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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
On echocardiography, leaflet morphology may reveal the etiology of TR. Right-sided volume overload causes dilation of the RV and RA and diastolic flattening (“D-shape”) of the interventricular septum. Table 14.8 summarizes the classification of TR severity. In severe TR, there is a large regurgitant jet, large coaptation defect or flail valve, and marked tethering of the leaflets (Figure 14.12). In patients with very severe tricuspid annulus dilation and massive TR, equalization of RV and RA pressures renders estimation of SPAP using the TR regurgitant jet inaccurate. With 3-D echo, the tricuspid valve appears to be circular due to dilation of the annulus. RV end-diastolic and end-systolic volume and TR regurgitant volume can be estimated with accuracy comparable to that of cardiac MRI (Table 14.8). Stress echocardiography may have a role for secondary TR, as exercise-induced increase in SPAP >60 mmHg is associated with adverse prognosis. (In contrast, increase in SPAP >30 mmHg for patients with pulmonary arterial hypertension is associated with improved outcome, indicating presence of RV contractile reserve). On cardiac catheterization, increased RV end-diastolic pressure and high C-V waves with blunt X and deep Y waves in RV pressure waveform are typical for severe TR.
Right Ventricle
Published in Takahiro Shiota, 3D Echocardiography, 2020
There were significant differences in RV end-diastolic volume (EDV) between men and women (129 ± 25 vs. 102 ± 33 mL, P < .01).16,17 However, adjusting to lean body mass (but not the body surface area or height) eliminated this difference (2.1 ± 0.5 vs. 2.2 ± 0.4 mL/kg, P = not significant).17 Normal upper limit values are for men 87 mL/m2 for EDV and 44 mL/m2 for end-systolic volume (ESV) and for women 74 mL/m2 for EDV and 36 mL/m2 for ESV.4
Pressure–Volume Loop of the Left Ventricle
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Contractility is defined as the intrinsic strength of myocardial (ventricular) contraction independent of external conditions imposed by preload and afterload. The relationship between pressure and volume within the left ventricle at the instant of maximal activation (end-systole) during a cardiac cycle is known as the End-Systolic Pressure-Volume (ESPVR] relationship. The ESPVR is linear over a wide range of conditions, and is independent of preload and afterload. The slope of this linear ESPVR, an index of myocardial contractility, indicates end-systolic elastance, Ees. With increased contractility (positive inotropy), the ESPVR is shifted to the left and becomes steeper with its gradient (Ees) increased and it is rotated anti-clockwise (Figure 26.7). The increased velocity of fibre shortening with positive inotropy increases the rate of ventricular pressure development (dp/dt), which increases ejection velocity and stroke volume and hence reduces end-systolic volume. Conversely, a negative inotropy decreases Ees gradient, ESPVR slope rotated clockwise), decreased ejection and stroke volume. These lead to an increase in end-systolic volume.
Resveratrol Attenuates Sepsis-Induced Cardiomyopathy in Rats through Anti-Ferroptosis via the Sirt1/Nrf2 Pathway
Published in Journal of Investigative Surgery, 2023
Youcheng Zeng, Guodong Cao, Liang Lin, Yixin Zhang, Xiqing Luo, Xiaoyu Ma, Akelibieke Aiyisake, Qinghong Cheng
Cardiac function assessment of each rat group was completed using echocardiography. The rats were anesthetized at the 24th hour after CLP, and cardiac ultrasonography was performed immediately after skin preparation. To take M-mode echocardiographic measurements, an ultrasound machine (PHILIPS EPIQ7C, USA) with a 15-MHz transducer probe was employed. The left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), as well as the left ventricular internal dimension diastole (LVIDd) and systole (LVIDs) were measured. Additionally, the following algorithms were used to compute the markers of left ventricular systolic function, left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS):
Impact of objective nutritional indexes on 1-year mortality after transcatheter aortic valve implantation: a prospective observational cohort study
Published in Acta Cardiologica, 2021
Mehmet Kucukosmanoglu, Salih Kilic, Orsan Deniz Urgun, Seyda Sahin, Arafat Yildirim, Omer Sen, İbrahim Halil Kurt
The baseline characteristics of the patients are summarised in Table 2. Compared with mortality group mean weight and BMI were higher and height were lower in non-mortality group. The laboratory parameters of the two groups were summarised in Table 3. The mean total cholesterol level in the non-mortality group was significantly higher than that in the mortality group. In addition, the mean low-density lipoprotein cholesterol (LDL-C) level in the non-mortality group was higher than that in the mortality group, although this was not statistically significant. The mean end-diastolic left ventricular volume was significantly higher in the mortality group as compared with that in the non-mortality group, but end-systolic volume and left ventricular ejection fraction (LVEF) were similar between the groups.
Three-dimensional versus two-dimensional transthoracic echocardiography for left ventricular outflow tract measurements in severe aortic stenosis. A cross-sectional study using computer tomography and Haegar sizers as reference
Published in Scandinavian Cardiovascular Journal, 2020
Ingvild Billehaug Norum, Thor Edvardsen, Vidar Ruddox, Anne Gunther, Gry Dahle, Jan Erik Otterstad
Left ventricular (LV) end-diastolic and end-systolic volume index and LV ejection fraction (EF) were calculated with the Simpson’s biplane method. The degree of calcification of the aortic valve was scored according to the following grading: none (no calcification), mild (isolated small spots), moderate (multiple bigger spots) and severe (extensive calcification of all cusps) [11]. Standard 2D TTE evaluation of aortic stenosis was done according to current European Society of Cardiology guidelines [1]. The antegrade systolic velocity across the narrowed aortic valve was measured with continuous wave Doppler both from the apical window and the right-sided parasternal views. The recording with the highest velocity on the average of three beats in sinus rhythm was selected for the continuity equation. For patients in atrial fibrillation an average of five beats was used. LV mass was measured in the parasternal long axis view as recommended by European Association of Cardiovascular imaging/American Society of Echocardiography (EACVI/ASE) [12]. For LVOT velocity time integral, a pulsed wave recording from the apical window was applied, with the sample volume moved approximately 0.5 cm from the valve. Other valvular pathologies were reported if categorized as more than moderate according to guidelines [1].