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1.
Medicine (Baltimore) ; 99(9): e19296, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118744

RESUMO

OBJECTIVE: The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT). METHODS: This study was approved by the local ethics committee of Huai'an First People's Hospital. Patient consent was not provided due to the use of completely anonymous images from which the individual could not be identified in this study. Thirty-three patients with nonischemic dilated cardiomyopathy underwent both TDI and ERNA before and within 48 hour after CRT implantation. RV dyssynchrony was measured with TDI using the difference in time to peak systolic velocity between the RV free wall and ventricular septum (RV-T). With ERNA, the standard of RV mean phase angle and RV phase standard deviation (RVmPA% and RVPSD%) were assessed. RESULTS: Moderate positive correlations were observed among baseline RVmPA%, RVPSD% and RV-T (r = 0.689 and 0.716, P < .001). Twenty patients (61%) with a reduction of at least 15% in LV end-systolic volume were categorized as acute responders after CRT. Responders showed significant reduction in RVmPA% and RVPSD% after CRT (53.60 ±â€Š4.15% to 43.95 ±â€Š6.88% and 14.00 ±â€Š2.41% to 10.40 ±â€Š1.67%, P < .05), whereas RV-T remained unchanged (50.10 ±â€Š10.28 ms to 49.25 ±â€Š13.64ms, NS). Receiver operating characteristic curve showed that the cut-off value of RV-T was 48.5ms, yielding 65% sensitivity and 77% specificity to predict acute respond to CRT. The cut-off value of RVmPA% was 49.5%, yielding 85% sensitivity and 85% specificity and the cut-off value of RVPSD% was 11.5%, yielding 85% sensitivity and 92% specificity. CONCLUSION: ERNA might be an appropriate alternative to TDI for assessment of RV dyssynchrony. Either RVmPA% or RVPSD% was highly predictive for acute response to CRT.


Assuntos
Terapia de Ressincronização Cardíaca/normas , Imagem do Acúmulo Cardíaco de Comporta/normas , Cardiopatias/diagnóstico , Função Ventricular Direita , Idoso , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Feminino , Imagem do Acúmulo Cardíaco de Comporta/métodos , Imagem do Acúmulo Cardíaco de Comporta/estatística & dados numéricos , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC
2.
Med Sci Monit ; 26: e920982, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127512

RESUMO

BACKGROUND Left ventricle diastolic malfunction (LVDMf) is a valvular cardiovascular disease. Here, we assessed the correlation between right ventricle (RV) load and function (L&F) and diastolic malfunction (DMf) in symptomless valvular cardiovascular disease patients. MATERIAL AND METHODS We enrolled 59 subjects who underwent right-heart catheterization, assessing their echocardiographic analysis results while performing exercises in supine position, comparing results at rest and during maximum exercise. Subjects were furthermore stratified according to resting DMf. Using cardiac resonance imaging (CRM), we assessed cardiac morphology and chamber size. RV stroke, pulmonary artery conformation, pulmonary artery elastance, pulmonary artery pulsatility, and right atrial (pRA) pressure were indexed for supine exercises. RESULTS We observed that DMf grade 1 (G-1) and grade 2 (G-2) were present in 28 patients and 16 patients, respectively, while the remaining 15 patients had a normal filling pattern in the left ventricle. In comparison to patients with DMf of G-1, patients with normal diastolic filling pattern had higher volume index for RV end-diastolic (endD) (81±14 mL/m² vs. 68±12 mL/m², P=0.08) and for RV end-systolic (endS) (34±11 mL/m² vs. 27±8 mL/m², P=0.07). We also observed that in G-2 DMf pulmonary artery, pressure and elastance of the pulmonary artery were enhanced and were correlated with optimum oxygen intake and RV volume (r=-0.69, P<0.001). CONCLUSIONS We found that enhancement in RV afterload, which returns to normal at rest, is correlated with mild DMf. Additionally, despite maximum exercise, it is reciprocally associated with maximum oxygen intake and right atrial pressure.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Ventrículos do Coração/fisiopatologia , Disfunção Ventricular Esquerda , Função Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Diástole , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Direita
3.
Ther Adv Cardiovasc Dis ; 14: 1753944719895902, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31918629

RESUMO

Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Fluxo Pulsátil , Disfunção Ventricular Direita/terapia , Função Ventricular Direita , Animais , Modelos Animais de Doenças , Insuficiência Cardíaca/fisiopatologia , Humanos , Desenho de Prótese , Carneiro Doméstico , Disfunção Ventricular Direita/fisiopatologia
4.
Int J Cardiovasc Imaging ; 36(1): 131-140, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31471763

RESUMO

To assess ventricular function and dyssynchrony using three-dimensional (3D) computed tomography (CT) strain in adult congenital heart disease (ACHD). We prospectively analyzed a multiphase cardiac CT data set for 22 adult patients with CHD, including 8 patients with congenital systemic right ventricle (RV) and 14 patients with repaired Tetralogy of Fallot (TOF). Eight patients had a cardiac pacemaker. Volume of Interest was drawn on a multiplanar reconstruction of the ventricle with strain overlay using a 3D-strain algorithm. Ventricular strain, inter- and intraventricular dyssynchrony, and right ventricle outflow tract (RVOT)-apex dyssynchrony were calculated. RVOT-apex dyssynchrony by ventriculography was also compared in 15 patients. Pulmonary ventricular strain, systemic ventricular strain, and septal wall strain were lower in ACHD patients than in the controls, and lower in the ACHD with pacing group than without pacing group as well. Maximum interventricular time difference and intraventricular time difference were longer than in ACHD than in the controls, and longer in the ACHD with pacing group than without pacing group as well. RVOT-apex delay was significantly longer in patients with a pacemaker than in those without a pacemaker (118.1 ± 31.9 ms vs. 76.1 ± 36.2 ms, p = 0.03). RVOT delay determined by 3D CT strain significantly correlated with that determined by ventriculography (Pearson r = 0.55, p = 0.03). 3D CT strain can detect reduced biventricular contraction and inter- and intraventricular and RVOT-apex mechanical dyssynchrony can be assessed in patients with ACHD.


Assuntos
Cardiopatias Congênitas/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada Multidetectores , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Esquerda , Função Ventricular Direita , Adulto , Estimulação Cardíaca Artificial , Feminino , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia , Disfunção Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/terapia
6.
Curr Opin Anaesthesiol ; 33(1): 27-36, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31724957

RESUMO

PURPOSE OF REVIEW: Right ventricular (RV) dysfunction following thoracotomy and pulmonary resection is a known phenomenon but questions remain about its mechanism, risk factors, and clinical significance. Acute RV dysfunction can present intraoperatively and postoperatively, persisting for 2 months after surgery. RECENT FINDINGS: Recently, the pulmonology literature has emphasized pulmonary arterial capacitance, rather than pulmonary vascular resistance, as a marker to predict disease progression and outcome in patients with pulmonary hypertension and heart failure. Diagnostic focus has emerged on the use of cardiac MRI and new echocardiographic parameters to better quantify the presence of RV dysfunction and the role of pulmonary capacitance in its development. SUMMARY: In this review, we examine the most recent literature on RV dysfunction following lung resection, including possible mechanisms, time span of RV dysfunction, and available diagnostic modalities. The clinical relevance of these factors on preoperative assessment and risk stratification are presented.


Assuntos
Hipertensão Pulmonar , Procedimentos Cirúrgicos Torácicos , Disfunção Ventricular Direita , Humanos , Artéria Pulmonar , Função Ventricular Direita
7.
Int J Cardiovasc Imaging ; 36(1): 33-43, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432289

RESUMO

Tricuspid annular (TA) size, assessed by 2D transthoracic echocardiography (TTE), has a well-established prognostic value in patients undergoing mitral valve surgery, with TA dilatation triggering simultaneous tricuspid annuloplasty. While TA dilatation is common in patients with dilated atria secondary to atrial fibrillation, little is known about the mechanisms of TA dilatation in patients with sinus rhythm (SR). This study aimed to identify echocardiographic parameters most closely related to the TA size as a potential tool for identification of patients prone to developing TA enlargement. 120 patients with SR underwent clinically indicated TTE, including 30 patients with normal hearts and 90 patients diagnosed with at least one right heart abnormality, defined as: right ventricular (RV) or right atrial (RA) dilatation, ≥ moderate tricuspid regurgitation (TR) and elevated systolic pulmonary artery pressure (sPAP). RA and RV end-diastolic and end-systolic volumes (EDV, ESV) and function were measured using commercial 3D software (TomTec). 3D RV long and short axes were used as surrogate indices of RV shape. Degrees of TR and sPAP were estimated by 2D TTE. 3D TA sizing was performed at end-diastole using 3D custom software. Linear regression analysis was used to identify variables best correlated with TA size, followed by multivariate analysis to identify independent associations. The highest correlations were found between TA area and: RA ESV (r = 0.73; p < 0.01), RV EDV (r = 0.58; p < 0.01), RV end-diastolic long and short axes (r = 0.53, 0.42; both p < 0.01), TR degree (r = 0.40; p < 0.01) and sPAP (r = 0.32; p < 0.01). Multivariate analysis revealed that RA ESV was the only parameter independently associated with TA area (p < 0.05, r = 0.85). In conclusion, RA volume plays an important role in TA dilatation even in patients with normal SR. Understanding of annular remodeling mechanisms could aid in identifying patients at higher risk for TA dilatation, especially those scheduled for mitral valve surgery.


Assuntos
Ecocardiografia Tridimensional , Hemodinâmica , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Pressão Arterial , Função do Átrio Direito , Remodelamento Atrial , Chicago , Dilatação Patológica , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Valva Tricúspide/patologia , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia , Insuficiência da Valva Tricúspide/fisiopatologia , Função Ventricular Direita
8.
Int J Cardiovasc Imaging ; 36(1): 59-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31664680

RESUMO

Myocardial deformation by speckle tracking echocardiography is a novel method for evaluating cardiac function. To test the hypothesis that right ventricular and left ventricular function have age-specific patterns of development, we tracked the evolution of ventricular strain mechanics by speckle tracking echocardiography in the fetus. We conducted a retrospective cross sectional echocardiography study in 154 healthy fetuses, and characterized cardiac function by measuring right and left ventricles global longitudinal strain and strain rate. Comparison of the data of both ventricles according to gestational age was carried out. The magnitudes of right and left ventricle global longitudinal strain show wide range values and decreased throughout gestation. Strain values are higher in left ventricle compared to the right one throughout pregnancy. Strain rate values were similar over gestation in each ventricle, but the magnitudes declined overtime in the right and left ventricle. The maturational patterns of left and right strain are gestational specific. With accepted physiological maturation patterns in healthy subjects, these myocardial deformation parameters can provide a valid basis that allows comparison between health and disease.


Assuntos
Ecocardiografia , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Função Ventricular Esquerda , Função Ventricular Direita , Adaptação Fisiológica , Estudos Transversais , Coração Fetal/fisiologia , Idade Gestacional , Humanos , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Heart Fail Clin ; 16(1): 61-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735316

RESUMO

Cardiac cachexia is a co-morbidity of heart failure (HF) defined by a non-edematous weight loss of ≥6% within the previous 6-12 months. Cachexia affects about 10-39% patients with HF and occurs typically in advanced stages of HF, especially in the presence of congestive right ventricular dysfunction. This review elucidates the approaches and pitfalls in the diagnosis of cachexia. It summarizes the prevalence and impact of cardiac cachexia. It also discusses changes in body composition over the course of HF and provides an overview of the mechanisms involved in wasting in HF.


Assuntos
Caquexia/etiologia , Insuficiência Cardíaca/complicações , Função Ventricular Direita/fisiologia , Composição Corporal , Caquexia/epidemiologia , Caquexia/fisiopatologia , Saúde Global , Insuficiência Cardíaca/fisiopatologia , Humanos , Morbidade , Prognóstico , Taxa de Sobrevida/tendências
11.
Am J Physiol Heart Circ Physiol ; 318(2): H366-H377, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31886720

RESUMO

Right ventricle (RV) pressure loading can lead to RV fibrosis and dysfunction. We previously found increased RV, septal hinge-point and left ventricle (LV) fibrosis in experimental RV pressure loading. However, the relation of RV wall stress to biventricular fibrosis and dysfunction is incompletely defined. Rabbits underwent progressive pulmonary artery banding (PAB) over 3 wk with hemodynamics, echocardiography, and myocardial samples obtained at a terminal experiment at 6 wk. An additional group received PAB and treatment with an endothelin receptor antagonist. The endocardial and epicardial borders of short-axis echo images were traced and analyzed with invasive pressures to yield regional end-diastolic (ED) and end-systolic (ES) wall stress. To increase clinical translation, computer model-derived wall stress was compared with Laplace wall stress. The relation of wall stress with fibrosis (picrosirius red staining) and ventricular function was analyzed. ED wall stress in all regions and RV and LV free-wall ES wall stress were increased in PAB rabbits versus sham animals. Laplace wall stress correlated well with computational models. In PAB, fibrosis was highest in the RV free wall, then septal hinge regions, and lowest in the septum and LV free wall. Fibrosis was moderately related to ED (r = 0.47, P = 0.0011), but not ES wall stress. RV ED wall stress was strongly related to echo indexes of function (strain rate: r = 0.71, P = 0.048; E', r = -0.75, P = 0.0077; tricuspid annular plane systolic excursion: r = 0.85, P = 0.0038) and RV fractional area change (r = 0.77, P = 0.027). ED, more than ES, wall stress is related moderately to fibrosis and strongly to function in experimental RV pressure loading, especially at the septal hinge-point regions, where fibrosis is prominent. This suggests that wall stress partially links RV pressure loading, fibrosis, and dysfunction and may be useful to follow clinically.NEW & NOTEWORTHY Biventricular fibrosis and dysfunction impact outcomes in RV pressure loading, but their relation to wall stress is poorly defined. Using a pulmonary artery band rabbit model, we entered echocardiography and catheter data into a computer model to yield regional end-diastolic (EDWS) and end-systolic (ESWS) wall stress. EDWS, more than ESWS, correlated with fibrosis and dysfunction, especially at the fibrosis-intense septal hinge-point regions. Thus, wall stress may be clinically useful in linking RV pressure loading to regional fibrosis and dysfunction.


Assuntos
Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Pressão Ventricular , Algoritmos , Animais , Simulação por Computador , Ecocardiografia , Fibrose , Hemodinâmica , Masculino , Miocárdio/patologia , Pressão , Coelhos , Volume Sistólico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/complicações , Remodelação Ventricular
12.
Am J Physiol Heart Circ Physiol ; 318(2): H345-H353, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31886724

RESUMO

Timing and indication for pulmonary valve replacement (PVR) in patients with repaired Tetralogy of Fallot (rToF) and pulmonary regurgitation (PR) are uncertain. To improve understanding of pumping mechanics, we investigated atrioventricular coupling before and after surgical PVR. Cardiovascular magnetic resonance was performed in patients (n = 12) with rToF and PR > 35% before and after PVR and in healthy controls (n = 15). Atrioventricular plane displacement (AVPD), global longitudinal peak systolic strain (GLS), atrial and ventricular volumes, and caval blood flows were analyzed. Right ventricular (RV) AVPD and RV free wall GLS were lower in patients before PVR compared with controls (P < 0.0001; P < 0.01) and decreased after PVR (P < 0.0001 for both). Left ventricular AVPD was lower in patients before PVR compared with controls (P < 0.05) and decreased after PVR (P < 0.01). Left ventricular GLS did not differ between patients and controls (P > 0.05). Right atrial reservoir volume and RV stroke volume generated by AVPD correlated in controls (r = 0.93; P < 0.0001) and patients before PVR (r = 0.88; P < 0.001) but not after PVR. In conclusion, there is a clear atrioventricular coupling in patients before PVR that is lost after PVR, possibly because of loss of pericardial integrity. Impaired atrioventricular coupling complicates assessment of ventricular function after surgery using measurements of longitudinal function. Changes in atrioventricular coupling seen in patients with rToF may be energetically unfavorable, and long-term effects of surgery on atrioventricular coupling is therefore of interest. Also, AVPD and GLS cannot be used interchangeably to assess longitudinal function in rToF.NEW & NOTEWORTHY There is a clear atrioventricular coupling in patients with Tetralogy of Fallot (ToF) and pulmonary regurgitation before surgical pulmonary valve replacement (PVR) that is lost after operation, possibly because of loss of pericardial integrity. The impaired atrioventricular coupling complicates assessment of ventricular function after surgery when using measurements of longitudinal function. Left ventricular atrioventricular plane displacement (AVPD) found differences between patients and controls and changes after PVR that longitudinal strain could not detect. This indicates that AVPD and strain cannot be used interchangeably to assess longitudinal function in repaired ToF.


Assuntos
Implante de Prótese de Valva Cardíaca , Valva Pulmonar/cirurgia , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Função Ventricular Esquerda , Função Ventricular Direita , Adulto , Teste de Esforço , Feminino , Testes de Função Cardíaca , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/diagnóstico por imagem , Volume Sistólico , Tetralogia de Fallot/diagnóstico por imagem , Resultado do Tratamento
14.
J Assoc Physicians India ; 67(10): 57-61, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571454

RESUMO

Background and objectives: Idiopathic pulmonary arterial hypertension (IPAH) is rare disorder of unknown aetiology associated with poor survival. Disease severity assessment by various prognostic factors play important role in management of these patients. The aim of our study was to assess various factors and their natural history and course of disease in Indian population. Material and Methods: We followed 27 patients of IPAH after complete work up of exclusion of other causes of pulmonary hypertension and analysed various demographic, echocardiographic and haemodynamic parameters and their correlation with mortality. Results: A total of 27 patients (14 new and 13 previously diagnosed) were followed for mean duration of 18 months. At time of data analysis, 11 patients were alive and 16 patients died with overall mortality rate of 59.25%. Among various factors, presence of pericardial effusion (p=0.005), pulmonary artery acceleration time (PAAT) (p = 0.005), tricuspid Annular Plane Systolic Excursion (TAPSE) (p = 0.0004), heart rate (p=0.031), mean blood pressure (p =0.017), right atrial pressure (p=0.045), mean pulmonary artery pressure (PAP) (p=0.039) and six minute walk distance (p= 0.0002) were significantly associated with mortality. On multivariate cox proportional hazard analysis, PAAT (p =0.034), TAPSE (p=0.003) and six minute walk distance (p=0.002) remained significant predictors of mortality. Conclusion: Idiopathic pulmonary arterial hypertension is associated with poor prognosis and survival despite advancements of disease specific therapies. Higher mortality in our study is due to delayed presentation and diagnosis. Also lack of availability of prostacyclins and lung transplantation in advanced stages of disease contribute to higher mortality in Indian setup. Non-invasive echocardiographic factors and six minute walk distance are important prognostic factors that help in disease severity stratification to identify patients in need of intensive medical management.


Assuntos
Hipertensão Pulmonar Primária Familiar/diagnóstico , Humanos , Hipertensão Pulmonar , Índia , Prognóstico , Função Ventricular Direita
15.
Medicine (Baltimore) ; 98(40): e17369, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577738

RESUMO

This study aimed to analyze the correlation between the efficiency coefficient of right ventricular-pulmonary artery coupling (ηvv) and the prognosis of patients with pulmonary arterial hypertension (PAH).A total of 64 patients who underwent right heart catheterization (RHC) were enrolled and divided into PAH and control groups depending on the RHC results. Pressure and volumetric methods were adopted to analyze the results of RHC and cardiac magnetic resonance imaging examination. The ηvv of patients in 2 groups were calculated, and the relationship between ηvv calculated by the 2 methods and the 2-year prognosis of patients with PAH was evaluated.The hemodynamic index and right ventricular-pulmonary artery coupling parameter of patients with PAH were significantly higher than those in the control group (P < .05). The right ventricular volume parameter in the PAH group was significantly different from that in the control group (P < .05). For patients with PAH, the end-systolic elastance/effective arterial elastance (Ees/Ea) calculated by the volumetric method was significantly related to the prognosis of patients (odds ratio = 0.192, 95% confidence interval: 0.042-0.868, P = .032). When Ees/Ea <0.67 was calculated by the volumetric method, the adverse prognosis of patients with PAH increased significantly (P < .05).The Ees/Ea calculated by the volumetric method may be better an independent factor for the prognosis of patients with PAH.


Assuntos
Hemodinâmica/fisiologia , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar/fisiopatologia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Idoso , Cateterismo Cardíaco , Criança , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/fisiologia , Prognóstico , Artéria Pulmonar/diagnóstico por imagem , Volume Sistólico , Adulto Jovem
16.
Congenit Heart Dis ; 14(5): 846-853, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489769

RESUMO

OBJECTIVE: A significant body of patients who have undergone Mustard or Senning procedure require lifelong follow up. In this retrospective review, we examined the cohort of such patients currently attending our center. DESIGN: Patients who had undergone either Mustard or Senning procedure were identified. We retrospectively reviewed medical records, recorded demographic information and data regarding the clinical state, NHYA class, cardiopulmonary exercise testing, NT-proBNP measurement, and recent cardiac MRI findings. RESULTS: Forty-six patients were identified, the mean age was 32.2 years (± 6.1 years), 67.4% were male. Thirty-two patients (69.6%) had undergone a Senning procedure. The median length of the follow-up was 32 years. Thirty-two patients (69.6%) were NHYA class 1. The mean VO2max achieved was 24.2 ± 5.8 mL/min/kg. The mean NT-proBNP was 266.4 pg/mL (± 259.9 pg/mL). The mean right ventricular end-diastolic volume (RVEDV) was 212.4 mL ± 73.1 mL (indexed 114.2 mL/m2  ± 34.4 mL/m2 ). The mean right ventricular ejection fraction (RVEF) was 53.7% ± 7.9%. The mean left ventricular end-diastolic volume (LVEDV) was 161.5 mL ± 73.7 mL (indexed 87.8 mL/m2  ± 41.1 mL/m2 ). The mean left ventricular ejection fraction (LVEF) was 59.8% ± 5.7%. There was a significant correlation between right ventricular (RV) size on MRI and NT-proBNP level. CONCLUSIONS: We present a relatively well cohort of patients with overall favorable long-term outcome. The majority of patients are NHYA class 1 and the systemic right ventricular function appears to be well preserved as assessed by MRI. The exercise tolerance is reduced, with the majority of patients achieving around 60% of the estimated VO2max . Regular specialist follow-up and assessment with advanced imaging at regular intervals remain important for this group.


Assuntos
Transposição das Grandes Artérias/métodos , Tolerância ao Exercício/fisiologia , Previsões , Volume Sistólico/fisiologia , Transposição dos Grandes Vasos/cirurgia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Imagem Cinética por Ressonância Magnética , Masculino , Estudos Retrospectivos , Transposição dos Grandes Vasos/diagnóstico , Transposição dos Grandes Vasos/fisiopatologia , Resultado do Tratamento , Adulto Jovem
17.
World J Pediatr Congenit Heart Surg ; 10(5): 572-581, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496415

RESUMO

PURPOSE: In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. METHODS: Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature (Rc), and normalized weighted radius of curvature (Rc-w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. RESULTS: Conventional measurements of proximal PA size correlated with differential pulmonary blood flow (r = 0.49, P = .001), but not with RV peak systolic pressures (r = -0.26, P = .18). In ASO patients, Rc-w correlated with higher RV systolic pressures (r = -0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc (r = -0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. CONCLUSIONS: Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.


Assuntos
Transposição das Grandes Artérias/métodos , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Adolescente , Transposição das Grandes Artérias/efeitos adversos , Cateterismo Cardíaco , Criança , Pré-Escolar , Constrição Patológica , Ecocardiografia , Feminino , Hemodinâmica , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Sístole , Função Ventricular Direita
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 972-977, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537222

RESUMO

OBJECTIVE: To investigate the role of cardiac magnetic resonance imaging (CMRI) in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PAH); and the relationship between CMRI parameters and pulmonary function parameters, blood gas analysis parameters and 6-minute walk test (6MWT) parameters in patients with COPD complicated with PAH. METHODS: Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016, who underwent transthoracic echocardiography (TTE) to measure pulmonary arterial systolic pressure (PASP), and were divided into COPD group and COPD+PAH group according to whether there was PAH [PASP > 40 mmHg (1 mmHg = 0.133 kPa) was defined as PAH]. All patients completed pulmonary function tests [1 second forced expiratory volume to forced vital capacity ratio (FEV1/FVC), FEV1 predicted value (FEV1pred)], blood gas analysis [arterial blood oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2)], CMRI examination [relative dilatation of the main pulmonary artery (mPAD), mean pulmonary artery pressure (mPAP), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), right ventricular end-diastolic myocardial mass (RVMED), right ventricular end-systolic myocardial mass (RVMES)], and 6MWD [6-minute walk distance (6MWD)] within 1 week. The obtained clinical parameters had been compared between the groups, and correlation was analyzed. RESULTS: Among the 37 patients with COPD, 16 patients were complicated with PAH. There were no significant differences in FEV1/FVC, FEV1pred, PaO2, PaCO2 and other baseline indicators between the two groups. In the COPD group, TTE obtained PASP of 2 patients were normal (PSAP < 40 mmHg), while CMRI measured mPAP were higher than the normal limit (> 25 mmHg). Compared with the COPD group, mPAD, RVEF and 6MWD were significantly decreased in the COPD+PAH group [mPAD: (25.64±5.01)% vs. (44.00±22.52)%, RVEF: 0.525±0.054 vs. 0.592±0.071, 6MWD (m): 319.3±116.5 vs. 408.2±38.0, all P < 0.01], mPAP, RVMED and RVMES were significantly increased [mPAP (mmHg): 28.89±3.16 vs. 20.18±2.43, RVMED (g): 57.19±15.46 vs. 40.71±15.44, RVMES (g): 45.99±11.16 vs. 33.71±13.39, all P < 0.01], and there was no significant differences in LVEF (0.663±0.082 vs. 0.699±0.075, P > 0.05). Correlation analysis showed that mPAD was positively correlated with FEV1/FVC and FEV1pred (r1 = 0.538, P1 = 0.021; r2 = 0.448, P2 = 0.049); RVMED was negatively correlated with PaO2 (r = -0.581, P = 0.015), and positively correlated with PaCO2 (r = 0.592, P = 0.014); 6MWD was positively correlated with RVEF (r = 0.485, P = 0.041), and had no correlation with LVEF (r = 0.271, P = 0.104). CONCLUSIONS: Compared with COPD patients, changes in pulmonary hemodynamics and right ventricular function in COPD patients with PAH are related to the severity of airflow limitation. CMRI can early monitor pulmonary hemodynamics and right heart function changes in patients with COPD. Once PAH appears, pulmonary hemodynamics, right heart function and exercise tolerance have changed.


Assuntos
Hipertensão Pulmonar , Artéria Pulmonar , Doença Pulmonar Obstrutiva Crônica , Função Ventricular Direita , Hemodinâmica , Humanos , Imagem por Ressonância Magnética
20.
Pediatr Cardiol ; 40(8): 1670-1678, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542803

RESUMO

Although elevated right ventricular pressure and left ventricular diastolic dysfunction measured by echocardiogram are independent predictors of death in adults with sickle cell disease (SCD), the utility of routine echocardiographic screening in the pediatric population is controversial. We performed a 3-year retrospective review of children ≥ 10 years of age with SCD who underwent an outpatient transthoracic echocardiogram as part of a screening program. Of 172 patients referred for screening, 105 (61%) had a measurable tricuspid regurgitation jet velocity (TRV): median 2.4 m/s (IQR 2.3-2.5). Elevated right ventricular (RV) pressure (TRV ≥ 2.5 m/s, 25 mmHg), documented in 30% (32/105), was significantly associated with chronic transfusion therapy and elevated lactate dehydrogenase. Left ventricle (LV) dilation, documented in 25% (44/172), was significantly associated with lower hemoglobin, and higher reticulocyte count, lactate dehydrogenase level, and bilirubin level. There was no association between elevated right ventricular pressure or left ventricle dilation and indices of biventricular systolic or diastolic function. The one death in the cohort during the study period had normal echocardiographic findings. In conclusion, mild RV pressure elevation and LV dilation in children with SCD is associated with abnormal laboratory markers of disease severity, but not with ventricular dysfunction over the 3-year study period.


Assuntos
Anemia Falciforme/fisiopatologia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adolescente , Anemia Falciforme/complicações , Criança , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco
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