Ratio of right to left ventricular ejection: a pilot study using Doppler to detect interventricular dyssynchrony.

Background: Chronic pulmonary hypertension (cPH) is known to delay maximal right ventricular (RV) deformation, causing mechanical dyssynchrony, which previously has been identified only through the use of myocardial tissue Doppler imaging. However, alterations between RV and left ventricular (LV) ejection should be easily identified during routine echocardiographic examinations.

Hypothesis: We hypothesized that assessment of differences in ejection fraction between left and right ventricles would be detected using pulsed Doppler.

Right ventricular apical contractility in acute pulmonary embolism: the McConnell sign revisited.

Background: The McConnell sign has been regarded as a highly specific echo finding in acute pulmonary embolism (aPE). However, a completely satisfying explanation to account for this observation in aPE remains elusive. We used longitudinal velocity vector imaging (VVI) using a dedicated software program (Research Arena, Siemens, California) to assess regional right ventricular global and apical (RVa) mechanics between aPE and chronic pulmonary hypertension (cPH) patients.

Pulmonary hypertension affects left ventricular basal twist: a novel use for speckle-tracking imaging.

Background: Chronic pulmonary hypertension (PH) results in right ventricular (RV) mechanical dyssynchrony. However, its effects on left ventricular (LV) mechanics have not been examined.

Objective: Since speckle-tracking echocardiography (STE) is a novel approach to quantify LV dyssynchrony; we decided to use STE to assess the effect of PH on LV mechanics.

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.

Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures.

Assessment of right ventricular (RV) systolic function can be somewhat difficult, particularly in pulmonary hypertension (PH). RV fractional area change (FAC) and tricuspid valve annular motion (TAPSE) although useful in the assessment of RV performance, their use can be sometimes limited and tedious. Thus, a quicker but yet reliable alternative is needed.

Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class.

Background: Abnormalities in right ventricular function are known to occur in patients with pulmonary arterial hypertension.

Objective: Test the hypothesis that chronic elevation in pulmonary artery systolic pressure delays mechanical activation of the right ventricle, termed dyssynchrony, and is associated with both symptoms and right ventricular dysfunction.

Methods: Fifty-two patients (mean age 46 +/- 15 years, 24 patients with chronic pulmonary hypertension) were prospectively evaluated using several echocardiographic parameters to assess right ventricular size and function.

Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging.

Several well-established echocardiographic parameters used in the assessment of right ventricular (RV) performance, as well as tissue Doppler imaging (TDI) to investigate RV free wall mechanical events, were prospectively obtained from a heterogenous group of 20 patients with varying degrees of pulmonary hypertension (mean age 51 +/- 13 years; World Health Organization class average 2.8, mean pulmonary systolic pressure 78 +/- 24 mm Hg) and compared with similar data retrospectively obtained from 20 healthy volunteers (mean age 45 +/- 15 years). Patients with varying degrees of pulmonary hypertension had worse RV performance parameters than healthy volunteers (RV fractional area change 37 +/- 13% vs 52 +/- 5%, p < 0.

The importance of increased interatrial septal thickness in patients with atrial fibrillation: a transesophageal echocardiographic study.

Background: Histological studies in animal models have showed that extensive atrial fibrosis or fatty deposition as a result of loss of atrial cardiomyocytes increases the propensity to develop atrial fibrillation (AF). Although several reports have suggested that AF in humans may be a consequence of these mechanisms, no study has correlated the presence of AF with interatrial septal thickness (IAST).

Methods: Accordingly, we conducted a prospective analysis in 150 consecutive patients referred for transesophageal echocardiography (TEE) for numerous medical reasons.

Large atrial appendage thrombus in the presence of severe mitral regurgitation: contradictory hemodynamics or expected findings.

A case of a large left atrial appendage thrombus in the presence of severe mitral regurgitation is presented. The use of transesophageal echocardiography in this setting was not only useful but also crucial despite the low anticipated diagnostic yield given the expected altered left atrial flow dynamics from the turbulent regurgitant lesion. However, additional confounding factors could have acted as potential mechanisms to enhance thrombosis in this setting and consequently are discussed.