BACKGROUND: Right ventricular (RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction (HFpEF). Coronary artery disease (CAD) can contribute to the pathophysiological characteristics of HFpEF. This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD. METHODS: This prospective study included 250 consecutive acute HFpEF patients with CAD. Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value, based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). The primary endpoint was a composite of all-cause death, recurrent ischemic events, and HF hospitalizations. RESULTS: TAPSE/PASP ≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling (area under the curve, 0.731; sensitivity, 61.4%; and specificity, 76.6%). Of the 250 patients, 150 and 100 patients could be grouped into the RV-arterial coupling (TAPSE/PASP >0.43) and uncoupling (TAPSE/PASP ≤0.43) groups, respectively. Revascularization strategies were slightly different between groups; the RV-arterial uncoupling group had a lower rate of complete revascularization (37.0% [37/100] vs . 52.7% [79/150], P <0.001) and a higher rate of no revascularization (18.0% [18/100] vs . 4.7% [7/150], P <0.001) compared to the RV-arterial coupling group. The cohort with TAPSE/PASP ≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP >0.43. Multivariate Cox analysis showed TAPSE/PASP ≤0.43 as an independent associated factor for the primary endpoint, all-cause death, and recurrent HF hospitalization (hazard ratios [HR]: 2.21, 95% confidence interval [CI]: 1.44-3.39, P <0.001; HR: 3.32, 95% CI: 1.30-8.47, P = 0.012; and HR: 1.93, 95% CI: 1.10-3.37, P = 0.021, respectively), but not for recurrent ischemic events (HR: 1.48, 95% CI: 0.75-2.90, P = 0.257). CONCLUSION RV-arterial uncoupling, based on TAPSE/PASP, is independently associated with adverse outcomes in acute HFpEF patients with CAD.
Humans ; Prognosis ; Prospective Studies ; Stroke Volume/physiology* ; Echocardiography, Doppler/adverse effects* ; Coronary Artery Disease/complications* ; Heart Failure ; Pulmonary Artery/diagnostic imaging* ; Ventricular Function, Right/physiology* ; Ventricular Dysfunction, Right

Child ; Child, Preschool ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; methods ; Male ; Pulmonary Valve Insufficiency ; diagnostic imaging ; Retrospective Studies ; Tetralogy of Fallot ; diagnostic imaging ; Ventricular Function, Right ; physiology

OBJECTIVE: To evaluate the superiority, feasibility and clinical signifi cance of the four-dimensional spatio-temporal image correlation (STIC) in detection of the right ventricle function of fetus. METHODS: Th e STIC dynamic images of 180 normal fetal hearts at 24+0 to 37+6 weeks of gestation were obtained by the three-dimensional (3D) probe. Th e post-process evaluation was done off -line with the virtual organ computer-aided analysis (VOCAL) software. The computer recorded the right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), and then calculated the right stroke volume (RSV), the right cardiac output (RCO) and the right ejection fraction (REF). RCO was standardized by biometric measurements obtained at prenatal screening, including head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). RESULTS: The overall successful rate in image acquisition was 83.89% and the repeatability was favorable. After the standardization of fetal biometric parameters (HC, AC, FL) and the right ventricle function indexes (RVEDV, RVESV, RSV), RCO was increased with the gestational age while the REF and RCO/EFW fluctuated within a certain range. CONCLUSION STIC technique can accurately and objectively measure the fetal ventricular volume and it might be a potential strategy in the clinical assessment of the fetal cardiac function.
Biometry ; Female ; Fetal Heart ; diagnostic imaging ; physiology ; Gestational Age ; Humans ; Pregnancy ; Stroke Volume ; Ultrasonography, Prenatal ; Ventricular Function, Right

OBJECTIVETo explore the effects of chronic hypoxia on left and right ventricular function and the expression of cardiac transient receptor potential canonical (TRPC) channels in rats.

METHODSForty eight SD male rats were randomly divided into control group (CON) and chronic hypoxic pulmonary hypertension model group (CH) (n = 24). In CH group, rats were exposed in chronic hypoxia environment (10% +/- 0.2% O2) to induce myocardial hypertrophy. After 3 weeks, mean systemic arterial pressure (mSAP), right ventricular systolic pressure (RVSP), left ventricular systolic pressure (LVSP), left or right ventricular pressure maximum rate of rise (LV/RV + dp/dt(max)), left or right ventricular pressure maximum rate of descent (LV/RV-dp/dt(max)), right ventricular hypertrophy index (RVMI) and left ventricular hypertrophy index (LVMI) were measured. Left and right ventricular myocardium tissue sections were stained by HE and observed under light microscope. Real-time polymerase chain reaction (real-time-PCR) and Western blot were performed to detect the expression of TRPC subfamily.

RESULTSRVSP, RVMI, RV + dp/dt(max) and RV-dp/dt(max) were markedly elevated in CH group (P < 0.01) in comparison to CON group. LVMI was markedly reduced in CH group in comparison to CON group (P < 0.01). LVSP, LV + dp/dt(max) and LV- dp/dt(max) had no significant changes in CH group in comparison to CON group. Right ventricular myocardial cells of CH group became thick, the nuclei stained deeply, the shape of nuclei became not regularity. Left ventricular myocardial fibers did not change significantly. There was significant difference in the levels of mRNA and protein of TRPC1 between CON and CH groups.

CONCLUSIONFor three weeks exposed to chronic hypoxia induced right ventricular hypertrophy specifically, raised the mRNA and protein expression of TRPC1 on right ventricular myocardial cells . TRPC1 might be involved in the development of cardiac hypertrophy.

Animals ; Disease Models, Animal ; Hypertension, Pulmonary ; metabolism ; physiopathology ; Hypoxia ; metabolism ; physiopathology ; Male ; Rats ; Rats, Sprague-Dawley ; Transient Receptor Potential Channels ; metabolism ; Ventricular Function, Left ; physiology ; Ventricular Function, Right ; physiology

OBJECTIVEThis review aims to provide an overview of conventional and novel indices used in clinical and research arenas for evaluation of right ventricular (RV) function in congenital heart diseases with a dual-chambered circulation.

DATA SOURCESArticles cited in this review were selected using PubMed search of publications in English with no date limits. The search terms included "echocardiography", "right ventricle", "RV function", "cardiac function", and "congenital heart disease". Key references were also searched for additional publications.

STUDY SELECTIONArticles related to description of echocardiographic techniques in the evaluation of subpulmonary or systemic RV function and their applications in congenital cardiac malformations were retrieved and reviewed.

RESULTSThree approaches have been used to evaluate subpulmonary and systemic RV function: (1) assessment of changes in RV size in the cardiac cycle, (2) determination of Doppler-derived velocities and systolic and diastolic time intervals, and (3) quantification of myocardial velocities and deformation.

CONCLUSIONSConventional and novel echocardiographic techniques enable the evaluation of subpulmonary and systemic RV function. Novel echocardiographic techniques have further allowed quantification of RV volumes and direct interrogation of myocardial deformation. These new techniques show promise in a more comprehensive evaluation beyond "eye-balling" of RV function in the growing population of adolescent and adult congenital heart patients.

Echocardiography ; methods ; Heart Defects, Congenital ; diagnosis ; physiopathology ; Humans ; Ventricular Function, Right ; physiology

BACKGROUNDMechanical asynchrony is an important parameter in predicting the response to cardiac resynchronization therapy, but detailed knowledge about cardiac timing in healthy persons is scarce. Therefore, in the current study, we sought to investigate the physiological status of interventricular synchronicity using pulse wave flow and tissue Doppler imaging in a healthy Chinese population.

METHODSEighty-eight healthy volunteers underwent standard flow and tissue Doppler echocardiographic examinations. Ventricular inflow and outflow pulse wave flow Doppler patterns were recorded together with annulus pulse tissue Doppler imaging. Time intervals from the beginning of the QRS complex to the onset, peak and end of each wave were measured.

RESULTSThe onsets of systole between left and right ventricles were highly synchronized by both imaging modalities. However, the left ventricle reached the peak flow ejection and peak mechanical contraction earlier than the right ventricle, (165.61 ± 26.23) ms vs. (204.3 ± 34.55) ms (P < 0.01) and (133.62 ± 26.19) ms vs. (191.25 ± 38.47) ms (P < 0.01). Time to peak early diastolic relaxation was earlier in the left ventricle than in the right heart, (500.23 ± 56.52) ms vs. (524.94 ± 47.42) ms (P < 0.01).

CONCLUSIONSLeft and right ventricles were well synchronized at the onsets of systole and diastole even though interventricular peak systolic and peak early diastolic dyssynchrony was observed in healthy people by pulse wave Doppler imaging. In addition, diastolic timing events were slightly affected by age and gender.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Diastole ; physiology ; Echocardiography, Doppler ; methods ; Female ; Heart Ventricles ; physiopathology ; Humans ; Male ; Middle Aged ; Systole ; physiology ; Ventricular Function, Left ; Ventricular Function, Right ; Young Adult

OBJECTIVE: To assess left and right ventricular systolic function in patients with dilated cardiomyopathy (DCM) using real-time three-dimensional echocardiography (RT-3DE). METHODS: Fifty DCM patients and 50 normal subjects were enrolled. Left and right ventricular systolic function parameters including end-systolic volume (ESV) and end-diastolic volume (EDV), stroke volume (SV) and ejection fraction (EF) were measured with RT-3DE. The systolicdyssynchrony index (SDI) for left ventricular systolic function was also measured in the same time. The study compared the data of the left and right ventricular systolic function parameters between the DCM group and the control group. Cardiac magnetic resonance (CMRI) was performed in a subgroup of the 30 DCM patients to confirm RT-3DE measurements. RESULTS: The results of EDV, ESV and SDI measured by RT-3DE were significantly higher in patient group with DCM than those in the control group (P<0.001). The result of EF was significantly lower in patients with DCM than in normal subjects (P<0.001), but SV showed no significant difference between the two groups (P>0.05). In the DCM group, the results showed a significantly negative correlation between left ventricular ejection fraction (LVEF) and SDI (r=-0.697, P<0.001), and there was also a moderate correlation between LVEF and right ventricular ejection fraction (RVEF) (r=0.496, P<0.01). The results of ESV, EDV and EF showed no significant differences as measured by RT-3DE or CMRI in the patient group (P>0.05), and there was also good correlation between the two measurements (LVEF: r=0.89, P<0.01; RVEF: r=0.85, P<0.01). CONCLUSION Left and right ventricular systolic function in DCM could be evaluated by RT-3DE with left and right ventricular systolic function parameters.
Adult ; Aged ; Cardiomyopathy, Dilated ; diagnostic imaging ; physiopathology ; Case-Control Studies ; Echocardiography, Three-Dimensional ; methods ; Female ; Heart Ventricles ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Stroke Volume ; Systole ; Ventricular Function, Left ; physiology ; Ventricular Function, Right ; physiology

OBJECTIVETo investigate the value of Tei index and the sensitivity of left versus right ventricular Tei index in evaluating the fetal cardiac function in pregnancy-induced hypertension syndrome in the third trimester.

METHODSFetal echocardiograms were performed in 30 women with pregnancy-induced hypertension (PIH) syndrome and 55 with normal pregnancy of the third trimester. Tei index was obtained by calculating the ratio of the isovolumic time (isovolumic contraction and relaxation time) to the ejection time of the left and right ventricle. Comparisons of the Tei index were made between the PIH group and control group, and also between the left and right ventricles in each group.

RESULTSSignificant difference was found in the left and right ventricular Tei index between PIH group and control group. No difference was noted between the left and right ventricular Tei index in the PIH group.

CONCLUSIONSTei index is a useful indicator in evaluating fetal global cardiac function, for which purpose the left ventricular Tei index can be as sensitive as the right ventricular Tei index.

Case-Control Studies ; Female ; Fetal Heart ; diagnostic imaging ; Humans ; Hypertension, Pregnancy-Induced ; Pregnancy ; Pregnancy Trimester, Third ; Sensitivity and Specificity ; Ultrasonography, Prenatal ; Ventricular Function, Left ; physiology ; Ventricular Function, Right ; physiology

To evaluate the global left and right ventricular function and establish the CT reference data of global ventricular function parameters in normal people, 56 normal subjects (male, 28 cases; female, 28 case) were scanned with retrospective ECG gated 64-detector row CT. Ten time-phases in the cardiac cycle were reconstructed and short-axis images were acquired. On the cardiac analysis software, endo-cardium and epi-cardium of left and right ventricle were delineated and global function parameters were calculated. Left and right ventricular end-diastolic volume (LV/RVEDV), end-systolic volume (LV/RVESV), stroke volume (LV/RVSV), and wall mass (LV/RVWM) were significantly greater (P < 0.05) in men than in women, but cardiac output (LV/RVCO) and ejection fraction (LV/RVEF) exhibited no difference in women and men. In man group and woman group, LVWM was greater than RVWM (P < 0.01). LVESV, RVESV and body mass Index (BMI) were shown to have significant negative-correlation; the correlation coefficient = -0.54 and r = -0.53. LV/RVSV, LV/RVEF and BMI were noted to have significant positive-correlation; the correlation coefficients were 0.87/0.97 and 0.69/0.62, respectively. The normal global left and right ventricular functions differ significantly according to gender and body size.
Adult ; Aged ; Electrocardiography ; Female ; Heart Ventricles ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; Reference Values ; Retrospective Studies ; Stroke Volume ; Tomography, Spiral Computed ; methods ; Ventricular Function, Left ; physiology ; Ventricular Function, Right ; physiology

BACKGROUNDRight ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass (OPCAB) surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter (PAC) and to evaluate right ventricular systolic and diastolic function by end-systolic elastance (E(ES)) and end-diastolic stiffness (E(ED)) in OPCAB surgery.

METHODSTwenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at: anesthesia steady-state before skin incision (T1); 5 minutes after the stabilizer device was placed for anastomosis on the heart's anterior wall (T2), lateral wall (T3), posterior wall (T4), respectively; after sternal closure (T5). Three sets of data were collected at each time point: first, hemodynamic variables were measured; second, right ventricular E(ES) and E(ED) were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point, end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point.

RESULTSRight ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2-T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred (P < 0.05) at T4 compared with values at T1. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of E(ES) was not statistically significant during operation. Right atrial pressure increased only during coronary anastomoses (T2-T4, P < 0.05), whereas E(ED) increased throughout OPCAB surgery (P < 0.05).

CONCLUSIONSRight ventricular pressure-volume loops can be constructed using a volumetric PAC. Right ventricular systolic dysfunction occurred during anastomoses on the heart's posterior wall not due to impaired myocardial contractility but as a result of reduced preload and a relative increase in afterload. Right ventricular diastolic function was impaired throughout OPCAB surgery.

Aged ; Blood Pressure ; Coronary Artery Bypass, Off-Pump ; methods ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Ventricular Function, Right ; physiology