Right ventricular outflow tract spectral signal: a useful marker of right ventricular systolic performance and pulmonary hypertension severity

López‐Candales, Angel; Eleswarapu, Ananth; Shaver, James A.; Edelman, Kathy; Gulyasy, Beth; Candales, Maria Dolores

doi:10.1093/ejechocard/jeq009

Cited by 22 publications

(33 citation statements)

References 38 publications

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“…A single experienced investigator performed all analysis. [12][13][14][15][16][17]21,25 Univariate analysis was performed when appropriate. Analysis of variance (ANOVA) with repeated measures was used to test statistical significance of the studied variables.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Pulsed-wave Doppler was used rather than continuous-wave Doppler to eliminate cases with increased pulmonary velocities secondary to either pulmonary valve or peripheral pulmonary artery stenosis and assess more accurately the duration of the signal. 14,22 Velocity time integral values were obtained by tracing the RVOT spectral pulsed Doppler signals, as previously described. 22 Continuous-wave Doppler was used to record the tricuspid regurgitation jet from multiple windows, and the highest velocity was then used to estimate PASP using the modified Bernoulli equation and an estimate of mean right atrial pressure using the diameter and collapse index of the inferior vena cava and the hepatic venous flow pattern.…”

Section: Echocardiographic Examinationmentioning

confidence: 99%

“…[12][13][14] Furthermore, assessment of the diastolic properties of both the left and right ventricles, known to be affected in cPH patients, [15][16][17] is easily attained by the use of annular tissue Doppler imaging (TDI). However, none of these measurements have been studied in this population to determine if any of these variables is predictive of mortality or need for transplantation of heart, lung or both.…”

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confidence: 99%

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Risk of Death and Need for Transplantation in Chronic Pulmonary Hypertension

López‐Candales

2014

The American Journal of the Medical Sciences

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Section: Discussionmentioning

confidence: 99%

Section: Echocardiographic Examinationmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk of Death and Need for Transplantation in Chronic Pulmonary Hypertension

López‐Candales

2014

The American Journal of the Medical Sciences

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“…19 Left ventricular ejection fraction was assessed using the biplane method of disks (modified Simpson's rule) and maximal excursion of the mitral annulus. 21,22 Pulsed-wave Doppler was used rather than continuous-wave Doppler to eliminate cases with increased pulmonary velocities secondary to either pulmonary valve or peripheral pulmonary artery stenosis and assess more accurately the duration of the signal. 15,19,20 To assess ejection of the RV, the RVOT pulsed Doppler signal was obtained by placing a 1 to 2 mm pulsed-wave Doppler sample volume just within the pulmonary valve from the parasternal short-axis view.…”

Section: Methods: Study Groupmentioning

confidence: 99%

“…19 RV fractional area change and maximal excursion of the TA were used to determine global RV systolic function. 21,22 Right ventricular outflow tract 2D images were obtained from the parasternal short-axis view at the level of the aortic root as previously described. The sample volume was placed so that the closing but not opening click of the pulmonary valve was visualized.…”

Section: Methods: Study Groupmentioning

confidence: 99%

Right Ventricular Outflow Tract Systolic Excursion: A Distinguishing Echocardiographic Finding in Acute Pulmonary Embolism

López‐Candales

Edelman

2013

Echocardiography

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Ratio of Right to Left Ventricular Ejection: A Pilot Study Using Doppler to Detect Interventricular Dyssynchrony

López‐Candales¹,

Edelman²

2011

Clinical Cardiology

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Background: Chronic pulmonary hypertension (cPH) is known to delay maximal right ventricular (RV) deformation, causing mechanical dyssynchrony, which previously has been identified only through the use of myocardial tissue Doppler imaging. However, alterations between RV and left ventricular (LV) ejection should be easily identified during routine echocardiographic examinations. Hypothesis: We hypothesized that assessment of differences in ejection fraction between left and right ventricles would be detected using pulsed Doppler. Methods: Standard echo and Doppler data were collected from 30 patients without PH (mean age, 53 ± 7 y; mean pulmonary artery systolic pressure [PASP], 31 ± 5 mm Hg) and from 40 patients with cPH (mean age, 53 ± 13 y, P not significant; mean PASP, 82 ± 24 mm Hg, P < 0.00001). Temporal differences in the ejection of both ventricles were measured as the ratio of total duration of RV to LV outflow tract (RVOT and LVOT) pulsed Doppler signals.Results: A ratio (<0.99) of RVOT to LVOT total duration of ejection was found not only to be the best Doppler parameter to identify an abnormal pulmonary artery systolic pressure, with a 90% sensitivity and 100% specificity (area under the curve 0.958, P = 0.0001), but also identified differences in the temporal ejection between the 2 ventricles, or dyssynchrony, as a result of cPH. Conclusions:The ratio of pulsed Doppler RV to LV total duration of ejection is easily obtainable and appears useful in identifying the presence of interventricular dyssynchrony in cPH patients. A prospective study is now required to determine if this Doppler ratio can identify minute changes in the ejection of both ventricles as a result of changes in disease status or response to PH therapy. IntroductionAssessment of right ventricular (RV) function is crucial, as RV dysfunction has been recognized to be a powerful independent predictor of both cardiovascular morbidity and mortality. 1 -8 Even though echocardiography allows for direct and noninvasive visualization of the RV and continues to be the most readily available noninvasive imaging modality to screen and follow up chronic pulmonary hypertension (cPH) patients, its utility is sometimes compromised either by the nondefined geometric shape of the RV with a separate infundibulum or by poor 2-dimensional visualization of the chamber. 9 -12 Tissue Doppler imaging has been used to identify the presence of RV dyssynchrony or a delayed development in maximal peak strain generation of the RV free wall in cPH when compared with the interventricular septum. 13 In fact, the extent of this RV dyssynchrony has not only been shown to correlate with higher pulmonary artery systolic pressure

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Right ventricular outflow tract spectral signal: a useful marker of right ventricular systolic performance and pulmonary hypertension severity

Cited by 22 publications

References 38 publications

Risk of Death and Need for Transplantation in Chronic Pulmonary Hypertension

Risk of Death and Need for Transplantation in Chronic Pulmonary Hypertension

Right Ventricular Outflow Tract Systolic Excursion: A Distinguishing Echocardiographic Finding in Acute Pulmonary Embolism

Ratio of Right to Left Ventricular Ejection: A Pilot Study Using Doppler to Detect Interventricular Dyssynchrony

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