The Hidden Value of Assessing Right Ventricular Performance with Exercise in Hypertensive Patients with Left Ventricular Diastolic Dysfunction

Background: Right ventricular (RV) dysfunction could develop during exercise in patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S, while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P = 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P = 0.05), A’ (P = 0.04). The global RV function showed also a significant increase (P = 0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P = 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (P = 0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (P = 0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.

三尖瓣环收缩期位移/肺动脉收缩压比值与脓毒性心肌病的相关性分析

目的:探讨TAPSE/PASP比值在脓毒性心肌病患者中的诊断、评估作用。方法:选取2021年11月~2022年10月入住唐山市工人医院ICU1的脓毒症患者为研究对象,将发生脓毒性心肌病者纳入脓毒性心肌病组(SIC组),未发生脓毒性心肌病者纳入无脓毒性心肌病组(无SIC组),比较SIC组与无SIC组患者不同时间内的超声心动图参数、血流动力学参数变化。结果:SIC组患者的TAPSE/PASP比值明显低于无SIC组,差异有统计学意义(P < 0.001)。结论:脓毒性心肌病患者中的右心室–肺动脉偶联指标明显低于无脓毒性心肌病患者的相应指标,故脓毒性心肌病发病过程中存在明显的右心室–肺动脉偶联变化(P = 0.006),即TAPSE下降(P < 0.001)、LVEF下降(P < 0.001)、VTI下降(P < 0.001)、CVP上升(P < 0.001)。明显,可通过大样本研究进行进一步观察。

超声心动图评估石墨粉尘接触工人右心功能变化

选取2018年1月至2019年1月进行职业体检的接尘人员151例作为观察组,同期选取151例年龄、性别匹配的健康体检者作为对照组,对两组人员均进行超声心动图三尖瓣环收缩期位移(TAPSE)的测定,将TAPSE<18 mm定义为右心功能不全,分析两组人员右心功能不全分布情况。观察组TAPSE<18 mm者14例,右心功能不全检出率为9.27%,对照组未见病例。相关分析显示,接尘工龄是影响右心功能不全发生的独立危险因素(OR值1.153,P<0.05)。提示超声心动图TAPSE可以早期评估右心功能,为临床诊断和干预提供依据。