Assuntos

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BACKGROUND: Even though the tricuspid annulus (TA) is anatomically and functionally related to right atrioventricular dependence and tricuspid annular plane systolic excursion (TAPSE) is a well-known measure of right ventricular (RV) systolic function, there is paucity of data regarding the potential impact that right atrial (RA) size and function have on TAPSE. Hence, we sought to determine whether RA volumetric and longitudinal measures affect TAPSE in patients with chronic pulmonary hypertension (cPH). METHODS: In this retrospective study, echocardiographic data from 110 patients were reviewed and the studied population was divided into Group I consisting of 50 patients (50±11 years) without PH and Group II that included 60 patients (55±14 years) with cPH. RESULTS: Even though RA areas, RA fractional area change, and maximal long-axis length measurements were abnormal in cPH patients, TA tissue Doppler imaging systolic velocity and RV fractional area change were the only useful variables in identifying patients with abnormal TAPSE (P<.0001 and P=.018, respectively). Additionally, TAPSE was independent of all RA measures, left ventricular ejection fraction, and age (P>.05). CONCLUSIONS: Based on these results, TAPSE does not appear to be influenced by either RA size or function. Additional studies using strain echocardiography to interrogate RA mechanics might now be very useful to advance our understanding of TA motion in cPH patients given recent data showing that RA function accounts for a significantly greater proportion of total right heart function in patients with cPH than in normal subjects.

Assuntos

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BACKGROUND: Although the influence of respiration on ventricular filling, as evaluated by Doppler technique, and the evaluation of diastolic velocities of mitral valve annulus (MVA), as measured by Doppler tissue imaging (DTI), can provide valuable information for the study of left ventricular (LV) diastolic function, the concomitant effects of aging, tidal volume (TV), and respiratory rate (RR) on these velocities have not been quantitatively investigated. METHODS: We evaluated 12 normal male volunteers (Group I) aged 20-26 years (mean: 22.8) and 8 normal subjects aged 41 to 54 years old (mean: 45.9) (Group II). Using DTI we measured peak early (E(a)) and late (A(a)) velocities of longitudinal axis expansion at lateral and medial MVA. Doppler mitral and tricuspid flow velocities were measured: peak early (E) and late (A) inflow velocity, early (E(i)) and late (A(i)) flow integral, and deceleration time of peak early mitral flow velocity (DT). Respiratory cycles were simultaneously recorded at RR of 9, 12, 15, and 18 cycles/min and TV of 600 and 900 mL during respiration (RESP). RESULTS AND CONCLUSIONS: (1) E, A, and A(i) in MV had negligible change during respiration, but E(i) was significantly reduced during inspiration; (2) DT reduced slightly with inspiration, but the change was significant only with TV of 900 mL; (3) an important increase of E in right ventricular flow was observed during inspiration; (4) variations of RR and TV did not significantly influence right and left ventricular inflow in normal subjects, in the conditions of this investigation; (5) a significant increase of E(a) at medial MVA was documented during inspiration only in young subjects; (6) a significant decrease of A(a) at medial MVA was observed during inspiration in both groups of volunteers; (7) RR and TV did not influence MVA velocities in young and adult subjects; (8) a consistent reduction in E(a) and a significant increase in A(a) were observed with increasing age; (9) these changes were more conspicuous and consistent than those documented in ventricular filling when young and middle-age men are compared, suggesting that the DTI is more sensitive to detect changes in diastolic function; and (10) in addition, these data suggest that, for evaluation of diastolic function, in clinical context, it is not necessary to control rigorously RR or TV.

Assuntos

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There are frequent citations in the literature stating that lesions of the tendinous cords cause functional disorders of the heart valves. This led us to conduct the present investigation on the anatomy of the tendinous cords. Our objective was to focus on the morphological characteristics of tendinous cords that are inserted directly into the interventricular septum, such as their frequency, number, dimensions and This study was conducted on 50 hearts from adults of both sexes that had been fixed in 10% formaldehyde. The right ventricle was opened by means of an incision parallel to the anterior interventricular groove, and the left ventricle was opened by means of a longitudinal incision in the middle of the pulmonary (left) surface. Our results showed that, in the right ventricle, these tendinous cords constantly appeared without the involvement of papillary muscles (98%). They ranged in number from one to ten, and between two and five was the most common (72%). They were short, mostly ranging from 0.3 to 1.9 cm in length (81.5%) and were preferentially located in the upper third of the interventricular septum (71.4%). They were usually attached to the septal cusp (76.7%) and sometimes to the anterior cusp (21.3%). The cusp insertion sites were the free edge (62%), ventricular surface (32%) and basal edge (6%). It was exceptional to find tendinous cords in the ventricular septum of the left ventricle. Tendinous cords directly inserted into the atrioventricular septum were constantly present in the right ventricle, with varying numbers. They were predominantly short because they were inserted into the upper third of the septum and most often headed towards the septal cusp. It was exception to find tendinous cords in the atrioventricular septum of the left ventricle.

Assuntos

Assuntos

RESUMO

OBJECTIVE: To assess right ventricular systolic function using indices derived from tricuspid annular motion, and to compare the results with right ventricular ejection fraction (RVEF) calculated from radionuclide angiography. DESIGN: Pulsed Doppler echocardiography indices were obtained from 10 patients with a normal RVEF (group 1) and from 20 patients whose RVEF was less than 45% (group 2). RESULTS: The patients in the two groups were similar in age, systolic blood pressure, and heart rate. There was a close correlation between the tricuspid annular motion derived indices (D wave integral (DWI), peak velocity of D wave (PVDW), and tricuspid plane systolic excursion (TPSE)) and RVEF (r = 0.72, 0.82, and 0.79, respectively). DWI was significantly higher in group 1 than in group 2. PVDW discriminated adequately between individuals with abnormal and normal right ventricular ejection fraction. The sensitivity and specificity of tricuspid annular motion derived indices were very good. CONCLUSIONS: Indices derived from tricuspid annular motion appear to be important tools for assessing right ventricular systolic function.

Assuntos

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PURPOSE: To compare the patterns of valvar dynamics expressed by the mitral prolapse and regurgitation across the valves, between competitive athletes players of distinctive sport modalities, and between these and sedentary control subjects. METHODS: Pulsed and continuous wave non-colour Doppler echocardiographic evaluation of mitral valvular movements and flow patterns across the different valves was comparatively performed in 10 cyclists, 10 runners, 19 football players, and in 17 sedentary nonathletes controls, all males with ages ranging between 16 and 28 years old (p > 0.05). Valvar dynamics was evaluated from the apical two and four-chamber and parasternal short-axis and long-axis views. The proportions of valvar functional patterns in each group were compared using the chi-square test. RESULTS: Similar (p > 0.05) and high frequency of mitral prolapse were detected in the cyclists (30%), runners (50%), football players (32%), and controls (47%). Mitral, tricuspid and pulmonary regurgitations were very frequent and their proportions similar (p > 0.05) in the cyclists (40%, 80% and 40%, respectively), runners (50%, 70% and 60%), football players (37%, 58% and 58%), and controls (41%, 35% and 35%). No significant difference (p > 0.05) was observed between cyclists (20%), runners (20%), football players (16%), and controls (35%) for the frequency of mitral prolapse plus regurgitation. Aortic regurgitation was not observed in any athlete or control subject. CONCLUSION: Neither the practice, nor the sport modalities studied appears to influence the prevalence of mitral prolapse and mitral, tricuspid and pulmonary valvar regurgitation. In all likelihood, these manifestations represent physiological variants of valvar dynamic which can be better detected by means of Doppler echocardiography.

Assuntos