scholarly journals Right Ventricular Global and Regional Remodeling in American-Style Football Athletes: A Longitudinal 3D Echocardiographic Study

2021 ◽  
Vol 11 (8) ◽  
pp. 3357
Author(s):  
Amir Hodzic ◽  
Gabriel Bernardino ◽  
Damien Legallois ◽  
Patrick Gendron ◽  
Hélène Langet ◽  
...  

Few data exist concerning the right ventricular (RV) physiological adaptation in American-style football (ASF) athletes. We aimed to analyze the RV global and regional responses among ASF-trained athletes. Fifty-nine (20 linemen and 39 non-linemen) ASF athletes were studied before and after inter-seasonal training. During this period, which lasted 7 months, all athletes were exposed to combined dynamic and static exercises. Cardiac longitudinal changes were examined using three-dimensional transthoracic echocardiography. A computational method based on geodesic distances was applied to volumetrically parcellate the RV into apical, outlet, and inlet regions. RV global and regional end-diastolic volumes increased significantly and similarly in linemen and non-linemen after training, with predominant changes in the apex and outlet regions. RV global and regional ejection fractions were preserved. Morphological changes were uniformly distributed among the four cardiac chambers, and it was independent of the field position. Assessment of RV end-diastolic global, inlet and apical volumes showed low intra-observer (3.3%, 4.1%, and 5.3%, respectively) and inter-observer (7%, 12.2%, and 9%, respectively) variability, whereas the outlet regional volumetric assessment was less reproducible. To conclude, ASF inter-seasonal training was associated with a proportionate biventricular enlargement, regardless of the field position. Regional RV analysis allowed us to quantify the amount of exercise-induced remodeling that was larger in the apical and outlet regions.

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A E Vijiiac ◽  
D Muraru ◽  
F Jarjour ◽  
K Kupczynska ◽  
C Palermo ◽  
...  

Abstract Background The right atrium (RA) is a highly dynamic chamber with 3 mechanical functions (reservoir, conduit, booster pump) and prognostic implications in heart failure (HF) and pulmonary hypertension (PH). However, RA function and its interplay with the right ventricular (RV) performance in patients (pts) with reduced left ventricular ejection fraction (LVEF) and without PH remain to be clarified. Methods We used three-dimensional echocardiography to study 55 pts (61 ± 14 years, 43 men) with LVEF < 40% no more than mild tricuspid regurgitation (TR), and maximum velocity of the TR jet < 3 m/s. We measured the three-dimensional RA total, passive, active ejection volumes (EV) and the respective emptying fractions (EF). In addition, we compared RV volumes and ejection fraction (RVEF) between patients with normal and abnormal RA function. Results Mean LVEF was 30 ± 7%. Mean echo-derived pulmonary vascular resistance was 1.64 ± 0.54 Wood units. 28 pts (51%) had reduced RA reservoir function (total EF = 34 ± 9%), 34 pts (62%) had reduced RA conduit function (passive EF = 15 ± 4%), and 10 pts (18%) had reduced RA pump function (active EF = 11 ± 3%). Pts with reduced RA reservoir function showed larger RV end-systolic volume (RVESV 124 ± 48ml vs. 90 ± 32ml; p = 0.004) and lower RVEF (38 ± 8% vs. 46 ± 6%; p < 0.001) than pts with normal RA function. Pts with reduced RA conduit function showed smaller RV stroke volume (RVSV 65 ± 19 ml vs. 80 ± 22ml; p = 0.009). Pts with impaired RA pump function showed larger RVESV (142 ± 45ml vs. 99 ± 41ml; p = 0.02) and lower RVEF (36 ± 6% vs. 43 ± 8%; p = 0.006). RVESV was positively correlated with total (r2 = 0.47, p < 0.001), passive (r2 = 0.29, p = 0.03) and active (r2 = 0.39, p = 0.003) RAEV, while it was negatively correlated with total (r2=-0.41, p = 0.002), passive (r2=-0.34, p = 0.01) and active (r2=-0.31, p = 0.02) RAEF. RVSV showed a positive correlation with both total (r2 = 0.4, p = 0.002) and passive (r2 = 0.41, p = 0.002) RAEV. Finally, RVEF was positively correlated with total (r2 = 0.51, p < 0.001), passive (r2 = 0.47, p < 0.001), and active (r2 = 0.36, p = 0.007) RAEF. Conclusions RA dysfunction is not uncommon in pts with reduced LVEF, even in the absence of PH. In these pts, RA function is associated with significant changes in RV function. The RA acts as a dynamic modulator of RV pump function by redistributing RV filling and ejection force among reservoir, conduit and pump functions in the setting of altered hemodynamics. The clinical and prognostic significance of RA function in pts with reduced LVEF warrant further studies.


F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 370 ◽  
Author(s):  
Sok-Leng Kang ◽  
Lee Benson

The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.


2020 ◽  
Vol 16 ◽  
Author(s):  
Andrés Ricardo Pérez-Riera ◽  
Raimundo Barbosa-Barros ◽  
Rodrigo Daminello-Raimundo ◽  
Luiz Carlos de Abreu ◽  
Kjell Nikus

: Until the mid-1980s, it was believed that the vectorcardiogram (VCG) presented a greater specificity, sensitivity and accuracy in comparison to the 12-lead electrocardiogram (ECG), in the cardiology diagnosis. Currently, the VCG still is superior to the ECG in specific situations, such as in the evaluation of myocardial infarctions when associated with intraventricular conduction disturbances, in the identification and location of accessory pathways in ventricular preexcitation, in the differential diagnosis of patterns varying from normal of electrical axis deviation, in the evaluation of particular aspects of Brugada syndrome, Brugada phenocopies, concealed form of arrhythmogenic right ventricular cardiomyopathy and zonal or fascicular blocks of the right bundle branch on right ventricular free wall .VCG allows us to analyze the presence of left septal fascicular block more accurately than ECG and in the diagnosis of the interatrial blocks and severity of some chambers enlargements. The three-dimensional spatial orientation of both the atrial and the ventricular activity provides a far more complete observation tool than the linear ECG. We believe that the ECG/VCG binomial simultaneously obtained by the technique called electro-vectorcardiography (ECG/VCG) brought a significant gain for the differential diagnosis of several pathologies. Finally, in the field of education and research, VCG provided a better and more rational tridimensional insight into the electrical phenomena that occurs spatially, and represented an important impact on the progress of electrocardiography.


1996 ◽  
Vol 271 (6) ◽  
pp. H2677-H2688 ◽  
Author(s):  
A. A. Young ◽  
Z. A. Fayad ◽  
L. Axel

We describe a method for reconstructing the three-dimensional motion and deformation of the midwall surface of the right ventricular free wall (RVFW) using magnetic resonance tissue tagging. Tag points were defined where the tag stripes intersected the midwall contour and were tracked through systole in both short- and long-axis images. A finite-element model of the midwall surface of the RVFW was constructed to fit the midwall shape at end diastole. The model was then deformed to each subsequent frame by fitting the tag displacements and midwall contour locations. The method was applied to two human studies, a normal subject and a patient with right ventricular hypertrophy. The root mean squared error between model tag planes and tracked tag points was 0.70 mm for the normal heart (180 points) and 0.67 mm for the hypertrophic heart (52 points), both less than the image pixel size of approximately 1.0 mm. The differences in contraction patterns were visualized between the two studies. We conclude that this method allows accurate, noninvasive measurement of in vivo RVFW deformation.


2015 ◽  
Vol 9 ◽  
pp. CMC.S27462 ◽  
Author(s):  
Antoine Kossaify

Background The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber. Objective We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography. Methods A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed. Results A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S′) <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography. Conclusion Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.


2021 ◽  
Vol 17 (1) ◽  
pp. 71-83
Author(s):  
Halszka Kamińska ◽  
Łukasz A. Małek ◽  
Marzena Barczuk-Falęcka ◽  
Bożena Werner

IntroductionThe role of three-dimensional echocardiography (3D-ECHO) chamber quantification in children is still underestimated.Material and methodsIn 43 children 3D-ECHO measurements of end-diastolic (EDV) and end-systolic ventricular volumes (ESV) were compared to cardiac magnetic resonance (CMR) using Bland-Altman analysis and linear regression. The values of left and right ventricular volumes calculated in 3D-ECHO were compared with each other and verified by CMR.ResultsThe values of LV-EDV and LV-ESV measured in 3D-ECHO showed highly significant correlations with CMR (for LV-EDV r = 0.892, p < 0.00001; for LV-ESV r = 0.896, p < 0.00001). In the case of the right ventricle the correlation of 3D-ECHO results with CMR was still high (RV-EDV r = 0.848, p < 0.00001, RV-ESV r = 0.914, p < 0.00001), although mean RV-EDV and RV-ESV in 3D-ECHO were underestimated compared to CMR (by 38% for RV-EDV and 45% for RV-ESV). Correction of 3D-ECHO results using the coefficient of 1.38 and 1.45 for RV-EDV and RV-ESV, respectively, significantly improved the consistency of the results with CMR. 3D-ECHO offered lower mean values of right ventricular volumes compared to the left ventricle. The discrepancy was again reduced by the calculated coefficients.Conclusions3D-ECHO is a valuable tool for assessment of left ventricular volume, which strongly correlates and agrees with CMR. The right ventricular volumes calculated in 3D-ECHO tend to be significantly underestimated in comparison to CMR and corresponding left ventricular volumes obtained from 3D-ECHO. The use of coefficients developed by the study improves the consistency of right ventricular volumes measured by 3D-ECHO with results obtained by CMR and reduces the volumetric discrepancy between ventricles in 3D-ECHO.


2020 ◽  
Vol 25 ◽  
pp. 4067
Author(s):  
E. Surkova ◽  
A. Kovács

Right ventricular (RV) performance is an important predictor of adverse events and mortality in patients with cardiovascular diseases. Echocardiography is the first-choice imaging modality for the assessment of RV systolic function, however conventional two-dimensional echocardiographic parameters have important limitations and under specific conditions poorly correlate with the gold-standard imaging modality, cardiac magnetic resonance. Recent advances in novel echocardiography techniques, including three-dimensional echocardiography and two-dimensional speckle-tracking echocardiography opened new era in RV imaging enabling more accurate and reproducible assessment of RV performance thus providing deeper insight into the pathophysiology of this intriguing cardiac chamber. In this comprehensive review authors summarize the state-of-the-art echocardiographic approach to the assessment of the RV systolic function with specific emphasis on modern techniques, their advantages, limitations and pitfalls in the various clinical settings.


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