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Right ventricular outflow-tract fractional shortening: an applicable measure of right ventricular systolic function.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Sundsvall Hospital, Sundsvall.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Royal Brompton Hospital, London.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Mälar Hospital, Eskilstuna.
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. Vol. 4, no 1, 29-35 p.
Keyword [en]
Echocardiography, right ventricular function, right ventricular outflow tract
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-29781DOI: 10.1053/euje.2002.0177PubMedID: 12565060OAI: oai:DiVA.org:umu-29781DiVA: diva2:278040
Available from: 2009-11-23 Created: 2009-11-23 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Right heart function in health and disease: a doppler echocardiography and doppler tissue imaging study
Open this publication in new window or tab >>Right heart function in health and disease: a doppler echocardiography and doppler tissue imaging study
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Högersidig hjärtfunktion hos hjärtfriska och vid hjärtpåverkan : en studie i Doppler ekokardiografi och vävnadsDoppler
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
Medicine, Echocardiography, Doppler tissue imaging, right ventricle, cardiac catheterisation, isovolumic relaxation, isovolumic contraction, Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-392 (URN)91-7305-787-8 (ISBN)
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

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Lindqvist, PerHenein, Michael

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