Right ventricular function / Advances in cardiomyopathies 209

Right ventricular function / Advances in cardiomyopathies
echocardiography including measurement of RV dimension and systolic function;
tricuspid annular plain systolic excursion (TAPSE), fractional area change (FAC)
and pulsed Doppler peak velocity at the annulus (s’). Our exclusion criteria were
as follows, atrial fibrillation, device implantation, significant aortic or mitral valve
disease, history of cardiac surgery, cardiac shunt and pulmonary hypertension.
We classified the patients into 3 groups according to septal e’ and symptom of
heart failure; normal group (e’≥8), preclinical DD group (e’<8, asymtomatic) and
clinical DD group (e’<8, symptomatic).
Results: Normal group, preclinical DD group and clinical DD group consisted
of 38 (19%), 116 (59%) and 44 (22%), respectively. Prevalence of DM was 16%,
34% and 30%, prevalence of hypertension was 21%, 63%, and 84%, respectively.
In preclinical DD and clinical DD group, Left atrial volume index (p=0.003) and E/e’
ratio (p<0.00001) were significantly larger than those of normal group. In clinical
DD group, TRPG (p=0.00001) were significantly larger than other groups, TAPSE
was significantly smaller (p=0.0055), FAC and s’ were smaller than other groups,
but they showed no significant difference.
Conclusion: Patient with HFpEF has reduced RV myocardial function compared
to normal subjects and ppatient with preclinical DD. And also RV function may be
reduced even in patient with preclinical DD.
Impaired right ventricular myocardial perfusion and right
ventricular dysfunction in patients with pulmonary arterial
hypertension: a study of contrast echocardiography and strain
H. Oe 1 , N. Watanabe 1 , N. Toh 2 , Y. Oono 2 , S. Ugawa 2 , Y. Tanabe 1 ,
K. Nakamura 2 , H. Morita 2 , K. Kusano 2 , H. Ito 2 . 1 Okayama University Hospital,
Okayama, Japan; 2 Okayama University, Department of Cardiovascular Medicine,
Okayama, Japan
Conclusion: Quantitative MCE revealed patients with PAH have impaired RV
myocardial perfusion, and this correlated well with the RV longitudinal myocardial
Right ventricular function in asymptomatic type 2 diabetic
patients. A conventional and tissue doppler echocardiographic
imaging study
W. Ammar, S. Abdallah, H. El Hossary, M. Abdel Ghani. Cairo University
Hospitals, Department of Cardiovascular Medicine, Cairo, Egypt
Introduction: Cardiac adverse effects influenced by diabetes have been demonstrated thus far for the left ventricle. Right ventricular dysfunction is relevant in a
variety of disease states affecting both the course and prognosis. Therefore assessment of right ventricular performance is also an important issue in diabetic
Aim of the work: To study right ventricular systolic and diastolic functions using conventional and tissue Doppler echocardiographic imaging in asymptomatic
type 2 diabetic patients and to asses the relationship of RV functions to diabetes
severity and complications.
Patients and methods: Fifty patients with type 2 diabetes with no cardiac diseases were prospectively enrolled. The control group included fifteen healthy volunteers. Patients with hypertension, valvular or coronary heart disease were excluded. Full clinical evaluation including fundus examination, laboratory work up
including (FBS, HbA1C, hs-CRP, S. creatinine and albuminuria), 12 lead ECG
and full conventional and tissue Doppler echocardiographic assessment of both
Results: Right ventricular diastolic function was abnormal in diabetic group as evidenced by significantly lower values of peak early diastolic velocity Em (p<0.001)
and prolonged IVRT (p<0.001) compared to control group. A significant reverse
relationship between FBS and RV systolic function assessed using fractional area
change (r= -0.280, p=0.049). RV diastolic dysfunction was significantly correlated
with severity and complications of type 2 DM. 1- FBS and RV regional IVRT, (r=
0.352, p=0.012). 2- HbA1c and Em of RV, (r= -0.403, p=0.004). 3- Albuminuria
and RV regional IVRT, (p=0.009). 4- hs-CRP and Am of RV, (r= 0.357, p=0.011).
Conclusions: Type 2 diabetes mellitus affects right ventricular diastolic function
in the presence of normal right ventricular systolic function. Impairment was evident mainly by TDI- derived indices and correlated significantly with severity and
complications of type 2 diabetes mellitus.
P1181 | SPOTLIGHT 2013
Right ventricular function by 3D-echocardiography and 2D-speckle
tracking in scleroderma patients in absence of pulmonary
D. Peluso 1 , D. Muraru 1 , U. Cucchini 1 , L. Dal Bianco 1 , E. Pigatto 2 , E. Zanatta 2 ,
L. Punzi 2 , F. Cozzi 2 , L.P. Badano 1 , S. Iliceto 1 . 1 University Hospital of Padua,
Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy; 2 Medicine,
Rheumatology Unit, University of Padua, Padua, Italy
Purpose: Right ventricular (RV) involvement in Systemic Sclerosis (SSc) is usually related to the appearance of pulmonary hypertension (PH) and it’s unknown
if SSc can directly affect RV function in absence of PH. Recently, new more accurate echocardiographic techniques, as 3D-echocardiography (3DE) and 2Dspeckle tracking (2DSTE), have been introduced for better assessment of heart
chamber function and mechanics. The aim of this study was to use 3DE and
2DSTE, in both SSc patients and sex and age-matched healthy subjects, to identify early echo markers of RV impairment.
Methods: 31 SSc patients (29 females, age 56±11 years, SSc duration 13.6±9.4
years), without known heart disease and PH, were studied. 21 patients were affected by limited and 10 by diffuse cutaneous form of SSc. 36 age and gendermatched healthy subjects were enrolled as controls. All subjects underwent a
complete echocardiogram, including RV volumes and ejection fraction measured
by 3DE dataset. In addition, we measured global and regional longitudinal strain
by 2D-speckle tracking method from a dedicated apical view of the RV.
Results: RV end-diastolic area and fractional area change were similar in SSc
and control subjects; conversely, end-systolic area was larger in SSc patients
(9±2.2 vs 8.1±1.4 cm2 , p=0.045). TAPSE (23±3 vs 26±3 mm, p=0.001) and
S wave of RV free wall (13±2 vs 15±3 cm, p=0.004) were lower in SSc patients than in controls. Pulmonary artery systolic pressure (28±6 vs 22±5 mmHg,
p=0.001) and pulmonary vascular resistance (1.7±0.3 vs 1.5±0.3 UW, p=0.011)
were higher in SSc patients than in controls, without reaching cut-off values for
PH diagnosis. Upper limits of RV end-diastolic volume (EDV) (114 ml) and endsystolic volume (ESV) (45 ml) and lower limit of RV ejection fraction (EF) (51%)
were obtained by 3DE in control subjects. EDV was similar in SSc and controls
(88±22 vs 85±14 ml, p=0.53); conversely, end-systolic volume was larger (43±11
vs 33±7 ml) and ejection fraction was lower (51±5% vs 61±6%) in SSc compared
to controls (p<0.0001 for both). However, using 2DSTE we found no differences
about RV global (-25.6±2.9% vs -25.5±2.8%, p=0.84) and free wall longitudinal
strain (-30.3±4.9% vs -31.1±3.6%, p=0.51) between SSc patients and controls.
Conclusions: 3DE evaluation showed an impairment of RV pump function, in
term of ejection fraction, in SSc patients, without impairment of myocardial mechanics as assessed by longitudinal strain. Our data suggest that RV ejection
fraction impairment in SSc patients without PH could be related to slightly increased afterload, in presence of preserved RV myocardial function.
Gender differences in cardiovascular causes of sudden cardiac
death in the young
S. Rizzo, K. Pilichou, E. Carturan, G. Thiene, C. Basso. University of Padua,
Department of Cardiac, Thoracic and Vascular Sciences, Pathological Anatomy,
Padua, Italy
Purpose: Sudden cardiac death (SCD) in the young is due to a wide spectrum
of cardiovascular causes but few studies specifically addressed their prevalence
and characteristics in the female (F) vs. male (M) gender.
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Background: Little is known about right ventricular (RV) dysfunction in patient
with pulmonary arterial hypertension (PAH). Recently, RV ischemia has been reported to be a contributory factor in the development of RV dysfunction. The aim
of this study is to evaluate RV myocardial perfusion and assess its relationship
with RV dysfunction.
Methods: This prospective study consisted of 10 consecutive patients (7 female,
51±17 years) with PAH (6 idiopathic PAH (IPAH), and 4 chronic thromboembolic pulmonary hypertension (CTEPH)), and 6 healthy controls (3 females, 37±6
years). Quantitative myocardial contrast echocardiography (MCE) was performed
using Philips iE33 imaging system with an S5-1 probe. We depicted the apical
four chamber view. A solution of Levovist (300mg/ml) was inravenously administered at a rate of 3ml/min with a volumetric pump. End-systolic images were
obtained every four heart beats. The MCE images were analyzed off-line using
VoluMap-445 system. The RV myocardium was divided into six segments, at each
myocardial segment, calibrated contrast intensity (CI) was determined as the difference (dB) between the mean myocardial CI and cavity CI. 2D speckle tracking
echocardiographic study was also performed using Vivid E9 ultrasound system.
Results: Among 96 RV myocardial segments, quantitative CI analysis was possible in 86 segments (90%). RV fractional area change was 46% (healthy), 34%
(CTEPH) and 25% (IPAH). Mean calibrated CI of RV free wall was -13.4dB, 19.3dB and -22.8dB, respectively (p=0.01). We found good inverse correlation
between calibrated CI and longitudinal strain of RV free wall (r=-0.5, p=0.0013).