No abstract

Significant differences exist in both amplitude and timing of AM events between the mitral and tricuspid annuli, likely reflecting intrinsic anatomical and electromechanical differences between both sides of the heart that require further investigation.

Our data reveal that mechanical systolic functions of the atria and the ventricles are more closely coupled on the right than on the left side of the heart. Whether this is a result of anatomic linking or chamber geometry will require further study.

This analysis provides a range of normal variables of RV size and function, not previously published, that can be used in routine evaluation and follow-up of patients with PH.

No abstract

Timing of onset and peak of the RVOT systolic spectral signal appears to be useful in characterizing the severity of the PASP, while the total duration of RVOT ejection is a better predictor of the systolic performance of the RV in PH patients. More studies are now required to determine the clinical utility of prospectively measuring RVOT in cPH.

T issue Doppler imaging (TDI) has allowed for better quantification of myocardial function by demonstrating specific regional changes in strain generation and in the development of myocardial velocities (1-4). Significant differences in these two TDI indexes (ie, strain and velocity) have been reported for both the right and left ventricles. These differences are likely explained, in part, by the different loading conditions and compliance properties of these two chambers (5,6). However, equally important are the differences noted in myocardial fibre arrangement between the right and left ventricles (7-9). Regardless of the mechanism(s), it has been described that, in contrast to the homogeneously distributed deformation properties within the left ventricle, strain values are inhomogeneously distributed in the right ventricle and show a reverse baso-apical gradient, reaching their highest values toward apical segments and the outflow tract (7,10).Because the Cardiovascular Institute at the University of Pittsburgh (Pittsburgh, Pennsylvania) previously demonstrated that pulmonary hypertension (PH) results in a significant right ventricular (RV) free wall (RVFW) mechanical delay (11), we assessed the effect of the degree of pulmonary arterial systolic pressure (PASP) on the RVFW strain gradient and on myocardial velocity generation to obtain a better understanding of RV failure in PH. METHODS Study populationIn addition to TDI information, complete echocardiographic data, including an acceptable tricuspid regurgitation signal to estimate RV systolic pressure, were recorded in 31 consecutive patients with a history of PH who were referred for an echocardiographic examination. CliniCal StuDieS©2009 Pulsus Group Inc. All rights reserved BACKGROUND:In contrast to the homogeneously distributed deformation properties within the left ventricle, the right ventricular (RV) free wall (RVFW) shows a more inhomogeneous distribution. It has been demonstrated that pulmonary hypertension (PH) results in significant RVFW mechanical delay. OBJECTivE: To assess the effect of the degree of pulmonary arterial systolic pressure on the RVFW strain gradient and on myocardial velocity generation. METHODS: Peak longitudinal strain and velocity data were collected from three different segments (basal, mid-and apical) of the RVFW in 17 normal individuals and 31 PH patients. RESULTS: A total of 144 RV wall segments were analyzed. RVFW strain values in individuals without PH were higher in the mid and apical segments than in the basal segment. In contrast, RVFW strain in PH patients was higher in basal segments and diminished toward the apex. In terms of RVFW velocities, both groups showed decremental values from basal to apical segments. Basal and mid-RVFW velocities were significantly lower in PH patients than in individuals without PH. CONCLUSiONS: PH results in significant alterations of strain and velocity generation that occurs along the RVFW. Of these abnormalities, the reduction in strain from the mid and apical RVFW segments was mos...

AP level sEI appears to be superior to traditional PM level sEI measurement as it correlates better with worsening PH severity, RV cavity dilation and RV systolic dysfunction. Further studies are now required to prospectively study how these septal abnormalities in cPH may affect RV as well as LV systolic and diastolic function. (Echocardiography 2010;27:534-538).