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Right ventricle filling indices in healthy people of different age

Sumin A. N., Arkhipov O. G.

Keywords: age, right ventricular diastolic dysfunction

DOI: 10.18087 / rhfj.2012.2.1617

Relevance. Prognostic value of RV diastolic dysfunction, its interrelation with HF clinical presentations and exercise tolerance are well-known. Due to age-related natural deterioration of compliance of the chambers of heart and depression of ventricle diastolic functions, there is a problem of differentiation between pathological and age-specific changes of RV diastolic function. Objective. Study in different age groups of RV diastolic function indices, including intraventricular propagation of early transtricuspid flow. Materials and methods. The study included 270 patients (129 male) at the age of 13 to 83 years (average age 45.3±0.9 years). The following groups were made: under 20 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years, 70 years and older. The subjects underwent EchoCG (Medison Sonacе 8 000 apparatus). Early (Eат) and late (Aат) tricuspid annular diastolic velocities, and their ratio (Eат/ Aат) was measured by tissue Doppler echocardiography; early transtricuspid flow velocity (Eт), atrial systole flow (Aт), and their ratio (Eт / Aт). RV filling flow velocity was measured (tricuspid flow velocity) in the combined color M-mode. Results. Eат index in the first three groups did not differ much, in the groups above 40 years old, a linear reduction of Eат by 1.5–2 cm / sec (by 10–15 %) per every ten years was observed (р=0.00001). On the contrary, Aat velocity increased significantly in subject older 50 years (р=0.00001). Eат / Aат ratio reduced linearly from the age of 30 by 8–15 % per every ten years from 1.6 to 0.75 (р=0.00001). Tricuspid flow velocity index reduced from 48.5 cm / sec in subjects under 20 years by 1–3 cm / sec per every ten years (р=0.00001). Conclusion. As healthy people grow older, natural deterioration of RV diastolic function index is observed. This was manifested by decrease of the early and late systolic transtricuspid flow velocity ratio, early and late systolic tricuspid annular diastolic velocities and RV early diastolic flow velocity. Moderate correlation between different examined indices of RV diastolic function indicates different diastole parameters evaluated by them. Comprehensive RV diastolic function assessment is advisable taking into account age-related changes of indices.
  1. Walker LA, Buttrick PM. The right ventricle: biologic insights and response to disease. Curr Cardiol Rev. 2009;5 (1):22–28.
  2. Mertens LL, Friedberg MK. Imaging the right ventricle – current state of the art. Nat Rev Cardiol. 2010;7 (10):551–563.
  3. Le Tourneau T, Piriou N, Donal E, et al. Imaging and modern assessment of the right ventricle. Minerva Cardioangiol. 2011;59 (4):349–374.
  4. Meluzin J, Spinarová L, Hude P et al. Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure. Int J Cardiol. 2005;105 (2):164–173.
  5. Atluri P. Careful echocardiographic analysis of right ventricular function as a long-term prognostic variable in systolic heart failure. Circ J. 2011;75 (9):2054–2055.
  6. Voelkel NF, Quaife RA, Leinwand LA et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114 (17):1883–1891.
  7. van Wolferen SA, Marcus JT, Boonstra A et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J. 2007;28 (10):1250–1257.
  8. Ghio S, Klersy C, Magrini G et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2010;140 (3):272–278.
  9. Rudski LG, Lai WW, Afilalo J еt al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23 (7):685–713.
  10. Gaynor SL, Maniar HS, Bloch JB et al. Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation. 2005;112 (9 Suppl): I212‑I218.
  11. Беленков Ю. Н., Агманова Э. Т. Возможности тканевой допплеровской эхокардиографиии в диагностике диастолической функции правого желудочка у больных с хронической сердечной недостаточностью I–IV функционального класса. Кардиология. 2007;47 (5):4–9.
  12. Gan CT, Holverda S, Marcus JT et al. Right ventricular diastolic dysfunction and the acute effects of sildenafil in pulmonary hypertension patients. Chest. 2007;132 (1):11–17.
  13. Cheng CC, Huang WC, Chiou KR et al. Tricuspid flow propagation velo­city predicts exercise tolerance and readmission in patients with systemic lupus erythematosus. J Am Soc Echocardiogr. 2009;22 (4):411–417.
  14. Shiina Y, Funabashi N, Lee K et al. Right atrium contractility and right ventricular diastolic function assessed by pulsed tissue Doppler imaging can predict brain natriuretic peptide in adults with acquired pulmonary hypertension. Int J Cardiol. 2009;135 (1):53–59.
  15. Lindqvist P, Waldenström A, Wikström G, Kazzam E. Right ventricular myocardial isovolumic relaxation time and pulmonary pressure. Clin Physiol Funct Imaging. 2006;26 (1):1–8.
  16. Pelà G, Regolisti G, Coghi P et al. Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects. Eur J Echocardiogr. 2004;5 (4):262–271.
  17. Watanabe S, Suzuki N, Kudo A et al. Influence of aging on cardiac function examined by echocardiography. Tohoku J Exp Med. 2005;207 (1):13–19.
  18. Innelli P, Esposito R, Olibet M et al. The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study. Eur J Echocardiogr. 2009;10 (4):491–498.
  19. Dalen H, Thorstensen A, Vatten LJ et al. Reference values and distribution of conventional echocardiographic Doppler measures and longitudinal tissue Doppler velocities in a population free from cardiovascular disease. Circ Cardiovasc Imaging. 2010;3 (5):614–622.
  20. Mego DM, DeGeare VS, Nottestad SY et al. Variation of flow propagation velocity with age. J Am Soc Echocardiogr. 1998;11 (1):20–25.
  21. Сумин А. Н., Гайфулин Р. А., Галимзянов Д. М. Внутрижелудочковые потоки наполнения в оценке диастолической функции левого желудочка у пожилых людей. Кардиология. 2003;43 (10):22–31.
  22. Cortina C, Bermejo J, Yotti R et al. Noninvasive assessment of the right ventricular filling pressure gradient. Circulation. 2007;116 (9):1015–1023.
  23. Teske AJ, Prakken NH, De Boeck BW et al. Effect of long term and intensive endurance training in athletes on the age related decline in left and right ventricular diastolic function as assessed by Doppler echocardiography. Am J Cardiol. 2009;104 (8):1145–1151.
  24. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Ревишвили А. Ш. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Журнал Сердечная Недостаточность. 2010;11 (1):3–62.
  25. Jurcut R, Giusca S, La Gerche A et al. The echocardiographic assessment of the right ventricle: what to do 2010? Eur J Echocardiogr. 2010;11 (2):81–96.
  26. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117 (11):1436–1448.
  27. Свирида О. Н., Овчинников А. Г., Агеев Ф. Т. Влияние кандесартана и его комбинации со спиронолактоном на диастолическую функцию левого желудочка и содержание биохимических маркеров баланса коллагена у пациентов с хронической сердечной недостаточностью и сохранённой систолической функцией левого желудочка. Журнал Сердечная недостаточность 2010;11 (5):263–275.
  28. Yotti R, Bermejo J, Benito Y et al. Noninvasive estimation of the rate of relaxation by the analysis of intraventricular pressure gradients. Circ Cardiovasc Imaging. 2011;4 (2):94–104.
  29. Фейгенбаум Х. Эхокардиография: перевод с английского. – М.: Видар, 1999. – 512 с.
  30. Sun Y, Belenkie I, Wang JJ, Tyberg JV. Assessment of right ventricular diastolic suction in dogs with the use of wave intensity analysis. Am J Physiol Heart Circ Physiol. 2006;291 (6):H3114‑H3121.
  31. Sabbah HN, Anbe DT, Stein PD. Can the human right ventricle create a negative diastolic pressure suggestive of suction? Cathet Cardiovasc Diagn. 1981;7 (3):259–267.
  32. Ueno Y, Nakamura Y, Kinoshita M et al. An early predictor of left ventricular remodeling after reperfused anterior acute myocardial infarction: ratio of peak E wave velocity / flow propagation velocity and mitral E wave deceleration time. Echocardiography. 2002;19 (7 Pt 1):555–563.
  33. Michaux I, Filipovic M, Skarvan K et al. Accuracy of Tissue Doppler estimation of the right atrial pressure in anesthetized, paralyzed, and mechanically ventilated patients. Am J Cardiol. 2006;97 (11):1654–1656.
  34. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.
  35. Pasipoularides A, Shu M, Shah A et al. Diastolic right ventricular filling vortex in normal and volume overload states. Am J Physiol Heart Circ Physiol. 2003;284 (4):H1064–1072.
  36. Chiha J, Boyd A, Thomas L. Does normal ageing alter right ventricular relaxation properties? A tissue Doppler study. Heart Lung Circ. 2010;19 (7):406–412.
  37. Orozco-Gutiérrez JJ, Castillo-Martínez L, Orea-Tejeda A et al. Effect of L-arginine or L-citrulline oral supplementation on blood pressure and right ventricular function in heart failure patients with preserved ejection fraction. Cardiol J. 2010;17 (6):612–618.
Sumin A. N., Arkhipov O. G. Right ventricle filling indices in healthy people of different age. Russian Heart Failure Journal. 2012;13(2):73-78

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