Letter to the Editor Received: September 29, 2014 Accepted: September 30, 2014 Published online: December 11, 2014
Cardiology 2015;130:46 DOI: 10.1159/000368748
The Effect of Age on Right Ventricular Diastolic Function Parameters Sait Demirkol a Cengiz Ozturk a Mustafa Aparci b Sevket Balta c Murat Unlu a Atila Iyisoy a a
Department of Cardiology, Gulhane Military Medical Academy, and b Department of Cardiology, Etimesgut Military Hospital, Ankara, and c Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey
cluding both pressure and volume overload in pathologies such as primary lung disease, congenital heart disease, cardiomyopathies, ischemic heart disease and systemic diseases [2]. Only a few studies assessed RV diastolic function. In these studies, RV diastolic function has been evaluated using Doppler velocities of transtricuspid flow [early (E), late (A) and E/A], tissue Doppler velocities of the tricuspid annulus (E’, A’, E’/A’), deceleration time and isovolumic relaxation time. Most commonly used in recent studies are the tricuspid E/E’ ratio, right atrial area or volume, and diastolic strain rate. A good correlation has been found between the tricuspid E/E’ ratio and right atrial volume, and hemodynamic parameters. An E/E’ ratio ≥4 had high sensitivity and specificity for predicting right atrial pressure ≥10 mm Hg in intensive care unit patients without cardiac surgery [3]. The study by Leibowitz et al. [1] did not evaluate RV Doppler parameters. Further studies should be performed to assess the correlation between age and RV tissue Doppler diastolic parameters such as the tricuspid E/E’ ratio.
© 2014 S. Karger AG, Basel 0008–6312/14/1301–0046$39.50/0 E-Mail [email protected] www.karger.com/crd
Conflict of Interest
The authors have no conflict of interest.
References 1 Leibowitz D, Gilon D, Jacobs JM, StessmanLande I, Stessman J: Pulmonary artery systolic pressure and mortality in the oldest old. Cardiology 2014;129:111–116. 2 Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et 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;23:685–713. 3 Sade LE, Gulmez O, Eroglu S, Sezgin A, Muderrisoglu H: Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr 2007;20:982– 988.
Assist. Prof. Sait Demirkol, MD Department of Cardiology Gulhane Military Medical Academy Tevfik Saglam St., TR–06018 Ankara (Turkey) E-Mail saitdemirkol @ yahoo.com
Downloaded by: Freie Universität Berlin 149.126.78.65 - 7/2/2015 10:32:47 AM
We read with great interest the article by Leibowitz et al. [1]. They aimed to explore pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. They found that an elevated right-ventricular (RV) systolic pressure is significantly associated with mortality in this population. We believe that this findings will act as a guide for further studies regarding measurements of pulmonary artery systolic pressure and mortality. Contrary to common belief, the right ventricle is not a passive chamber. RV function can be assessed echocardiographically using several parameters, including the RV index of myocardial performance, tricuspid annular plane systolic excursion, myocardial acceleration during isovolumic contraction, RV fractional area change, tissue Doppler-derived tricuspid lateral annular systolic velocity, and longitudinal strain and strain rate. A large number of acute and chronic diseases have been associated with RV diastolic dysfunction, in-
Cardiology 2015;130:46 DOI: 10.1159/000368748
The Effect of Age on Right Ventricular Diastolic Function Parameters Sait Demirkol a Cengiz Ozturk a Mustafa Aparci b Sevket Balta c Murat Unlu a Atila Iyisoy a a
Department of Cardiology, Gulhane Military Medical Academy, and b Department of Cardiology, Etimesgut Military Hospital, Ankara, and c Department of Cardiology, Eskisehir Military Hospital, Eskisehir, Turkey
cluding both pressure and volume overload in pathologies such as primary lung disease, congenital heart disease, cardiomyopathies, ischemic heart disease and systemic diseases [2]. Only a few studies assessed RV diastolic function. In these studies, RV diastolic function has been evaluated using Doppler velocities of transtricuspid flow [early (E), late (A) and E/A], tissue Doppler velocities of the tricuspid annulus (E’, A’, E’/A’), deceleration time and isovolumic relaxation time. Most commonly used in recent studies are the tricuspid E/E’ ratio, right atrial area or volume, and diastolic strain rate. A good correlation has been found between the tricuspid E/E’ ratio and right atrial volume, and hemodynamic parameters. An E/E’ ratio ≥4 had high sensitivity and specificity for predicting right atrial pressure ≥10 mm Hg in intensive care unit patients without cardiac surgery [3]. The study by Leibowitz et al. [1] did not evaluate RV Doppler parameters. Further studies should be performed to assess the correlation between age and RV tissue Doppler diastolic parameters such as the tricuspid E/E’ ratio.
© 2014 S. Karger AG, Basel 0008–6312/14/1301–0046$39.50/0 E-Mail [email protected] www.karger.com/crd
Conflict of Interest
The authors have no conflict of interest.
References 1 Leibowitz D, Gilon D, Jacobs JM, StessmanLande I, Stessman J: Pulmonary artery systolic pressure and mortality in the oldest old. Cardiology 2014;129:111–116. 2 Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et 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;23:685–713. 3 Sade LE, Gulmez O, Eroglu S, Sezgin A, Muderrisoglu H: Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr 2007;20:982– 988.
Assist. Prof. Sait Demirkol, MD Department of Cardiology Gulhane Military Medical Academy Tevfik Saglam St., TR–06018 Ankara (Turkey) E-Mail saitdemirkol @ yahoo.com
Downloaded by: Freie Universität Berlin 149.126.78.65 - 7/2/2015 10:32:47 AM
We read with great interest the article by Leibowitz et al. [1]. They aimed to explore pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. They found that an elevated right-ventricular (RV) systolic pressure is significantly associated with mortality in this population. We believe that this findings will act as a guide for further studies regarding measurements of pulmonary artery systolic pressure and mortality. Contrary to common belief, the right ventricle is not a passive chamber. RV function can be assessed echocardiographically using several parameters, including the RV index of myocardial performance, tricuspid annular plane systolic excursion, myocardial acceleration during isovolumic contraction, RV fractional area change, tissue Doppler-derived tricuspid lateral annular systolic velocity, and longitudinal strain and strain rate. A large number of acute and chronic diseases have been associated with RV diastolic dysfunction, in-
