Abstract 1589: Pulmonary Hypertension Is Associated With Regional Right Ventricular Systolic Dysfunction And Dyssynchrony: Strain and Strain Rate Assessment Using Velocity Vector Imaging Technique.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Hong Meng ◽  
Hector R Villarraga ◽  
PuWai Lee ◽  
Shah A Aijaz ◽  
Maytinee Kittipovanonth ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Strain Rate ◽  
Velocity Vector ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Tangential Velocity ◽  
Velocity Vector Imaging ◽  
Strain And Strain Rate

Background: Strain and strain rate has been shown to identify subtle contraction abnormalities of left ventricle. Objectives: We hypothesized that S and SR derived from velocity vector imaging (VVI) will allow early identification of global and regional RV systolic function in patients with pulmonary hypertension (PHT) compared to conventional echo parameters. Methods: 96 patients, 35 normal RV Systolic Pressure (RVSP < 30 mmHg) and 61 with PHT, {24 mild-moderate (RVSP > 60 mmHg) and 37 severe (RVSP < 60 mmHg)} underwent echo-Doppler assessment of RV. Apical 4 chamber images at end expiration were used for RV lateral wall (LW) and ventricular septal (VS) segment analysis for systolic tangential velocity (Ta V), S and SR. In addition RV end systolic and diastolic area, RV fractional area change (RV FAC), RV performance index (RIMP) and tricuspid annulus systolic excursion were measured. Results: Peak S, systolic SR and Ta V at the basal, mid and apical segments of the RV LW and VS were depressed in patients with PHT compared with controls, Table 1 , P 0.001. Similarly, significant decrease in RIMP was seen in patients with PHT compared to controls, p <0.001. Significant correlation (p<0.001, r >0.6) was noted between the 2D FAC and S, SR. The time to peak systolic S indexed to end diastolic area (EDA) is significantly prolonged, p<0.01 in all segments in patients with PHT indicating dyssynchrony. Conclusion: S and SR allows assesment of Regional RV systolic function otherwise difficult to assess from conventional echo-Doppler technique. PHTN is associated with not only regional RV systolic dysfunction but also with dyssynchrony. Thus, this new tool can offer new insights in the functioning of right ventricular global and regional function. mean±SD of strain

Abstract 13973: Impaired Right Ventricular Hemodynamics Suggest Preclinical Pulmonary Hypertension in Patients With Metabolic Syndrome

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Deepa M Gopal ◽  
Yi-Chih Wang ◽  
Nir Ayalon ◽  
Courtney Donohue ◽  
Rajalakshmi Santhanakrishnan ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Doppler Measurement ◽  
Ejection Time ◽  
Pulsed Wave Doppler ◽  
Lv Diastolic Dysfunction

Introduction: Metabolic syndrome (MetS) is associated with preclinical metabolic heart disease (MHD) as reflected by left ventricular (LV) diastolic dysfunction. Very little is known about right ventricular (RV) function and/or pulmonary hypertension in MetS or early MHD. Hypothesis: We tested the hypothesis that that MetS is associated with subclinical RV dysfunction and pulmonary hypertension. Methods: A total of 164 subjects with MetS but without cardiovascular disease (mean age 45 years, 71% women, mean BMI 41 kg/m 2 ), 40 similarly obese controls without MetS, and 36 non-obese healthy controls underwent echocardiography, including pulsed-wave Doppler measurement of pulmonary artery acceleration time (PAAT) and ejection time (ET). PA systolic pressure was estimated from PAAT using validated equations. Results: MetS was associated with lower tricuspid valve e', shorter PAAT, shorter ET, and larger PA diameter compared with controls (Table). A total of 24% of individuals with MetS had an abnormal PAAT (<100 msec). Estimated PA systolic pressure based on PAAT was 42±10 mmHg in MetS compared with 32±10 and 32±9 mmHg in healthy and obese controls (P for ANOVA <0.0001). In contrast, RV structure and systolic function were similar in MetS compared with controls ( Table ). After adjustment for age, sex, hypertension, diabetes, and body-mass index, MetS remained associated with shorter PAAT (P=0.03 vs healthy; P=0.0005 vs obese). Among MetS, PAAT was correlated with mitral mean e’ (r=0.20, P=0.004), E/A ratio (r=0.21, P=0.008), and tricuspid e’ (r=0.20, P=0.04). A total of 40% of participants with abnormal PAAT also had low mean e’ (<8 cm/s). Conclusions: MetS is associated with abnormal RV hemodynamics as evidenced by shorter PAAT, which correlates with measures of LV diastolic function. Estimated PA systolic pressures are significantly higher in preclinical MetS and MHD, and raise the possibility that pulmonary hypertension contributes to the pathophysiology of MHD.

Abstract 5781: Evaluation of Global and Regional Right Ventricular Systolic Function in Patient Prosthesis Mismatch after Mitral Valve Replacement using Velocity Vector Imaging

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Aylin Tugcu ◽  
Yelda Tayyareci ◽  
Ozlem Yildirimturk ◽  
Saide Aytekin
Keyword(s):  
Strain Rate ◽  
Velocity Vector ◽  
Systolic Function ◽  
Strain Rates ◽  
Free Wall ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Patient Prosthesis Mismatch ◽  
Rv Function

The aim of this study was to compare right ventricular (RV) global and regional systolic function in patients with and without patient prosthesis mismatch (PPM) after isolated mitral valve replacement (MVR) using Velocity Vector Imaging (VVI) method. The PPM group consisted of 20 patients that underwent isolated MVR with an indexed effective orifice area (EOA) ≤ 1.2 cm 2 /m 2 determined by continuity equation and indexed for body surface area. The non-PPM group consisted of 20 patients that also underwent isolated MVR with an indexed EOA > 1.2cm 2 /m 2 . Echocardiographic images in apical planes were analyzed for RV volumes, ejection fractions, myocardial velocity, strain and strain rate at the basal, mid and apical segments of RV free wall and ventricular septum using VVI. The demographic and preoperative data were similar between PPM and non-PPM groups. Evidence of PA hypertension defined as systolic PA pressure > 40 mmHg was present in 50% of patients in PPM group, whereas none of the patients in non-PPM group had PA hypertension. RV volumes were significantly increased, and RV ejection fraction, peak systolic myocardial velocities, strain and strain rates were significantly impaired in patients with PPM compared to non-PPM group (p<0.001 for all). Indexed EOA correlated strongly with myocardial velocities, strain and strain rates in all segments of the RV (p<0.05 for all). Multivariate stepwise regression analysis demonstrated that indexed EOA and systolic PA pressure were the independent determinants of basal free wall peak systolic strain (β=0.547, p<0.001 and β=−0.304, p=0.033 respectively) and strain rate (β=0.497, p=0.001 and β=−0.332, p = 0.026 respectively). Using receiver-operating characteristics analysis cut-off values for basal free wall peak systolic strain and strain rate in determining patients with indexed EOA ≤ 1.2 cm 2 /m 2 were −25.62 % (sensitivity 85%, specificity 95%) and −1.87 1/s (sensitivity 95%, specificity 95%) respectively. PPM after MVR is associated with RV global and regional RV dysfunction. Two-dimensional echocardiography has some limitations in evaluating RV function due to its complex geometry. VVI is a feasible modality in assessment of RV global and regional RV function.

scholarly journals Sex Differences in Immunology: More Severe Development of Experimental Pulmonary Hypertension in Male Rats Exposed to Vascular Endothelial Growth Factor Receptor Blockade

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Julien Guihaire ◽  
Tobias Deuse ◽  
Dong Wang ◽  
Elie Fadel ◽  
Hermann Reichenspurner ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Coupling Efficiency ◽  
Systolic Pressure ◽  
Muscle Cells ◽  
Male Rats ◽  
Promising Therapeutic Approach

Background.The epidemiology of pulmonary hypertension (PH) is characterized by a female preponderance, whereas males share higher severity of the disease.Objective.To compare the severity of experimental PH between male and female athymic rats.Methods.PH was induced in 11 male and 11 female athymic rats (resp., SU_M and SU_F groups) using an inhibitor of VEGF-receptors I and II, semaxanib (40 mg/kg). After 28 days, right ventricular (RV) remodeling, systolic function, and hemodynamics were measured using echocardiography and a pressure-volume admittance catheter. Morphometric analyses of lung vasculature and RV myocardium were performed.Results.Four weeks after semaxanib injection, RV end-systolic pressure was higher in SU_M than in SU_F. Males developed marked RV enlargement and systolic dysfunction compared to females. Impairment of RV-PA coupling efficiency was observed only in SU_M. The smooth muscle cells of the pulmonary arteries switched from a contractile state to a dedifferentiated state only in males.Conclusions.Female athymic rats were protected against the development of severe PH. RV-PA coupling was preserved in females through limitation of pulmonary artery muscularization. Control of smooth muscle cells plasticity may be a promising therapeutic approach to reverse established vascular remodeling in PH patients.

Abstract P059: Arterial Thickness and Stiffness are Independent Predictors of Myocardial Strain

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Connie E McCoy ◽  
Philip R Khoury ◽  
Stephanie N Stewart ◽  
Lauren E Longhshore ◽  
Nicolas L Madsen ◽  
...  
Keyword(s):  
Young Adults ◽  
Strain Rate ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Myocardial Strain ◽  
Structure And Function ◽  
Vascular Structure ◽  
Strain And Strain Rate ◽  
Cardiac Strain ◽  
And Function

Vascular dysfunction is associated with cardiac dysfunction, a precursor of CV events (MI,CHF) in adults. We hypothesized that abnormalities in vascular structure and function are associated with cardiac systolic dysfunction as measured by cardiac strain and strain rate in young adults. Carotid ultrasound and echocardiography were performed on 338 subjects (22.2 + 3.7 years; 38% male (M); 63% non-white (NW); 33% lean, 36% obese and 31% T2DM). CIMT was traced along the far wall of the distal CCA, bulb, and proximal ICA. Stiffness measures included carotid-femoral pulse wave velocity (PWVf), brachial distensibility (BrachD) and Peterson’s Elastic Modulus in the CCA (PEM). LV systolic function was assessed by global longitudinal (4-chamber) strain (GS) and strain rate in systole (GSRs). Anthropometry, BP, HR, fasting lipids, CRP, and glucose were collected. Correlations were calculated between vascular measures and cardiac strain. General linear models were constructed to determine if vascular measures were independent predictors of GS and GSRs. Covariates included age, sex, race, BMI z-score, MAP, group, TG, HDL, LDL, insulin, glucose, and CRP. GS and GSRs correlated with peripheral arterial stiffness (lower BrachD, higher PEM, higher PWVf) and structure (thicker CIMT), all p<.01 (Figure). After adjusting for other risk factors, BrachD was an independent predictor of poorer GSRs: GSRs=-1.1611 -.13*BrachD + .05 (if M) + .06 (if NW) + .004*MAP - .0003*glucose + .07*Insulin. CCA IMT independently predicted both GS and GSRs: GS=-.26 + 4.6* CCA + .92 (if M) + .58*BMIZ + .56*MAP- .03*HDL + 1.06*insulin; GSRs= -1.4 + .26*CCA+ .05 (if M) + .03*BMIZ + .003*MAP - .0003*glucose + .06*Insulin. All factors were significant at p<.05 in these models. We conclude that adverse pre-clinical vascular and cardiac findings are present in youth simultaneously and may increase risk for future CV events. Assessment of vascular structure and function may add incremental benefit in stratifying risk in young adults for future CV events.

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