Role of Right Ventricular Wall Motion Abnormalities in Risk Stratification and Prognosis of Patients Referred for Stress Echocardiography

Bangalore, Sripal; Yao, Siu‐Sun; Chaudhry, Farooq A.

doi:10.1016/j.jacc.2007.07.061

Cited by 43 publications

(32 citation statements)

References 22 publications

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“…97,131 Markers of high IHD event rates include not only the inability to perform an ETT but also numerous echocardiographic markers (Table 5). Among these are the number of abnormal segments at rest, the number of segments that become ischemic, the stress wall-motion score index, the change in wall-motion score index from rest to stress, an increase in systolic size with stress, LV ischemia that extends into the right ventricle, 132 an increase in end-systolic size, and a decrease in LV ejection fraction (LVEF) with stress. 109 Both short-and long-term follow-up studies show that stress echocardiography is predictive of subsequent MI, need for coronary revascularization, IHD death, and all-cause mortality.…”

Section: Risk Assessmentmentioning

confidence: 99%

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

Mieres¹,

Gulati²,

Merz³

et al. 2014

Circulation

217

176

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Section: Risk Assessmentmentioning

confidence: 99%

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

Mieres¹,

Gulati²,

Merz³

et al. 2014

Circulation

217

176

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“…It has been demonstrated that RV free wall dysfunction or lack of increase in tricuspid annular plane excursion during dobutamine stress are indicators of right coronary or multi-vessel disease 49,50 and predictive of prognosis. 51 …”

Section: Discussionmentioning

confidence: 99%

Stress echocardiography for the detection and assessment of coronary artery disease

Fine

Pellikka

2011

Journal of Nuclear Cardiology

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“…Patients with increased age, diabetes mellitus, hypertension, and known coronary artery disease were at higher risk of developing RV wall motion abnormalities. 2 Evaluating the RV can be difficult, as in our case, given the technically difficult images and use of perflutren contrast.…”

mentioning

confidence: 85%

“…3 When exercise-induced RV dilatation and hypokinesis may be seen on exercise stress echocardiography, its presence in the absence of LV abnormalities is unusual, 2 and, physicians should have a high suspicion for an abnormality of the pulmonary vasculature, specifically increased pulmonary vascular resistance. These manifestations become more evident when the cardiac output increases during stress and the RV lacks contractile reserve in the setting of increased pulmonary vascular resistance.…”

mentioning

confidence: 99%

Pulmonary Embolism Diagnosed From Right Heart Changes Seen After Exercise Stress Echocardiography

Case

Zemedkun

Sangkharat

et al. 2015

Circ: Cardiovascular Imaging

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A 47-year-old black woman with no prior medical problems presented to the emergency department after a syncopal event associated with palpitations while walking. The patient noticed new onset of palpitations while walking that lasted about an hour. She subsequently had a syncopal episode. She denied dizziness, lightheadedness, dehydration, or seizure-like activity. Medications included antihistamines and oral contraceptives. On admission she was afebrile, heart rate 84 bpm, blood pressure 121/73 mm Hg, respiratory rate 18 breaths per minute, and her oxygen saturation was 97% on room air. The physical examination was normal except for a small (1 cm) head laceration.A noncontrast computed tomography of the head was negative for any acute intracranial findings. The chest radiograph showed no acute cardiopulmonary disease. The electrocardiogram showed normal sinus rhythm at a ventricular rate of 69 bpm, no evidence of ST segment changes, and an isolated T wave inversion in V2 (Figure 1).She was admitted with high suspicion for cardiac syncope given her symptoms of palpitations before the event. Myocardial infarction was ruled out. A pro-B-type natriuretic peptide was normal and thyroid-stimulating hormone test was normal. A D-dimer level was not checked. Telemetry was only significant for episodes of sinus tachycardia. A resting transthoracic echocardiogram was technically difficult but showed normal left ventricular (LV) size and function, ejection fraction 50%, and grossly normal right ventricular (RV) size and function (Figure 2; Movies I and II in the Data Supplement). There was not enough tricuspid regurgitation on the resting echocardiogram for estimation of pulmonary artery systolic pressure at rest.The clinical team ordered a stress echocardiogram which was performed for evaluation of ischemia and arrhythmia. The test was terminated at 3 minutes and 53 seconds, after the patient exhibited symptoms of dyspnea and fatigue. The electrocardigram was positive for exercise-induced myocardial ischemia (>2 mm ST segment depression in the inferior and lateral leads) at maximal stress of 103% maximum predicted heart rate and 5 metabolic equivalents (Figure 3). There was blunted blood pressure response to exercise from 110/68 mm Hg at baseline to 118/62 mm Hg at peak stress. After stress echocardiographic imaging, using perflutren contrast for improved endocardial border visualization demonstrated normal augmentation of LV function. However, there was significant dilation of the RV, with severe RV dysfunction and flattening of the interventricular septum, suggestive of RV pressure and volume overload (Figure 4; Movies I and II in the Data Supplement). There was an insufficient degree of tricuspid regurgitation to allow for estimation of RV systolic pressures. This information suggested an abnormality in the pulmonary vascular physiology, likely because of increased pulmonary vascular resistance and inadequate contractile reserve of the RV. In our clinical scenario, these findings were considered suspicious for an acute...

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Role of Right Ventricular Wall Motion Abnormalities in Risk Stratification and Prognosis of Patients Referred for Stress Echocardiography

Cited by 43 publications

References 22 publications

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease

Stress echocardiography for the detection and assessment of coronary artery disease

Pulmonary Embolism Diagnosed From Right Heart Changes Seen After Exercise Stress Echocardiography

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