scholarly journals Influence of selective stimulation of the right ventricle on electric and mechanical myocardial disynchrony

2021 ◽  
Author(s):  
A. E. Komlev ◽  
V. N. Shitov
Keyword(s):  
Right Ventricle ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Interventricular Dyssynchrony ◽  
Group 2 ◽  
The Right ◽  
Stimulation Of ◽  
Group 1

Relevance. Prolonged apical stimulation of the right ventricle can lead to the development of interventricular and intraventricular dyssynchrony. Selective (alternative) stimulation of various parts of the interventricular septum due to a more physiological propagation of the excitation wave makes it possible to prevent the deterioration of the mechanical function of the myocardium associated with constant pacing.Purpose. To study the dynamics of indicators of electrical and mechanical ventricular dyssynchrony in the traditional (apical) and alternative with the installation of a right ventricular electrode in the interventricular septum or the outlet tract of the right ventricle in patients with constant pacing in the early and late postoperative period.Materials and methods. Were included 73 patients (mean age 61.0 ± 2.5 years) with indications for continuous cardiac pacing without signs of heart failure above 2 FC according to NYHA and previous Q-forming myocardial infarction. Patients of group 1 (n = 39) were implanted with a pacing ventricular electrode in the middle section of the interventricular septum (subgroup 1A, n = 25) or in the outflow tract of the right ventricle (subgroup 1B, n = 14). The control group 2 included 34 patients with electrode implantation in the apex of the right ventricle.Results. The time of pre-ejection from the right and left ventricles before and after implantation did not differ in group 1 and significantly differed in group 2 (25 ± 3 ms and 50 ± 6 ms, p < 0.05). There was no significant difference in the parameters of ventricular remodeling between the groups within 2 years, but there was a tendency towards a lower value of the left ventricular ejection fraction (59 ± 6 % and 50 ± 2 %, p = 0.05) and a higher frequency of mitral regurgitation 2 degree and higher in patients in the apical stimulation group. Within the group of alternative stimulation, after 2 years of follow-up, there was a tendency towards a smaller value of the delay time of systolic contraction between the basal segments of the free wall of the right ventricle and the interventricular septum during stimulation of the outflow tract compared with stimulation of the middle part of the interventricular septum (30 ± 8 ms and 38 ± 10 ms , p = 0.05).Conclusions. Alternative stimulation of the right ventricle compared with the apical is characterized by a lower degree of interventricular dyssynchrony both immediately after surgery and in the long-term period. New echocardiographic technologies, including tissue myocardial Doppler ultrasonography, make it possible to quantify the indicators of systolic and diastolic myocardial function and various parameters of dyssynchrony.Conclusion. To assess the physiology, clinical efficacy and safety of the new method of stimulating the interventricular septum, a more thorough study of the severity of intra- and interventricular dyssynchrony, indicators of global and regional systolic and diastolic function of the left and right ventricles is necessary.

scholarly journals The effect of right ventricular pacemaker lead position on functional status in patients with preserved left ventricular ejection fraction

2016 ◽  
Vol 69 (7-8) ◽  
pp. 212-216
Author(s):  
Vladimir Mitov ◽  
Zoran Perisic ◽  
Aleksandar Jolic ◽  
Tomislav Kostic ◽  
Aleksandar Aleksic ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Lead Position ◽  
The Right

Introduction. The study was aimed at assessing the difference between the right ventricle apex versus the right ventricular outflow tract lead position in functional capacity in the patients with the preserved left ventricular ejection fraction after 12 months of pacemaker stimulation. Material and Methods. This was a prospective, randomized, follow-up study, which lasted for 12 months. The study sample included 132 consecutive patients who were implanted with permanent anti-bradicardiac pacemaker. Regarding the right ventricular lead position the patients were divided into two groups: the right ventricle apex group consisting of 61 patients with right ventricular apex lead position. The right ventricular outflow tract group included 71 patients with right ventricular outflow tract lead position. Functional capacity was assessed by Minnesota Living With Heart Failure score, New York Heart Association class and Six Minute Walk Test. Left ventricular ejection fraction was assessed by echocardiography. Results. Minnesota Living With Heart Failure score and New York Heart Association class had a statistically significant improvement in both study groups. The patients from right ventricle apex group walked 20.95% (p=0.03) more in comparison to starting values. The patients from right ventricular outflow tract group walked only 13.63% (p=0.09) longer distance than the starting one. Conclusion. Analysis of tests of functional status New York Heart Association class and Minnesota Living With Heart Failure questionnaire showed an even improvement in the right ventricle apex and right ventricular outflow tract groups. Analysis of 6 minute walk test showed that only the patients with the preserved left ventricular ejection fraction from the right ventricle apex group had a significant improvement after 12 months of pacemaker stimulation.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

scholarly journals TWO-DIMENSIONAL ECHOCARDIOGRAPHIC CHARACTERISTICS IN PRE-ADOLESCENT ATHLETES

2016 ◽  
Vol 3 (3) ◽  
pp. 138-141
Author(s):  
O. Onikiienko
Keyword(s):  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Myocardial Remodeling ◽  
Two Dimensional ◽  
Ventricular Ejection Fraction ◽  
Cardiac Adaptation ◽  
Group 3 ◽  
Group 2 ◽  
Sports Activities ◽  
Group 1

Data of echocardiographic characteristics of 59 children 10-11 years old, involved in football is presented in article. Depending on the duration of sports activities the children were divided into 3 groups: group 1 - children who play football up to 3 years (24 children), Group 2 - children who play football from 3 to 5 years (23 children), Group 3 - training duration over 5 years (12 children). It was found that the linear sizes of the heart were not significantly different in the groups studied, which may indicate that myocardial remodeling as cardiac adaptation to sporting loads takes more time. It was revealed that more trained children (group 3) have significantly higher left ventricular ejection fraction compared with group 1 (p = 0.05) and Group 2 (p = 0.0051). Keywords: athletes, children, echocardiography РезюмеО. ОникиенкоДвумерные эхокардиографические характеристики препубертатных спортсменов В статье приведены результаты ультразвукового обследования 59 детей 10-11 лет, занимающихся футболом. В зависимости от длительности занятий спортом дети были разделены на 3 группы: группа 1 – дети со стажем до 3 лет (24 ребенка), группа 2  - стаж занятий от 3 до 5 лет (23 ребенка), группа 3 – стаж занятий более 5 лет (12 детей). Установлено, что линейные размеры сердца достоверно не отличались в группах обследованных, что может свидетельствовать о более длительном процессе ремоделирования миокарда как адаптации сердца к спортивным нагрузкам. Выявлено, что у более тренированных детей (группа 3) достоверно выше фракция выброса левого желудочка по сравнению с группой 1 (p = 0.05) и с группой 2 (p = 0.0051). Ключевые слова: спортсмены, дети, эхокардиография   РезюмеО. ОнікієнкоДвовимірні ехокардіографічні характеристики препубертатних спортсменівУ статті наведено результати ультразвукового обстеження 59 дітей 10-11 років, які займаються футболом. Залежно від тривалості занять спортом діти були розділені на 3 групи: група 1 - діти зі стажем до 3 років (24 дитини), група 2 - стаж занять від 3 до 5 років (23 дитини), група 3 - стаж занять більше 5 років (12 дітей). Встановлено, що лінійні розміри серця достовірно не відрізнялися в групах обстежених, що може свідчити про більшу тривалість ремоделювання міокарда як адаптації серця до спортивних навантажень. Виявлено, що у більш тренованих дітей (група 3) достовірно вища фракція викиду лівого шлуночка в порівнянні з групою 1 (p = 0.05) і з групою 2 (p = 0.0051). Ключові слова: спортсмени, діти, ехокардіографія

scholarly journals Epicardial Adipose Tissue Role as a Marker of Higher Vulnerability in Patients with Coronary Artery Disease

2018 ◽  
Vol 3 (2) ◽  
pp. 77-83 ◽  
Author(s):  
Tiberiu Nyulas ◽  
Mirabela Morariu ◽  
Nora Rat ◽  
Emese Marton ◽  
Victoria Ancuta Rus ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Epicardial Adipose Tissue ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background: Epicardial adipose tissue (EAT) has been recently identified as a major player in the development of the atherosclerotic process. This study aimed to investigate the role of EAT as a marker associated with a higher vulnerability of atheromatous coronary plaques in patients with acute myocardial infarction (AMI) as compared to patients with stable angina. Material and methods: This analysis enrolled a total of 89 patients, 47 with stable angina (SA) and 42 with AMI, who underwent echocardiographic investigations and epicardial fat measurement in 2D-parasternal long axis view. The study lot was divided as follows: Group 1 included patients with prior AMI, and Group 2 included patients with SA. Results: There were no significant differences between the two groups regarding cardiovascular risk factors, excepting smoking status, which was recorded more frequently in Group 1 as compared to Group 2 (36.17% vs. 11.63%, p = 0.02). The mean epicardial fat diameter was 9.12 ± 2.28 mm (95% CI: 8.45–9.79 mm) in Group 1 and 6.30 ± 2.03 mm (95% CI: 5.675–6.93 mm) in Group 2, the difference being highly significant statistically (p <0.0001). The mean value of left ventricular ejection fraction was significantly lower in patients with AMI (Group 1 – 47.60% ± 7.96 vs. Group 2 – 51.23% ± 9.05, p = 0.04). EAT thickness values showed a weak but significant positive correlation with the level of total cholesterol (r = −0.22, p = 0.03) and with the value of end-systolic left ventricle diameter (r = 0.33, = 0.001). Conclusions: The increased thickness of EAT was associated with other serum- or image-based biomarkers of disease severity, such as the left ventricular ejection fraction, end-systolic diameter of the left ventricle, and total cholesterol. Our results indicate that EAT is significantly higher in patients with acute coronary syndrome, proving that EAT could serve as a marker of vulnerability in cardiovascular diseases.

Systemic to Pulmonary Collaterals in Extremely Low Birth Weight Infants: Incidence, Clinical Significance, and Hemodynamic Features

2019 ◽  
Author(s):  
Cynthia Hayek ◽  
Rowena Cayabyab ◽  
Ima Thompson ◽  
Mahmood Ebrahimi ◽  
Bijan Siassi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Echocardiographic Parameters ◽  
Group 2 ◽  
The Right ◽  
Group 1

Abstract Objective To determine the incidence of systemic to pulmonary collaterals (SPCs) in extremely low birth weight infants and to assess its clinical and hemodynamic significance beyond the neonatal period. Study Design Retrospective cohort study was conducted on 61 infants with echocardiogram performed at the time of discharge to determine the presence of SPC and to measure the right and left ventricular outputs and left atrium to aortic ratio. We compared two groups: small or no SPC (Group 1) to moderate or large SPC (Group 2) on demographics, clinical outcomes, and echocardiographic parameters. Results Sixty-one infants were included. The incidence of SPC was 57%; 21% of infants had moderate or large shunts and 31% had small SPC. Demographics, clinical outcomes, and echocardiographic parameters were not significantly different between small or no SPC and moderate to large SPC. Conclusion More than half of the infants had SPC. The size of the shunt did not affect the clinical outcomes nor the echocardiographic parameters measured. All infants had cardiac output above the normative mean.

scholarly journals Predictors of Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

2016 ◽  
Vol 1 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Sorin Pop ◽  
Roxana Hodaş ◽  
Edvin Benedek ◽  
Diana Opincariu ◽  
Nora Rat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

AbstractBackground:The acute loss of myocardium, following an acute myocardial infarction (AMI) leads to an abrupt increase in the loading conditions that induces a pattern of left ventricular remodeling (LVR). It has been shown that remodeling occurs rapidly and progressively within weeks after the AMI.Study aim:The aim of our study was to identify predictors for LVR, and find correlations between them and the cardiovascular (CV) risk factors that lead to remodeling.Material and methods:One hundred and five AMI patients who underwent primary PCI were included in the study. A 2-D echocardiography was performed at baseline (day 1 ± 3 post-MI) and at 6 months follow-up. The LV remodeling index (RI), was defined as the difference between the Left Ventricular End-Diastolic diameter (LVEDD) at 6 months and at baseline. The patients were divided into 2 groups, according to the RI: Group 1 – RI >15% with positive remodeling (n = 23); Group 2 – RI ≤15% with no remodeling (n = 82).Results:The mean age was 63.26 ± 2.084 years for Group 1 and 59.72 ± 1.267 years for Group 2. The most significant predictor of LVR was the female gender (Group 1 – 52% vs. Group 2 – 18%, p <0.0001). Men younger than 50 years showed a lower rate of LVR (Group1 – 9% vs. Group 2 – 20%, p = 0.0432). In women, age over 65 years was a significant predictor for LVR (Group 1 – 26% vs. Group 2 – 9%, p = 0.0025). The CV risk factors associated with LVR were: smoking (p = 0.0008); obesity (p = 0.013); dyslipidemia (p = 0.1184). The positive remodeling group had a higher rate of LAD stenosis compared to the no-remodeling group (48% vs. 26%, p = 0.002). The presence of multi-vessel disease was shown to be higher in Group 1 (26% vs. 9%, p = 0.0025). The echocardiographic parameters that predicted LVR were: LVEF <45% (p = 0.048), mitral regurgitation (p = 0.022), and interventricular septum hypertrophy (p <0.0001).Conclusions:The CV risk factors correlated with LVR were smoking, obesity and dyslipidemia. A >50% stenosis in the LAD and the presence of multi-vessel CAD were found to be significant predictors for LVR. The most powerful predictors of LVR following AMI were: LVEF <45%, mitral regurgitation, and interventricular septum hypertrophy.

Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 15-19
Author(s):  
A. N. Kostomarov ◽  
M. A. Simonenko ◽  
M. A. Fedorova ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Death Rate ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

scholarly journals Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Bortolo Martini ◽  
Nicola Trevisi ◽  
Nicolò Martini ◽  
Li Zhang
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Diverticulum ◽  
Right Ventricular Wall ◽  
Left Ventricular Diverticulum ◽  
The Right

A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches.

scholarly journals INFLUENCE OF NOCTURNAL INCREASE OF BLOOD PRESSURE ON CARDIAC REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION

2019 ◽  
Vol 19 (1-2) ◽  
pp. 65-69
Author(s):  
A. I Miroshnichenko ◽  
K. M Ivanov
Keyword(s):  
Blood Pressure ◽  
Left Ventricle ◽  
Right Ventricle ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Cardiac Remodeling ◽  
Interventricular Septum ◽  
Posterior Wall ◽  
The Right ◽  
Group 1

Actuality. Arterial hypertension (AH) is the main risk factor for the development of cardiovascular diseases, disability and cardiovascular mortality. Episodes of blood pressure (BP) increase during the day in patients receiving antihypertensive therapy are an unfavourable factor contributing to the development and progression of cardiac remodeling. Aim. The purpose of the research is to study the features of changes in the structural and functional state of the heart under the influence of high blood pressure at night in patients with arterial hypertension with the dynamic three-year observation. Material and methods. 47 patients with the diagnosis of AH were examined. Patients were divided into two groups, randomized by age, duration and severity of AH. Group 1 included 24 patients who as a result of ambulatory blood pressure monitoring (ABPM) on the background of combined antihypertensive therapy suffered from constantly increased BP at night. The second group combined 23 patients without the increase in BP during the night according to the ABPM with antihypertensive therapy. The examination included measurement of the office BP, ABPM, two-fold echocardiography with a three-year interval. Results. When assessing the indices of office BP in the groups, there were no significant differences, all patients achieved the target values of BP. In patients in Group 1, higher values of BP were observed during the day, according to ABPM. Echocardiography over a three year period of observation revealed a more pronounced increase in diastolic interventricular septum thickness, the thickness of the left ventricle posterior wall during diastole, sizes of left atrium in the patients of the first group, patients of the second group had a more pronounced thickness of the left ventricle posterior wall during systole. The increase in the size of the right ventricle was revealed in both groups. Conclusions. 1) In patients with the increase in blood pressure at night, the values of BP variability were higher during the day. 2) Three-year dynamic observation revealed that the increase in BP at night in patients with hypertension facilitated acceleration of cardiac remodelling and was associated with an increase in the left ventricular posterior wall, interventricular septum thickness, the size of the left atrium, and the size of the right ventricle.

scholarly journals P304 The importance of echocardiographic pulmonary flow notch ratio in the assessment of patients with acute pulmonary embolism

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Kurnicka ◽  
A Furdyna ◽  
S Goliszek ◽  
B Lichodziejewska ◽  
M Ciurzynski ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricle ◽  
Acute Pulmonary Embolism ◽  
Interventricular Septum ◽  
Pulmonary Arteries ◽  
Doppler Flow ◽  
Pulmonary Flow ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Abstract Background There are several echocardiographic features such as right ventricle dilatation, interventricular septum flattening, McConnel sign and 60/60 sign reflecting the extent and severity of acute pulmonary embolism (APE). In quite a large number of APE patients we can observe a pulmonary flow (PF) profile abnormality in the form of a mid-systolic notch (MSN). Purpose To assess the profile of pulmonary Doppler flow in consecutive patients with acute pulmonary embolism and to establish its clinical utility. Methods We reviewed pulmonary Doppler flow profiles from 127 consecutive patients (m. age 64 years,72 F) with symptomatic APE managed in our department. APE was confirmed by contrast-enhanced multi detector computed tomography when thromboemboli were visualized at least in segmental pulmonary arteries. Individuals with preexisting pulmonary arterial hypertension were excluded. The pulmonary flow notch ratio (PNR) defined as the time from onset of PF until mid-systolic notch divided by the time from notch to the end of pulmonary ejection was evaluated. The comparison of patients with PNR &lt; 1 (Group 1) and PNR &gt; 1 (Group 2) was performed. Results We found the MSN in 50 patients (39.4%). Seventy seven patients had a normal shape of Doppler PF envelope. The presence of MSN was associated with more pronounced echocardiographic signs of right ventricle overload (RVOT diameter 32.4± 5.2 vs 29.1 ±3.3 mm, p &lt; 0.001; TRPG 42.3 ± 14.4 vs 24.8 ±9.5 mmHg, p &lt; 0.0001; RVSP 49.4 ±14.9 vs 31.2 ±10.6 mmHg, p &lt; 0.0001; TAPSE 20.3± 4.1 vs 23.4 ±4.0 mm, p &lt; 0.001; PF Acceleration Time 64.5 ±13.7 vs 109.8 ±24.6 ms, p &lt; 0.001, and a presence of septal flattening). Obviously, patients with MSN presented more proximal location of thrombi in comparison to those with symmetrical shape of PF envelope (in MPA 18% vs 5.2%, p = 0.038 and in both LPA + RPA 22% vs 9%, p = 0.08, respectively). The PNR &lt; 1 was found in 35 (70%) of 50 patients with MSN (Group 1). In these patients thrombi were located more proximally than in patients with PNR &gt; 1 (Group 2), and angio-CT confirm anatomically massive PE. A percentage of patients with thrombi in both, left and right pulmonary arteries, in both lobar pulmonary arteries and lobar+ segmental arteries was higher in Group 1 (PNR &lt; 1) than in Group 2 (PNR &gt; 1): LPA + RPA: 28.6 vs 6.7%, lobar L and R: 57 vs 26.6%, lobar + segmental: 31 vs 20%. A number of patients with thrombi in the MPA was similar in both groups. Conclusion A noninvasive pulmonary flow notch ratio (PNR) may be useful for indicating APE patients with more extensive disease and proximal location of thrombi, at least in lobar pulmonary arteries.

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