Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy.

AIMS: Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. Limited information is available on the genesis of the underlying reversible contractile disorder. Our objective in this prospective study was to investigate biventricular changes in systolic long-axis function and diastolic parameters in the acute phase and after recovery. METHODS AND RESULTS: Thirteen consecutive patients were examined by echocardiography and coronary angiography at admission and again by echocardiography after 3 months. Amplitudes, systolic and diastolic velocities of the mitral and tricuspid annuli and conventional diastolic parameters were measured. Systolic long-axis shortening of the left ventricle (LV) and right ventricle (RV) improved from 9.6 ± 2.2 mm to 11.2 ± 1.9 mm (P = 0.02) and from 21.3 ± 3.6 mm to 24.1 ± 2.8 mm (P = 0·02), respectively. LV systolic, early and late diastolic velocities measured by pulsed-wave tissue Doppler also improved, while additional conventional diastolic parameters of the LV and RV diastolic function were unchanged. CONCLUSIONS: Takotsubo cardiomyopathy temporarily affects systolic LV and RV function, while most diastolic parameters remain unchanged.

Echocardiographic measurements of the right ventricle: right ventricular outflow tract 1.

PURPOSE: The size of the ventricles of the heart is important to establish during the clinical echocardiographic examination. Due to the complex anatomy of the right ventricle, it is difficult to measure its size at times. One of the most frequently used ways is to measure the right ventricular outflow tract (RVOT1), probably due to its good reproducibility. However, in the literature different ways are described to measure RVOT1, both at different sites and using different methods such as M-mode and 2D. The first aim of the present study was to exam if there is a significant difference in the outcome of RVOT1 using different sites and methods to measure it. The second aim was to study if there is a significant difference between the usually preferred left lateral decubitus position during the echocardiographic examination and the supine decubitus position, which the echocardiographer sometimes can be compelled to use if the patient is unable to lie in the left lateral decubitus position. METHODS: Twenty-seven healthy subjects were included and examined by echocardiography. RVOT1 was measured at different sites using different methods; first with the subject in the left lateral decubitus position and then repeating the same measurements with the subject in the supine decubitus position. RESULTS: Comparing the RVOT1 measured at different sites and with different methods showed an overall significant difference (p < 0.001). Also when comparing the different body positions, there was an overall significant difference (p = 0.001). CONCLUSIONS: When comparing RVOT1 of the same patient or subject over time, the results from the present study indicate that the same site, method and body position should be used.

A comparison of right ventricular volume change during systole obtained using the monoplane Simpson's method in two-dimensional echocardiographic apical four-chamber view with right ventricular volume change obtained using a prisma model reflecting the systolic long-axis shortening of the right ventricle of the heart: A pilot study.

The right ventricle of the heart has a complex geometry, making it difficult to measure its function and volume. In the present study, right ventricular (RV) volume change during systole in two-dimensional echocardiographic apical four-chamber view was estimated using the monoplane Simpson's method. Measurements of volume change using the monoplane Simpson's method were compared with those obtained using a theoretical prisma model, which is believed to reflect RV systolic long-axis shortening. The mean volume change during systole obtained using the theoretical prisma model (10.2+/-3.2 mL) was significantly (P<0.001) smaller than that obtained using the monoplane Simpson's method (20.7+/-7.1 mL). This difference was probably due to the patient group studied, which had a mean (+/- SD) age of 58.6+/-14.1 years. In elderly individuals, systolic shortening in the short-axis direction has a greater impact on volume change during the heart cycle more than in younger individuals. However, not even the volume change during systole obtained using the monoplane Simpson's method in echocardiographic four-chamber view was able to determine the 'real' RV stroke volume. Thus, the volume change during systole in other echocardiographic views needs to be considered as well.

Comparison between maximal early diastolic velocity in long-axis direction obtained by M-mode echocardiography and by tissue Doppler in the assessment of right ventricular diastolic function.

Recently the maximal early diastolic velocity in long-axis direction of the right ventricle (RV) obtained by tissue Doppler imaging (MDV TDI) has been introduced in the assessment of RV diastolic function (RVDF). There are reasons to think that also the maximal early diastolic velocity in long-axis direction of the RV obtained using M-mode echocardiography (MDV TAM) could be used to assess RVDF. Therefore, 29 patients were examined with echocardiography and MDV TAM and MDV TDI were measured and compared. A good correlation (r = 0.76, P < 0.001) was found between MDV TAM and MDV TDI indicating that MDV TAM might be used in the assessment of RVDF. However, the velocities obtained by MDV TDI (126.7 +/- 38.9 mm s(-1)) were significantly (P < 0.001) higher than the velocities obtained by MDV TAM (78.3 +/- 27.8 mm s(-1)) and the agreement between MDV TAM and MDV TDI was rather poor probably mainly due to differences in the measuring technique. This means that reference values cannot be used interchangeably between MDV TAM and MDV TDI. If MDV TAM is going to be used in the assessment of RVDF new reference values have to be produced if today's technique and recommendations to measure MDV TAM and MDV TDI are used. However, as most new echocardiographs are equipped with PW-TDI technology it seems preferable to use this technique and compare obtained values with already established reference values.

Isovolumetric relaxation time of the right ventricle assessed by tissue Doppler imaging.

OBJECTIVES: The isovolumetric relaxation time of the right ventricle (RV-IVRT) can be assessed using a method based on ECG and pulsed wave Doppler (PW). Recently pulsed wave Doppler tissue imaging (PW-DTI) has been introduced in the assessment. DESIGN: RV-IVRT obtained by the two methods was compared in 20 consecutive patients as was the time from the R wave on the ECG to the onset of tricuspid flow (R-T), to the closure of the pulmonic valve (R-P), to the onset of early diastolic motion of the tricuspid annulus tissue (R-E) and to the end of the systolic motion (R-S). RESULTS: RV-IVRT obtained by the PW method was significantly (p < 0.001) shorter than RV-IVRT obtained by PW-DTI. R-S had significantly (p < 0.001) shorter duration than R-P, while there was no significant difference between R-E and R-T. CONCLUSIONS: The methods are not measuring the same interval. Only the PW method measures RV-IVRT according to the usual definition. Different reference values have to be used if the methods are used in the assessment of RV diastolic function.