Differences in the duration of total ejection between right and left ventricles in chronic pulmonary hypertension.

Background: Chronic pulmonary hypertension (cPH) is known to delay pulmonic valve closure resulting in a closely split second heart sound. We decided to measure total duration of right (RV) and left ventricular (LV) outflow tract (RVOT and LVOT) spectral signals using pulsed Doppler to determine if this approach was useful in identifying this narrowing in auscultation that should then result in a shorter temporal difference between the ejection of both ventricles.

Methods: Standard measures of RV and LV performance as well as Doppler data was collected from 85 patients divided into two groups according to their estimated pulmonary artery systolic pressure obtained at the time of their echocardiographic examination.

The effect of chronic pulmonary hypertension on diastolic annular tissue velocities: a pilot study.

Background: Tissue Doppler imaging (TDI) of mitral (MA) and tricuspid annular (TA) events has been shown to describe systolic and diastolic properties of each respective ventricle. However, the effect of chronic elevations in pulmonary artery systolic pressure (PASP) on individual diastolic annular velocities has not been well characterized.

Methods: Measurements of left (LV) and right ventricular (RV) performance and TDI of the lateral MA and TA to measure systolic and early and late diastolic velocities were recorded from 50 individuals (group I: mean age was 56 ± 15 years and mean PASP of 29 ± 6 mm Hg) and from 50 patients (group II: mean age was 55 ± 14 years and mean PASP of 83 ± 27 mm Hg).

Chronic pulmonary hypertension shortens the duration of mitral annular systolic and diastolic tissue Doppler signals.

Some data suggests that both left ventricular (LV) systolic and diastolic function are impaired in patients with chronic pulmonary hypertension (cPH); however, a clear understanding of these specific abnormalities remains poorly characterized. LV systolic and diastolic function as well as LV myocardial performance index (MPI) were obtained and compared to total duration of mitral annular (MA) TDI systolic (MASTDId) and diastolic (MADTDId) measurements, corrected for heart rate, in 20 controls (Group I: mean 53 ± 18 years) and 30 patients (Group II: mean 55 ± 14 years) with cPH. Group II patients had relatively faster heart rates (75 ± 14 bpm vs.

Normal parameters of right ventricular mechanics with exertion in healthy individuals: a tissue Doppler imaging study.

Introduction: Tissue Doppler imaging (TDI) has been a useful tool to evaluate of resting right ventricular (RV) function; however, the response of the RV to exercise has not been well established. This study attempts to determine RV mechanics at rest and immediately after exercise in healthy subjects using TDI and to define normal values.

Methods: The authors studied 30 patients (mean age: 46 ± 14 years) who underwent a treadmill stress echocardiogram and had a normal exercise response without cardiac abnormalities.

New annular tissue Doppler markers of pulmonary hypertension.

Background: Tissue Doppler imaging (TDI) of mitral (MA) and tricuspid annulus (TA) events characterizes systolic and diastolic properties of each respective ventricle. However, the effect of chronic pulmonary hypertension (cPH) on these TDI annular events has not been well described.

Methods: Measurements of right ventricular (RV) performance with TDI of the lateral mitral and tricuspid annuli, to measure isovolumic contraction (IVC) and systolic (S) signals were recorded from 50 individuals without PH and from 50 patients with cPH.

Apical systolic eccentricity index: a better marker of right ventricular compromise in pulmonary hypertension.

Background: Systolic eccentricity index (sEI) has been traditionally measured at the papillary muscle (PM) level. However, this measurement does not take into account the remodeling that occurs in the right ventricle (RV) during chronic pulmonary hypertension (cPH).

Methods: Standard echocardiographic data were collected on 50 patients (age 58 + or - 14 years) with known cPH (74 + or - 22 mmHg; range 45-120 mmHg) who had adequate short-axis views at the mitral valve (MV), PM, and apical (AP) levels to measure sEI.

Right ventricular outflow tract spectral signal: a useful marker of right ventricular systolic performance and pulmonary hypertension severity.

Aims: Right ventricular outflow tract (RVOT) acceleration shortens with chronic pulmonary hypertension (cPH). However, the overall value of this spectral Doppler signal in the assessment of PH patients is not well understood.

Methods And Results: Markers of RV systolic performance, time to onset, time to peak, and total duration of the RVOT systolic spectral Doppler signal were examined.

Altered early left ventricular diastolic wall velocities in pulmonary hypertension: a tissue Doppler study.

Background: Left ventricular diastolic dysfunction (LVDD) is known to occur in severe chronic pulmonary hypertension (PH); however, the mechanism(s) remains unclear.

Methods: Tissue Doppler imaging (TDI) was used to track early (E) diastolic signals of basal and mid portions of the interventricular septum (IS) and LV free wall (LVFw) in 20 patients (60 +/- 8 years) with documented LVDD without PH and in 30 patients (60 +/- 11 years) with known chronic PH. All subjects were in normal sinus rhythm and had normal LV ejection fraction.

Normal range of mechanical variables in pulmonary hypertension: a tissue Doppler imaging study.

Background: Tissue Doppler imaging (TDI) has been quite useful in determining the mechanical properties of right ventricular (RV) function in patients with pulmonary hypertension (PH). However, to what extent these mechanical properties are expected to identify RV dysfunction in PH patients is less clear.

Methods: Our echocardiography database was queried for patients with PH of different etiologies (111 patients, age 55 +/- 14 years, mean pulmonary artery pressure 63 +/- 24 mmHg) who had undergone TDI analysis and compared to similarly collected data from a group of healthy individuals (35 patients, mean age 45 +/- 15 years, mean pulmonary artery pressure 27 +/- 5 mmHg).

A delayed time of the peak tricuspid regurgitation signal: marker of right ventricular dysfunction.

Background: Worsening degrees of tricuspid regurgitation (TR) have been associated with worse outcomes. We investigated the time it takes for the TR jet to attain its maximum peak (tmpTR) with measures of right ventricular (RV) function.

Methods: Several echocardiographic variables of RV size and function and tmpTR corrected for heart rate were collected from 140 patients (mean age 57 +/- 20 years).

Evidence of robust coupling of atrioventricular mechanical function of the right side of the heart: insights from M-mode analysis of annular motion.

Background: Extensive data exist regarding annular descent and ventricular function. We have already demonstrated significant differences in amplitude and timing of events between maximal mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion as well as described quantitative temporal differences in annular ascent (AA) between the right and left sides of the heart. However, whether any relationship exists between annular ascent and descent components remains uninvestigated.

Quadricuspid aortic valve: an unusual echocardiographic finding and a review of the literature.

This case report presents a rare clinical finding of an isolated quadricuspid aortic valve in an otherwise healthy 24-year-old female who was referred for cardiac evaluation due to newly identified murmur. A transthoracic echocardiogram suggested an unusual case of a bicuspid aortic valve with two raphes with normal opening and mild aortic regurgitation. This case exemplified that caution should be taken when encountering circumstances like the one presented, as the aortic valve anatomy might be mistaken based on a new proposed classification for bicuspid aortic valves recently published.

Delayed tricuspid valve ascent and descent components in pulmonary hypertension.

Even though pulmonary hypertension (PH) results in right ventricular (RV) dilatation and contractile dysfunction; the exact mechanism(s) remain to be identified. RV fractional area change (RVFAC), right atrial (RA) areas, tricuspid annular plane systolic excursion (TAPSE), and systolic (sEI) eccentricity index were measured in 19 PH patients and 11 individuals without PH. Furthermore, time to maximal peak (tmp) TV annular ascent and descent intervals were obtained and corrected for heart rate.

Abnormal right ventricular myocardial strain generation in mild pulmonary hypertension.

Background: Although right ventricular (RV) dyssynchrony has been identified in patients with severe pulmonary hypertension due to significant RV enlargement and compromise in systolic function, a more clinically relevant question pertains to RV mechanical properties in patients with mild elevation in pulmonary artery systolic pressures (PASP).

Methods: Several echocardiographic parameters and peak longitudinal strain were measured in 40 patients and divided into two groups of 20 patients based on their PASP.

Results: Group I included 20 individuals (mean age 48 +/- 16 years with a mean PASP of 27 +/- 5 mmHg) and Group II included 20 patients (mean age 63 +/- 14 years with a mean PASP of 49 +/- 7 mmHg.

Comparative echocardiographic analysis of mitral and tricuspid annular motion: differences explained with proposed anatomic-structural correlates.

Background: Annular motion (AM) has been shown to occur during all dynamic phases of the cardiac cycle; but little is known regarding comparisons between mitral and tricuspid AM. We elected to use M-mode to examine the extent and timing of mitral and tricuspid AM events.

Methods: A complete echocardiogram was obtained in 50 patients [mean age 53 +/- 16 years, mean left ventricular ejection fraction (LVEF) 57 +/- 19%, and mean right ventricular fractional area change (RVFAC) of 49 +/- 20%].

Right ventricular systolic function is not the sole determinant of tricuspid annular motion.

Maximal tricuspid annular plane systolic excursion (TAPSE) correlates well with right ventricular (RV) function; however, little is known regarding the impact of left ventricular (LV) systolic function on TAPSE. Consequently, TAPSE was examined in 206 patients (105 men; mean age 56 +/- 17 years), and the data were analyzed with respect to RV (RV fractional area change 45 +/- 19%) and LV (56 +/- 17%) systolic function. The mean TAPSE for the population studied was 1.

Constrictive pericarditis: an unusual clinical entity suggested during dobutamine stress echocardiography.

A 44-year-old female presents with disabling dyspnea and is unable to perform a regular treadmill stress test; instead a dobutamine stress echocardiogram is performed and although negative for ischemia reveals a vigorous paradoxical motion of the interventricular septum with dilatation of the inferior vena cava without respiratory variation and an increased diastolic flow signal in the hepatic veins after expiration with the infusion of dobutamine. The diagnosis of constrictive physiology is confirmed with cardiac magnetic resonance imaging (MRI) and right heart hemodynamics and the patient underwent pericardiectomy without complications with resolution of symptoms.