Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of inherited cardio-myopathy, which is characterized by fibro-fatty replacement of right ventricular myocardium, leading to ventricular arrhythmia. However, rapid atrial arrhythmias are also common, including atrial fibrillation, atrial flutter and atrial tachycardia. Long term rapid atrial arrhythmia can lead to further deterioration of cardiac function. This case is a 51-year-old male. He was admitted to Department of Cardiology, Peking University Third Hospital with palpitation and fatigue after exercise. Electrocardiogram showed incessant atrial tachycardia. Echocardiography revealed dilation of all his four chambers, especially the right ventricle, with the left ventricular ejection fraction of 40% and the right ventricular hypokinesis. Cardiac magnetic resonance imaging found that the right ventricle was significantly enlarged, and the right ventricular aneurysm had formed; the right ventricular ejection fraction was as low as 8%, and the left ventricular ejection fraction was 35%. The patients met the diagnostic criteria of ARVC, and both left and right ventricles were involved. His physical activities were restricted, and metoprolol, digoxin, spironolactone and ramipril were given. Rivaroxaban was also given because atrial tachycardia could cause left atrial thrombosis and embolism. His atrial tachycardia converted spontaneously to normal sinus rhythm after these treatments. Since the patient had severe right ventricular dysfunction, frequent premature ventricular beats and non-sustained ventricular tachycardia on Holter monitoring, indicating a high risk of sudden death, implantable cardioverter defibrillator (ICD) was implanted. After discharge from hospital, physical activity restriction and the above medicines were continued. As rapid atrial arrhythmia could lead to inappropriate ICD shocks, amiodarone was added to prevent the recurrence of atrial tachycardia, and also control ventricular arrhythmia. After 6 months, echocardiography was repeated and showed that the left ventricle diameter was reduced significantly, and the left ventricular ejection fraction increased to 60%, while the size of right ventricle and right atrium decreased slightly. According to the clinical manifestations and outcomes, he was diagnosed with ARVC associated with arrhythmia induced cardiomyopathy. According to the results of his cardiac magnetic resonance imaging, the patient had left ventricular involvement caused by ARVC, and the persistent atrial tachycardia led to left ventricular systolic dysfunction.
Arrhythmogenic Right Ventricular Dysplasia/complications* ; Atrial Fibrillation ; Humans ; Male ; Middle Aged ; Stroke Volume ; Ventricular Function, Left ; 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

BACKGROUNDCor pulmonale is often associated with changes of structure and function of the right ventricle (RV) and thus further affects functional changes of the left heart. Our study aimed to assess the left ventricular (LV) and RV function in patients with cor pulmonale using high-definition CT (HDCT).

METHODSWe prospectively studied 18 cor pulmonale patients determined by the pulmonary function test, clinical examination, chest radiograph, electrocardiogram, and echocardiogram. The subject group was compared to a control group consisting of 18 subjects. The RV and LV functions and RV myocardial mass (MM) were obtained by HDCT in the two groups. The results were compared between the two groups using the independent sample t test. Echocardiographic examination for cardiac function analysis was performed on the same day.

RESULTSThe RV end-diastolic volume (EDV), RV end-systolic volume (ESV) and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group (P < 0.05). The right ventricular ejection fraction (RVEF) was significantly lower in the 18 cor pulmonale patients than in controls (P < 0.01). The left ventricular EDV (LVEDV) and LVEF were significantly lower in cor pulmonale patients than in controls (P < 0.01). There were strong correlations between MDCT and echocardiography, rRVEF = 0.839 and rLVEF = 0.916, respectively.

CONCLUSIONSHDCT can accurately quantify RV and LV function. The right ventricular function is impaired in patients with cor pulmonale, while at the same time the left ventricular function is also impaired.

Adult ; Aged ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Heart Disease ; diagnostic imaging ; physiopathology ; Stroke Volume ; Tomography, X-Ray Computed ; methods ; Ventricular Function, Left ; Ventricular Function, Right

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

BACKGROUND AND OBJECTIVES: Heart failure rarely occurs in patients with thyrotoxicosis (6%), with half of the cases having left ventricular dysfunction (LVD). Although a few studies reported isolated right heart failure in thyrotoxicosis, there has been no evaluation of relationship between LVD and right ventricular dysfunction (RVD). SUBJECTS AND METHODS: We enrolled 12 patients (mean age: 51+/-11 years, 9 females) diagnosed as having thyrotoxicosis with heart failure and LVD {left ventricular ejection fraction (LVEF) <40%}, and divided them into two groups {Group I with RVD defined as tricuspid annular plane excursion (TAPSE) less than 15 mm and Group II without RVD}. Clinical features, laboratory variables, and echocardiographic parameters were compared between two groups. RESULTS: RVD was found in 6 (50%) patients. On admission, there were no significant differences between the two groups in clinical features, laboratory variables, or echocardiographic parameters including atrial fibrillation {6 vs. 5, not significant (NS)}, heart rate (149+/-38 vs. 148+/-32/min, NS), LVEF (36.7+/-9.5 vs. 35.1+/-6.3%, NS), or the tricuspid regurgitation peak pressure gradient (TRPPG, 30.9+/-2.0 vs. 36.3+/-9.3 mmHg, NS). After antithyroid treatment, all achieved an euthyroid state and both ventricular functions were recovered. All data, including the recovery time of LVEF and the change of heart rate between two groups, displayed no significant differences. CONCLUSION: In half of patients, RVD was combined with thyrotoxicosis-associated LVD. There were no differences in clinical factors or hemodynamic parameters between patients with and without RVD. This suggests that RVD is not secondary to thyrotoxicosis-associated LVD.
Atrial Fibrillation ; Heart Failure ; Heart Rate ; Hemodynamics ; Humans ; Stroke Volume ; Thyrotoxicosis ; Tricuspid Valve Insufficiency ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right ; Ventricular Function

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

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

BACKGROUND AND OBJECTIVES: Cardiomyopathy is a common cause of heart failure, yet it is sometimes difficult to determine its exact etiology. Endomyocardial biopsy (EMBx) has been considered to be one of the important diagnostic modalities for unexplained cardiomyopathy. The aim of this study was to analyze the diagnostic value of EMBx. SUBJECTS AND METHODS: 30 patients (M : F=26 : 4, mean age: 41+/-11 yrs) who underwent EMBx since 1992 at St. Mary's hospital were enrolled. The patients were classified into 4 groups by their clinical manifestations as follows: Group I: 11 patients with left ventricular hypertrophy (LVH) of an unknown etiology and suspicious of having infiltrative disease on their non-invasive tests, Group II: 15 patients with heart failure of an unknown etiology and rapid progression, Group III: 2 patients with heart failure and peripheral eosinophilia, Group IV: 2 patients with suspicious arrhythmogenic right ventricular dysplasia and cardiac mass. RESULTS: EMBx confirmed the diagnosis in 8 of 30 cases (26.7%). In Group I, 3 patients were confirmed to have amyloidosis (27.3%). In Group II, 2 patients were diagnosed as having lymphocytic myocarditis (13.3%). In Group III, all of 2 patients (100%) were diagnosed as eosinophilic myocarditis. In Group IV, 1 patient was confirmed to have cardiac metastasis from esophageal cancer. The diagnostic rate was higher for Group III than for Group II (p=0.007). There were no complications related with EMBx. CONCLUSION: EMBx may be a useful tool to confirm the causes of cardiomyopathy in selected patients.
Amyloidosis ; Arrhythmogenic Right Ventricular Dysplasia ; Biopsy ; Cardiomyopathies ; Endocardium ; Eosinophilia ; Eosinophils ; Esophageal Neoplasms ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Myocarditis ; Neoplasm Metastasis