1
|
Hirasawa K, Izumo M, Mizukoshi K, Nishikawa H, Sato Y, Watanabe M, Kamijima R, Akashi YJ. Prognostic significance of right ventricular function during exercise in asymptomatic/minimally symptomatic patients with nonobstructive hypertrophic cardiomyopathy. Echocardiography 2021; 38:916-923. [PMID: 33971038 DOI: 10.1111/echo.15075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The risk stratification of hypertrophic cardiomyopathy (HCM) without left ventricular outflow tract (LVOT) obstruction and the utility of exercise stress echocardiography (ESE) remains unclear. We investigated the value of right ventricular (RV) function and RV-pulmonary artery (PA) coupling during exercise in asymptomatic/minimally symptomatic patients with nonobstructive HCM (nHCM). METHOD AND RESULTS This retrospective study evaluated 74 HCM patients (age 63 ± 13 years, 65% men) without LVOT obstruction (≥30 mmHg) who underwent ESE. Eight patients (11%) suffered from HCM-related cardiac events during a median 2.5 years follow-up. During exercise, tricuspid annular plane systolic excursion (Ex-TAPSE) and Ex-TAPSE/systolic pulmonary artery pressure [SPAP] ratio were more impaired in patients with than in those without events (22 ± 4 vs 26 ± 4 mm, P = .005; and 0.45 [0.41, 0.47] vs 0.56 [0.47, 0.82] mm/mmHg, P = .002). In Cox regression analysis, Ex-TAPSE (HR: 1.397, P = .002) and the Ex-TAPSE/SPAP ratio (HR: 2.737, P = .006) were associated with cardiac events. In Kaplan-Meier analysis, patients with a low Ex-TAPSE (<24 mm) and Ex-TAPSE/SPAP ratio (<0.50 mm/mmHg) had a higher incidence of adverse outcomes than those with high Ex-TAPSE (Log rank, P < .001 and =.001, respectively). CONCLUSIONS A low Ex-TAPSE and Ex-TAPSE/SPAP ratio were associated with adverse outcomes in nHCM. Evaluation of RV functional performance during exercise may play a crucial role in the risk stratification of nHCM.
Collapse
Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Haruka Nishikawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yukio Sato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mika Watanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
2
|
Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
|
3
|
Mitra A, Ghosh RK, Bandyopadhyay D, Ghosh GC, Kalra A, Lavie CJ. Significance of Pulmonary Hypertension in Hypertrophic Cardiomyopathy. Curr Probl Cardiol 2020; 45:100398. [DOI: 10.1016/j.cpcardiol.2018.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022]
|
4
|
Graziani F, Lillo R, Panaioli E, Pieroni M, Camporeale A, Verrecchia E, Sicignano LL, Manna R, Lombardo A, Lanza GA, Crea F. Prognostic significance of right ventricular hypertrophy and systolic function in Anderson-Fabry disease. ESC Heart Fail 2020; 7:1605-1614. [PMID: 32432376 PMCID: PMC7373914 DOI: 10.1002/ehf2.12712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/24/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023] Open
Abstract
AIMS Right ventricular hypertrophy (RVH) is a common finding in Anderson-Fabry disease (AFD), but the prognostic role of right ventricular (RV) involvement has never been assessed. The aim of our study was to evaluate the prognostic significance of RVH and RV systolic function in AFD. METHODS AND RESULTS Forty-five AFD patients (56% male patients) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed-up for an average of 51.2 ± 11.4 months. RV systolic function was assessed by standard and tissue Doppler echocardiography. Cardiovascular events were defined as new-onset atrial fibrillation (AF), sustained ventricular arrhythmias, heart failure, or pacemaker/implantable cardioverter defibrillator implantation; renal events were defined as progression to dialysis and/or renal transplantation or significant worsening of glomerular filtration rate; and cerebrovascular events were defined as transient ischaemic attack or stroke. Fourteen patients (31.1%) presented RVH, while RV systolic function was normal in all cases. During the follow-up period, 13 patients (28.8%, 11 male) experienced 18 major events, including two deaths. Cardiovascular events occurred in eight patients (17.7%). The most common event was pacemaker/implantable cardioverter defibrillator implantation (six patients, 13.3%), followed by AF (three cases, 6.6%). Only one case of worsening New York Heart Association class (from II to III and IV) was observed. Ischaemic stroke occurred in three cases (6.6%). Renal events were recorded in three patients (6.6%). At univariate analysis, several variables were associated with the occurrence of events, including RVH (HR: 7.09, 95% CI: 2.17 to 23.14, P = 0.001) and indexes of RV systolic function (tricuspid annular plane systolic excursion HR: 0.77, 95% CI: 0.62 to 0.96, P = 0.02; and RV tissue Doppler systolic velocity HR: 0.76, 95% CI: 0.61 to 0.93, P = 0.01). At multivariate analysis, proteinuria (HR:8.3, 95% CI: 2.88 to 23.87, P < 0.001) and left ventricular mass index (HR: 1.02, 95% CI: 1.00 to 1.03, P = 0.03) emerged as the only independent predictors of outcome. CONCLUSIONS RVH and RV systolic function show significant association with clinical events in AFD, but only proteinuria and left ventricular mass index emerged as independent predictors of outcome. Our findings suggest that RV involvement does not influence prognosis in AFD and confirm that renal involvement and left ventricular hypertrophy are the main determinant of major cardiac and non-cardiac events.
Collapse
Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy
| | - Rosa Lillo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Panaioli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Antonia Camporeale
- Multi-modality Cardiac Imaging, San Donato Milanese Hospital, San Donato Milanese, Italy
| | - Elena Verrecchia
- UOC Medicina Interna Columbus, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ludovico Luca Sicignano
- UOC Medicina Interna Columbus, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Raffaele Manna
- Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Medicina Interna Columbus, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Periodic Fever Research Center, Institute of Internal Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Li X, Shi K, Yang ZG, Guo YK, Huang S, Xia CC, He S, Li ZL, Li C, He Y. Assessing right ventricular deformation in hypertrophic cardiomyopathy patients with preserved right ventricular ejection fraction: a 3.0-T cardiovascular magnetic resonance study. Sci Rep 2020; 10:1967. [PMID: 32029853 PMCID: PMC7004999 DOI: 10.1038/s41598-020-58775-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/07/2020] [Indexed: 02/05/2023] Open
Abstract
To assess the global and regional right ventricular (RV) deformation in hypertrophic cardiomyopathy (HCM) patients with preserved right ventricular ejection fraction (RVEF) using 3.0-T cardiovascular magnetic resonance tissue tracking (CMR-TT). Eighty-two HCM patients and 32 age- and sex-matched healthy controls were enrolled. HCM patients were divided into groups depending on the presence or absence of right ventricular hypertrophy (RVH), RV late gadolinium enhancement (RV-LGE), and left ventricular outflow tract obstruction (LVOTO), respectively. The RV global and apical longitudinal peak strain (LPS) in HCM patients with RVH were significantly lower than that in HCM patients without RVH and controls (P < 0.05). The global, apical and mid-ventricular LPS in HCM patients with RV-LGE were significantly lower than that in HCM patients without RV-LGE and controls (P < 0.05). Lower LPS was demonstrated in HCM patients without RV-LGE compared with controls in apical and mid-ventricular levels (P < 0.05). No significant difference was found regarding global and regional LPS in HCM patients with LVOTO compared without LVOTO (all P > 0.05). CMR-TT was able to detect subclinical RV myocardial deformation prior to RVEF impairment, which was more severe in the presence of RVH and RV-LGE.
Collapse
Affiliation(s)
- Xiang Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Hiemstra YL, Debonnaire P, Bootsma M, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Prevalence and Prognostic Implications of Right Ventricular Dysfunction in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2019; 124:604-612. [PMID: 31204037 DOI: 10.1016/j.amjcard.2019.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/28/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022]
Abstract
Right ventricular (RV) dysfunction is a well-known prognostic factor in several cardiac diseases. However, the prevalence of RV dysfunction in hypertrophic cardiomyopathy (HC) is unclear and its prognostic value is unknown. This study aims at addressing these issues assessing RV function with speckle tracking echocardiography. In 267 HC patients (52 ± 15 years, 68% male), standard and advanced echocardiographic measurements of RV function were performed including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall longitudinal strain (RVFWLS). The primary end point was all-cause mortality and heart failure development. RV dysfunction was observed in 9% of patients based on tricuspid annular plane systolic excursion (≤17 mm), 5% based on fractional area change (<35%), 23% based on RVFWLS ≥-19%, 39% based on RVFWLS ≥-23%, and 55% based on RV4CLS ≥-20%. In total 59 (22%) patients reached the primary end point during a median follow-up of 6.7 (interquartile range 4.2 to 9.8) years. Kaplan-Meier survival curve showed a significant worse survival free of the end point for patients with impaired RV4CLS ≥-20% versus patients with preserved RV4CLS <-20% (log-rank 7.0, p = 0.008) and for patients with impaired RVFWLS ≥-19% versus patients with preserved RVFWLS <-19% (log-rank 4.4, p = 0.037). Multivariable Cox regression analysis showed that E/E' (hazards ratio [HR] 2.26 [1.30 to 3.92], p = 0.004), left ventricular global longitudinal strain LV GLS (HR 1.08 (1.01 to 1.17), p = 0.034) and RV4CLS (HR 1.08 (1.02 to 1.15), p = 0.007) were independently associated with the primary end point. In conclusion, RV dysfunction as measured by longitudinal strain is relatively frequent in HC patients. Impaired RV4CLS is - together with LV GLS and E/E' - associated with adverse outcome, which may indicate a more severe form of HC.
Collapse
Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Debonnaire
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
7
|
Keramida K, Lazaros G, Nihoyannopoulos P. Right ventricular involvement in hypertrophic cardiomyopathy: Patterns and implications. Hellenic J Cardiol 2018; 61:3-8. [PMID: 30508591 DOI: 10.1016/j.hjc.2018.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/17/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022] Open
Abstract
Although hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy worldwide, the criteria for its definition and most of the literature concern the left ventricle, thus confirming the theory that the right ventricle is the neglected one. Right ventricular (RV) involvement includes structural and functional changes with significant impact on clinical presentation and prognosis. The pattern of RV hypertrophy can be variable with possible dynamic obstruction. Histological findings suggest similar pathogenetic changes in both ventricles supporting the common myopathic process with sarcomeric mutations. Systolic dysfunction of the RV is subtle, and the classical echocardiographic indices are usually within normal limits, while global longitudinal strain is significantly impaired. Diastolic dysfunction of the RV is also evident in patients with HCM possibly due to fibrosis of the RV free wall and/or the obstruction of the RV filling with significant prognostic implications. RV involvement in HCM is associated with increased incidence of supraventricular and ventricular arrhythmias, severe dyspnea, pulmonary thromboembolism, progressive heart failure, and increased risk of sudden cardiac death. Therefore, the RV should be routinely included in the detailed assessment of patients with HCM.
Collapse
Affiliation(s)
- Kalliopi Keramida
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.
| | - George Lazaros
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Petros Nihoyannopoulos
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece; National Heart and Lung Institute Imperial College London, London, UK
| |
Collapse
|
8
|
McCullough SA, Fifer MA, Mohajer P, Lowry PA, Reen CO, Baggish AL, Vlahakes GJ, Shimada YJ. Clinical Correlates and Prognostic Value of Elevated Right Atrial Pressure in Patients With Hypertrophic Cardiomyopathy. Circ J 2018. [PMID: 29526913 DOI: 10.1253/circj.cj-17-0959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical characteristics associated with elevated right atrial pressure (RAP) in hypertrophic cardiomyopathy (HCM) are unknown. Few data exist as to whether elevated RAP has prognostic implications in patients with HCM. This study investigated the clinical correlates and prognostic value of elevated RAP in HCM.Methods and Results:This retrospective cohort study was performed on 180 patients with HCM who underwent right heart catheterization between 1997 and 2014. Elevated RAP was defined as >8 mmHg. Baseline characteristics, mean pulmonary artery pressure, and mean pulmonary capillary wedge pressure (PCWP) were assessed for association with elevated RAP. The predictive value of elevated RAP for all-cause mortality and the development of atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), and stroke was evaluated. Elevated RAP was associated with higher New York Heart Association class, dyspnea on exertion, orthopnea, edema, jugular venous distention, larger left atrial size, right ventricular hypertrophy, higher pulmonary artery pressure, and higher PCWP. RAP independently predicted all-cause mortality (adjusted hazard ratio [aHR] 2.18 per 5-mmHg increase, 95% confidence interval [CI] 1.05-4.50, P=0.04) and incident AF (aHR 1.85 per 5-mmHg increase, 95% CI 1.20-2.85, P=0.005). Elevated RAP did not predict VT/VF (P=0.36) or stroke (P=0.28). CONCLUSIONS Elevated RAP in patients with HCM is associated with left-sided heart failure and is an independent predictor of all-cause mortality and new-onset AF.
Collapse
Affiliation(s)
- Stephen A McCullough
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Michael A Fifer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Pouya Mohajer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Patricia A Lowry
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Caitlin O'Callaghan Reen
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Aaron L Baggish
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| | - Gus J Vlahakes
- Cardiac Surgical Division, Department of Surgery, Massachusetts General Hospital and Harvard Medical School
| | - Yuichi J Shimada
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School.,Division of Cardiology, Department of Medicine, Columbia University Medical Center
| |
Collapse
|
9
|
Guo X, Fan C, Tian L, Liu Y, Wang H, Zhao S, Duan F, Zhang X, Zhao X, Wang F, Zhu H, Lin A, Wu X, Li Y. The clinical features, outcomes and genetic characteristics of hypertrophic cardiomyopathy patients with severe right ventricular hypertrophy. PLoS One 2017; 12:e0174118. [PMID: 28323875 PMCID: PMC5360271 DOI: 10.1371/journal.pone.0174118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction Severe right ventricular hypertrophy (SRVH) is a rare phenotype in hypertrophic cardiomyopathy (HCM) for which limited information is available. This study was undertaken to investigate the clinical, prognostic and genetic characteristics of HCM patients with SRVH. Methods HCM with SRVH was defined as HCM with a maximum right ventricular wall thickness ≥10 mm. Whole-genome sequencing (WGS) was performed in HCM patients with SRVH. Multivariate Cox proportional hazards regression models were used to identify risk factors for cardiac death and events in HCM with SRVH. Patients with apical hypertrophic cardiomyopathy (ApHCM) were selected as a comparison group. The clinical features and outcomes of 34 HCM patients with SRVH and 273 ApHCM patients were compared. Results Compared with the ApHCM group, the HCM with SRVH group included younger patients and a higher proportion of female patients and also displayed higher cardiovascular morbidity and mortality. The multivariate Cox proportional hazards regression models identified 2 independent predictors of cardiovascular death in HCM patients with SRVH, a New York Heart Association class ≥III (hazard ratio [HR] = 8.7, 95% confidence interval (CI): 1.43-52.87, p = 0.019) and an age at the time of HCM diagnosis ≤18 (HR = 5.5, 95% CI: 1.24-28.36, p = 0.026). Among the 11 HCM patients with SRVH who underwent WGS, 10 (90.9%) were identified as carriers of at least one specific sarcomere gene mutation. MYH7 and TTN mutations were the most common sarcomere mutations noted in this study. Two or more HCM-related gene mutations were observed in 9 (82%) patients, and mutations in either other cardiomyopathy-related genes or ion-channel disease-related genes were found in 8 (73%) patients. Conclusions HCM patients with SRVH were characterized by poor clinical outcomes and the presentation of multiple gene mutations.
Collapse
Affiliation(s)
- Xiying Guo
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chaomei Fan
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (CMF); (LT)
| | - Lei Tian
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail: (CMF); (LT)
| | - Yanling Liu
- Department of Ultrasound, Fuwai Hospital, Beijing, China
| | - Hongyue Wang
- Department of Pathology, Fuwai Hospital, Beijing, China
| | - Shihua Zhao
- Department of Radiology, Fuwai Hospital, Beijing, China
| | - Fujian Duan
- Department of Ultrasound, Fuwai Hospital, Beijing, China
| | - Xiuling Zhang
- Department of Cardiology, Anqiu Chinese Medicine Hospital, Anqiu, China
| | - Xing Zhao
- Department of Cardiology, Heze Zone Central Hospital, Heze, China
| | - Fengqi Wang
- Department of Cardiology, Zhecheng People’s Hospital, Zhecheng, China
| | - Hongguang Zhu
- Department of Cardiology, The Harbor Hospital of Yantai, Yantai, China
| | - Aiqing Lin
- Department of Cardiology, Muping District Chinese Medicine Hospital of Yantai, Yantai, China
| | - Xia Wu
- Department of Cardiology, Laiwu Central Hospital, Laiwu, China
| | - Yishi Li
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
10
|
The impact of age and gender on right ventricular diastolic function among healthy adults. J Cardiol 2017; 70:387-395. [PMID: 28325518 DOI: 10.1016/j.jjcc.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Doppler echocardiography is ideally suited for assessment of diastolic function, being widely available, non-invasive, and less expensive than other techniques. However, data regarding age- and gender-matched reference values of right ventricular diastolic function are limited. This study aims to explore the physiologic variations of right ventricle (RV) diastolic function in a large cohort of healthy adults, and to investigate clinical and echocardiographic correlates. METHODS From June 2007 to February 2014, 1168 healthy Caucasian subjects [mean age 45.1±15.6 years, range 16-92; 555 (47.5%) men] underwent comprehensive transthoracic echocardiography (TTE) following current guidelines. The following RV main diastolic measurements were measured: peak early inflow velocity (E), annular both early (e') and atrial (a') velocities, E/e' ratio. RESULTS RV E/e' constantly increases with age in females, but do not change substantially in males. RV E/A constantly decreases with age in both genders. Stepwise multiple linear regression analysis underlined a close significant association of RV diastolic function with both right and left heart morphologic measurements (right atrial area, RV diameters, left atrial volume) and functional indexes (TAPSE, RV tissue Doppler peak systolic velocity, left ventricular E/Ee'), as well as with indexes of increased pulmonary resistance. CONCLUSION Our data highlight the potential usefulness of different normal reference values according to the age and gender to correctly evaluate RV diastolic function. Differences in terms of demographic and anthropometric parameters could be useful to avoid potential misclassification of RV diastolic function when based on dichotomously suggested normal cut-off values.
Collapse
|
11
|
Baxi AJ, Restrepo CS, Vargas D, Marmol-Velez A, Ocazionez D, Murillo H. Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and Management. Radiographics 2017; 36:335-54. [PMID: 26963450 DOI: 10.1148/rg.2016150137] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of diseases related to sarcomere gene mutations exhibiting heterogeneous phenotypes with an autosomal dominant mendelian pattern of inheritance. The disorder is characterized by diverse phenotypic expressions and variable natural progression, which may range from dyspnea and/or syncope to sudden cardiac death. It is found across all racial groups and is associated with left ventricular hypertrophy in the absence of another systemic or cardiac disease. The management of HCM is based on a thorough understanding of the underlying morphology, pathophysiology, and clinical course. Imaging findings of HCM mirror the variable expressivity and penetrance heterogeneity, with the added advantage of diagnosis even in cases where a specific mutation may not yet be found. The diagnostic information obtained from imaging varies depending on the specific stage of HCM-phenotype manifestation, including the prehypertrophic, hypertrophic, and later stages of adverse remodeling into the burned-out phase of overt heart failure. However, subtle or obvious, these imaging findings become critical components in diagnosis, management, and follow-up of HCM patients. Although diagnosis of HCM traditionally relies on clinical assessment and transthoracic echocardiography, recent studies have demonstrated increased utility of multidetector computed tomography (CT) and particularly cardiac magnetic resonance (MR) imaging in diagnosis, phenotype differentiation, therapeutic planning, and prognostication. In this article, we provide an overview of the genetics, pathophysiology, and clinical manifestations of HCM, with the spectrum of imaging findings at MR imaging and CT and their contribution in diagnosis, risk stratification, and therapy.
Collapse
Affiliation(s)
- Ameya Jagdish Baxi
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Carlos S Restrepo
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Daniel Vargas
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Alejandro Marmol-Velez
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Daniel Ocazionez
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| | - Horacio Murillo
- From the Departments of Radiology (A.J.B., C.S.R.) and Cardiology (A.M.V.), University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229-3900; Department of Radiology, University of Colorado Hospital, Denver, Colo (D.V.); Department of Radiology, University of Texas Medical School at Houston, Houston, Tex (D.O.); and Department of Radiology, Sutter Medical Group, Sacramento, Calif (H.M.)
| |
Collapse
|
12
|
D'Andrea A, Limongelli G, Baldini L, Verrengia M, Carbone A, Di Palma E, Vastarella R, Masarone D, Tagliamonte G, Riegler L, Calabrò R, Russo MG, Bossone E, Pacileo G. Exercise speckle-tracking strain imaging demonstrates impaired right ventricular contractile reserve in hypertrophic cardiomyopathy. Int J Cardiol 2017; 227:209-216. [DOI: 10.1016/j.ijcard.2016.11.150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 11/15/2022]
|
13
|
Right ventricular involvement in feline hypertrophic cardiomyopathy. J Vet Cardiol 2016; 18:297-309. [DOI: 10.1016/j.jvc.2016.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/18/2016] [Accepted: 08/07/2016] [Indexed: 01/01/2023]
|
14
|
D'Andrea A, Martone F, Liccardo B, Mazza M, Annunziata A, Di Palma E, Conte M, Sirignano C, D'Alto M, Esposito N, Fiorentino G, Russo MG, Bossone E, Calabrò R. Acute and Chronic Effects of Noninvasive Ventilation on Left and Right Myocardial Function in Patients with Obstructive Sleep Apnea Syndrome: A Speckle Tracking Echocardiographic Study. Echocardiography 2016; 33:1144-55. [PMID: 27060461 DOI: 10.1111/echo.13225] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In patients with obstructive sleep apnea syndrome (OSAS), repetitive hypoxia due to sleep-induced apnea adversely affects the interaction between myocardial oxygen demand and supply, resulting in the development of subclinical cardiac dysfunction. The purpose of the study was to analyze the different involvement of left and right heart myocardial function in patients with OSAS treated with noninvasive ventilation (NIV). METHODS Conventional Doppler echocardiography, Doppler myocardial imaging (DMI), and two-dimensional speckle tracking echocardiography (2DSTE) of left (LV) and right ventricular (RV) longitudinal and right atrial (RA) deformation were performed in 55 patients with OSAS undergoing NIV (M/F 38/17; mean age 67.8 ± 11.2 years). LV and RV global longitudinal strain (GLS) was calculated by averaging local strain along the entire right and left ventricle, before and during NIV, and after 6 months of nocturnal NIV therapy. RESULTS LV morphology was comparable before and during NIV, whereas LV ejection fraction and LV DMI early diastolic peak velocity were significantly improved in patients with OSAS during NIV, as was LV regional peak myocardial strain (P < 0.001). RV diameters were slightly increased in patients with OSAS during ventilation, whereas pulmonary artery systolic pressure (PASP), RV GLS, and regional peak myocardial RV strain were significantly reduced during ventilation (P < 0.0001). RA transverse diameters and RA area were also slightly increased during NIV, whereas RA lateral wall strain was reduced (P < 0.001). Acute RV myocardial impairment completely reversed at follow-up, with a decrease in PASP and subsequent increase in both RV and RA myocardial performance. CONCLUSIONS Conventional 2DSTE is a useful tool for assessing left and right heart morphology and myocardial deformation in patients with OSAS and for monitoring both acute and chronic effects of NIV.
Collapse
Affiliation(s)
- Antonello D'Andrea
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Francesca Martone
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Biagio Liccardo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Mariano Mazza
- Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Anna Annunziata
- Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Enza Di Palma
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Marianna Conte
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Cesare Sirignano
- Institute of Biostructure and Bioimaging (IBB) of the Italian National Research Council, Naples, Italy
| | - Michele D'Alto
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Nicolino Esposito
- Division of Cardiology, Evangelic Hospital Villa Betania, Naples, Italy
| | - Giuseppe Fiorentino
- Division of Pneumology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Maria Giovanna Russo
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Raffaele Calabrò
- Chair of Cardiology, Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples, Italy
| |
Collapse
|
15
|
Roşca M, Călin A, Beladan CC, Enache R, Mateescu AD, Gurzun MM, Varga P, Băicuş C, Coman IM, Jurcuţ R, Ginghină C, Popescu BA. Right Ventricular Remodeling, Its Correlates, and Its Clinical Impact in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2015; 28:1329-38. [DOI: 10.1016/j.echo.2015.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Indexed: 10/23/2022]
|
16
|
Afonso L, Briasoulis A, Mahajan N, Kondur A, Siddiqui F, Siddiqui S, Alesh I, Cardozo S, Kottam A. Comparison of right ventricular contractile abnormalities in hypertrophic cardiomyopathy versus hypertensive heart disease using two dimensional strain imaging: a cross-sectional study. Int J Cardiovasc Imaging 2015; 31:1503-9. [DOI: 10.1007/s10554-015-0722-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 07/25/2015] [Indexed: 11/28/2022]
|
17
|
D'Andrea A, La Gerche A, Golia E, Teske AJ, Bossone E, Russo MG, Calabrò R, Baggish AL. Right Heart Structural and Functional Remodeling in Athletes. Echocardiography 2014; 32 Suppl 1:S11-22. [DOI: 10.1111/echo.12226] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Andrè La Gerche
- Department of Medicine; St. Vincent's Hospital; University of Melbourne; Melbourne Australia
| | - Enrica Golia
- Chair of Cardiology; Second University of Naples; Naples Italy
| | - Arco J. Teske
- Department of Cardiology; Division of Heart and Lungs; University Medical Center Utrecht; Utrecht The Netherlands
| | - Eduardo Bossone
- Department of Cardiac Surgery; Istituto di Ricovero e Cura a Carattere Scientifico; Policlinico San Donato; San Donato Milanese Milan Italy
| | | | | | - Aaron L. Baggish
- Cardiovascular Performance Program; Massachusetts General Hospital; Boston Massachusetts USA
| |
Collapse
|
18
|
Quintana E, Johnson JN, Sabate Rotes A, Cetta F, Ommen SR, Schaff HV, Dearani JA. Surgery for biventricular obstruction in hypertrophic cardiomyopathy in children and young adults: technique and outcomes†. Eur J Cardiothorac Surg 2014; 47:1006-12. [DOI: 10.1093/ejcts/ezu313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
|
19
|
Cincin A, Tigen K, Karaahmet T, Dündar C, Gürel E, Bulut M, Sünbül M, Başaran Y. Right ventricular function in hypertrophic cardiomyopathy: A speckle tracking echocardiography study. Anatol J Cardiol 2014; 15:536-41. [PMID: 25537994 PMCID: PMC5337031 DOI: 10.5152/akd.2014.5538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The aim of this study was to explore right ventricular (RV) mechanical function in patients with hypertrophic cardiomyopathy (HCM) by 2-D speckle tracking echocardiography (2-D-STE). Methods: Forty-three patients with HCM (mean age 48, 17 females) and 40 healthy subjects were consecutively included in this cross-sectional study. The diagnosis of HCM was based on the presence of typical clinical, electrocardiographic (ECG), and echocardiographic features. Patients with LV systolic impairment, significant valvular disease, history of coronary artery disease, hypertension, malignancy, and chronic obstructive pulmonary disease were excluded. Right and left ventricular (LV) function was assessed by tissue Doppler imaging (TDI) and 2-D-STE. Hypertrophic cardiomyopathy patients were divided into two groups according to ACC/ESC guidelines (LVOT gradient below and above 30 mm Hg). Student t-test was used to compare differences between groups. Non-parametric tests (Mann-Whitney U) were used in cases of abnormal distribution. Results: Hypertrophic cardiomyopathy patients had a significantly larger right atrium and RV diameters compared to controls. Mean pulmonary artery pressures (mPAB) were significantly higher in HCM patients (19.01±13.09 mm Hg vs. 8.40±4.50 mm Hg; p<0.001). Although RV Sm measure-ments were similar, RV strain measurements (-28.51±5.36% vs. -32.06±7.65%; p=0.016) were significantly lower in HCM patients. Left ventricular global longitudinal, radial, and circumferential strain values were also significantly different between the two groups (-20.50±3.58% vs. -24.12±3.40%; p<0.001, 38.18±12.67% vs. 44.80±10.15%; p=0.012, -21.94±4.28% vs. -23.91±3.95%; p=0.036 consecutively). Rotational movement of LV in each apical, mid-, and basal left ventricular segment was determined, and only mid-ventricular rotation of the HCM patients was more clockwise (-1.71±2.16 ° vs. 0.04±1.72 p<0.001). Although mPAP measurements were higher in HCM patients with significant LVOT obstruction (21.52±13.26 mm Hg vs. 12.31±10.53 mm Hg; p=0.049), none of the other TDI or 2-D-STE parameters was significantly different between groups. Conclusion: Speckle tracking echocardiography-derived right ventricular systolic function is impaired in HCM patients when compared with healthy subjects. However, RV systolic function is not affected form LVOT obstruction and left ventricular rotation dynamics in HCM patients.
Collapse
Affiliation(s)
- Altuğ Cincin
- Department of Cardiology, Faculty of Medicine, Marmara University; İstanbul-Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Finocchiaro G, Knowles JW, Pavlovic A, Perez M, Magavern E, Sinagra G, Haddad F, Ashley EA. Prevalence and clinical correlates of right ventricular dysfunction in patients with hypertrophic cardiomyopathy. Am J Cardiol 2014; 113:361-7. [PMID: 24230980 DOI: 10.1016/j.amjcard.2013.09.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
Hypertrophic cardiomyopathy (HC) is a disease that mainly affects the left ventricle (LV), however recent studies have suggested that it can also be associated with right ventricular (RV) dysfunction. The objective of this study was to determine the prevalence of RV dysfunction in patients with HC and its relation with LV function and outcome. A total of 324 consecutive patients with HC who received care at Stanford Hospital from 1999 to 2012 were included in the study. A group of 99 prospectively recruited age- and gender-matched healthy volunteers were used as controls. RV function was quantified using the RV fractional area change, tricuspid annular plane systolic excursion (TAPSE), and RV myocardial performance index (RVMPI). Compared with the controls, the patients with HC had a higher RVMPI (0.51 ± 0.18 vs 0.25 ± 0.06, p <0.001) and lower TAPSE (20 ± 3 vs 24 ± 4, p <0.001). RV dysfunction based on an RVMPI >0.4 and TAPSE <16 mm was found in 71% and 11% of the HC and control groups, respectively. Worst LV function and greater pulmonary pressures were independent correlates of RV dysfunction. At an average follow-up of 3.7 ± 2.3 years, 17 patients had died and 4 had undergone heart transplantation. LV ejection fraction <50% and TAPSE <16 mm were independent correlates of outcome (hazard ratio 3.98, 95% confidence interval 1.22 to 13.04, p = 0.02; and hazard ratio 3.66, 95% confidence interval 1.38 to 9.69, p = 0.009, respectively). In conclusion, RV dysfunction based on the RVMPI is common in patients with HC and more frequently observed in patients with LV dysfunction and pulmonary hypertension. RV dysfunction based on the TAPSE was independently associated with an increased likelihood of death or transplantation.
Collapse
|
21
|
Badran HM, Soliman M, Hassan H, Abdelfatah R, Saadan H, Yacoub M. Right ventricular mechanics in hypertrophic cardiomyopathy using feature tracking. Glob Cardiol Sci Pract 2013; 2013:185-97. [PMID: 24689019 PMCID: PMC3963737 DOI: 10.5339/gcsp.2013.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 06/04/2013] [Indexed: 11/26/2022] Open
Abstract
Objectives: Right ventricular (RV) mechanics in hypertrophic cardiomyopathy (HCM) are poorly understood. We investigate global and regional deformation of the RV in HCM and its relationship to LV phenotype, using 2D strain vector velocity imaging (VVI). Methods: 100 HCM patients (42% females, 41 ± 19 years) and 30 control patients were studied using VVI. Longitudinal peak systolic strain (ϵsys), strain rate (SR), time to peak (ϵ) (TTP), displacement of RV free wall (RVFW) and septal wall were analyzed. Similar parameters were quantified in LV septal, lateral, anterior and inferior segments. Intra-V-delay was defined as SD of TTP. Inter-V-delay was estimated from TTP difference between the most delayed LV segment & RVFW. Results: ϵsys and SR of both RV & LV, showed loss of base to apex gradient and significant decline in HCM (p < 0.001). Deformation variables estimated from RVFW were strongly correlated with each other (r = 0.93, p < 0.0001). Both were directly related to LV ϵsys, SRsys, SRe, ejection fraction (EF)%, RVFW displacement (P < 0.001) and inversely related to age, positive family history (p < 0.004, 0.005), RV wall thickness, maximum wall thickness (MWT), intra-V-delay, LA volume (P < 0.0001), LVOT gradient (p < 0.02, 0.005) respectively. ROC curves were constructed to explore the cut-off point that discriminates RV dysfunction. Global and RVFW ϵsys: − 19.5% shows 77, 70% sensitivity & 97% specificity, SRsys: − 1.3s− 1 shows 82, 70% sensitivity & 30% specificity. Multivariate analyses revealed that RVFW displacement (β = − 0.9, p < 0.0001) and global LV SRsys (β = 5.9, p < 0.0001) are independent predictors of global RV deformation. Conclusions: Impairment of RV deformation is evident in HCM using feature tracking. It is independently influenced by LV mechanics and correlated to the severity of LV phenotype. RVFW deformation analysis and global RV assessment are comparable.
Collapse
|
22
|
Nerbass FB, Pedrosa RP, Danzi-Soares NJ, Drager LF, Arteaga-Fernández E, Lorenzi-Filho G. Obstructive sleep apnea and hypertrophic cardiomyopathy: a common and potential harmful combination. Sleep Med Rev 2012; 17:201-6. [PMID: 23046848 DOI: 10.1016/j.smrv.2012.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 05/03/2012] [Accepted: 06/26/2012] [Indexed: 11/20/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease and is characterized by large and asymmetric septal and left ventricle hypertrophy. HCM is a cause of disability, including heart failure, atrial fibrillation, and sudden death, with an annual mortality varying from 1% to 6%. Obstructive sleep apnea (OSA) is extremely common among patients with established cardiovascular disease, including hypertension and atrial fibrillation and when present may contribute to worse cardiovascular outcome. Although patients with HCM do not necessarily have typical characteristics of patients with OSA, such as obesity and increasing age, there is recent evidence that OSA is extremely common among patients with HCM, with a prevalence ranging from 32% to 71%. The presence of OSA among patients with HCM is independently associated with worse structural and functional impairment of the heart, including atrial and aorta enlargement, worse New York Heart Association functional class, and worse quality of life. The prevalence of atria fibrillation, an independent marker of mortality among patients with HCM, is significantly higher (∼four times) in the presence of OSA. Therefore, the recognition of OSA is a new area of research that may impact the management of patients with HCM.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Aorta, Thoracic/physiopathology
- Atrial Fibrillation/complications
- Atrial Fibrillation/diagnosis
- Atrial Fibrillation/epidemiology
- Atrial Fibrillation/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/epidemiology
- Cardiomyopathy, Hypertrophic/physiopathology
- Comorbidity
- Cross-Sectional Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Heart Atria/physiopathology
- Humans
- Male
- Middle Aged
- Oxygen/blood
- Polysomnography
- Prognosis
- Quality of Life
- Risk Factors
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Sleep Apnea, Obstructive/physiopathology
- Sympathetic Nervous System/physiopathology
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
Collapse
Affiliation(s)
- Flávia B Nerbass
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo School of Medicine, Brazil
| | | | | | | | | | | |
Collapse
|
23
|
Cappelli F, Porciani MC, Bergesio F, Perlini S, Attana P, Moggi Pignone A, Salinaro F, Musca F, Padeletti L, Perfetto F. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging 2011; 13:416-22. [DOI: 10.1093/ejechocard/jer289] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Pagourelias ED, Efthimiadis GK, Parcharidou DG, Gossios TD, Kamperidis V, Karoulas T, Karvounis H, Styliadis IH. Prognostic value of right ventricular diastolic function indices in hypertrophic cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:809-17. [DOI: 10.1093/ejechocard/jer126] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
25
|
Tadic M, Ivanovic B, Grozdic I. Metabolic Syndrome Impacts the Right Ventricle: True or False? Echocardiography 2011; 28:530-8. [DOI: 10.1111/j.1540-8175.2011.01390.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
26
|
D'Andrea A, Caso P, Bossone E, Scarafile R, Riegler L, Di Salvo G, Gravino R, Cocchia R, Castaldo F, Salerno G, Golia E, Limongelli G, De Corato G, Cuomo S, Pacileo G, Russo MG, Calabro R. Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:492-500. [DOI: 10.1093/ejechocard/jeq007] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Right ventricular dysfunction in early systemic hypertension: a tissue Doppler imaging study in patients with high-normal and mildly increased arterial blood pressure. J Hypertens 2010; 28:615-21. [PMID: 20191674 DOI: 10.1097/hjh.0b013e328334f181] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyze the relationship between increasing systemic blood pressure (BP) and right ventricular (RV) function. SUBJECTS AND METHODS Ninety-eight never-treated, nonobese patients with BP values varying from the optimal to the mild hypertensive range. Peak early diastolic (Em) and systolic (Sm) velocities were recorded at the tricuspid and mitral annuli by tissue Doppler imaging (TDI); global RV and left ventricular (LV) structure and function by conventional echo-Doppler sonography; insulin sensitivity by homeostasis model assessment (HOMA) index. Data were analyzed by 24-h systolic BP (cut-offs 117 and 130 mmHg), thus partitioning an optimal BP from an intermediate high-normal and an upper mildly increased BP stratum. RESULTS Em decreased in the mid-third and decelerated further in association with reduced Sm in the upper BP tertile; both correlated negatively to septal thickness and positively to homologous TDI-derived LV indices. RV and LV indices of global ventricular function, estimated pulmonary pressure, HOMA did not differ by systemic BP. CONCLUSION RV diastolic and systolic function deteriorates in response to slightly increased systemic BP. The process paralleled homologous changes at the LV side and was driven by interventricular septum remodeling, perhaps as a reflection of its role in RV function and biventricular interdependence. Insulin sensitivity seemed to play no relevant role.
Collapse
|
28
|
Zimbarra Cabrita I, Ruisanchez C, Dawson D, Grapsa J, North B, Howard LS, Pinto FJ, Nihoyannopoulos P, Gibbs JSR. Right ventricular function in patients with pulmonary hypertension; the value of myocardial performance index measured by tissue Doppler imaging. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:719-24. [PMID: 20410189 DOI: 10.1093/ejechocard/jeq051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Myocardial performance index (MPI) measured by conventional Doppler is routinely used to assess right ventricular (RV) systolic function in patients with pulmonary hypertension (PH). Our aim was to determine whether MPI measured by Doppler tissue imaging (tMPI) is effective in assessing RV function in these patients. METHODS AND RESULTS Retrospectively, we have studied 196 patients with chronic PH [pulmonary arterial systolic pressure (PASP) 81 +/- 40 mmHg] and 37 healthy volunteers (PASP of 27 +/- 7 mmHg). According to the exclusion criteria, 172 patients were included in the final study cohort. All patients were evaluated for RV systolic function by different parameters. MPI was measured by both conventional and tissue Doppler imaging. Bland-Altman analysis showed moderate agreement between MPI and tMPI (the mean difference was -0.02, absolute difference = -0.32 to 0.29; 95% intervals of agreement, percentage of average = -46.6 to 40.8%). In 50 consecutive PH patients where additional parameters were calculated, we found a significant correlation between tMPI and RV ejection fraction (r = -0.73, P< 0.0001) and RV fractional area change (r = -0.58, P< 0.0001). No significant inter- and intra-observer variability was identified. CONCLUSION This study demonstrated a moderate agreement between two methods of measuring MPI. A good correlation of tMPI with RV ejection fraction and RV fractional area change was found indicating that tMPI might be superior to MPI Doppler. tMPI is a parameter unaffected by RV geometry and importantly has the advantage of simultaneously recording the time intervals from the same cardiac cycle.
Collapse
Affiliation(s)
- Inês Zimbarra Cabrita
- Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Du Cane Road, W12 0HS London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Lindqvist P, Henein MY, Wikström G. Right ventricular myocardial velocities and timing estimate pulmonary artery systolic pressure. Int J Cardiol 2009; 137:130-6. [DOI: 10.1016/j.ijcard.2008.06.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 06/09/2008] [Accepted: 06/28/2008] [Indexed: 11/24/2022]
|
30
|
Emilsson K, Loiske K. Isovolumetric relaxation time of the right ventricle assessed by tissue Doppler imaging. SCAND CARDIOVASC J 2009; 38:278-82. [PMID: 15513310 DOI: 10.1080/14017430410022849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The isovolumetric relaxation time of the right ventricle (RV-IVRT) can be assessed using a method based on ECG and pulsed wave Doppler (PW). Recently pulsed wave Doppler tissue imaging (PW-DTI) has been introduced in the assessment. DESIGN RV-IVRT obtained by the two methods was compared in 20 consecutive patients as was the time from the R wave on the ECG to the onset of tricuspid flow (R-T), to the closure of the pulmonic valve (R-P), to the onset of early diastolic motion of the tricuspid annulus tissue (R-E) and to the end of the systolic motion (R-S). RESULTS RV-IVRT obtained by the PW method was significantly (p < 0.001) shorter than RV-IVRT obtained by PW-DTI. R-S had significantly (p < 0.001) shorter duration than R-P, while there was no significant difference between R-E and R-T. CONCLUSIONS The methods are not measuring the same interval. Only the PW method measures RV-IVRT according to the usual definition. Different reference values have to be used if the methods are used in the assessment of RV diastolic function.
Collapse
Affiliation(s)
- K Emilsson
- Department of Clinical Physiology, Karlskoga Hospital, Sweden.
| | | |
Collapse
|
31
|
Kaga S, Mikami T, Onozuka H, Omotehara S, Abe A, Yamada S, Okada M, Komatsu H, Inoue M, Yokoyama S, Nishida M, Shimizu C, Matsuno K, Tsutsui H. Right ventricular diastolic dysfunction in patients with left ventricular hypertrophy: analysis of right ventricular myocardial relaxation using two-dimensional speckle tracking imaging. J Echocardiogr 2009; 7:25-33. [PMID: 27278227 DOI: 10.1007/s12574-009-0009-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/31/2009] [Accepted: 03/31/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although several previous studies have suggested the presence of right ventricular (RV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM) and those with hypertensive left ventricular hypertrophy (HT-LVH), the mechanisms are still unclear. This study aimed to clarify the relationship between the RV global diastolic dysfunction in these patients and the regional myocardial diastolic function, including synchronicity of the interventricular septum and RV free wall. METHODS In 20 age-matched patients with HT-LVH, 20 patients with HCM and 22 control subjects without pulmonary hypertension, RV isovolumic relaxation time (IRTR) was measured using continuous-wave Doppler echocardiography. The early diastolic peak strain rate (E SR) and time from QRS to E SR (T-E SR) were measured in the apical, mid-ventricular and basal segments of the interventricular septum and RV free wall using two-dimensional speckle tracking imaging (2DST). RESULTS IRTR was more prolonged both in HT-LVH and in HCM than in the controls. The averaged septal E SR was reduced both in HT-LVH and in HCM (P < 0.0001, respectively), but the averaged RV free wall E SR was decreased only in HCM (P = 0.0007). E SR averaged for six septal and RV free wall segments was correlated with IRTR (r = -0.46, P = 0.0001). Neither intergroup difference nor correlation with IRTR was observed in a coefficient of variation of T-E SR for the six segments. CONCLUSIONS RV global diastolic function is impaired in patients with HT-LVH and HCM due to relaxation abnormalities, not an asynchrony, of the myocardium surrounding the RV cavity. The detection of RV free wall relaxation abnormality using 2DST may be useful to differentiate HCM from HT-LVH.
Collapse
Affiliation(s)
- Sanae Kaga
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Taisei Mikami
- Faculty of Health Sciences, Hokkaido University Graduate School, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan.
| | - Hisao Onozuka
- Faculty of Health Sciences, Hokkaido University Graduate School, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Ayumu Abe
- Faculty of Health Sciences, Hokkaido University Graduate School, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan
| | - Satoshi Yamada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masako Okada
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Komatsu
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamiko Inoue
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Chikara Shimizu
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazuhiko Matsuno
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
32
|
Affiliation(s)
- Gisela C Mueller
- Department of Radiology, University of Michigan Health Systems, Ann Arbor, Michigan 48109-2713, USA
| | | |
Collapse
|
33
|
Bayram NA, Ciftci B, Bayram H, Keles T, Durmaz T, Akcay M, Yeter E, Bozkurt E. Effects of continuous positive airway pressure therapy on right ventricular function assessment by tissue Doppler imaging in patients with obstructive sleep apnea syndrome. Echocardiography 2008; 25:1071-8. [PMID: 18771543 DOI: 10.1111/j.1540-8175.2008.00731.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The effects of continuous positive airway pressure (CPAP) therapy on right ventricular (RV) function in patients with obstructive sleep apnea syndrome (OSAS) has not been previously studied by tissue Doppler imaging (TDI). The aim of this study was to assess RV function using TDI in patients with OSAS before and after CPAP therapy. METHODS Twenty-eight patients with newly diagnosed OSAS in the absence of any confounding factors and 18 controls were included in this study. The peak systolic velocity (S'm), early (E'm) and late (A'm) diastolic myocardial peak velocities at tricuspid lateral annulus, isovolumic acceleration (IVA), myocardial precontraction time (PCT'm), myocardial contraction time (CT'm), and myocardial relaxation time (RT'm) were measured. All echocardiographic parameters were calculated 6 months after CPAP therapy. RESULTS The RV diastolic parameters such as E'm velocity and E'm-to-A'm ratio were significantly lower, RT'm was significantly prolonged, A'm velocity was similar in patients with OSAS compared to controls; and the RV systolic parameters such as IVA and CT'm were significantly lower and S'm was similar in patients with OSAS compared to controls. At the end of the treatment, 20 of 28 patients were compliant with CPAP therapy. E'm velocity, E'm-to-A'm ratio, IVA, and CT'm increased, PCT'm, PCT'm-to-CT'm ratio, and RT'm decreased significantly after therapy, whereas S'm velocity and A'm velocity did not change after CPAP treatment in the compliant patients. CONCLUSION OSAS is associated with RV systolic and diastolic dysfunction, and 6 months of CPAP therapy improves the RV systolic and diastolic dysfunction.
Collapse
Affiliation(s)
- Nihal Akar Bayram
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Cheng TO. Hypertrophic cardiomyopathy is a biventricular disease. Int J Cardiol 2008; 129:3-4. [DOI: 10.1016/j.ijcard.2008.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 02/13/2008] [Indexed: 11/16/2022]
|
35
|
Mörner S, Lindqvist P, Waldenström A, Kazzam E. Right ventricular dysfunction in hypertrophic cardiomyopathy as evidenced by the myocardial performance index. Int J Cardiol 2008; 124:57-63. [PMID: 17383757 DOI: 10.1016/j.ijcard.2006.12.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 11/01/2006] [Accepted: 12/30/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Left ventricular function in hypertrophic cardiomyopathy (HCM) has been extensively studied, whereas right ventricular function is much less explored. The myocardial performance index (MPI) has been shown to be useful in functional assessment of both ventricles. Furthermore, right ventricular MPI was found to be of predictive value in heart failure due to dilated cardiomyopathy and ischemic heart disease. The aim of this study was, therefore, to evaluate the right ventricular MPI in patients with HCM. METHODS Fifty patients with HCM and 250 healthy controls were studied by conventional Doppler echocardiography and Doppler tissue imaging. RESULTS Patients showed increased global, 0.48 (0.15) vs. 0.21 (0.14), and regional, 0.71 (0.23) vs. 0.55 (0.17), right ventricular MPI, as compared to controls, p<0.001. Tricuspid annular plane systolic excursion and peak myocardial systolic velocities were also reduced. Patients with dyspnoea had increased global right ventricular MPI (0.53 vs. 0.36, p<0.05) as compared to those without dyspnoea. CONCLUSION In the present study, patients with HCM showed evidence of both global and regional right ventricular dysfunction. Previous studies of the right ventricle in HCM have only shown evidence of diastolic dysfunction, contrary to our results, showing impairment of both systolic and diastolic function. This study suggests that HCM should not only be regarded as an isolated disease of the left ventricle, but rather as a biventricular disease. The predictive value of our findings in HCM needs to be assessed in a separate study with special reference to those with and without dyspnoea.
Collapse
Affiliation(s)
- Stellan Mörner
- Department of Cardiology, Heart Center, Umeå University Hospital, S-901 85 Umeå, Sweden.
| | | | | | | |
Collapse
|
36
|
Maron MS, Hauser TH, Dubrow E, Horst TA, Kissinger KV, Udelson JE, Manning WJ. Right ventricular involvement in hypertrophic cardiomyopathy. Am J Cardiol 2007; 100:1293-8. [PMID: 17920373 DOI: 10.1016/j.amjcard.2007.05.061] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/22/2007] [Accepted: 05/22/2007] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess, using cardiovascular magnetic resonance (CMR), whether morphologic right ventricular (RV) abnormalities are present in patients with hypertrophic cardiomyopathy (HC). Left ventricular hypertrophy has been considered the predominant phenotypic expression of HC. Whether structural abnormalities of the right ventricle are also present in HC is unknown. CMR provides complete coverage of both ventricles with high spatial resolution. CMR was applied to study RV morphology in HC. CMR was performed on 46 subjects with HC (mean age 39 +/- 16 years; 70% men) free of pulmonary hypertension and 22 healthy subjects (mean age 44 +/- 16 years; 50% men). Mass, wall thickness, chamber volume, the ejection fraction, and fibrosis were assessed for both ventricles. Maximum RV wall thickness was increased in patients with HC compared with referent controls (7 +/- 2 vs 5 +/- 1 mm, p <0.001), including 15 (33%) with maximum wall thicknesses > or =8 mm (> or =2 SDs higher than the mean for controls) and 4 (9%) with extreme hypertrophy (> or =10 mm). RV hypertrophy was predominantly a diffuse process involving the entire or a significant proportion of the RV wall in most patients (n = 8 [53%]). The RV wall mass index was also increased in patients with HC (28 +/- 9 vs 22 +/- 4 g, p <0.001). A significant correlation was found between maximum RV and left ventricular wall thickness (R(2) = 0.4, p <0.001) and between RV and left ventricular mass (R(2) = 0.4, p <0.001). Only 1 (2%) patient with HC had evidence of RV wall fibrosis. In conclusion, morphologic RV abnormalities are present in a substantial proportion of patients with HC.
Collapse
Affiliation(s)
- Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts-New England Medical Center, Boston, MA, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Gondi S, Dokainish H. Right Ventricular Tissue Doppler and Strain Imaging: Ready for Clinical Use? Echocardiography 2007; 24:522-32. [PMID: 17456072 DOI: 10.1111/j.1540-8175.2007.00430.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although tissue Doppler (TD) imaging of the left ventricle is now commonly used in clinical settings, TD imaging of the right ventricle (RV) is not routinely practiced. Yet, there are significant data on clinical uses of RV TD imaging, including established normal values using both color and spectral TD. In acute left ventricular (LV) inferior wall myocardial infarction, depressed RV TD velocities have been shown to correlate with the presence of RV impairment, and with patient outcome. In patients with LV heart failure, TD imaging has been correlated to RV ejection fraction by radionuclide angiography, and is an independent predictor of outcome. In patients with congenital heart disease, RV TD has been especially valuable for assessing RV function, and has been correlated to invasive hemodynamic indices, and RV ejection fraction by magnetic resonance imaging. The RV performance (Tei) index has been calculated and validated using TD-derived, rather than conventional pulsed Doppler time intervals. RV TD indices have been shown to be useful in the detection of subclinical and clinical disease in morbid obesity, chronic pulmonary, and systemic disease. TD-derived RV strain imaging can detect segmental myocardial dysfunction, overcoming limitations to conventional TD imaging resulting from tethering. For both TD velocity and strain imaging, however, appreciation of the limitations of these techniques is necessary for their appropriate use. Given its rapid acquisition times, reproducibility, and ease of addition to standard transthoracic echocardiographic protocols, RV TD and strain imaging are important additional modalities in the comprehensive echo-Doppler assessment of RV function.
Collapse
Affiliation(s)
- Sreedevi Gondi
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA
| | | |
Collapse
|
38
|
Tavil Y, Kanbay A, Sen N, Ciftçi TU, Abaci A, Yalçin MR, Köktürk O, Cengel A. Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension. Int J Cardiovasc Imaging 2006; 23:469-77. [PMID: 17054014 DOI: 10.1007/s10554-006-9168-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 09/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction. METHODS The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography. RESULTS Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0.45, P < 0.05). CONCLUSION Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.
Collapse
Affiliation(s)
- Yusuf Tavil
- Department of Cardiology, Gazi University Medical School, Erzurum m. Gul s. 5/23, Cebeci, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Hsiao SH, Lin SK, Wang WC, Yang SH, Gin PL, Liu CP. Severe tricuspid regurgitation shows significant impact in the relationship among peak systolic tricuspid annular velocity, tricuspid annular plane systolic excursion, and right ventricular ejection fraction. J Am Soc Echocardiogr 2006; 19:902-10. [PMID: 16825000 DOI: 10.1016/j.echo.2006.01.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Peak systolic mitral annular velocities correlate with left ventricular ejection fraction (EF) regardless of mitral regurgitation severity. Peak systolic tricuspid annular velocity (RV-Sm) and tricuspid annular plane systolic excursion (TAPSE) are used to assess right ventricular (RV) EF (RVEF). We investigated whether tricuspid regurgitation (TR) affects the relationship among RV-Sm, TAPSE, and RVEF. METHODS Patients (n = 625) underwent echocardiography and Doppler tissue studies. Left ventricular EF and RVEF were estimated by Simpson's rule. Because of confounding, we excluded patients with diseases that influence mitral annular motion or left ventricular function. We finally enrolled 225 patients: 125 with mild TR, 50 with moderate TR, and 50 with severe TR. Forty study patients (20 with mild TR, 10 with moderate TR, and 10 with severe TR) received radionuclide ventriculography. RESULTS The RVEF estimated by Simpson's method correlated strongly to that estimated by the radionuclide method (r = 0.793, r2 = 0.629, P < .0001). With mild or moderate TR, RV-Sm correlated well to RVEF (mild TR group: r = 0.765, r2 = 0.59, P < .0001; moderate TR group: r = 0.756, r2 = 0.57, P < .0001). RV-Sm had no significant correlation to RVEF in patients with severe TR (r = 0.212, r2 = 0.05, P = .167). Over a range of TR severities, the relationship between TAPSE and RVEF showed a similar trend to that between RV-Sm and RVEF. CONCLUSION Severe TR has a significant impact on the relationship between RV-Sm and RVEF and between TAPSE and RVEF. TAPSE and RV-Sm in patients with severe TR show poor correlation to RVEF. When applying Doppler tissue method or TAPSE to assess RV function, severe TR is a significantly confounding factor.
Collapse
Affiliation(s)
- Shih-Hung Hsiao
- Cardiovascular Center, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | | | | | | | | | | |
Collapse
|
40
|
D'Andrea A, D'Andrea L, Caso P, Scherillo M, Zeppilli P, Calabrò R. The usefulness of Doppler myocardial imaging in the study of the athlete's heart and in the differential diagnosis between physiological and pathological ventricular hypertrophy. Echocardiography 2006; 23:149-57. [PMID: 16445736 DOI: 10.1111/j.1540-8175.2006.00186.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Athlete's heart is a cardiac adaptation to long-term, intensive training, which includes changes as increased ventricular cavity diameters, wall thickness and mass, produced with a degree consistent with sports activities and exercise programs. The Doppler myocardial imaging (DMI) permits characterization of the velocities of each ventricular myocardial segment by placing the sample volume at the center of the cardiac muscle. Even if the standard two-dimensional (2D) echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercise, the data currently available suggests the usefulness of DMI in the assessment of the myocardial systolic and diastolic functions of the athlete's heart. In particular, an athlete's left ventricular hypertrophy is characterized by a "supernormal" DMI pattern, with increased myocardial early-diastolic velocity. Therefore, DMI analysis in the trained subject has demonstrated interesting prospective for: (1) the differential diagnosis from pathological, both, left and right ventricular hypertrophy; (2) the prediction of cardiac performance during physical effort; (3) the evaluation of the biventricular interaction; (4) the analysis of the myocardial adaptations to various training protocols; and (5) the early identification of specific genotypes associated with cardiomyopathies. On this ground, a combined use of standard 2D echo and DMI may be taken into account for a valid noninvasive and easy-repeatable evaluation of both physiological and pathological ventricular hypertrophies.
Collapse
|
41
|
D'Andrea A, Caso P, Cuomo S, Salerno G, Scarafile R, Mita C, De Corato G, Sarubbi B, Scherillo M, Calabrò R. Prognostic value of intra-left ventricular electromechanical asynchrony in patients with mild hypertrophic cardiomyopathy compared with power athletes. Br J Sports Med 2006; 40:244-50; discussion 244-50. [PMID: 16505082 PMCID: PMC2491996 DOI: 10.1136/bjsm.2005.022194] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential diagnostic tools and predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM) compared with power athletes. BACKGROUND the distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function. METHODS The study population comprised 70 young patients with HCM (mean (SD) age 29.4 (5.9) years) with mild septal hypertrophy (15-19 mm) and 85 age and sex matched athletes with septal thickness >12 mm, followed up for 44.4 (10.8) months. Using pulsed DMI, myocardial peak velocities, systolic time intervals, and myocardial intraventricular and interventricular systolic delays were measured in six different basal myocardial segments. RESULTS DMI analysis showed in HCM lower myocardial both systolic and early diastolic peak velocities of all the segments. Patients with HCM also showed significant interventricular and intraventricular delay (p<0.0001), whereas athletes showed homogeneous systolic activation of the ventricular walls. During the follow up, seven sudden deaths occurred in the HCM group, while no cardiovascular event was observed in the group of athletes. In patients with HCM, intraventricular delay on DMI was the most powerful independent predictor of sudden cardiac death (p<0.0001). An intraventricular delay >45 ms identified with high sensitivity and specificity patients with HCM at higher risk of ventricular tachycardia and cardiac events (test accuracy 90.6%). CONCLUSIONS DMI may be a valid supporting tool for the differential diagnosis between HCM and "athlete's heart". In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up. Accordingly, such patients may benefit from early intensive treatment and survey. MINIABSTRACT: Doppler myocardial imaging may represent a valid supporting tool for the differential diagnosis between mild hypertrophic cardiomyopathy (HCM) and "athlete's heart". In patients with HCM, DMI indexes of intraventricular delay may provide additional information for selecting subgroups of patients with HCM at increased risk of ventricular arrhythmias and sudden cardiac death at follow up.
Collapse
Affiliation(s)
- A D'Andrea
- Second University of Naples, Monaldi Hospital, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MSJ, Stewart WJ. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2006; 18:1440-63. [PMID: 16376782 DOI: 10.1016/j.echo.2005.10.005] [Citation(s) in RCA: 8599] [Impact Index Per Article: 477.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
43
|
Caso P, D'Andrea A, Caso I, Severino S, Calabrò P, Allocca F, Mininni N, Calabrò R. The athleteʼs heart and hypertrophic cardiomyopathy: two conditions which may be misdiagnosed and coexistent. Which parameters should be analysed to distinguish one disease from the other? J Cardiovasc Med (Hagerstown) 2006; 7:257-66. [PMID: 16645399 DOI: 10.2459/01.jcm.0000219318.12504.bb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
According to the statements from the International Cardiological Committees on Eligibility for Sports, athletes with a clinical diagnosis of hypertrophic cardiomyopathy (HCM) should be excluded from most competitive sports, with the possible exception of those of low intensity. Clinical distinctions between physiological athlete's heart and pathological conditions such as HCM have critical implications especially for trained athletes. Even if the standard two-dimensional echocardiography represents an irreplaceable method in the evaluation of cardiac adaptations to physical exercise, the data currently available suggest the usefulness of Doppler myocardial imaging (DMI) in the assessment of the myocardial systolic and diastolic function of the athlete's heart. On this ground, the combined use of standard two-dimensional echocardiography and DMI may be taken into account for a valid, non-invasive and easily repeatable evaluation of both physiological and pathological ventricular hypertrophy, and in selecting a subgroup of HCM patients at higher risk of cardiac events. In particular, DMI analysis in the trained individual has demonstrated an interesting opportunity for: (1) the differential diagnosis from pathological left ventricular hypertrophy due to HCM; (2) the prediction of cardiac performance during physical effort; (3) the evaluation of bi-ventricular interaction; (4) the analysis of myocardial adaptations to various training protocols; and (5) the early identification of specific genotypes associated with cardiomyopathies.
Collapse
Affiliation(s)
- Pio Caso
- U.O.C. di Cardiologia, Seconda Università di Napoli, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Arinc H, Gunduz H, Tamer A, Seyfeli E, Kanat M, Ozhan H, Akdemir R, Celebi H, Uyan C. Evaluation of Right Ventricular Function in Patients with Thyroid Dysfunction. Cardiology 2006; 105:89-94. [PMID: 16319454 DOI: 10.1159/000089855] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 10/04/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. PATIENTS AND METHODS 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. RESULTS Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. CONCLUSIONS Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.
Collapse
Affiliation(s)
- Huseyin Arinc
- Department of Cardiology, Izzet Baysal Medical Faculty, Abant Izzet Baysal University, Bolu, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Saccheri MC, Cianciulli TF, Konopka IV, Guerra JE, Acunzo RS, Serans DF, Lax JA, Prezioso HA, Vidal LA, Elizari MV. Utilidad del Doppler pulsado tisular en la detección precoz de anormalidades diastólicas en familiares de primer grado de pacientes con miocardiopatía hipertrófica familiar. Rev Esp Cardiol 2006. [DOI: 10.1157/13083648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
46
|
Lindqvist P, Waldenström A, Wikström G, Kazzam E. Right ventricular myocardial isovolumic relaxation time and pulmonary pressure. Pulsed Doppler tissue imaging in resurrection of Burstin's nomogram. Clin Physiol Funct Imaging 2006; 26:1-8. [PMID: 16398663 DOI: 10.1111/j.1475-097x.2005.00639.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Non-invasive assessment of pulmonary artery systolic pressure (PASP) has several limitations. As previously described by Burstin, the right ventricular (RV) isovolumic relaxation time (IVRt) is sensitive to changes in PASP. We therefore compared RV myocardial IVRt, derived by Doppler tissue imaging (DTI), with simultaneously measured invasive PASP. METHODS AND RESULTS Twenty-six consecutive patients (18 males, mean age 52 +/- 12 years, range 23-75) underwent a simultaneous Doppler echocardiography, including DTI, and cardiac catheterization examination for measurement of PASP and right atrial mean pressures. IVRt was measured using the myocardial velocities by pulsed DTI at both basal and mid cavity segments of the RV free wall. As diastolic time intervals are influenced by heart rate IVRt was corrected for heart rate (IVRt/RR%). A significant correlation was found between PASP and regional IVRt/RR% at both the basal (r = 0.42, P<0.05) and mid cavity segment (r = 0.71, P<0.001). Furthermore, when only patients with normal right atrial pressures (<7 mmHg) were taken into account, the correlation coefficient improved at both basal and mid cavity segments (r = 0.74, P<0.05 and r = 0.83, P<0.01). CONCLUSION Pulsed Doppler-derived IVRt correlates well with PASP. The use of pulsed DTI for measurement of IVRt is simple, reproducible and easy to obtain. We propose this method as an additional non-invasive tool in the assessment of PASP.
Collapse
Affiliation(s)
- Per Lindqvist
- Department of Cardiology, Heart Centre, University Hospital, Umeå, Sweden
| | | | | | | |
Collapse
|
47
|
D'Andrea A, Caso P, Severino S, Cuomo S, Capozzi G, Calabrò P, Cice G, Ascione L, Scherillo M, Calabrò R. Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy†. Eur Heart J 2005; 27:1311-8. [PMID: 16364972 DOI: 10.1093/eurheartj/ehi688] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM). The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function. METHODS AND RESULTS The study population included 123 HCM patients (39.4+/-5.9 years) and 123 age- and sex-matched healthy subjects, followed up for 48.4+/-8.8 months. By use of pulsed DMI, the following regional parameters were evaluated in six different basal myocardial segments: myocardial peak velocities and systolic time-intervals; myocardial intraventricular (intra-V-Del) and interventricular (inter-V-Del) systolic delays. DMI analysis in HCM showed lower myocardial systolic and early-diastolic peak velocities of all the segments. As for time intervals, HCM showed significant inter- and intra-V delays (P<0.0001), whereas homogeneous systolic activation of the ventricular walls was assessed in controls. During the follow-up, 16 cardiac deaths (12 sudden deaths) were observed in HCM patients. InHCM, DMI intra-V-Del was the most powerful independent predictor of sudden cardiac death (P<0.0001). In particular, an intra-V-Del>45 ms is identified with high sensitivity and specificity in HCM patients at higher risk of ventricular tachycardia and sudden cardiac death (test accuracy: 88.8%). CONCLUSION In HCM patients, DMI indexes of intra-V-Del may provide additional information for selecting subgroups of HCM patients at increased risk of ventricular arrhythmias and sudden cardiac death at follow-up. Accordingly, such patients may be more actively identified for early intensive treatment and survey.
Collapse
MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/pathology
- Case-Control Studies
- Death, Sudden, Cardiac/etiology
- Echocardiography, Doppler, Pulsed/standards
- Electrocardiography
- Female
- Follow-Up Studies
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/mortality
- Hypertrophy, Left Ventricular/pathology
- Male
- Observer Variation
- Prognosis
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/pathology
Collapse
Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Second University of Naples, Monaldi Hospital, Via G. Martucci 35, 80121 Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Chetboul V, Sampedrano CC, Gouni V, Concordet D, Lamour T, Ginesta J, Nicolle AP, Pouchelon JL, Lefebvre HP. Quantitative Assessment of Regional Right Ventricular Myocardial Velocities in Awake Dogs by Doppler Tissue Imaging: Repeatability, Reproducibility, Effect of Body Weight and Breed, and Comparison with Left Ventricular Myocardial Velocities. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02774.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
49
|
Lindqvist P, Caidahl K, Neuman-Andersen G, Ozolins C, Rantapää-Dahlqvist S, Waldenström A, Kazzam E. Disturbed Right Ventricular Diastolic Function in Patients With Systemic Sclerosis. Chest 2005; 128:755-63. [PMID: 16100164 DOI: 10.1378/chest.128.2.755] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cardiopulmonary involvement in patients with systemic sclerosis (SSc) carries a poor prognosis, mainly due to pulmonary hypertension and right-heart failure. To date, right ventricular (RV) involvement has not been studied in detail. We therefore assessed RV function in patients with SSc and related the findings to the clinical features of the disease. METHOD Twenty-six consecutive patients (21 women) with SSc (mean age, 56 +/- 15 years [+/- SD]) and 25 healthy, age-matched control subjects (21 women) were studied. Doppler echocardiography including Doppler tissue imaging was used to evaluate cardiac function. Pulmonary function was also studied. RESULTS Compared with control subjects, RV free wall thickness (5.8 +/- 1.7 mm vs 3.7 +/- 1.1 mm, p < 0.001) and right atrial (RA) systolic area (15.9 +/- 3.7 cm2 vs 13.0 +/- 2.3 cm2, p < 0.01) were increased in patients with SSc, while the global early diastolic/atrial component velocity ratio was reduced (1.2 +/- 0.4 vs 1.7 +/- 0.6, p < 0.01). The global isovolumic relaxation time (IVRT) [64 +/- 23 ms vs 39 +/- 13 ms, p < 0.001] and regional IVRT (83 +/- 40 ms vs 46 +/- 24 ms, p < 0.001) were prolonged in patients vs control subjects, whereas the RV global filling time was reduced (454 +/- 122 ms vs 548 +/- 104 ms, p < 0.01). RV systolic function and pulmonary pressures at rest were similar in the two groups, but the pulmonary artery acceleration time was reduced (119 +/- 34 ms vs 141 +/- 29 ms, p < 0.05) in patients compared to control subjects. Left ventricular function did not differ between the two groups. CONCLUSION Patients with SSc exhibit altered RV diastolic function together with an increase in RV wall thickness and RA area. These findings appear to be early markers of RV disturbance, probably in response to intermittent pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Per Lindqvist
- Department of Clinical Medicine, Umeå University Hospital, Umeå, Sweden
| | | | | | | | | | | | | |
Collapse
|
50
|
D'Andrea A, Caso P, Severino S, Scotto di Uccio F, Vigorito F, Ascione L, Scherillo M, Calabrò R. Association between Intraventricular Myocardial Systolic Dyssynchrony and Ventricular Arrhythmias in Patients with Hypertrophic Cardiomyopathy. Echocardiography 2005; 22:571-8. [PMID: 16060893 DOI: 10.1111/j.1540-8175.2005.40073.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM), which results in regional heterogeneity of LV systolic and diastolic function. The aim of the study was to evaluate LV regional systolic asynchrony in patients with HCM by pulsed Doppler myocardial imaging (DMI). METHODS We studied 35 HCM patients and 45 age- and sex-matched controls. By the use of DMI, the following five different basal myocardial segments were measured: systolic peak velocity (Sm); early- and late-diastolic peak velocities; pre-contraction time (Q-Sm) (from the beginning of Q-wave of ECG to the onset of Sm); intraventricular systolic delay (IntraV-Del) (difference of Q-Sm in different LV myocardial segments); interventricular delay (InterV-Del) (difference of Q-Sm between the most delayed LV segment and right ventricular lateral wall). RESULTS DMI analysis showed in HCM lower myocardial systolic and early-diastolic peak velocities of all the analyzed segments. As for time intervals, controls showed homogeneous systolic activation of the ventricular walls. Conversely, HCM group, despite the absence of intraventricular conduction defects by surface ECG, showed significant both Inter- and IntraV-Del (P < 0.0001). Linear regression models pointed out independent positive associations of IntraV-Del with LV outflow gradient and septal wall thickness in HCM (P < 0.001). An IntraV-Del >30 msec well differentiated controls and HCM. In addition, an IntraV-Del > 45 msec (ROC curve) identified a subgroup of HCM patients with nonsustained ventricular tachycardia during Holter monitoring (90.9% sensitivity and 95.8% specificity). CONCLUSIONS The impairment of intrarventricular systolic synchronicity is strongly related to increased septal thickness and LV outflow-tract gradient in HCM. DMI analysis may be able to select subgroups of HCM patients at an increased risk of ventricular tachyarrhythmias.
Collapse
MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Echocardiography, Doppler, Pulsed
- Electrocardiography, Ambulatory
- Female
- Humans
- Hypertrophy, Left Ventricular/complications
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Myocardial Contraction
- Tachycardia, Ventricular/complications
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnostic imaging
Collapse
|