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Seminars in Respiratory and Critical... Dec 2023The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as... (Review)
Review
The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as well as survival. In a healthy situation, the right ventricle is part of a low pressure, high compliance system. It is built to accommodate changes in preload, but not very well suited for dealing with pressure overload. In PH, right ventricular (RV) contractility must increase to maintain cardiac output. In other words, the balance between the degree of RV contractility and afterload determines stroke volume. Hypertrophy is one of the major hallmarks of RV adaptation, but it may cause stiffening of the ventricle in addition to intrinsic changes to the RV myocardium. Ventricular filling becomes more difficult for which the right atrium tries to compensate through increased stroke work. Interaction of RV diastolic stiffness and right atrial (RA) function determines RV filling, but also causes vena cava backflow. Assessment of RV and RA function is critical in the evaluation of patient status. In recent guidelines, this is acknowledged by incorporating additional RV parameters in the risk stratification in PH. Several conventional parameters of RV and RA function have been part of risk stratification for many years. Understanding the pathophysiology of RV failure and the interactions with the pulmonary circulation and right atrium requires consideration of the unique RV anatomy. This review will therefore describe normal RV structure and function and changes that occur during adaptation to increased afterload. Consequences of a failing right ventricle and its implications for RA function will be discussed. Subsequently, we will describe RV and RA assessment in clinical practice.
Topics: Humans; Hypertension, Pulmonary; Heart Ventricles; Pulmonary Circulation; Heart Failure; Stroke Volume; Ventricular Function, Right; Ventricular Dysfunction, Right
PubMed: 37487527
DOI: 10.1055/s-0043-1770117 -
Journal of Medical Ultrasonics (2001) Apr 2024The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected,... (Review)
Review
The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected, there is the possibility of RV volume overload, RV pressure overload, RV myocardial disease, and even nonpathological RV dilatation. With respect to congenital heart disease with RV volume overload, defects or valvular abnormalities can be easily detected with TTE, with the exception of some diseases. Volumetric assessment using three-dimensional echocardiography may be useful in determining the intervention timing in these diseases. When the disease progresses in patients with pulmonary hypertension as a result of RV pressure overload, RV dilatation becomes more prominent than hypertrophy, and RV functional parameters predict the prognosis at this stage of maladaptive remodeling. The differential diagnosis of cardiomyopathy or comparison with nonpathological RV dilatation may be difficult in the setting of RV myocardial disease. The characteristics of RV functional parameters such as two-dimensional speckle tracking may help differentiate RV cardiomyopathy from other conditions. We review the diseases presenting with RV dilatation, their characteristics, and echocardiographic findings and parameters that are significant in assessing their status or intervention timing.
Topics: Humans; Diagnosis, Differential; Echocardiography; Heart Ventricles; Ventricular Dysfunction, Right; Hypertrophy, Right Ventricular; Echocardiography, Three-Dimensional; Dilatation, Pathologic; Hypertension, Pulmonary
PubMed: 38228943
DOI: 10.1007/s10396-023-01399-4 -
The American Journal of Cardiology Feb 2024Hypertrophic cardiomyopathy (HCM) is a complex, heterogeneous disorder that affects approximately 1 in every 500 persons worldwide and about 750,000 Americans. It is... (Review)
Review
Hypertrophic cardiomyopathy (HCM) is a complex, heterogeneous disorder that affects approximately 1 in every 500 persons worldwide and about 750,000 Americans. It is characterized by left ventricular hypertrophy that is usually asymmetric, with enlarged myocytes in disarray, unexplained by loading conditions. Obstruction to left ventricular outflow occurs in approximately 60% of patients. The natural history and cardiac morphology of HCM are quite heterogeneous. Although most patients with HCM are asymptomatic or mildly symptomatic, a minority are disabled by dyspnea, angina, or syncope, develop advanced heart failure, or die suddenly.
Topics: Humans; Cardiomyopathy, Hypertrophic; Death, Sudden, Cardiac; Heart Failure; Heart Ventricles; Hypertrophy, Left Ventricular; Syncope
PubMed: 38368032
DOI: 10.1016/j.amjcard.2023.10.075 -
European Journal of Radiology Dec 2023Regardless of whether there are morphological abnormalities of right ventricle in hypertrophic cardiomyopathy (HCM) patients, the exact contribution of right ventricular...
PURPOSE
Regardless of whether there are morphological abnormalities of right ventricle in hypertrophic cardiomyopathy (HCM) patients, the exact contribution of right ventricular (RV) global strains remains unresolved. We aimed to study the prognostic value of RV global strains in HCM patients with and without RV hypertrophy (RVH).
METHOD
A total of 358 HCM patients who underwent the CMR examination and carried out the follow-up were finally included in this retrospective study. The endpoint was a composite of all-cause mortality, aborted SCD, and heart failure readmission. RV hypertrophy (RVH) was defined as maximal RVWT ≥ 5 mm at end-diastole. RV global strains (RV global longitudinal strain (GLS) and RV global circumferential strain (GCS) were measured in HCM patients by cardiac MRI feature tracking technique. The intraobserver and interobserver reproducibility were evaluated. Receiver-operating characteristic curves and Kaplan-Meier curves, cox proportional hazards regression, Likelihood ratio test and Integrated Discrimination Improvement (IDI) analysis were performed. P-value were corrected for multiple testing when using many covariables by a false discovery rate adjustment.
RESULTS
Over a median follow-up of 25 (range 3-54) months, 49 patients reached the composite endpoints. HCM patients were divided into the RVH group and non-RVH groups. In the multivariate cox proportional hazards regression, after adjusting multiple clinical and imaging variables, RV GLS and RV GCS were independently associated with the composite endpoints in the RVH group (HR: 1.123; 95 % CI: 1.048-1.205; P = 0.002) and non-RVH group (HR: 1.174; 95 % CI: 1.031-1.337; P = 0.015), respectively. And The IDI index of models improved when adding RV GLS (IDI = 0.030, p < 0.001) and RV GLS (IDI = 0.056, p = 0.020), respectively.
CONCLUSIONS
RV GLS and RV GCS are independent predictors of HCM with RVH and without RVH, respectively. RV GLS in the RVH group and RV GCS in the non-RVH group provide additional values for predicting the risk of adverse events.
Topics: Humans; Hypertrophy, Right Ventricular; Retrospective Studies; Heart Ventricles; Reproducibility of Results; Cardiomyopathy, Hypertrophic; Prognosis; Stroke Volume
PubMed: 37871355
DOI: 10.1016/j.ejrad.2023.111148 -
High Blood Pressure & Cardiovascular... Jul 2022The increase in the pulsatile component of left ventricle afterload is suspected to cause a mismatch between the left ventricle (LV) and the vascular tree. (Observational Study)
Observational Study
INTRODUCTION
The increase in the pulsatile component of left ventricle afterload is suspected to cause a mismatch between the left ventricle (LV) and the vascular tree.
AIM
To demonstrate that ventricular-arterial uncoupling is frequently present in the development of LV hypertrophy (H) and diastolic dysfunction (DD) in hypertension (HBP).
METHODS
Observational study, HBP patients with ejection fraction > 54%. Conventional 2D echocardiography and tissue Doppler performed following imaging guidelines. LV end systolic elastance (Ees), the effective arterial elastance (Ea), and ventricular-arterial coupling (VAC) measured by Chen single beat method.
RESULTS
288 patients, mean age 56.3 ± 12.5 years and 168 patients (58.3%) males. Mean LV mass index was 87.2 ± 20.4 grs/m and frequency of LVH 20.1% (58 patients). The mean VAC was 0.54 ± 9.23. LV Stroke volume, stroke work and systolic stress were 46.2 ± 10.3 cc/m, 91.4 ± 22.2 g-min/m, and 57 ± 14.6 dynes/cm in quartile 1, and 33.5 ± 6.6 cc/m, 65.5 ± 15.2 g-min/m, and 77.8 ± 17.1 dynes/cm, in quartile 4, respectively (p < 0.001). Peripheral resistance index was 3349 ± 1072 and 4410 ± 1143 dynes*s/cm-5/m quartiles 1 vs. 4 (p < 0.005). The frequency of LVH was 31.9% in quartile 1 and 11.3% in quartile 4 (p < 0.005) and LVH or DD was 37.5% and 12.7%, respectively (p < 0.001).
CONCLUSIONS
Stroke volume and stroke work were significantly increased while systolic stress and peripheral resistance index were significantly reduced in patients with worst VAC. Ventricular-arterial uncoupling is mostly caused by an increase in Ees rather than by an elevation of Ea. LVH or DD are more frequent in the worst cases of ventricular-arterial uncoupling.
Topics: Adult; Aged; Female; Heart Ventricles; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Middle Aged; Stroke Volume; Ventricular Function, Left
PubMed: 35460512
DOI: 10.1007/s40292-022-00521-w -
The International Journal of... Mar 2020Apical variant hypertrophic cardiomyopathy (AHCM) is characterized by asymmetric hypertrophy of the left ventricular (LV) apex. T wave inversions of variable degree,... (Review)
Review
Apical variant hypertrophic cardiomyopathy (AHCM) is characterized by asymmetric hypertrophy of the left ventricular (LV) apex. T wave inversions of variable degree, particularly in the left precordial leads, and left ventricular hypertrophy (LVH) are common EKG findings in AHCM. Echocardiography is typically the initial imaging modality used in the diagnosis and evaluation of AHCM. The diagnosis is made when the LV apex has apical wall thickness of ≥ 15 mm or a ratio of apical to basal LV wall thickness of ≥ 1.3 at end-diastole. The use of microbubble contrast agents with echocardiography is helpful for visualization of the apex. Cardiac magnetic resonance (CMR) has the advantage of a large field of view and the ability to perform tissue characterization. Late gadolinium enhancement (LGE) sequences are essential in the assessment of potential areas of myocardial scarring. Cardiac computed tomography (CCT) has the advantage of being able to evaluate coronary arteries in addition to assessing cardiac anatomy and function. A "Solar Polar" map pattern is the characteristic feature of AHCM on myocardial perfusion imaging (MPI) in cases not associated with apical aneurysm (APA). Recognition of typical perfusion patterns in AHCM patients is not only important in the diagnostic evaluation of this disease process, but also for avoiding unnecessary and costly tests. The purpose of this article is to review the imaging features of AHCM from different imaging modalities and assess the value added of each modality in the diagnosis of AHCM.
Topics: Aged; Aged, 80 and over; Cardiomyopathy, Hypertrophic; Echocardiography; Female; Heart Ventricles; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Myocardial Perfusion Imaging; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index; Tomography, X-Ray Computed; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31853820
DOI: 10.1007/s10554-019-01739-x -
BMC Cardiovascular Disorders Dec 2022Left ventricular (LV) geometry is closely associated with cardiovascular disease; however, few studies have evaluated the relationship between basal septal hypertrophy...
BACKGROUND
Left ventricular (LV) geometry is closely associated with cardiovascular disease; however, few studies have evaluated the relationship between basal septal hypertrophy (BSH) and LV geometry. In this study, we examined the relationship between BSH and LV geometry in a Beijing community population.
METHODS
The clinical and echocardiographic data of 1032 participants from a community in Beijing were analyzed. BSH was defined as a basal interventricular septal thickness ≥ 14 mm and a basal septal thickness/mid-septal thickness ≥ 1.3. On the basis of their echocardiographic characteristics, patients were described as having a normal geometry, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy. Multivariable logistic regression was used to analyze the relationship between BSH, LV mass index (LVMI), and relative wall thickness (RWT).
RESULTS
The prevalence of BSH was 7.4% (95% confidence interval [CI] 5.8-9.0%). Basal and middle interventricular septal thickness, LV posterior wall thickness, and RWT were greater, while LVMI and LV end-diastolic dimension were lower in the BSH group than in the non-BSH group (p < 0.05). The BSH group accounted for the highest proportion of patients with concentric remodeling. A multivariable regression analysis showed that BSH increased by 3.99-times (odds ratio [OR] 3.99, 95% CI 2.05-7.78, p < 0.01) when RWT was > 0.42, but not when LVMI increased (OR 0.16, 95% CI 0.02-1.19, p = 0.07). There were no interactions between BSH and age, body mass index, sex, diabetes mellitus, coronary heart disease, stroke, and smoking in relation to an RWT > 0.42.
CONCLUSION
BSH was independently associated with an RWT > 0.42.
Topics: Humans; Hypertrophy, Left Ventricular; Echocardiography; Cardiovascular Diseases; Diabetes Mellitus; Heart Ventricles; Ventricular Remodeling
PubMed: 36587201
DOI: 10.1186/s12872-022-03004-x -
International Journal of Molecular... Jan 2021In the heart, connexins form gap junctions, hemichannels, and are also present within mitochondria, with connexin 43 (Cx43) being the most prominent connexin in the... (Review)
Review
In the heart, connexins form gap junctions, hemichannels, and are also present within mitochondria, with connexin 43 (Cx43) being the most prominent connexin in the ventricles. Whereas the role of Cx43 is well established for the healthy and diseased left ventricle, less is known about the importance of Cx43 for the development of right ventricular (RV) dysfunction. The present article focusses on the importance of Cx43 for the developing heart. Furthermore, we discuss the expression and localization of Cx43 in the diseased RV, i.e., in the tetralogy of Fallot and in pulmonary hypertension, in which the RV is affected, and RV hypertrophy and failure occur. We will also introduce other Cx molecules that are expressed in RV and surrounding tissues and have been reported to be involved in RV pathophysiology. Finally, we highlight therapeutic strategies aiming to improve RV function in pulmonary hypertension that are associated with alterations of Cx43 expression and function.
Topics: Animals; Connexin 43; Heart Ventricles; Humans; Hypertension, Pulmonary; Tetralogy of Fallot; Ventricular Function
PubMed: 33498172
DOI: 10.3390/ijms22030987 -
JACC. Cardiovascular Imaging Aug 2019Aortic stenosis (AS) causes left ventricular remodeling (hypertrophy, remodeling, fibrosis) and other cardiac changes (left atrial dilatation, pulmonary artery and... (Review)
Review
Aortic stenosis (AS) causes left ventricular remodeling (hypertrophy, remodeling, fibrosis) and other cardiac changes (left atrial dilatation, pulmonary artery and right ventricular changes). These changes, and whether they are reversible (reverse remodeling), are major determinants of timing and outcome from transcatheter or surgical aortic valve replacement. Cardiac changes in response to AS afterload can either be adaptive and reversible, or maladaptive and irreversible, when they may convey residual risk after intervention. Structural and hemodynamic assessment of AS therefore needs to evaluate more than the valve, and, in particular, the myocardial remodeling response. Imaging plays a key role in this. This review assesses how multimodality imaging evaluates AS myocardial hypertrophy and its components (cellular hypertrophy, fibrosis, microvascular changes, and additional features such as cardiac amyloid) both before and after intervention, and seeks to highlight how care and outcomes in AS could be improved.
Topics: Aortic Valve Stenosis; Echocardiography; Fibrosis; Heart Valve Prosthesis Implantation; Heart Ventricles; Humans; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Multimodal Imaging; Predictive Value of Tests; Prognosis; Tomography, X-Ray Computed; Ventricular Function, Left; Ventricular Remodeling
PubMed: 31395243
DOI: 10.1016/j.jcmg.2019.02.034 -
International Journal of Sports Medicine May 2024Changes in cardiac geometry develop after intense and prolonged training. Left ventricular enlargement, increased relative wall thickness, and growing mass of the left...
Changes in cardiac geometry develop after intense and prolonged training. Left ventricular enlargement, increased relative wall thickness, and growing mass of the left ventricle occur after strenuous exercise. Combat sports such as judo can lead to left ventricular hypertrophy. Previous studies have found that there are differences in left ventricular chamber size and thickness between the sexes, with female athletes having smaller wall diameters and less hypertrophy than male athletes. The research aims to examine heart muscle adaptations and remodeling of cardiac geometry among elite judo athletes and to evaluate differences between males and females. A cross-sectional study included a group of 19 (males n=10, females n=9) professional judokas between 20 and 30 years. Demographic and anthropometric data were collected. Cardiac geometry was determined by two-dimensional transthoracic echocardiography. In terms of left ventricular mass and the left ventricular mass index significant differences were found between male and female judokas (233.44±68.75 g vs. 164.11±16.59 g, p=0.009), (105.16±24.89 vs. 84.66±15.06, p=0.044), respectively. A greater enlargement of the heart muscle is observed in male athletes compared to the female group. Left ventricle enlargement is likely to occur among elite-level judokas.
Topics: Humans; Martial Arts; Female; Male; Cross-Sectional Studies; Hypertrophy, Left Ventricular; Echocardiography; Adult; Sex Factors; Young Adult; Heart Ventricles; Athletes; Ventricular Remodeling; Adaptation, Physiological
PubMed: 38401535
DOI: 10.1055/a-2252-1239