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McErlane J, Glass A, Soosay A, McCall P, Shelley B. Feasibility of Strain Assessment of Right Ventricular Contractile Reserve in Patients Undergoing Lung Resection. J Cardiothorac Vasc Anesth 2024; 38:344-346. [PMID: 37827920 DOI: 10.1053/j.jvca.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Affiliation(s)
- James McErlane
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group,University of Glasgow, Glasgow, United Kingdom; Department of Anaesthesia, Golden Jubilee National Hospital, Clydebank, United Kingdom.
| | - Adam Glass
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group,University of Glasgow, Glasgow, United Kingdom; School of Anaesthesia, Northern Ireland Medical and Dental Training Agency, Belfast, United Kingdom
| | - Alvin Soosay
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group,University of Glasgow, Glasgow, United Kingdom; Department of Anaesthesia, Forth Valley Royal Hospital, Larbert,United Kingdom
| | - Philip McCall
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group,University of Glasgow, Glasgow, United Kingdom; Department of Anaesthesia, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Ben Shelley
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group,University of Glasgow, Glasgow, United Kingdom; Department of Anaesthesia, Golden Jubilee National Hospital, Clydebank, United Kingdom
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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Tun HN, Almaghraby A, Kavalerchyk V, Muraru D, Soliman-Aboumarie H, Abdelnabi M. Acute Right Ventricular Failure: Pathophysiology, Diagnostic Approach with Emphasis on the Role of Echocardiography. Curr Cardiol Rev 2023; 19:e060223213452. [PMID: 36748814 PMCID: PMC10494269 DOI: 10.2174/1573403x19666230206115611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 02/08/2023] Open
Abstract
Right ventricular function is one of the important predictors of survival in heart failure patients. In the past, there has been only limited knowledge regarding right-sided heart failure when compared to left-sided failure. However, there are more emerging data in recent years, and several studies have emphasized the unique features of the right ventricle regarding its anatomy, pathophysiology, clinical consequences, diagnostic modalities, and treatment options. Despite that, management of acute right ventricular failure is still challenging. This article summarizes an overview of acute right heart failure including pathophysiology, causes, clinical features, and diagnostic work-up with emphasis on the role of echocardiography.
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Affiliation(s)
- Han Naung Tun
- Larner College of Medicine’s UVM Medical Centre, University of Vermont, Burlington, Vermont, 05405, USA
| | - Abdallah Almaghraby
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Denisa Muraru
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan 20149, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Clinical Group, Guy’s and St Thomas NHS Foundation Trust, Hill End Road, Uxbridge, London UB9 6JH, UK
| | - Mahmoud Abdelnabi
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Lange TJ, Borst M, Ewert R, Halank M, Klose H, Leuchte H, Meyer FJ, Seyfarth HJ, Skowasch D, Wilkens H, Held M. [Current Aspects of Definition and Diagnosis of Pulmonary Hypertension]. Pneumologie 2020; 74:847-863. [PMID: 32663892 DOI: 10.1055/a-1199-1548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.
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Affiliation(s)
- T J Lange
- Uniklinik Regensburg, Klinik für Innere Medizin II, Bereich Pneumologie, Regensburg
| | - M Borst
- Medizinische Klinik I, Caritas-Krankenhaus, Bad Mergentheim
| | - R Ewert
- Pneumologie, Uniklinik Greifswald, Greifwald
| | - M Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Pneumologie, Hamburg
| | - H Leuchte
- Klinik der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Lehrkrankenhaus der LMU München, München
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik gGmbH, München
| | - H-J Seyfarth
- Bereich Pneumologie, Universitätsklinikum Leipzig, Leipzig
| | - D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik II, Sektion Pneumologie, Bonn
| | - H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - M Held
- Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg
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Jin Y, Gao Y, Hou R, Cong S. Evaluation of left ventricular myocardial movement in rats by velocity vector imaging. PLoS One 2020; 15:e0239869. [PMID: 33006976 PMCID: PMC7531783 DOI: 10.1371/journal.pone.0239869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To use velocity vector imaging (VVI) technology to evaluate the correlation between the apical four-chamber view and short-axis myocardial movement in rats. METHODS We used 25 10-week-old male Sprague-Dawley rats to measure the myocardium peak systolic velocity (Vs; cm/s), peak diastolic velocity (Vd; cm/s), peak systolic strain (SR; %), peak systolic strain rate (SRs; 1/s), and peak diastolic strain rate (SRd; 1/s) from the apical four-chamber view of the left ventricle (LV) and the parasternal mitral valve (PMV)-level short-axis view, and to analyze the correlation between myocardial motion in corresponding views of the two sections. RESULTS Comparing the myocardial motion between the lateral wall's basal segment in the apical four-chamber view of the LV and the lateral wall of the PMV-level short-axis view revealed that the Vd was positively correlated (r = 0.59, p<0.01), as was SRs (r = 0.68, p<0.05). Comparing the myocardial motion between the lateral wall's middle segment in the apical four-chamber view of the LV and the lateral wall of the PMV-level short-axis view demonstrated that Vd, SRs, and SRd were positively correlated (r = 0.63, 0.82, 0.79, respectively, all p<0.01). Our comparison of myocardial motion between the posterior septum's basal segment in the apical four-chamber view of the LV and the posterior septum of PMV-level short-axis view showed that Vd and SRs were positively correlated (r = 0.57, 0.68, respectively, both p<0.01). Comparing the myocardial motion between the posterior septum's middle segment in the apical four-chamber view of the LV and the posterior septum of the PMV-level short-axis view revealed that Vs, Vd, SR, and SRd were positively correlated (r = 0.89, 0.63, 0.64, 0.6, respectively, all p<0.01), and the SRs also had a significant positive correlation (r = 0.53, p<0.05). CONCLUSION VVI technology could be a valuable tool for evaluating the myocardial walls motion of the apical four-chamber view of the rat LV.
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Affiliation(s)
- Yuetong Jin
- Department of Ultrasound, The Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Yihua Gao
- Department of Ultrasound, The Affiliated Hospital of Yanbian University, Yanji, Jilin, China
- * E-mail:
| | - Rui Hou
- Department of Ultrasound, General Hospital of Tianjin Medical University, Tianjin, Tianjin, China
| | - Shanshan Cong
- Department of Ultrasound, The Affiliated Hospital of Yanbian University, Yanji, Jilin, China
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D'Andrea A, Stanziola AA, Saggar R, Saggar R, Sperlongano S, Conte M, D'Alto M, Ferrara F, Gargani L, Lancellotti P, Bossone E. Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study. Chest 2018; 155:297-306. [PMID: 30543808 DOI: 10.1016/j.chest.2018.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/30/2018] [Accepted: 11/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF. METHODS Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed. RESULTS At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (ΔPAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (ΔRV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and ΔRV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo2; P < .0001). Δ RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001). CONCLUSIONS RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic.
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Affiliation(s)
- Antonello D'Andrea
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy.
| | - Anna Agnese Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rajan Saggar
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rajeev Saggar
- Department of Medicine, University of Arizona, Phoenix, AZ
| | - Simona Sperlongano
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Marianna Conte
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Michele D'Alto
- Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," A.O. dei Colli Monaldi Hospital, Naples, Italy
| | - Francesco Ferrara
- Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast' Hospital, University Hospital, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège, University Hospital Sart Tilman, Liège, Belgium
| | - Eduardo Bossone
- Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast' Hospital, University Hospital, Salerno, Italy
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Bagheri RK, Ahmadi M, Alimi H, Valaee L, Sahranavard T, Andalibi MSS. Dobutamine stress-induced ischemic right ventricular dysfunction in patients with three-vessel coronary artery disease. Electron Physician 2018; 10:6775-6780. [PMID: 29997761 PMCID: PMC6033131 DOI: 10.19082/6775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/04/2018] [Indexed: 11/20/2022] Open
Abstract
Background Dobutamine stress echocardiography (DSE) is a non-invasive technique to detect coronary artery diseases (CAD). There are limited studies on evaluation of the right ventricular function by stress echocardiography. The appropriate evaluation of RV function and early diagnosis of its failure can help to improve outcomes for the patients undergoing cardiac surgery. Objective To determine right ventricular dysfunction in patients with three-vessel CAD by using DSE. Methods This cross-sectional study was among 13 patients who were candidates for coronary artery bypass grafting (CABG) referred to Ghaem Hospital, Mashhad, Iran; from September 2015 to May 2016. After a physical examination and initial measures, DSE was performed and echocardiographic parameters were recorded by a cardiologist. Paired-samples t-test was performed using SPSS Software v.16.0 for data analysis. Results The study included 13 patients (9 males) with a mean age of 65.4±7.6 years. The mean of TAPS was 16.9±4.5 mm and 15.7±2.9 mm before and after stress echocardiography, respectively (p=0.69). Systolic right ventricular (SRV) peak increased from before DSE compared with after DSE (8.0±2.2 vs. 13.7±4.2 mm/s, p<0.001). In addition, after dobutamine injection, right ventricular (RV) cardiac output decreased in 7 patients and one patient was affected by post-ejection shortening. Conclusion It seems that TAPS and RV cardiac output after injection of dobutamine, can be used as markers for the recognition of ischemic RV dysfunction.
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Affiliation(s)
- Ramin Khameneh Bagheri
- Cardiologist, Assistant Professor, Cardiovascular Research Center, Department of Cardiology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Ahmadi
- Cardiologist, Assistant Professor, Cardiovascular Research Center, Department of Cardiology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedyeh Alimi
- Cardiologist, Assistant Professor, Cardiovascular Research Center, Department of Cardiology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Laya Valaee
- M.D., Resident of Cardiology, Cardiovascular Research Center, Student Research Committee, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktam Sahranavard
- M.D., Cardiovascular Research Center, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Sobhan Sheikh Andalibi
- M.D., Cardiovascular Research Center, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 11/15/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Chia EM, Lau EMT, Xuan W, Celermajer DS, Thomas L. Exercise testing can unmask right ventricular dysfunction in systemic sclerosis patients with normal resting pulmonary artery pressure. Int J Cardiol 2015; 204:179-86. [PMID: 26681539 DOI: 10.1016/j.ijcard.2015.11.186] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/21/2015] [Accepted: 11/28/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a frequent complication of systemic sclerosis (SSc). Diagnosis usually occurs late and often after the development of irreversible right heart dysfunction. Exercise testing is increasingly used for assessing right ventricular (RV) function when resting hemodynamics do not account for symptoms. We hypothesized that SSc patients without resting pulmonary hypertension could have impaired exercise capacity and RV contractile reserve with exercise thus unmasking early RV dysfunction and pulmonary vascular disease. METHODS Treadmill exercise stress echocardiography with concurrent expired gas analysis was performed in 25 SSc patients with normal resting pulmonary arterial pressure (PAP) and healthy controls (n = 50). Additionally, controls and SSc patients were compared to those with established PAH (n = 23). Parameters of RV systolic function (RV fractional area change (FAC), Doppler tissue (DTI) s' velocity, systolic strain and strain rate (S-Sr)) were evaluated at baseline and post-exercise with the difference (Δ) being contractile reserve. RESULTS RV contractile reserve was reduced in the SSc group with normal resting PAP, compared with healthy controls (Δs': 6.1 ± 2.3 vs 8.0 ± 2.2 cm s(-1), p < 0.001; and ΔS-Sr: 2.3 ± 0.5 vs 2.6 ± 0.2s(-1), p = 0.02) in association with a significantly higher mean PAP with exercise (25.5 ± 6.6 vs 19.9 ± 7.2 mmHg, p < 0.001). PAH patients demonstrated the lowest levels of contractile reserve (Δs', Δ strain, ΔS-Sr and ΔFAC, all p < 0.05). CONCLUSION Exercise stress testing unmasks reduced RV contractile reserve in SSc patients with normal resting PAP. Subclinical RV dysfunction during exercise may be a surrogate for early pulmonary vascular disease in SSc patients.
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Affiliation(s)
| | - Edmund M T Lau
- Pulmonary Hypertension Service, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Wei Xuan
- Liverpool Hospital, Sydney, Australia
| | - David S Celermajer
- Pulmonary Hypertension Service, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Liza Thomas
- Liverpool Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia.
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Kossaify A. Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber. Clin Med Insights Cardiol 2015; 9:65-75. [PMID: 26244034 PMCID: PMC4493918 DOI: 10.4137/cmc.s27462] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/02/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber. OBJECTIVE We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography. METHODS A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed. RESULTS A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S') <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography. CONCLUSION Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.
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Affiliation(s)
- Antoine Kossaify
- Echocardiography unit, cardiology division, University Hospital Notre Dame de Secours, Byblos, Lebanon
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D'Andrea A, Stanziola A, Di Palma E, Martino M, D'Alto M, Dellegrottaglie S, Cocchia R, Riegler L, Betancourt Cordido MV, Lanza M, Maglione M, Diana V, Calabrò R, Russo MG, Vannan M, Bossone E. Right Ventricular Structure and Function in Idiopathic Pulmonary Fibrosis with or without Pulmonary Hypertension. Echocardiography 2015; 33:57-65. [DOI: 10.1111/echo.12992] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Anna Stanziola
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Enza Di Palma
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Maria Martino
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Michele D'Alto
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | | | - Rosangela Cocchia
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Lucia Riegler
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | | | - Maurizia Lanza
- Division of Pneumology; Federico II University; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Marco Maglione
- Global Marketing US Cardio - Esaote Ultrasound Technology; Florence Italy
| | - Veronica Diana
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Raffaele Calabrò
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Maria Giovanna Russo
- Department of Cardiology; Second University of Naples; Monaldi Hospital; “dei Colli - Monaldi” Hospitals; Naples Italy
| | - Mani Vannan
- Department of Cardiovascular Medicine; Piedmont Heart Institute; Atlanta Georgia
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery; “San Giovanni di Dio e Ruggi d'Aragona” University Hospital; Salern Italy
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Choi EY. Accurate and reproducible measurements of right ventricular function in daily practice. J Cardiovasc Ultrasound 2014; 22:111-2. [PMID: 25309686 PMCID: PMC4192407 DOI: 10.4250/jcu.2014.22.3.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Hasan BS, Lunze FI, Chen MH, Brown DW, Boudreau MJ, Rhodes J, McElhinney DB. Effects of Transcatheter Pulmonary Valve Replacement on the Hemodynamic and Ventricular Response to Exercise in Patients With Obstructed Right Ventricle-to-Pulmonary Artery Conduits. JACC Cardiovasc Interv 2014; 7:530-42. [DOI: 10.1016/j.jcin.2014.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/20/2014] [Accepted: 02/13/2014] [Indexed: 01/28/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Vitarelli A, Cortes Morichetti M, Capotosto L, De Cicco V, Ricci S, Caranci F, Vitarelli M. Utility of strain echocardiography at rest and after stress testing in arrhythmogenic right ventricular dysplasia. Am J Cardiol 2013; 111:1344-50. [PMID: 23411103 DOI: 10.1016/j.amjcard.2013.01.279] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 01/05/2023]
Abstract
The introduction of speckle tracking imaging (STI) allowed the quantification of the regional myocardial function in the right ventricular (RV) free wall using deformation parameters. We sought to evaluate the potential utility of STI at rest and after stress to predict arrhythmogenic RV dysplasia (ARVD). We studied 19 patients with ARVD (diagnosed according to the task force criteria) and 19 healthy age- and gender-matched subjects. Both 2-dimensional and 3-dimensional echocardiography were performed. The RV and left ventricular annular peak systolic velocities were measured using tissue Doppler imaging. The RV-left ventricular peak systolic longitudinal strain (LS) was obtained in the basal, mid, and apical segments in the apical 4-chamber view using STI. An exercise stress-echocardiographic test was undertaken using bicycle ergometry with the patient in the supine position for all patients, and the indexes were assessed at peak effort. The STI measurements were determined using offline analysis programs. The 3-dimensional RV ejection fraction and strain were significantly lower in patients with ARVD than in the controls. The RV strain values at rest did not change significantly during maximum physical effort in the patients with ARVD. The receiver operating characteristic curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the detection of ARVD were 9.35 cm/s for the RV annular peak systolic velocity (area under the curve 0.81), 42% for 3-dimensional RV ejection fraction (area under the curve 0.85), -25% for mean global RV-LS (area under the curve 0.86), -18% for the lowest peak systolic RV-LS (area under the curve 0.88), and -1.2 for peak minus baseline global change of stress RV-LS (area under the curve 0.92). In conclusion, STI at rest and during stress might enable quantitative assessment of RV function and the detection of ARVD and have potential clinical value in the treatment of these patients.
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La Gerche A, Burns AT, D’Hooge J, MacIsaac AI, Heidbüchel H, Prior DL. Exercise Strain Rate Imaging Demonstrates Normal Right Ventricular Contractile Reserve and Clarifies Ambiguous Resting Measures in Endurance Athletes. J Am Soc Echocardiogr 2012; 25:253-262.e1. [DOI: 10.1016/j.echo.2011.11.023] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Indexed: 11/24/2022]
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Velasco-Sanchez D, Lambert R, Turpin S, Laforge S, Fournier A, Lapierre C, Dahdah N. Right ventricle myocardial perfusion scintigraphy: feasibility and expected values in children. Pediatr Cardiol 2012; 33:295-301. [PMID: 21968577 DOI: 10.1007/s00246-011-0128-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/12/2011] [Indexed: 11/24/2022]
Abstract
Stress myocardial perfusion scintigraphy imaging (SMPSI) has important applications for evaluating coronary disease and ventricular function. Studies consistently focus on the left ventricle (LV), with no normal right ventricle (RV) data available. This study sought to evaluate the feasibility of RV perfusion with technetium (Tc-99m) sestamibi using a low radiotracer dose for children free of coronary artery (CA) anomalies and to determine its normal pattern. Patients with a history of Kawasaki disease who showed no coronary complications on selective angiography or no LV perfusion defects on SMPSI were studied at rest and during an exercise challenge. The RV uptake counts were compared with those for different segments of the LV, and multiple ratios of the uptakes between RV and LV segments were calculated. The study subjects were 23 children (age, 11.1 ± 3.3 years) imaged with 0.12 ± 0.03 mCi/kg at rest and 0.31 ± 0.06 mCi/kg during stress. The RV to LV uptake proportion was approximately 6%. Exercise-related uptake increased threefold in both the RV and the LV. The findings showed RV myocardial scintigraphy to be feasible with reproducible ratios. Potential clinical applications include acquired and congenital CA anomalies such as Kawasaki disease, right CA ostium stenosis after a switch operation, and anomalous origin of the right CA.
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