13 research outputs found
Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension
No full textThe present study examined whether tricuspid annular plane systolic excursion (TAPSE) can simply predict right ventricular ejection fraction (RVEF) in patients with pulmonary hypertension (PH). The TAPSE cut-off value to predict reduced RVEF was also evaluated. The association between TAPSE and cardiac magnetic resonance imaging (CMRI)-derived RVEF was examined in 53 PH patients. The accuracy of the prediction equation to calculate RVEF using TAPSE was also evaluated. In PH patients, TAPSE was strongly correlated with CMRI-derived RVEF in PH patients (r = 0.86, p < 0.0001). We then examined the accuracy of the two equations: the original regression equation (RVEF = 2.01 x TAPSE + 0.6) and the simplified prediction equation (RVEF = 2 x TAPSE). Bland-Altman plot showed that the mean difference +/- A limits of agreement was 0.0 +/- A 10.6 for the original equation and -0.6 +/- A 10.6 for the simplified equation. Intraclass correlation coefficient was 0.84 for the original and 0.82 for the simplified equation. Normal RVEF was considered to be a parts per thousand yen40 % based on the data from 53 matched controls, and the best TAPSE cut-off value to determine reduced RVEF (< 40 %) was calculated to be 19.7 mm (sensitivity 88.9 %, specificity 84.6 %). A simple equation of RVEF = 2 x TAPSE enables easy prediction of RVEF using TAPSE, an easily measurable M-mode index of echocardiography. TAPSE of 19.7 mm predicts reduced RVEF in PH patients with clinically acceptable sensitivity and specificity
Understanding Mutrateeta Through A Clinical Lens
No full textMicturition or urination is a complex and multi system involved process. In the present era of varying lifestyle even the minimal alterations make a huge difference to the system and so the healthcare worker may encounter such cases during the routine practice. One among them is urinary incontinence where the symptoms are highly prevalent among women and the patient is unable to hold the urge to urinate voluntarily. As per Ayurveda, urinary disorders are classified as Mutra Apravritti and Atipravritti Rogas caused by the imbalance of Vata dosha, particularly Apana Vata, which governs the downward movement of metabolic waste including urine. This report presents the case of a 22-year-old female who experienced severe degree of symptoms with urgency and increased frequency of urination for 1 year. She also reported with associated complaints of abdominal pain. After the thorough examination, the patient was treated efficiently with the principles of Ayurveda as mentioned in the classic
Validation Study on the Accuracy of Echocardiographic Measurements of Right Ventricular Systolic Function in Pulmonary Hypertension
No full textBackground: Accuracy of echocardiographic parameters of right ventricular (RV) function has not been sufficiently validated in patients with pulmonary hypertension (PH). We attempted to evaluate whether echocardiographic measurements reliably reflect RV systolic function in PH using cardiac magnetic resonance imaging (CMRI)-derived RV ejection fraction (EF) as a gold standard. Materials and Methods: A total of thirty-seven consecutive patients with PH, 20 with pulmonary arterial hypertension, 12 with chronic thromboembolic pulmonary hypertension, and 5 others, were prospectively studied. All patients underwent echocardiography, CMRI and right heart catheterization within a 1-week interval. Associations between 5 echocardiography-derived parameters of RV systolic function and CMRI-derived RVEF were evaluated. Results: All 5 echocardiography-derived parameters were significantly correlated with CMRI-derived RVEF (%RV fractional shortening: r=0.48, p=0.0011; %RV area change: r=0.40, p=0.0083; tricuspid annular plane systolic excursion (TAPSE): r=0.86, p<0.0001, RV myocardial performance index: r=-0.59, p<0.0001; and systolic lateral tricuspid annular motion velocity (TVlat): r=0.63, p<0.0001). When compared with the other indices, TAPSE exhibited the highest correlation coefficient. Of the 5 echocardiographic measurements, only TAPSE significantly predicted CMRI-derived RVEF in multiple regression analysis (p<0.0001). Intra- and interobserver reproducibility was favorable for all 5 indices, and for TAPSE and TVlat was particularly high. Conclusion: Echocardiographic measurements are promising noninvasive indices of RV systolic function in patients with PH. In particular, TAPSE is superior to other indices in accuracy
Normal Values of Echocardiographic Parameters Indicating Right Ventricular Systolic Functions in 607 Healthy Children
No full textBackground: This study aimed to define the normal ranges of echocardiographic parameters that are used to evaluate right ventricular systolic functions. Methods: A total of 607 children within the age range of 0-18 years without any cardiac pathology or chronic disorders were included in the study. The study population was categorized into different age groups and underwent transthoracic echocardiog-raphy. In this study, tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (TAPSV), and right ventricular myocardial performance index (RVMPI) values were measured. Results: There was no statistically significant difference between the mean TAPSE and TAPSV values of male and female subjects. The mean RVMPI was higher in females than in males. The study population was categorized into nine groups according to their age. The TAPSE, TAPSV, and RVMPI values were calculated for each group. Additionally, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, and ± 2 standard deviation (SD) and ± 3 SD values of TAPSE measurements were calculated for each age group. The study population was divided into eight groups according to their body surface area (BSA). Moreover, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of TAPSE measurements were calculated. There was a strong positive correlation between TAPSE and BSA. The TAPSE was also positively correlated with TAPSV but not with RVMPI. Conclusions: This study determined the normal values for TAPSV and RVMPI. It is important to have knowledge of the normal ranges of these parameters to recognize right ventricular dysfunction early in various cardiac disorders. © 2023, Author(s)
Deep learning to assess right ventricular ejection fraction from two-dimensional echocardiograms in precapillary pulmonary hypertension
No full textBackground: Precapillary pulmonary hypertension (PH) is characterized by a sustained increase in right ventricular (RV) afterload, impairing systolic function. Two-dimensional (2D) echocardiography is the most performed cardiac imaging tool to assess RV systolic function; however, an accurate evaluation requires expertise. We aimed to develop a fully automated deep learning (DL)-based tool to estimate the RV ejection fraction (RVEF) from 2D echocardiographic videos of apical four-chamber views in patients with precapillary PH. Methods: We identified 85 patients with suspected precapillary PH who underwent cardiac magnetic resonance imaging (MRI) and echocardiography. The data was divided into training (80%) and testing (20%) datasets, and a regression model was constructed using 3D-ResNet50. Accuracy was assessed using five-fold cross validation. Results: The DL model predicted the cardiac MRI-derived RVEF with a mean absolute error of 7.67%. The DL model identified severe RV systolic dysfunction (defined as cardiac MRI-derived RVEF < 37%) with an area under the curve (AUC) of .84, which was comparable to the AUC of RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) measured by experienced sonographers (.87 and .72, respectively). To detect mild RV systolic dysfunction (defined as RVEF <= 45%), the AUC from the DL-predicted RVEF also demonstrated a high discriminatory power of .87, comparable to that of FAC (.90), and significantly higher than that of TAPSE (.67). Conclusion: The fully automated DL-based tool using 2D echocardiography could accurately estimate RVEF and exhibited a diagnostic performance for RV systolic dysfunction comparable to that of human readers
Right ventricular-pulmonary arterial coupling in secondary tricuspid regurgitation
No full textChronic pressure-overload induces right ventricular (RV) adaptation to maintain RV -pulmonary arterial (PA) coupling. RV remodeling is frequently associated with secondary tricuspid regurgitation (TR) which may accelerate uncoupling. Our aim is to determine whether the non-invasive analysis of RV-PA coupling could improve risk stratification in patients with secondary TR. A total of 1,149 patients (median age 72[IQR, 63 to 79] years, 51% men) with moderate or severe secondary TR were included. RV-PA coupling was estimated using the ratio between two standard echocardiographic measurements: tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). The risk of all-cause mortality across different values of TAPSE/PASP was analyzed with a spline analysis. The cut-off value of TAPSE/PASP to identify RV-PA uncoupling was based on the spline curve analysis. At the time of significant secondary TR diagnosis the median TAPSE/PASP was 0.35 (IQR, 0.25 to 0.49) mm/mm Hg. A total of 470 patients (41%) demonstrated RV-PA uncoupling (< 0.31 mm/mm Hg). Patients with RV-PA uncoupling presented more frequently with heart failure symptoms had larger RV and left ventricular dimensions, and more severe TR compared to those with RV-PA coupling. During a median follow-up of 51 (IQR, 17 to 86) months, 586 patients (51%) died. The cumulative 5-year survival rate was lower in patients with RV-PA uncoupling compared to their counterparts (37% vs 64%, p < 0.001). After correcting for potential confounders, RV-PA uncoupling was the only echocardiographic parameter independently associated with all-cause mortality (HR 1.462; 95% CI 1.192 to 1.793; p < 0.001). In conclusion, RV-PA uncoupling in patients with secondary TR is independently associated with poor prognosis and may improve risk stratification. (C) 2021 The Author(s). Published by Elsevier Inc.Cardiolog
Imaging data in COVID-19 patients: focused on echocardiographic findings
No full textTo assess imaging data in COVID-19 patients and its association with clinical course and survival and 86 consecutive patients (52 males, 34 females, mean age = 58.8 year) with documented COVID-19 infection were included. Seventy-eight patients (91) were in severe stage of the disease. All patients underwent transthoracic echocardiography. Mean LVEF was 48.1 and mean estimated systolic pulmonary artery pressure (sPAP) was 27.9 mmHg. LV diastolic dysfunction was mildly abnormal in 49 patients (57.6) and moderately abnormal in 7 cases (8.2). Pericardial effusion was present in 5/86 (minimal in size in 3 cases and mild- moderate in 2). In 32/86 cases (37.2), the severity of infection progressed from �severe� to �critical�. Eleven patients (12.8) died. sPAP and computed tomography score were associated with disease progression (P value = 0.002, 0.002 respectively). Tricuspid annular plane systolic excursion (TAPSE) was significantly higher in patients with no disease progression compared with those who deteriorated (P value = 0.005). Pericardial effusion (minimal, mild or moderate) was detected more often in progressive disease (P = 0.03). sPAP was significantly lower among survivors (P value = 0.007). Echocardiographic findings (including systolic PAP, TAPSE and pericardial effusion), total CT score may have prognostic and therapeutic implication in COVID-19 patients. © 2021, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature
Association of Fitness and Obesity with Right Ventricular Function
No full textThe general metadata -- e.g., title, author, abstract, subject headings, etc. -- is publicly available, but access to the submitted files is restricted to UT Southwestern campus access and/or authorized UT Southwestern users.BACKGROUND: Low Cardiorespiratory Fitness (CRF) and obesity are well-established risk factors for heart failure (HF). However, the mechanisms through which CRF and BMI influence HF risk remain uncertain especially with regards to the right ventricle.
OBJECTIVES: We hypothesized that lower levels of CRF and higher measures of obesity in young adulthood along with greater decline in CRF and greater increase in BMI from young adulthood to middle-age would be associated with greater abnormalities in RV function in middle-age.
METHODS: The CARDIA study is a multi-center longitudinal cohort study of young adults. For the present study, 3,433 participants with baseline CRF test and BMI data and echocardiographic examination at year 25 were selected. 2,544 participants with repeat CRF test and BMI data at year 20 were included in secondary analyses. CRF was measured as the maximal treadmill test duration (in seconds) using a graded, symptom-limited maximal treadmill test using a modified Balke protocol. Study participants were stratified into fit/fat groups using median CRF and median BMI as cutoffs. TAPSE (Tricuspid Annular Plane Systolic Excursion) and RVS' (velocity of tricuspid annular systolic motion) were used as measures of RV systolic function with larger values representing better function. PASP (Pulmonary Artery Systolic Pressure) (N = 1,292 with adequate tricuspid regurgitation jet) was used as a measure of pulmonary artery filling pressures. Multivariable adjusted linear regression analyses were performed to evaluate the independent associations of baseline CRF, baseline BMI, % change in CRF ((CRF at year 20 - CRF at year 0)/CRF at year 0 *100), and % change in BMI ((BMI at year 20 - BMI at year 0)/BMI at year 0 *100) with each echocardiographic measure of RV function at year 25.
RESULTS: In unadjusted analysis, both TAPSE and RVS' were highest in the high fitness/high BMI group; PASP was highest with higher BMI. In multivariable adjusted linear regression analyses we observed a significant, direct association between baseline BMI and PASP such that higher BMI in young adulthood was associated with higher PA pressures in middle-age (β 0.12, P-value .0002); this remained significant after adjusting for % change in CRF and % change in BMI. A similar result was seen with % change in BMI and PASP. On the other hand, baseline CRF levels were not significantly associated with PASP (β -.0004, P-value 0.99). While there was a significant negative association between % change in CRF and PASP (β -0.08, P-value 0.02), this association became nonsignificant after adjusting for % change in BMI (β -0.05, P-value 0.22). There was a significant, direct association observed between both baseline CRF levels and baseline BMI and measures of RV systolic function (TAPSE and RVS') such that both higher CRF and BMI at baseline were associated with better RV systolic function in middle-age. Similar results were seen in groups stratified by CRF and BMI where greater RVS' and TAPSE were seen in the high fitness/high BMI group while the lowest PASP was seen in the high fitness/low BMI group.
CONCLUSIONS: Given that obesity rather than fitness was associated with higher PASP suggests that the risk of HF seen with obesity could move through the pathway of elevated PA filling pressures while the risk seen with decreased fitness moves through an independent pathway. Given that both fitness and BMI moved in the same direction with regards to TAPSE and RVS', measures of RV systolic dysfunction appear to be less helpful in assessing HF risk. This may have important implications in better understanding the contributions of weight loss towards prevention of diseases characterized by RV dysfunction and pulmonary hypertension
The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children
No full textObjectives. The purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy.Clin Exp Otorhinolaryngol. 2016 Jun;9(2):163-7. doi: 10.21053/ceo.2015.00087. Epub 2016 Apr 19.The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children.Acar OÇ(1), Üner A(1), Garça MF(2), Ece İ(1), Epçaçan S(1), Turan M(2), Kalkan F(3). Author information: (1)Division of Pediatric Cardiology, Department of Pediatrics, Yüzüncü Yıl University Medical Faculty, Van, Turkey. (2)Department of Otorhinolaryngology, Yüzüncü Yıl University Medical Faculty, Van, Turkey. (3)Department of Otolaryngology, Training and Research Hospital, Van, Turkey.OBJECTIVES: The purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy. METHODS: Fifty-three healthy children after routine laboratory, imaging and clinical examinations, with adenoid and/or tonsillar hypertrophy were evaluated before and 3 months after adenotonsillectomy for cardiac functions using M mode and Doppler echocardiography. RESULTS: The mean age of cases was 6.4±3.0 years, 34 (65%) were male, and 19 (35%) were female. Pulmonary hypertension was observed to be mild in 3 patients and moderate in 1 patient preoperatively. When the preoperative and postoperative echocardiographic measurements of the patients were compared, the tricuspid valve E wave velocity, the E/A ratio (E, early diastolic flow rate; A, late diastolic flow rate), and the TAPSE values were determined to be significantly higher postoperatively (P<0.05). The tricuspid valve deceleration time, the isovolumetric relaxation time and the systolic pulmonary artery pressure were found to be significantly lower compared to the preoperative values (P<0.05). CONCLUSION: Adenoidectomy and/or tonsillectomy may prevent cardiac dysfunctions that can develop in the later periods due to adenoid and/or tonsil hypertrophy in children, before the appearance of the clinical findings of cardiac failure.</p
Assessment of right ventricular systolic and diastolic parameters in pulmonary sarcoidosis
No full text#nofulltext# --- Yolcu, Mustafa (Arel Author)The clinical manifestations of cardiac involvement are seen in about 5% of patients with sarcoidosis; however, the incidence of cardiac involvement is higher in the autopsy series. About 14% of patients with pulmonary sarcoidosis (PS) without known cardiac involvement had diastolic dysfunction. We aimed to determine the role of parameters of right ventricular (RV) systolic and diastolic function in patients with PS without evidence of cardiac symptoms. Our study population consisted of 28 patients with grades 1–4 PS and 24 healthy subjects. This study was a clinical prospective cohort study. RV end-diastolic area was found to be significantly higher in the PS group (p=0.032). RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were shown to be statistically lower in the PS group as compared to the control group (p<0.001). However, pulmonary arterial systolic pressure was significantly higher in the PS group (p=0.003). The tricuspid E velocity and E/A ratio were found to be significantly lower in the PS group (p=0.025 and 0.009, respectively), while the tricuspid A velocity and myocardial performance index (MPI) were found to be significantly lower in the control group (p=0.034 and 0.007, respectively). Early detection of cardiac involvement in PS is crucial because of the increased morbidity and risk of sudden cardiac death. RV diastolic Doppler parameters, tissue Doppler MPI, RVFAC and TAPSE are practical and cheap techniques in the diagnosis of cardiac involvement in patients with PS. A thorough transthorasic echocardiographic examination including RV systolic and diastolic functions and tissue Doppler MPI should constitute the mainstay of initial management and follow-up in PS
