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Pulmonary vascular resistance (PVR) has important prognostic implications in the assessment of patients with pulmonary hypertension. Using echocardiography to measure PVR would have the advantage of being able to follow patients serially and to assess their response to treatment noninvasively. The authors sought to assess whether right ventricular strain rate imaging (SRI) can predict PVR in patients with pulmonary hypertension. The study population consisted of 46 patients referred for right heart catheterization. The inclusion criteria was mean pulmonary artery pressure ≥25 mm Hg in right heart catheterization in patients with pulmonary hypertension including chronic systolic heart failure. Echocardiography was performed to obtain SRI just before right heart catheterization. Mean values of peak systolic longitudinal strain and strain rate obtained from basal and mid-right ventricular free wall were calculated. The control group consisted of 35 healthy adults matched for age and sex. The most significant correlations were between basal right ventricular strain and strain rate (SR) and mean pulmonary arterial pressure (r=0.63, P=.000), transpulmonary gradient (r=0.6, P=.001), and PVR (r=0.5, P=.003). SR was independently correlated with PVR (PVR=26.9-16.9×basal right ventricular SR; r=0.53, P=.003). The present study shows that basal right ventricular free wall strain and SR could be independently correlated with PVR in patients with pulmonary hypertension., (© 2012 Wiley Periodicals, Inc.)

Background: Left ventricular (LV) twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR) on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI). LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs. 13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively), both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020), but there was statistically no significant difference in the LV twist rate. Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients. [ABSTRACT FROM AUTHOR]

Background: More diagnostic techniques require a better understanding of the forces and stresses developed in the wall of the left ventricle. The aim of this study was to differentiate significant coronary artery disease (CAD) patients using a noninvasive quantification of myocardial wall stress in the diastole phase. Methods: Sixty male subjects with sinus rhythm (30 patients with significant and 30 with moderate left anterior descending coronary artery stenosis in the proximal portion) as well as 35 healthy subjects as the control group were recruited into the present study. By two-dimensional, pulsed wave, and tissue Doppler echocardiography, the average end-diastolic wall stress was calculated at the left ventricle anterior and interventricular septum wall segments using regional wall thickness, meridional and circumferential radii, and non-invasive left ventricular end-diastolic pressure. Results: A comparison of the calculated end-diastolic myocardial wall stress between the patients with significant and moderate coronary stenosis on the one hand and the healthy subjects on the other showed statistically significant differences in the anterior and septum wall segments (p value < 0.05). The patients with significant left anterior descending coronary artery stenosis had higher end-diastolic myocardial wall stress than did those with moderate stenosis and the healthy group in all the anterior and septum wall segments. Conclusion: It is concluded that non-invasive end-diastolic myocardial wall stress in coronary artery disease patients is an important index in evaluating myocardial performance. [ABSTRACT FROM AUTHOR]