Regional and global right ventricular function in healthy individuals aged 20-90 years: a pulsed Doppler tissue imaging study: Umeå General Population Heart Study.
Department of Public Health and Clinical Medicine, Umeå, Sweden. Echocardiography
(Impact Factor: 1.25).
The aim of the present study was to describe regional and global right ventricular (RV) function in a wide age range of healthy subjects of both sexes. We studied 255 (125 females) healthy individuals randomly selected from the Umeå General Population Register, age 58 +/- 19 (range 22-89) years. RV function was studied using myocardial tissue Doppler imaging of the RV free wall. Isovolumic contraction (IVCv), systolic (Sv), early (Ev), and late (Av) diastolic velocities were measured. Furthermore, isovolumic periods and ejection time intervals were also measured. Conventional Doppler was used to study RV global filling properties. While systolic myocardial velocities were conserved over age, there was a decrease in myocardial E/A ratio with increasing age (r =-0.67, P < 0.001, for base) taken from the RV free wall. A similar age relation was found in RV global filling velocities with a reduced tricuspid E/A ratio (r =-0.57, P < 0.001). Furthermore, a significant correlation was found between global and regional E/A ratios at the basal (r = 0.58, P </= 0.001) and mid-segmental levels (r = 0.46, P </= 0.001). Systolic myocardial velocities behaved independent of age whereas regional as well as global E/A ratio were age-related. No relationship was found between regional isovolumic time intervals and age. Knowledge of these age-dependent relationships is fundamental when evaluating RV function in patients.
Available from: Fabian Sanchis-Gomar
- "The TAPSE has proven to correlate with ejection fraction derived by radionuclide angiography or echocardiography  whereas the S′-wave is one of the few 2-dimensional echocardiography variables that has been well-validated in population based studies. Thus, the Umea General Population Heart Study carried out in Sweden, evaluated RV function in 255 healthy individuals aged 22–89 years . The speed of the ring ranged between 8.5 and 10 cm·s −1 , while the speed in the base of the RV free wall was higher, ranging between 9.3 and 11 cm·s "
Available from: PubMed Central
- "Pulsed TDI can be used to measure the velocity of myocardial excursion (S’) at the tricuspid annulus or lateral RV basal segment. It has been validated in a population-based study with a wide age range and discriminates normal and abnormal EFs well when compared to radionuclide angiography. Like TAPSE, TDI is angle-dependent and extrapolates basal RV function to assume global function. "
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ABSTRACT: Right ventricular (RV) function is a strong independent predictor of outcome in a number of distinct cardiopulmonary diseases. The RV has a remarkable ability to sustain damage and recover function which may be related to unique anatomic, physiologic, and genetic factors that differentiate it from the left ventricle. This capacity has been described in patients with RV myocardial infarction, pulmonary arterial hypertension, and chronic thromboembolic disease as well as post-lung transplant and post-left ventricular assist device implantation. Various echocardiographic and magnetic resonance imaging parameters of RV function contribute to the clinical assessment and predict outcomes in these patients; however, limitations remain with these techniques. Early diagnosis of RV function and better insight into the mechanisms of RV recovery could improve patient outcomes. Further refinement of established and emerging imaging techniques is necessary to aid subclinical diagnosis and inform treatment decisions.
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ABSTRACT: BackgroundAlthough several previous studies have suggested the presence of right ventricular (RV) diastolic dysfunction in patients
with hypertrophic cardiomyopathy (HCM) and those with hypertensive left ventricular hypertrophy (HT-LVH), the mechanisms are
still unclear. This study aimed to clarify the relationship between the RV global diastolic dysfunction in these patients
and the regional myocardial diastolic function, including synchronicity of the interventricular septum and RV free wall.
MethodsIn 20 age-matched patients with HT-LVH, 20 patients with HCM and 22 control subjects without pulmonary hypertension, RV isovolumic
relaxation time (IRTR) was measured using continuous-wave Doppler echocardiography. The early diastolic peak strain rate (E
SR) and time from QRS to E
SR) were measured in the apical, mid-ventricular and basal segments of the interventricular septum and RV free wall using two-dimensional
speckle tracking imaging (2DST).
ResultsIRTR was more prolonged both in HT-LVH and in HCM than in the controls. The averaged septal E
SR was reduced both in HT-LVH and in HCM (P<0.0001, respectively), but the averaged RV free wall E
SR was decreased only in HCM (P=0.0007). E
SR averaged for six septal and RV free wall segments was correlated with IRTR (r=−0.46, P=0.0001). Neither intergroup difference nor correlation with IRTR was observed in a coefficient of variation of T–E
SR for the six segments.
ConclusionsRV global diastolic function is impaired in patients with HT-LVH and HCM due to relaxation abnormalities, not an asynchrony,
of the myocardium surrounding the RV cavity. The detection of RV free wall relaxation abnormality using 2DST may be useful
to differentiate HCM from HT-LVH.
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