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Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
2001 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 86, no 1, 31-38 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).

DESIGN Prospective observational study.

SETTING University Hospital.

SUBJECTS 15 patients with ARVC and a control group of 25 healthy subjects.

METHODS Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.

RESULTS Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (EA) velocity and an accompanying decrease in early (EA) to late diastolic (AA) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.

CONCLUSIONS Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.

Place, publisher, year, edition, pages
2001. Vol. 86, no 1, 31-38 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26984DOI: 10.1136/heart.86.1.31Local ID: 11620OAI: oai:DiVA.org:liu-26984DiVA: diva2:247535
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-02Bibliographically approved
In thesis
1. Annular Motion: Assessment of Cardiac Function using Echocardiography and Magnetic Resonance Imaging
Open this publication in new window or tab >>Annular Motion: Assessment of Cardiac Function using Echocardiography and Magnetic Resonance Imaging
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concentrates on the assessment of cardiac function, both systolic and diastolic using variables originating from the longitudinal motion of the heart using both established and novel non-invasive imaging techniques. We developed a new magnetic resonance imaging (MRI) technique that creates an M-mode MRI image, analogous to the one used in echocardiography and enables quantitative assessment of cardiac motion. The MRI M-mode method was compared with M-mode echocardiography in a phantom study, by measuring mitral and tricuspid annular motion in 20 normal subjects, and in a study of right ventricular function in 17 patients after coronary artery bypass surgery. The agreement between M-mode MRI and Mmode echocardiography was good. However, the amplitudes were somewhat higher measured by MRI, probably because of less angle error in the MRI calculation, furthermore the lower resolution in the MRI image may have contributed.

Pulsed tissue Doppler, a recently developed Doppler modality that gives the possibility of recording instantaneous annular /or myocardial velocities on-line, was used to obtain reference values of mitral and tricuspid annular motion in 27 normal subjects of different ages. Diastolic left ventricular function was assessed in 15 patients with systemic hypertension and in 10 patients with moderate to severe aortic stenosis. Furthermore, pulsed tissue Doppler was used in the evaluation of right and left ventricular function in 15 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).

The mitral and tricuspid annular velocity pattern in normal subjects is characterised by three major components: asystolic (SA) velocity, an early (EA) diastolic velocity, and a late (AA) diastolic velocity. In normal young subjects, the EA-peak velocity was highest; with increasing age, the EA-peak velocity decreases and the AA-peak velocity increases, with similar changes in both the mitral and tricuspid annular velocity pattern. In patients with left ventricular hypertrophy the EA/AA-ratio was significantly decreased compared with age- match normal subjects. Comparing ARVC patients with normal subjects the tricuspid annular EA-peak velocity was significantly decreased as well as the lateral SA-peak velocity. Our result indicates that abnormal diastolic tricuspid annular velocity pattern may be an early sign of right ventricular myocardial dysfunction in patients with ARVC. The septal mitral annular SA-peak velocity was significantly decreased in ARVC patients compared to the controls. This in accordance with subjective analysis of echocardiographic wall motion and T1-201 SPECT that showed left ventricular abnormalities in 93% of the patients predominantly located in the anteroseptal and posteroseptal segments.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 56 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 620
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27516 (URN)12172 (Local ID)91-7219-577-0 (ISBN)12172 (Archive number)12172 (OAI)
Public defence
2000-03-24, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-02Bibliographically approved

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