventricle functional parameters such as EDV (End-diastolic volume), ESV (End-systolic volume), and RVEF (Right ventricular ejection fraction) are computed according to the volume results. The volume variation curves of several patients during a cardiac cycle have been successfully plotted out. The obtained results are compared with those from Tomtec medial image workstation. The comparison indicates the proposed approach is practical and meaningful.
Algorithms ; Echocardiography, Three-Dimensional ; instrumentation ; methods ; Heart Ventricles ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Ventricular Dysfunction, Right ; diagnostic imaging ; physiopathology ; 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

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