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      Evaluation of Right Ventricular Function in Patients with Thyroid Dysfunction

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          Abstract

          Background: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. Patients and Methods: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. Results: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. Conclusions: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.

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          Most cited references 14

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          Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects.

          Assessment of myocardial velocities by Doppler tissue imaging is gaining in importance. However, generally accepted reference values are still missing. In this study we examined 62 consecutive healthy subjects (mean age 46, range 22-82 years) by pulsed wave Doppler tissue imaging to characterize the systolic and diastolic velocity profiles of the left and right ventricles. The subjects were divided into 3 different age-groups: group I, younger than 40 years; group II, 40 to 59 years; and group III, 60 years and older. Recordings were made along the long axis in the apical 4- and 2-chamber views by using 4 sites (septal, anterior, lateral, and inferior) at the mitral annulus and 1 site at the tricuspid annulus. Systolic mitral annular velocity (10.3 +/- 1.4 cm/s) correlated strongly with global left ventricular function determined by M-mode echocardiographic mitral annular displacement (r = 0.70, P <.001). The systolic velocity was significantly lower in group III than in group I (9.6 vs 10.8 cm/s, P <.01). A relatively weak, but significant, correlation was found between systolic velocity and the age of the subjects (r = -0.43, P <.001). Mitral annular early diastolic velocity was also lower in group III compared with group I (11.3 vs 17.7 cm/s, P <.001), with a strong correlation with age (r = -0.81, P <.001) and other conventional Doppler diastolic parameters. Both the systolic and early diastolic mitral annular velocities at the septum were lower than at other left ventricular sites. Tricuspid annular systolic velocity (15.2 +/- 1.9 cm/s) was higher than mitral annular systolic velocity (P <.001). Unlike mitral annular velocity, systolic tricuspid annular velocity was not correlated with age. However, the diastolic tricuspid annular velocities correlated well with transtricuspid Doppler diastolic parameters. The method of recording the annular velocities was feasible in all subjects, simple and highly reproducible.
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            Normal regional right ventricular function and its change with age: a Doppler myocardial imaging study.

            Doppler Myocardial Imaging (DMI) is a new technique currently being studied for the assessment of regional systolic and diastolic left ventricular (LV) function. No normal values or data on age-related changes in regional myocardial right ventricular (RV) velocities are available. Color DMI was used in 32 healthy volunteers (aged 16-76 years) to derive regional velocities from basal, medial, and apical segments of the RV free wall in the apical 4-chamber view, and from distal segments as well as from the tricuspid annulus in the parasternal long-axis view. Both mitral annular and regional LV velocities (4-chamber, long-axis parasternal view) were also recorded and compared with corresponding RV regional velocities. The M-mode displacement of the cardiac base was measured. Corresponding RV and LV DMI data sets were compared. For longitudinal function, RV free wall systolic velocities were consistently higher than velocities recorded in corresponding LV segments (analysis of variance, P <.05). Older subjects (40-76 years; 13 men, 2 women) had lower RV long-axis regional velocities than younger subjects (16-39 years; 15 men, 2 women), but had higher short-axis RV systolic velocities. For diastolic velocities, a negative correlation between age and the ratio of regional early diastolic to late diastolic velocity was shown for all RV free wall segments (eg, basal segment: r = -0.63, P <.0001). The right ventricle has higher long-axis regional velocities, a greater excursion of its lateral atrioventricular valve ring, and reduced circumferential shortening velocities compared with the left ventricle. Right ventricular longitudinal shortening is dominant over short-axis function in healthy young subjects. Normal age-related changes of diastolic velocities for each segment of the normal RV free wall have been defined.
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              Reversible alterations in myocardial gene expression in a young man with dilated cardiomyopathy and hypothyroidism.

              Thyroid hormone effects on myocardial gene expression have been well defined in animal models, but their relationship to the pathogenesis of cardiac dysfunction in hypothyroid humans has been uncertain. We evaluated a profoundly hypothyroid young man with dilated cardiomyopathy. Before and during 9 months of thyroxine therapy, serial assessment of myocardial performance documented substantial improvements in the left ventricular ejection fraction (16-37%), left ventricular end-diastolic diameter (7.8-5.9 cm), and cardiac index (1.4-2.7 liters.min-1.m-2). Steady-state levels of mRNAs encoding selected cardiac proteins were measured in biopsy samples obtained before and after thyroxine replacement. In comparison with myocardium from nonfailing control hearts, this patient's pretreatment alpha-myosin heavy-chain mRNA level was substantially lower, the atrial natriuretic factor mRNA level was markedly elevated, and the phospholamban mRNA level was decreased. All of these derangements were reversed 9 months after restoration of euthyroidism. These observations in an unusual patient with profound myxedema and cardiac dilatation permit correlation between the reversible changes in myocardial function and steady-state mRNA levels in a cardiomyopathy. They suggest that alterations in gene expression in the dilated myopathic heart may be correctable when a treatable cause is identified.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2006
                February 2006
                10 February 2006
                : 105
                : 2
                : 89-94
                Affiliations
                Departments of aCardiology and bInternal Medicine, Izzet Baysal Medical Faculty, Abant Izzet Baysal University, Bolu, cDepartment of Cardiology, Medical Faculty, Mustafa Kemal University, Antakya, and dDepartment of Cardiology, Duzce Medical Faculty, Abant Izzet Baysal University, Duzce, Turkey
                Article
                89855 Cardiology 2006;105:89–94
                10.1159/000089855
                16319454
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 4, References: 23, Pages: 6
                Categories
                Original Research

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