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Differential right ventricular regional function and the effect of pulmonary hypertension: three-dimensional echo study
  1. Avin Calcutteea1,
  2. Robin Chung2,
  3. Per Lindqvist1,
  4. Margaret Hodson2,
  5. Michael Y Henein1
  1. 1Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  2. 2Department of Echocardiography, Imperial College and Royal Brompton Hospital and Harefield NHS Trust, London, UK
  1. Correspondence to Professor Michael Y Henein, Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; michael.henein{at}medicin.umu.se

Abstract

Background The right ventricle is multicompartmental in orientation.

Objective To assess the normal differential function of the right ventricular (RV) inflow, apical and outflow compartments, also their inter-relations and the response to pulmonary arterial hypertension (PAH).

Methods 45 people were studied—16 controls and 29 patients with left-sided heart failure, 15 without (group 1) and 14 with (group 2) secondary PAH, using two-dimensional (2D) and 3D echocardiography in addition to conventional Doppler techniques.

Results There was a strong correlation between RV inlet diameter (2D) and end-diastolic volume (3D) (r=0.69, p<0.001) and between tricuspid annular plane systolic excursion and RV ejection fraction (3D) (r=0.71, p<0.001). In controls and patients, the apical ejection fraction was less than the inflow and outflow (controls: p<0.01 and p<0.01, group 1: p<0.05 and p<0.01 and group 2: p<0.05 and p<0.01, respectively). Ejection fraction was reduced in patients (inflow: p<0.001 for both, apical: p<0.01 for both and outflow tract: p<0.05 for both). In controls, the inflow compartment reached the minimum volume 20 ms before the outflow and apex but in group 2 it was simultaneous. Isovolumic contraction and relaxation times were prolonged in patients (Group 1: p=0.02 and p<0.01 and Group 2: p=0.01 for both). Peak RV ejection time correlated with the rate of outflow volume fall in controls but with the apex in group 2 (r=0.6, p<0.05).

Conclusion The right ventricle has distinct features for the inflow, apical and outflow tract compartments, with different extent of contribution to the overall systolic function. In PAH, the right ventricle becomes one dyssynchronous compartment, which itself may have perpetual effect on overall cardiac dysfunction.

  • Echocardiography (three-dimensional)

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Royal Brompton and National Heart and Lung Institute, London, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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