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Right Ventricular Ejection Fraction (right + ventricular_ejection_fraction)
Selected AbstractsEffect of Bisoprolol on Right Ventricular Function and Brain Natriuretic Peptide in Patients With Heart FailureCONGESTIVE HEART FAILURE, Issue 3 2004Luís Beck-da-Silva MD Beta-blocker use improves left ventricular ejection fraction (LVEF) in patients with heart failure. A similar effect of , blockers on right ventricular function has been proposed, although the effect of bisoprolol, a highly selective ,-1 blocker, on right ventricular function has not been assessed. This study investigated the short-term effect of bisoprolol on right ventricular function in chronic heart failure patients. A cohort of 30 heart failure patients who were not taking , blockers at baseline was studied prospectively. Right ventricular ejection fraction (RVEF) and LVEF were measured at both baseline and 4 months by radionuclide angiography. Bisoprolol was up-titrated during four monthly visits by a preestablished protocol to a target dose of 10 mg/d. The dose of vasodilators was not changed. Quality of life and brain natriuretic peptide level were assessed. Mean age was 62.7±14.3 years. Baseline RVEF was 30.7%±6.3% and baseline LVEF was 21.7%±9.4%. Mean bisoprolol dose reached was 5.3±3.9 mg daily. At 4 months, RVEF significantly increased by 7.1 % (95% confidence interval, 3.9,10.2; p=0.0001) and LVEF also increased significantly by 7.9% (95% confidence interval, 4.0%,11.9%p=0.0003). Quality-of-life score improved from 42.8 to 30.8 (p=0.047). No correlation was found between brain natriuretic peptide levels and RVEF. Bisoprolol treatment for 4 months resulted in a significant improvement of RVEF, which paralleled the improvement of LVEF. [source] Right Ventricular Function Assessment: Comparison of Geometric and Visual Method to Short-Axis Slice Summation MethodECHOCARDIOGRAPHY, Issue 10 2007Daniel Drake M.D. Background: Short-axis summation (SAS) method applied for right ventricular (RV) volumes and right ventricular ejection fraction (RVEF) measurement with cardiac MRI is time consuming and cumbersome to use. A simplified RVEF measurement is desirable. We compare two such methods, a simplified ellipsoid geometric method (GM) and visual estimate, to the SAS method to determine their accuracy and reproducibility. Methods: Forty patients undergoing cine cardiac MRI scan were enrolled. The images acquired were analyzed by the SAS method, the GM (area and length measurement from two orthogonal planes) and visual estimate. RVEF was calculated using all three methods and RV volumes using the SAS and GM. Bland,Altman analysis was applied to test the agreement between the various measurements. Results: Mean RVEF was 49 ± 12% measured by SAS method, 54 ± 12% by the GM, and 49 ± 11% by visual estimate. There were similar bias and limits of agreement between the visual estimate and the GM compared to SAS. The interobserver variability showed a bias close to zero with limits of agreement within ±10% absolute increments of RVEF in 35 of the patients. The RV end-diastolic volume by GM showed wider limits of agreement. The RV end-systolic volume by GM was underestimated by around 10 ml compared to SAS. Conclusion: Both the visual estimate and the GM had similar bias and limits of agreement when compared to SAS. Though the end-systolic measurement is somewhat underestimated, the geometric method may be useful for serial volume measurements. [source] Right Heart Function and Scleroderma: Insights from Tricuspid Annular Plane Systolic ExcursionECHOCARDIOGRAPHY, Issue 2 2007Chiu-Yen Lee M.D. Objective: The purpose of this study was to evaluate the use of echocardiographic parameters as predictors of rehospitalization in scleroderma patients. Methods: Echocardiographic studies were conducted in 38 patients with systolic scleroderma (SSc) to assess cardiopulmonary function. Forty-five age-matched volunteers without any sign of heart failure served as the control group. Transmitral flow pattern, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), and right ventricular ejection fraction (RVEF) were evaluated. All patients were subsequently followed for one year. Results: Peak transmitral early-diastolic velocity (mitral E) and TAPSE measurements were significantly different between SSc and control patients (mitral E: 74.1 ± 16.3 vs. 83.5 ± 17.0 cm/s with P = 0.012; TAPSE: 2.4 ± 0.43 vs. 1.9 ± 0.39 cm with P < 0.0001). LVEF was similar, but RVEF was lower in the SSc group (LVEF: 61.7 ± 9.7 vs. 61.7 ± 5.8% with P = 0.962; RVEF: 49.6 ± 6.8 vs. 39.2 ± 6.7% with P < 0.0001). A strong correlation was found between TAPSE and RVEF. A TAPSE less than 1.96 cm indicted a RVEF less than 40% with a sensitivity of 81% and specificity of 78%. Contrary to expectation, pulmonary artery systolic pressure (PASP) did not correlate well with RV function (r = 0.261, r2= 0.068, P = 0.016). Finally, the frequency of rehospitalization was inversely correlated with RVEF and TAPSE in SSc patients. Conclusions: We can predict the rehospitalization rate of SSc patients by TAPSE and RVEF, suggesting the involvement of heart, skin, lung, and other organs in scleroderma patients. [source] Global and right ventricular end-diastolic volumes correlate better with preload after correction for ejection fractionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010M. L. N. G. MALBRAIN Background: Volumetric monitoring with right ventricular end-diastolic volume indexed (RVEDVi) and global end-diastolic volume indexed (GEDVi) is increasingly being suggested as a superior preload indicator compared with the filling pressures central venous pressure (CVP) or the pulmonary capillary wedge pressure (PCWP). However, static monitoring of these volumetric parameters has not consistently been shown to be able to predict changes in cardiac index (CI). The aim of this study was to evaluate whether a correction of RVEDVi and GEDVi with a measure of the individual contractile reserve, assessed by right ventricular ejection fraction (RVEF) and global ejection fraction, improves the ability of RVEDVi and GEDVi to monitor changes in preload over time in critically ill patients. Methods: Hemodynamic measurements, both by pulmonary artery and by transcardiopulmonary thermodilution, were performed in 11 mechanically ventilated medical ICU patients. Correction of volumes was achieved by normalization to EF deviation from normal EF values in an exponential fashion. Data before and after fluid administration were obtained in eight patients, while data before and after diuretics were obtained in seven patients. Results: No correlation was found between the change in cardiac filling pressures (,CVP, ,PCWP) and ,CI (R2 0.01 and 0.00, respectively). Further, no correlation was found between ,RVEDVi or ,GEDVi and ,CI (R2 0.10 and 0.13, respectively). In contrast, a significant correlation was found between ,RVEDVi corrected to RVEF (,cRVEDVi) and ,CI (R2 0.64), as well as between ,cGEDVi and ,CI (R2 0.59). An increase in the net fluid balance with +844 ± 495 ml/m2 resulted in a significant increase in CI of 0.5 ± 0.3 l/min/m2; however, only ,cRVEDVi (R2 0.58) and ,cGEDVi (R2 0.36) correlated significantly with ,CI. Administration of diuretics resulting in a net fluid balance of ,942 ± 658 ml/m2 caused a significant decrease in CI with 0.7 ± 0.5 l/min/m2; however, only ,cRVEDVi (R2 0.80) and ,cGEDVi (R2 0.61) correlated significantly with ,CI. Conclusion: Correction of volumetric preload parameters by measures of ejection fraction improved the ability of these parameters to assess changes in preload over time in this heterogeneous group of critically ill patients. [source] Effects of intra-abdominal CO2 -insufflation on normal and impaired myocardial function: an experimental studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2003C. A. Greim Background:, Intra-abdominal pressure (IAP) elevation during CO2 -pneumoperitoneum increases cardiac afterload and may enhance dysfunction of the already compromized heart. This study focused on the effects of acute IAP increases on left and right ventricular loadings and contractility in the heart with impaired global function. Methods:, Impairment of myocardial function (IMF) was pharmacologically induced in 16 pigs by administration of halothane and propranolol, while baseline arterial pressure was maintained by intravenous phenylephrine. Intra-abdominal pressure was gradually increased by 10 mmHg up to 30 mmHg in the supine position (IMF group 1, n = 8) or in a head-down tilted position (IMF group 2, n = 8). In two control groups with normal myocardial function, IAP was also increased in the supine position or the head-down tilted position. Cardiac function in all groups was assessed by epicardial echocardiography, intraventricular pressure measurements and pulmonary artery catheterization. Results:, The increase in IAP was accompanied by a transient rise in LV end-systolic wall stress and reduced cardiac output significantly by 16,24% in all groups. In the IMF groups, LV end-diastolic transmural pressure increased by 34,60% to peak values of 24 mmHg, while cross-sectional LV end-diastolic areas remained unchanged. Increases in right ventricular end-diastolic volume and decreases in right ventricular ejection fraction as well as in cardiac output were most pronounced at IAP 20 mmHg and significantly stronger in both IMF groups than in the control groups (P < 0.001). Conclusion:, Following the acute elevation of IAP, the right ventricular volume load shifted more extensively in the IMF groups than in the animals with normal myocardial function. Myocardial function in the impaired heart may worsen during IAP elevation due to right ventricular load alterations rather than a LV afterload increase. [source] Influence of right ventricular pre- and afterload on right ventricular ejection fraction and preload recruitable stroke work relationCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 1 2001Wolfram Burger When right ventricular (RV) afterload is abnormally increased, it correlates inversely with right ventricular ejection fraction (RVEF). We tested, whether this would be different with normal afterload. Additionally, we investigated whether previous studies on the slope of RV preload recruitable stroke work (SW) relation, which used rather non-physiological measures to change RV preload, could be transferred to more physiological loading conditions. RV volumes were determined by thermodilution in 16 patients with stable coronary artery disease and normal pulmonary artery pressure (PAP) at rest. Pre- and afterload were varied by body posture, nitroglycerin (NTG) application and by exercise at different body positions. At rest, the change from recumbent to sitting position decreased PAP, cardiac index (Ci), RV diastolic and systolic volumes, and RVEF. Additionally, mean pulmonary artery pressure (MPAP) correlated positively with both RVEF and cardiac index. After correction for mathematical coupling, the RV preload recruitable SW relation was: right ventricular stroke work index (RVSWi) (103 erg m,2)= 8·1 × (RV end-diastolic volume index ,4·9), with n=96, r=0·57, P,0·001. Exercise abolished this correlation and led to an inverse correlation between RV end-systolic volume (ESV) and RVSW. In conclusion, (i) RVEF correlates positively with RV afterload when afterload varies within normal range; (ii) the slope of the RV preload recruitable SW relation, which is obtained at steady state under normal loading conditions, is substantially flatter than previously described for dynamic changes of RV preload. With increasing afterload, preload loses its determining effect on RV performance, while afterload becomes more important. This puts earlier assumptions of an afterload independent RV preload recruitable SW relation into question. [source] | ||||||||||