Three-dimensional echocardiography and 2D-3D speckle tracking imaging in chronic pulmonary hypertension. diagnostic accuracy in detecting hemodynamic signs of RV failure

Background and objective. Our aim was to compare three-dimensional (3D) and 2D and 3D speckle tracking (2D-STE, 3D-STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure. Methods. Seventy-three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV-FAC -fractional area change-, TAPSE -tricuspid annular plane systolic excursion-) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes, and global and regional ejection fraction (3D-RVEF) were determined. RV strains were calculated by 2D-STE and 3D-STE. Results. RV 3D global-free-wall longitudinal strain (3DGFW-RVLS), 2D global-free-wall longitudinal strain (GFW-RVLS), apical-free-wall longitudinal strain (AFW-RVLS), basal-free-wall longitudinal strain (BFW-RVLS), and 3D-RVEF were lower in patients with pre-capillary PH (p<0.0001) and post-capillary PH (p<0.01) compared to controls. 3DGFW-RVLS (HR 4.6, 95% CI 2.79-8.38, p=0.004) and 3D-RVEF (HR 5.3, 95% CI 2.85-9.89, p=0.002) were independent predictors of mortality. ROC curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D-RVEF (AUC 0.89), -17% for 3DGFW-RVLS (AUC 0.88), -18% for GFW-RVLS (AUC 0.88), -16% for AFW-RVLS (AUC 0.85), 16mm for TAPSE (AUC 0.67), and 38% for RV-FAC (AUC 0.62). Conclusions. In chronic PH, 3D, 2D-STE and 3D-STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices

Optical properties of traditional clay tiles for ventilated roofs and implication on roof thermal performance

A remarkable advantage of clay tiles roof coverings in hot climates is the realization of a ventilated air layer between them and the roofing underlay that allows a natural and forced convection through the tiles joints and the channel from eaves to ridge, thus cooling the roof materials. However recently, in many countries, regulatory developments on buildings energy efficiency or buildings sustainability certification protocols are increasingly encouraging the use of alternative strategies, with the aim of reducing the urban heat island (UHI) effect and the buildings’ cooling consumptions. Among them, the use of ‘cool’ materials for roof covering. These mandatory or voluntary measures de facto push the construction products market towards specific directions, risking penalizing traditional components such as clay tiles. This article reports the results of experimental and numerical activities carried out in order to extensively characterize the optical properties of clay tile materials and investigate their impact, also coupled with above sheathing ventilation, on the thermal performance of a ventilated roof under warm-temperate climate. In the first phase of the research, the main optical properties of over 30 different clay products have been experimentally characterized in order to get a clear and extensive picture of such properties for the materials spread in the market. In a second phase, starting from the thermal data collected on an experimental real-scale building, a dynamic energy analysis tool was calibrated and used to perform simulations by varying the optical properties of the roof covering thus assessing the impact on the roof temperatures, also in comparison to a clay tiles roof. The results underline that the use of the above sheathing ventilation obtained through clay tiles is an effective strategy to reduce roof temperatures, even if covering materials are not qualified as ‘cool’, thus impacting on both UHI and indoor comfort

Three-dimensional speckle tracking echocardiographic assessment of right ventricular function in chronic obstructive pulmonary disease with and without pulmonary hypertension.

Background: The purpose of this study was to assess right ventricular (RV) function in patients with chronic obstructive pulmonary disease (COPD) with and without pulmonary hypertension (PH) using three-dimensional speckle tracking echocardiography (3DSTE) and compare 3DSTE parameters with conventional RV function indexes. Methods: Thirty-two patients with COPD and thirty-two healthy subjects were studied. Twelve patients had PH confirmed by right heart catheterization (mean pulmonary artery pressure >25mmHg). Twenty patients had normal pulmonary artery pressures. Standard 2D measurements (tricuspid annulus excursion -TAPSE-, fractional area change -RVFAC-) and mitral and tricuspid tissue-Doppler annular velocities were obtained. RV 3D volumes, and RV global and regional ejection fraction (3DRVEF) were determined. Peak systolic velocities and strain were measured in the LV and RV free-wall segments. Respiratory function tests were performed (FEV1/VC = forced expiratory volume in one second / vital capacity; DLCO/VA = carbon monoxide diffusion lung capacity per unit of alveolar volume). Results: Global free-wall RV longitudinal strain (GFW-RVLS) and 3DRVEF were significantly lower compared to controls both in patients with PH (p<0.0001 and p=0.0003 respectively) and without PH (p<0.001 and p<0.005 respectively). Both GFW-RVLS and 3DRVEF correlated similarly with mean pulmonary artery pressure (r=0.62 and r=0.64; p=0.004 for both) and with pulmonary vascular resistance (r=0.65 and r=0.67; p=0.003 for both). No correlation was observed between RV and LV strain parameters. A significant relationship was shown between GFW-RVLS and DLCO/VA (r=0.72, p<0.005), and GFW-RVLS and FEV1/VC (r=0.75, p<0.001). Conclusions: RV 3D and 3DSTE parameters were abnormal in COPD patients compared to normals and had a higher association with COPD severity compared to standard RV function measurements. RV deformation changes did not appear to be a consequence of LV dysfunction. Detection of RV systolic impairment, even in the absence of pulmonary hypertension, suggests that RV myocardial damage in COPD cannot be blamed solely to pressure overload

Assessment of right ventricular function in obstructive sleep apnea syndrome and effects of continuous positive airway pressure therapy. a pilot study

Background. It is known that obstructive sleep apnea syndrome (OSAS) can affect right ventricular (RV) performance even in the absence of systemic hypertension and other known cardiac or obstructive pulmonary disease. The purpose of the present study was to assess RV function in OSAS by three-dimensional (3D) echocardiography and speckle tracking echocardiography (STE) and evaluate changes after continuous positive airway pressure (CPAP) treatment. Methods. Thirty-seven patients with OSAS without comorbidities and thirty controls were studied with 3D-echocardiography and STE. Fifteen patients underwent CPAP therapy and were studied before and after treatment. RV 3D ejection fraction was calculated. Peak-systolic strain was determined. RV dyssynchrony was defined as standard deviation of the six time to peak-systolic strain values. Results. 3D RV ejection fraction was lower and RV dyssynchrony was greater in patients with moderate-severe OSAS compared to controls both in the presence and absence of pulmonary hypertension. 3D RV ejection fraction and RV dyssynchrony were independently associated with apnoea-hypopnea index. Patients treated with CPAP had significant changes in RV parameters. Conclusions. 3D RV ejection fraction and RV dyssynchrony were abnormal in OSAS patients compared to controls and associated with OSAS severity. RV-3D-STE abnormalities improved after chronic application of CPAP