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Right ventricular long-axis response to different chronic loading conditions: Its relevance to clinical symptoms.
MedLine Citation:
PMID:  22261688     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The intervention timing in atrial septal defect (ASD) or pulmonary valvular stenosis (PVS) is more dependent on symptoms than right ventricular (RV) damage in clinical practice. RV long-axis function is sensitive in revealing RV myocardial dysfunction. We evaluate the impact of different chronic loading conditions on RV long-axis function and its relationship to patients' symptoms in ASD or PVS. METHODS: Transthoracic echocardiography was performed in normals (n=39) and patients with isolated secundum ASD (n=45) or PVS (n=38). RV volume- and pressure-overloading were defined as the ratio of RV/left ventricular end-diastolic dimension ≥0.5 and RV systolic pressure ≥40mmHg, respectively. RV long-axis dysfunction was defined as M-mode tricuspid annular plane systolic excursion (TAPSE) <1.6cm. New York Heart Association (NYHA) functional class and other symptoms (decreased exercise tolerance, palpitation and chest pain) were recorded. RESULTS: Thirty-nine (32.0%) had normal loading (Group 1; 39 normals); 24 (19.6%) had isolated volume-overloading (Group 2; all ASDs); 21 (17.2%) had isolated pressure-overloading (Group 3; 21 PVSs) and 38 (31.1%) had both overloading conditions (Group 4; 21 ASDs and 17 PVSs). RV long-axis dysfunction in abnormal loading groups were zero (0%, Group 2), 21 (100%, Group 3) and 22 (57.8%, Group 4) (χ(2)=45.9, p<0.001). Group 3 were more symptomatic (NYHA functional class 2.5±0.6 versus 1.6±0.5, p<0.05) and had lower TAPSE (1.6±0.4 versus 3.0±0.7cm, p<0.05) than Group 2. RV long-axis dysfunction was the strongest predictor of the presence of symptoms (odds ratio=9.298, p<0.001). CONCLUSION: Chronic volume-overloading accentuates while pressure-overloading attenuates RV long-axis excursion and its impairment was associated with the presence of symptoms.
Authors:
Fang Fang; Micheal Y Henein; Cheuk-Man Yu; Wei Li; Mehmet G Kaya; Andrew J Coats; Yat-Yin Lam
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-17
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Institute of Vascular Medicine and Division of Cardiology, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, China; Ultrasound Department, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China.
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