Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study.

AIM AND METHODS: The aim of our study was to compare the development of echocardiographic parameters and functional status of patients with hypertrophic obstructive cardiomyopathy (HOCM) treated conservatively (n = 41) or by alcohol septal ablation (ASA; n = 39). RESULTS: Left ventricular outflow tract gradient (LVOTG) decreased in the first year by 53.7±36.4 mmHg in ASA group versus 5.5±47.1 mmHg in conservatively treated group (p<0.001), in the third year by 53.1±41.4 mmHg versus 23.9±42.7 mmHg (p = NS) and in the fifth year, the reduction of LVOTG was 52.1±44.5 mmHg in ASA group and 3.0±63.2 mmHg in conservatively treated group (p<0.05).Change in NYHA class in the first year was -1.1±0.4 versus 0.1±0.5, in the third year -1.0±0.6 versus 0.1±0.4 and in the fifth year -0.8±0.5 versus 0.1±0.4 (all p<0.001). CONCLUSION: Our results showed for the first time that decline of LVOTG after ASA creates a favorable left ventricle remodeling and leads to significant improvement of functional status of HOCM patients in comparison with conservative treatment (Tab. 3, Fig. 2, Ref. 42).

[Diastolic dysfunction in the elderly subjects. Disease or a physiological manifestation of ageing?]. / Diastolická dysfunkce levé komory ve vyssím veku. Nemoc, nebo fyziologický projev stárnutí?

AIM: The purpose of this summary paper is to discuss the current knowledge of the impact of age on diastolic function of the left ventricle. Data from the literature: Reports published till this time have convincingly demonstrated a significant relationship of age to diastolic function of the left ventricle. Ageing is a physiological process accompanied by structural changes in both myocardium and arterial bed resulting in worsening of parameters characterizing the left ventricular diastolic function. This "physiological" diastolic dysfunction in the elderly subjects can be explained by the deterioration of passive left ventricular filling properties and by worsening of left ventricular relaxation. The detailed analysis of published reports shows problems in distiguishing this "physiological" diastolic dysfunction resulting from physiological tissue ageing from "pathological" diastolic dysfunction reflecting a disease of cardiovascular system. CONCLUSION: To interprete correctly values of parameters quantifying diastolic function of the left ventricle, one should take into account the age of subjects under the examination. Further studies are necessary to distinguish exactly "physiological" deterioration of diastolic function associated with ageing from really "pathological" diastolic dysfunction in the elderly subjects.

Association between three single nucleotide polymorphisms in eotaxin (CCL 11) gene, hexanucleotide repetition upstream, severity and course of coronary atherosclerosis.

The impact of three single-nucleotide polymorphisms in eotaxin (SCYA11) gene promoter (-426C>T and -384A>G) and first exon (67G>A) and recently described hexanucleotide (GAAGGA)(n) 10.9 kb upstream on coronary atherosclerosis was investigated. Elective coronary angiography of 1050 consecutive subjects was performed. All patients were genotyped for the three SNPs. In a subset of the first 472 samples, the number of (GAAGGA)(n) repetitions was determined. For further evaluation, short and long variants were distinguished; the borderline corresponded with the median value of all alleles: ≤8 repetitions were considered as short sequence, ≥9 repetitions as long. Patients with bronchial asthma or insignificant atherosclerosis were excluded; the remaining group of 933 subjects was further investigated. Patients were grouped according to the form of CAD (ACS vs. stable angina) and the number of diseased vessels. The GG variant of 67 G>A polymorphism was associated with acute form of CAD compared to stable angina (p=0.0011, p(corr.)=0.013). The number of (GAAGGA)(n) repetitions in our set of patients ranged from 3 to 12. There were no subjects with 4 or 5 repetitions. The frequency of short repetition alleles increased with the number of affected vessels (1 vs. 3 diseased vessels: p=0.0043, p(corr)=0.034). In our study, the (GAAGGA)(n) hexanucleotide was associated with the severity of CAD. The 67 GG was associated with acute form of CAD. None of the two SNPs in eotaxin promoter had any relation to CAD. The number of (GAAGGA)(n) repetitions can thus be a novel genetic marker of the extent of CAD.

The effect of regular physical activity on the left ventricle systolic function in patients with chronic coronary artery disease.

The purpose of this study was to assess the influence of aerobic training on the left ventricular (LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 cohorts. While patients in the cohort I (n=14) had continued training individually for 12 months, patients in the cohort II (n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A- walls supplied by nonstenotic artery; B- walls supplied by coronary artery with stenosis ≤50 %; C- walls supplied by coronary artery with stenosis 51-70 %; D- walls with stenosis of supplying artery 71-99 %; and E- walls with totally occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22 (p=NS), and by 1.25±0.45 cm/s (p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E: 0.37±0.60 versus -1.76±0.40 cm/s (p<0.05). At the maximal load, the significant difference was found only in walls A (0.16±0.84 versus -2.67±0.87 cm/s; p<0.05). Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary artery.

Association of polymorphisms of zinc metalloproteinases with clinical response to stem cell therapy.

AIM: The purpose of this study was to assess the associations of polymorphisms in two metalloproteinase genes-metalloproteinase-2 (MMP-2) and angiotensin converting enzyme (ACE)-with clinical response to autologous transplantation of mononuclear bone marrow cells (MBMC) in patients with acute myocardial infarction. METHODS: The double centre study included 48 patients with a first acute myocardial infarction treated with primary coronary angioplasty, stent implantation and transplantation of MBMC. According to the changes in perfusion defect size, left ventricle ejection fraction, end-systolic volume and peak systolic velocity of the infracted wall (dSaMI) after cell therapy, the patients were retrospectively divided into group A (responders) and group B (non-responders). Genomic DNA was isolated from peripheral leukocytes by a standard technique using proteinase K. Three MMP-2 promoter (-1575G/A, -1306C/T and -790T/G) as well as I/D ACE gene polymorphisms were detected by PCR methods with restriction analyses (when necessary) according to standard protocols. RESULTS: Of the 48 patients who received MBMC transplantation, 17 responded to the therapy. There were no significant differences in the prevalence of matrix metalloproteinase-2 triple genotype GGCCTT between responder/non-responder groups (71% versus 61%, p=0.375). Similarly, no differences in either genotype distribution or allelic frequencies of I/D ACE polymorphism between responders and non-responders to the cell therapy were observed (p=0.933). Compared to patients with ACE genotype ID or DD, the patients with ACE II genotype significantly improved in regional systolic LV function of the infarcted wall after implantations of MBMC (dSaMI - 0.4 versus 1.4 cm/s, p=0.037). CONCLUSION: In our study, the ACE genotype II was associated with improvement of regional systolic LV function of the infarcted wall after implantations of MBMC. The detected polymorphism in matrix metalloproteinase-2 gene was not associated with clinical response to cell therapy.

Association of the eNOS 4a/b and -786T/C polymormphisms with coronary artery disease, obesity and diabetes mellitus.

The aim was to assess the relationship between eNOS 4a/b and -786T/C polymorphisms with coronary artery disease (CAD), obesity and diabetes mellitus. Total number of 1313 patients underwent coronary angiography, 939 had significant CAD (stenosis of > or = 1 coronary artery > or = 50%), 222 had smooth coronary arteries. Patients with insignificant atherosclerosis were excluded, the study finally comprised 1161 patients. The analysis of eNOS 4a/b and -786T/ C polymorphisms was performed by polymerase chain reaction. No significant interaction was found between -786T/C polymorphism and solitary CAD or CAD with diabetes and obesity. For 4a/b polymorphism, genotypes aa+ab were almost three times more frequent in diabetic patients without CAD versus patients without CAD and without diabetes--OR 2.79; P = 0.009, Pcorr = 0.03. In 4a/b polymorphism and CAD with obesity and diabetes: bb genotype was significantly more frequent: in patients with CAD, diabetes and obesity in comparison with obese diabetic patients without CAD (OR = 3.63, Pcorr = 0.05); in non-diabetic non-obese patients with CAD, versus diabetic and obese patients without CAD (OR = 3.38, Pcorr = 0.05); in obese non-diabetic patients without CAD vs. obese diabetic patients without CAD (OR = 5.91, Pcorr = 0.01); in patients without CAD, obesity and diabetes vs. obese diabetic patients without CAD (OR = 3.59, Pcorr = 0.05). The eNOS 4a/b polymorphism has significant association with diabetes mellitus in CAD-negative patients, and with CAD in combination with obesity and diabetes mellitus. No association between 4a/b or -786T/C polymorphism and solitary CAD was found.

Contribution to the V-V interval optimization in patients with cardiac resynchronization therapy.

The present study proposed procedure for predicting an optimal left and right ventricular pacing interval delay (V-V interval). In 16 patients (heart failure, left bundle branch block, biventricular pacing) two methods (A and B) identifying optimal V-V interval were tested. Method A: predicted optimal V-V interval A (POVV-A) = electromechanical delay of the segment paced by left ventricle lead minus electromechanical delay of the segment paced by right ventricle lead. Method B: predicted optimal V-V interval B (POVV-B) = difference in the onset of aortic and pulmonary flows. Both methods were validated using echocardiography and right-sided heart catheterization. Cardiac output during POVV-A (4.6 l.min(-1)) was significantly better than that during POVV-A minus 20 ms (4.3 l.min(-1), p<0.01) and POVV-A plus 20 ms (4.3 l.min(-1), p<0.01), and than that during POVV-B (4.4 l.min(-1), p<0.05). LV dP/dt during POVV-A (818 mm Hg.s(-1), exceeded that during POVV-A plus 20 ms (717 mm Hg.s(-1),, p<0.05) and POVV-A minus 20 ms (681 mm Hg.s(-1), p<0.05), and that during POVV-B (727 mm Hg.s(-1), p<0.01). The time difference in onsets of myocardial deformation of left ventricle segment paced by the left ventricle and right ventricle lead allows identifying the optimal V-V interval and improves left ventricle performance.

WITHDRAWN: Prognostic Importance of the Right Ventricular Function Assessed by Doppler Tissue Imaging.

The publisher regrets that this was an accidental duplication of an article that has already been published in Eur. J. Echocardiogr., 4 (2003) 262-271, . The duplicate article has therefore been withdrawn.

[Non-pharmacologic therapy of hypertrophic obstructive cardiomyopathy--results of therapy based on percutaneous transluminal septal myocardial ablation compared with results of dual-chamber cardiac pacing]. / Nefarmakologická lécba hypertrofické obstrukcní kardiomyopatie--srovnání vysledku lécby metodami perkutánní transluminální septální myokardiální ablace a dvoudutinové kardiostimulace.

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) and pacemaker (PM) therapy with apical preexcitation are therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) patients with symptoms despite pharmacological therapy. AIM: evaluation and comparison of treatment results of PTSMA and PM implantation. PATIENTS: 22 HOCM patients (NYHA class III and IV) with left ventricle outflow tract gradient (LVOTG) at rest more than 30 mm Hg. In group A were evaluated 11 patients treated by PTSMA. Left ventricle outflow tract gradient (LVOTG) was 90.5 +/- 16.0 mm Hg, NYHA class 3.1 +/- 0.2. Group B included 11 patients treated by dual chamber PM implantation, LVOTG in this group was 105 +/- 48 mm Hg, NYHA class 3.0 +/- 0.4. RESULTS: NYHA class in the group A decreased after treatment to 1.8 +/- 0.6 (p < 0.01), LVOTG to 24 +/- 12 mm Hg (p < 0.001). There was observed significant decrease in grade of systolic anterior motion (SAM), interventricular septum (IVS) thickness and left atrium (LA) size. Left ventricle end systolic diameter (LV SD) and left ventricle end diastolic diameter (LV DD) increased during follow-up. Decrease of NYHA class in the group B was to 2.1 +/- 0.6 (p < 0.001), LVOTG to 25.5 +/- 21.0 mm Hg (p < 0.001). Changes of other parameters in the group B were not significant, except decrease of SAM. Comparison of both groups: NYHA class change PTSMA/PM: 1.3 +/- 0.6/0.9 +/- 0.4 (p < 0.05), LVOTG change PTSMA/PM: -66 +/- 20/-79 +/- 46 mm Hg (p = n.s.). LV SD assessment comparison of LV SD change PTSMA/PM: 5 +/- 5/1 +/- 5 mm (p < 0.05). LA assessment - comparison of LA change PTSMA/PM: 5 +/- 5/-1 +/- 4 mm (p < 0.05). Other changes were not significant. CONCLUSION: Both therapeutic approaches - PTSMA and PM implantation - resulted in significant improvement of functional capacity assessed by NYHA classification. Decrease of LVOTG was also significant and was similar in both groups, NYHA class improvement as well as LA size decrease and LV DS increase were more expressed in PTSMA group.

[Interval and continuous training in cardiovascular rehabilitation]. / Intervalový a kontinuální trénink v kardiovaskulární rehabilitaci.

The objective of the study was to evaluate the physiological effectiveness and the influence of two modifications of aerobic training (interval and continuous) on the physical performance in the patients with coronary heart disease. 38 males with coronary heart disease (age 60 +/- 10.2 years) passed three months training programme of 60 min 3 times a week (10 min of warm up phase, 25 min of aerobic phase, 15 min of resistance training, 10 min of relaxing phase). Patients with coronarographically verified stenosis > 50% luminal diameter and/or left ventricular ejection fraction lower than 40 % (n = 22) had in terms of aerobic phase interval training prescribed (30 second work phases with work load intensity on the level of anaerobic threshold alternating with 60 second recovery phases with intensity of 5 W); other patients (n = 16) passed aerobic phase of the programme with continual work load of intensity on the level of ventilatory anaerobic threshold. After the determination of three month rehabilitation programme the maximal achieved performance as well as aerobic capacity evaluated by spiroergometric examination statistically significantly increased in the group of patients with interval training and also in the group with continuous training. Despite the group with interval training performed 2.5-3 times less work in each training unit (p < 0.01), the performance and aerobic capacity parameters after the termination of three month programme did not statistically significantly differ from the group with continuous training. The advantage of the continuous training is a possibility to achieve an improvement also in the patients with left ventricular dysfunction and chronic coronary heart disease who could have worse tolerance of the continual work load.

[Echocardiography--a stethoscope of the 21st century]. / Echokardiografie--stetoskop 21. století.

The goal of this article is to provide a report of a current potential of an ultrasound examination of heart and to outline future development of echocardiography and its use in clinical practice. Since echocardiography appearance in the middle of the 20th century till today, the method has undergone a very dynamic development. From a simple one-dimensional image (M-mode), through two-dimensional image (2D) complemented with Doppler imaging of blood flows, echocardiography developed into currently up to date methods such as contrast echocardiography, tissue Doppler imaging, assessment of myocardial strain and strain rate, methods based on detection of ultrasonic backscatter (acoustic densitometry, automated border detection, colored image of wall motion--"color kinesis") and others. Possibility of an ultrasonic assessment of heart significantly supplemented transesophageal echocardiography and newly emerging three-dimensional imaging of heart structures. As a routine method to prove myocardial ischemia and viability a stress echocardiography is currently used. Its results significantly improved after technical innovations enabling simultaneous monitoring and evaluation of images at various projection displays and at various levels of stress. A big promise for further bigger use of echocardiography has become a miniaturisation of devices enabling one man to carry the device to a patient outside a health care facility. These small, more affordable ultrasound devices can soon become real stethoscopes of the 21st century.

Prognostic importance of the right ventricular function assessed by Doppler tissue imaging.

AIMS: We sought to assess whether the peak systolic and diastolic tricuspid annular velocities as indicators of the right ventricular systolic and diastolic function are of prognostic importance in patients with symptomatic heart failure. METHODS AND RESULTS: The study included 139 consecutive patients with symptomatic heart failure. Their mean left ventricular ejection fraction was 24% (range, 10-39%); 107 patients (77%) were in functional class III according to the New York Heart Association. All patients underwent clinical and laboratory examination, standard echocardiography completed by the Doppler tissue imaging of the tricuspid annular motion, and the right-sided heart catheterization. They were followed up for cardiac-related death and non-fatal cardiac events including the need for implantation of a cardioverter-defibrillator and hospitalization for heart failure. The median follow-up was 11 months (range, 1-48 months). There were 17 cardiac-related deaths and 23 non-fatal cardiac events. The multivariate stepwise Cox regression modelling revealed three effective predictors for both survival and event-free survival: aetiology of heart failure, left ventricular end-diastolic diameter, and the peak systolic tricuspid annular velocity (Sa). Patients with Sa<10.8cms(-1) exhibited worse survival (P=0.048) and event-free survival (P<0.001) compared with those having Sa>/=10.8cms(-1). Risk values of Sa (<10.8cms(-1)) and the left ventricular end-diastolic diameter (>70mm) were found to be of additive simultaneous influence leading to a very poor prognosis, mainly if aetiology of heart failure was idiopathic dilated cardiomyopathy (P<0.001). CONCLUSION: The Sa represents a significant independent predictor of survival and event-free survival in patients with symptomatic heart failure. Its combination with the left ventricular end-diastolic diameter provides a very powerful tool for patient risk stratification.

[Combined training in patients with systolic left ventricular dysfunction]. / Kombinovaný trénink u nemocných se systolickou dysfunkcí levé komory srdecní.

The objective of the work was to evaluate the effect of eight-week combined training on the performance, aerobic capacity and basic haemodynamic parameters in patients with systolic dysfunction of the left ventricle and to assess its safety. The investigation comprised 26 patients, men mean age (x +/- SD) 61.8 +/- 11.1 years with coronarographically verified chronic ischaemic heart disease and with a left ventricular ejection fraction lower than 40% (EF 35 +/- 4%). Before the beginning and after completion of the rehabilitation programme (eight weeks) a spiroergometric examination was made, up to the symptom-limited maximum. Fitness elements were included after 2 weeks of aerobic training. The lesson lasted 60 mins. and included warming up (10 mins.), aerobic load on an ergometer with an intensity of the load at the level of the anaerobic threshold (20 mins.), the stage of fitness training on a combined training machine (20 mins) and the relaxation stage (10 mins). In the fitness stage the patients started to exercise at the 30% level, after two weeks at the 60% level 1-RM (one repetition maximum) The results showed after eight-week combined training a significant (p < 0.05) increase of the maximum achieved performance (from 104 +/- 27 to 132 +/- 32 W) in patients with systolic left ventricular dysfunction. There was a significant increase in the capacity of the transport system expressed by the value of the maximum oxygen uptake (from 1545 +/- 312 to 1740 +/- 359 ml.min-1) and MET (from 5.3 +/- 1.3 to 6.0 +/- 1.4). There was a significant decrease of the blood pressure at rest, systolic and diastolic, and of the baseline value of the heart rate at rest and of the "product rate, pressure"--RPP. Changes in the EF were not significant.

Heart rate and increased intravascular volume.

The objective was to establish whether an intravascular volume increase leads to a heart rate (HR) increase without increased sympathetic tonus. HR changes at rest and at deep breathing (6/min - simulated increase of atrial filling pressure) were measured in patients after heart transplantation. Evaluation of dependency of HR changes on breathing depth was done through a new time series methodology. The data was evaluated through graphs displaying a significant increase in the graph area at deep breathing, when compared with breathing at rest (p<0.01). We presume that an increase in HR corresponds to increased intravascular volume and malfunctioning kidneys.

[Echocardiography after orthotopic heart transplantation]. / Echokardiografie po ortotopické transplantaci srdce.

UNLABELLED: One of the most serious complications after orthotopic transplantation of the heart (OTH) is graft rejection. Its early detection can help successful control. The diagnostic gold standard is myocardial biopsy, it is however not always supreme. We tried to find out whether some modern echocardiographic methods can provide further valuable information. At the same time we were concerned with the follow up of basic variables of the circulation and echocardiographic indicators of left ventricular function. MATERIAL AND METHODS: The authors examined repeatedly 22 patients where in 1998-2000 OTH was performed, who did not have an acute severe rejection, who had at least one myocardial biopsy between the first and second month after OTH without signs of rejection and who were easily examined by echocardiography. In addition to the standard follow up according to a routine pattern they were subjected to clinical and echocardiographic examination during the 1st-2nd month after OTH, 6 months after the first examination and one year after the second examination. Classical echocardiography, acoustic densitometry and Doppler tissue examination of the movement of the mitral ring were used. RESULTS: The patients had throughout the investigation period clinical cardiological complications. Between the first and second examination the systolic pressure rose from 125.4 +/- 9.5 to 135.4 +/- 13.5 mm Hg (p < 0.05), the diastolic pressure from 79.6 +/- 8.2 to 86.4 +/- 9.5 mm (p < 0.05), during the third examination it dropped again to original values. During the follow up no significant differences developed in indicators of classical echocardiography, acoustic densitometry and Doppler tissue echocardiography. Of 22 patients however myocardial biopsy of the right ventricle proved rejection only in two. In those the authors did not observe any echocardiographic changes during rejection. In one patient who died echocardiography revealed a decline of left ventricular function and a non-specific bioptic finding, and on necropsy severe cellular vascular rejection. CONCLUSIONS: Blood pressure rises early in some patients after OTH, it is therefore important to monitor it carefully and to administer early and systematic treatment of hypertension. In non-complicated patients the echocardiographic findings did not change. Because of the low number of rejections the authors were not able to prove the importance of some new echocardiographic methods. In view of discrepancies between methods in some patients with rejection a comprehensive diagnostic approach is still necessary: myocardial biopsy supplemented by further examinations, in particular echocardiographic ones.

Coronary artery bypass grafting in patients with left ventricular ejection fraction of 30% or less.

BACKGROUND: The results of a merely pharmacological therapy in patients with advanced left ventricular dysfunction are unsatisfactory. Coronary artery bypass grafting is frequently the only therapeutic option, but ventricular dysfunction is generally considered to be a risk factor. AIM: To find out the frequency of coronary artery bypass grafting and its outcome in patients with a ejection fraction of 30% or less who were operated on at a single institution. METHODS: Between January 1st, 1996 and October 30th, 1999, 90 patients (4.6% of all patients operated on due to of coronary artery disease) with EF of 30% or less underwent coronary artery bypass grafting. This group consisted of 12 women and 78 men at an average age of 60.2 +/- 9.4 years (range, 33 to 78 years); 75.6% patients were in functional class III or IV and 80.0% had three-vessel disease. On the average, 2.5 grafts per patient were implanted, the left internal mammary artery was used in 24.4% patients, and 10.0% of patients had cardiac surgery without cardiopulmonary bypass. RESULTS: Hospital mortality was 10%. The main cause of death was cardiac or multiorgan failure. Low cardiac output syndrome and supraventricular dysrrhythmias were the most common postoperative complications. Advanced age and low cardiac output syndrome were found to be risk factors of early mortality. Five other patients died during the follow-up (4 to 48 months). One- and three-year survival rate were 83.1% and 81.9%, respectively. Ejection fraction improved during the follow-up from 27.5% to 33.7%. The improvement was more pronounced in patients in whom preoperative end-diastolic diameter of the left ventricle was below 70 mm, and in patients with two and more hibernating segments on dobutamine stress echo. CONCLUSIONS: Successful results of surgical revascularization in patients with severe impairment of left ventricular function can be achieved by careful selection of patients (the presence of viable myocardium is necessary) and management. Early mortality and morbidity was higher than in patients with normal ventricular function. Age and low cardiac output syndrome were revealed as risk factors of early mortality. Long-term prognosis for hospital survivals was satisfactory. (Tab. 5, Fig. 1, Ref. 13.)

Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function.

AIMS: Rapid, accurate, and widely available non-invasive evaluation of right ventricular function still presents a problem. The purpose of the study was to determine whether the parameters derived from Doppler tissue imaging of tricuspid annular motion could be used as indexes of right ventricular function in patients with heart failure. METHODS: Standard and pulsed Doppler tissue echocardiography were obtained in 44 patients with heart failure (mean left ventricular ejection fraction 24 +/- 7%) and in 30 age- and sex-matched healthy volunteers. The tricuspid annular systolic and diastolic velocities were acquired in apical four-chamber views at the junction of the right ventricular free wall and the anterior leaflet of the tricuspid valve using Doppler tissue imaging. Within 2 h of Doppler tissue imaging, the first-pass radionuclide ventriculogram, determining right ventricular ejection fraction and equilibrium gated radionuclide ventriculography single photon emission computed tomography, were performed in all patients. RESULTS: In patients with heart failure, the peak systolic annular velocity was significantly lower and the time from the onset of the electrocardiographic QRS complex to the peak of systolic annular velocity was significantly greater than the corresponding values in healthy subjects (10.3 +/- 2.6 cm. s(-1) vs 15.5 +/- 2.6 cm.s(-1), P < 0.001, and 198 +/- 34ms vs 171 +/- 29 ms, P < 0.01, respectively). There was a good correlation between systolic annular velocity and right ventricular ejection fraction (r = 0.648, P <0.001). A systolic annular velocity < 11.5 cm.s(-1)predicted right ventricular dysfunction (ejection fraction < 45%) with a sensitivity of 90% and a specificity of 85%. CONCLUSION: We conclude that the evaluation of peak systolic tricuspid annular velocity using Doppler tissue imaging provides a simple, rapid, and non-invasive tool for assessing right ventricular systolic function in patients with heart failure.