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Right heart function in health and disease: a doppler echocardiography and doppler tissue imaging study
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Högersidig hjärtfunktion hos hjärtfriska och vid hjärtpåverkan : en studie i Doppler ekokardiografi och vävnadsDoppler (Swedish)
Abstract [en]

Background: It is well known that performance of the right ventricle (RV) determines exercise capacity and may confer prognostic information in different cardiopulmonary diseases. To allow optimal patient management, ideal methods to assess right heart function are therefore important. Echocardiography is an attractive investigation for that purpose, although limited by the anatomical and functional complexities of the RV.

The aim of the present thesis was to present applicable methods useful in clinical practice by traditional 2D/Doppler echocardiography and Doppler tissue imaging (DTI) in the assessment of global and regional RV function in both health and disease.

Methods: The studies were performed on 4 different groups; (1) 255 healthy subjects (125 females), (2) 92 consecutive patients with different cardiac diseases (36 females), (3) 26 patients with systemic sclerosis, (SSc) (21 females) and (4) 26 consecutive patients with heart failure (8 females) undergoing cardiac catheterisation.

Results: RV outflow tract fractional shortening (RVOT fs), which is a new method in the assessment of RV function, correlated significantly with RV systolic long axis motion (r= 0.66, p< 0.001), pulmonary artery acceleration time (r= 0.80, p< 0.001) and RV-right atrial peak systolic pressure drop gradient (r= -0.53, p< 0.001). Furthermore, RVOT fs was reduced in patients with pulmonary hypertension whereas RV systolic long axis motion was not in difference. This finding was confirmed after comparing RV function with invasive pressures. In healthy subjects, while the systolic myocardial velocities were preserved over age, the peak isovolumic contraction velocity (IVCv) was weakly increased with advanced age (r= 0.34, p< 0.01). Furthermore, both global and regional E/A ratios were reduced (r= -0.57, r= -0.67, p< 0.001 for both) with age whereas no alteration was found in the myocardial isovolumic relaxation time (IVRt). In patients with systemic sclerosis (SSc) both global (64± 23 vs. 39± 12 ms, p< 0.001) as well as regional (83± 40 vs. 46± 24 ms, p< 0.001) IVRt were prolonged. After evaluating echocardiographic parameters with invasive pressures we found a significant correlation between DTI derived IVRt and pulmonary artery systolic pressures (r= 0.83, p< 0.01) while the IVCv was related to the state of contractility (r= 0.77, p< 0.001). Furthermore, an IVCv below 6 cm/s was shown to be an accurate marker of increased right atrial pressure (>6 mm Hg).

In conclusion, RVOT fs can be used as a complementary measurement of RV systolic function, being more sensitive to elevated pulmonary artery systolic pressures than the systolic longitudinal RV motion. Right heart function, mainly the diastolic function, is relatively weakly influenced by age compared to the left heart function. In patients with SSc, we found diastolic disturbances, including a prolonged IVRt and proposed the findings to be early markers related to intermittent pulmonary hypertension. This observation was strengthened after evaluating IVRt against invasive pulmonary artery systolic pressures. IVCv can be used to determine the state of RV contractility and also be used to identify patients with elevated filling pressures. The presented methods can be used to detect early signs of RV dysfunction which might prohibit right heart failure. All presented methods are non-invasive, reproducible, easy obtainable, and thus useful in clinical practice.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2005. , 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 937
Keyword [en]
Medicine, Echocardiography, Doppler tissue imaging, right ventricle, cardiac catheterisation, isovolumic relaxation, isovolumic contraction
Keyword [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-392ISBN: 91-7305-787-8 (print)OAI: oai:DiVA.org:umu-392DiVA: diva2:143362
Public defence
2005-01-28, Sal D, Tandläkarhuset, 901 85, UMEÅ, 09:00 (English)
Opponent
Supervisors
Available from: 2005-01-05 Created: 2005-01-05 Last updated: 2009-11-24Bibliographically approved
List of papers
1. Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function.
Open this publication in new window or tab >>Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function.
2003 (English)In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 4, no 1, 29-35 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Assessment of right ventricular function is important. However, this is not easy to achieve due to the complex anatomy and geometry of the right ventricle, making the evaluation of its function limited. Therefore, a simple reliable and easy method is needed. This study was performed (1) to evaluate the use of right ventricular outflow tract fractional shortening obtained by M-mode echocardiography as a measure of right ventricular systolic function and (2) to determine the relationship between this parameter and other established measurements of right ventricular function such as long axis excursion.

METHODS AND RESULTS: Ninety-two consecutive patients referred for echocardiographic assessment of left and right ventricular function, age mean+/-SD was 68+/-14 years, were investigated. Twenty healthy controls, age 46+/-12 years were also studied. M-mode echocardiography was used to measure right ventricular outflow tract fractional shortening and right ventricular long axis excursion. Doppler echocardiography was used for the estimation of right ventricular-right atrial pressure drop and pulmonary artery acceleration time. Right ventricular outflow tract fractional shortening (P<0.0001), right ventricular long axis excursion (P<0.0001) and pulmonary acceleration time (P<0.0001) were reduced in patients compared to controls. Right ventricular outflow tract fractional shortening correlated with long axis excursion (r=0.66 P<0.0001), pulmonary artery acceleration time (r=0.80 P<0.0001) and right ventricular-right atrial pressure drop (r=-0.53 P<0.0001). Right ventricular long axis excursion correlated with right ventricular-right atrial pressure drop though to a lesser significance (r=-0.27 P <0.001). Furthermore, right ventricular outflow tract fractional shortening was reduced in patients with pulmonary hypertension compared to patients without, this difference was not observed in the right ventricular systolic long axis excursion.

CONCLUSION: Right ventricular outflow tract fractional shortening provides a simple and non-invasive measure of right ventricular systolic function. In combination with long axis excursion and Doppler velocities they should provide comprehensive assessment of right ventricular function.

Place, publisher, year, edition, pages
Oxford University Press, 2003
Keyword
Echocardiography, right ventricular function, right ventricular outflow tract
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-29781 (URN)10.1053/euje.2002.0177 (DOI)12565060 (PubMedID)
Available from: 2009-11-23 Created: 2009-11-23 Last updated: 2017-12-12Bibliographically approved
2. Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study.
Open this publication in new window or tab >>Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study.
Show others...
2005 (English)In: Echocardiography, Vol. 22, no 4, 305-314 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to describe regional and global right ventricular (RV) function in a wide age range of healthy subjects of both sexes. We studied 255 (125 females) healthy individuals randomly selected from the Umeå General Population Register, age 58 +/- 19 (range 22-89) years. RV function was studied using myocardial tissue Doppler imaging of the RV free wall. Isovolumic contraction (IVCv), systolic (Sv), early (Ev), and late (Av) diastolic velocities were measured. Furthermore, isovolumic periods and ejection time intervals were also measured. Conventional Doppler was used to study RV global filling properties. While systolic myocardial velocities were conserved over age, there was a decrease in myocardial E/A ratio with increasing age (r =-0.67, P < 0.001, for base) taken from the RV free wall. A similar age relation was found in RV global filling velocities with a reduced tricuspid E/A ratio (r =-0.57, P < 0.001). Furthermore, a significant correlation was found between global and regional E/A ratios at the basal (r = 0.58, P </= 0.001) and mid-segmental levels (r = 0.46, P </= 0.001). Systolic myocardial velocities behaved independent of age whereas regional as well as global E/A ratio were age-related. No relationship was found between regional isovolumic time intervals and age. Knowledge of these age-dependent relationships is fundamental when evaluating RV function in patients.

Identifiers
urn:nbn:se:umu:diva-16049 (URN)10.1111/j.1540-8175.2005.04023.x (DOI)15839985 (PubMedID)
Available from: 2007-08-16 Created: 2007-08-16 Last updated: 2009-11-24Bibliographically approved
3. Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study.
Open this publication in new window or tab >>Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study.
Show others...
2005 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 128, no 2, 755-763 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Adult, Aged, Diastole, Echocardiography; Doppler, Female, Humans, Male, Middle Aged, Scleroderma; Systemic/*complications/*ultrasonography, Ventricular Dysfunction; Right/*etiology/*ultrasonography
Identifiers
urn:nbn:se:umu:diva-14793 (URN)10.1378/chest.128.2.755 (DOI)16100164 (PubMedID)
Available from: 2008-01-11 Created: 2008-01-11 Last updated: 2017-12-14Bibliographically approved
4. Right ventricular myocardial isovolumic relaxation time and pulmonary pressure.
Open this publication in new window or tab >>Right ventricular myocardial isovolumic relaxation time and pulmonary pressure.
2006 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 26, no 1, 1-8 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Adult, Aged, Blood Pressure/physiology, Diagnostic Techniques; Cardiovascular, Diastole/*physiology, Echocardiography; Doppler; Pulsed, Feasibility Studies, Female, Heart Catheterization, Heart Diseases/physiopathology/ultrasonography, Hemodynamics, Humans, Male, Middle Aged, Nomograms, Pulmonary Artery/physiology/*physiopathology, Time Factors, Ventricular Dysfunction; Right/physiopathology/ultrasonography, Ventricular Function; Right/*physiology
Identifiers
urn:nbn:se:umu:diva-16139 (URN)10.1111/j.1475-097X.2005.00639.x (DOI)163898663 (PubMedID)
Available from: 2007-08-17 Created: 2007-08-17 Last updated: 2017-12-14Bibliographically approved
5. The use of isovolumic contraction velocity to determine right ventricular state of contractility and filling pressures A pulsed Doppler tissue imaging study.
Open this publication in new window or tab >>The use of isovolumic contraction velocity to determine right ventricular state of contractility and filling pressures A pulsed Doppler tissue imaging study.
2005 (Swedish)In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Eur J Echocardiogr, Vol. 6, no 4, 264-270 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Echocardiographic techniques have not so far been able to provide a good estimation of myocardial contractility in humans. Myocardial motion during the isovolumic contraction phase, measured by Doppler tissue imaging, has only recently in experimental models been shown to describe myocardial contractility. The aim of the present clinical study was to investigate the relationship between right ventricular isovolumic contraction velocity and right ventricular state of contractility. METHODS AND RESULTS: Doppler tissue imaging and cardiac catheterization were performed simultaneously in 26 consecutive patients with different cardiac diseases (18 males, mean age 52 +/- 12, range 23-75 years). Peak isovolumic contraction velocity was measured using Doppler tissue imaging at 2 levels of the right ventricular free wall. During cardiac catheterization, the first derivative of right ventricular pressure related to the pulmonary artery peak pressure (dP/dt/P(max)) was measured. Furthermore, right ventricular end diastolic pressure, right atrial mean pressure, pulmonary artery systolic pressure, and pulmonary artery resistance, were also measured. A significant relationship was found between isovolumic contraction velocity and dP/dt/P(max) (r = 0.59, p < 0.01). This relationship was strengthened after excluding patients with elevated right atrial pressures (r = 0.77, p < 0.001). Furthermore, a correlation was also found between basal and mid cavity isovolumic contraction velocity and right ventricular end diastolic pressure (r = -0.47, r = -0.49, p < 0.05) as well as right atrial mean pressure (r = -0.63, r = -0.55, p < 0.01). CONCLUSION: Isovolumic contraction velocity is a reproducible and easily obtainable non-invasive parameter which correlates with invasive measurements of right ventricular state of contractility and right ventricular filling pressures.

Identifiers
urn:nbn:se:umu:diva-16050 (URN)10.1016/j.euje.2004.11.002 (DOI)15992709 (PubMedID)
Available from: 2007-08-16 Created: 2007-08-16 Last updated: 2017-12-14Bibliographically approved

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