PMID- 17919570
OWN - NLM
STAT- MEDLINE
DCOM- 20071026
LR  - 20161124
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 50
IP  - 15
DP  - 2007 Oct 9
TI  - Restrictive right ventricular physiology: its presence and symptomatic 
      contribution in patients with pulmonary valvular stenosis.
PG  - 1491-7
AB  - OBJECTIVES: The aim of this study was to examine whether restrictive right 
      ventricular (RV) physiology (the presence of antegrade pulmonary arterial flow in 
      late diastole) occurred in patients with moderate to severe isolated pulmonary 
      valvular stenosis (PVS) and to estimate its prevalence and relationship to RV 
      function and patient symptoms. BACKGROUND: Little is published about RV diastolic 
      performance in adult patients with PVS. METHODS: A total of 43 consecutive 
      patients (age 44 +/- 10 years) with moderate to severe PVS referred to Royal 
      Brompton Hospital from 2002 to 2005 were retrospectively studied. Patient New 
      York Heart Association (NYHA) functional class was recorded. The RV (lateral 
      tricuspid annulus motion) long-axis movement was measured by M-mode and 
      pulsed-wave (PW) tissue Doppler imaging (TDI). Restrictive RV physiology was 
      assessed by PW Doppler echocardiography. RESULTS: Eighteen patients (42%) had 
      restrictive RV physiology. They were more symptomatic (NYHA functional class 1.8 
      +/- 0.5 vs. 1.3 +/- 0.5; p < 0.001) and had poorer RV long-axis function (TDI 
      peak systolic velocity 7.3 +/- 2.1 cm/s vs. 9.7 +/- 2.7 cm/s; TDI early diastolic 
      velocity 6.6 +/- 1.6 cm/s vs. 8.5 +/- 2.4 cm/s; RV long-axis systolic amplitude 
      1.3 +/- 0.2 cm vs. 1.5 +/- 0.3 cm; p < 0.01 for all) compared with other PVS 
      patients despite similar RV ejection fraction, myocardial performance index, and 
      RV systolic pressure. The presence of restrictive RV physiology (odds ratio [OR] 
      6.05, 95% confidence interval [CI] 1.45 to 10.29; p = 0.01) and peak pulmonary 
      valve pressure gradient (OR 1.07, 95% CI 1.01 to 1.13; p = 0.04) were the 2 
      independent echocardiographic predictors for decreased exercise tolerance in 
      patients on multivariate analysis. CONCLUSIONS: Restrictive RV physiology is 
      common in PVS patients. Its presence is related to a worse deterioration in RV 
      long-axis function and decreased exercise tolerance in patients.
FAU - Lam, Yat-Yin
AU  - Lam YY
AD  - Adult Congenital Heart Unit, Royal Brompton Hospital, London, United Kingdom. 
      homalam@hotmail.com
FAU - Kaya, Mehmet G
AU  - Kaya MG
FAU - Goktekin, Omer
AU  - Goktekin O
FAU - Gatzoulis, Michael A
AU  - Gatzoulis MA
FAU - Li, Wei
AU  - Li W
FAU - Henein, Michael Y
AU  - Henein MY
LA  - eng
PT  - Journal Article
DEP - 20070924
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Adult
MH  - Comorbidity
MH  - Echocardiography, Doppler
MH  - Exercise Tolerance
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Artery/physiopathology
MH  - Pulmonary Valve Stenosis/diagnostic imaging/epidemiology/*physiopathology
MH  - Regional Blood Flow
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Ventricular Dysfunction, Right/epidemiology/*physiopathology
EDAT- 2007/10/09 09:00
MHDA- 2007/10/30 09:00
CRDT- 2007/10/09 09:00
PHST- 2007/03/05 00:00 [received]
PHST- 2007/06/14 00:00 [revised]
PHST- 2007/06/25 00:00 [accepted]
PHST- 2007/10/09 09:00 [pubmed]
PHST- 2007/10/30 09:00 [medline]
PHST- 2007/10/09 09:00 [entrez]
AID - S0735-1097(07)02303-0 [pii]
AID - 10.1016/j.jacc.2007.06.042 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Oct 9;50(15):1491-7. doi: 10.1016/j.jacc.2007.06.042. 
      Epub 2007 Sep 24.