Automated assessment of right heart function by artificial intelligence: A systematic review and meta-analysis

Chronic pulmonary disease is associated with varying degrees of cardiac dysfunction. Because of the potentially predominant effect of severe lung disease on right ventricular (RV) size and function, a reliable method to assess RV mechanics before and after lung transplantation may provide information of long-term significance and/or prognosis. Conventional invasive and non-invasive imaging methods have a number of limitations in evaluating RV function. Ultrafast computed tomographic (ultrafast CT) scanning has been shown to provide quantitative assessment of RV and left ventricular (LV) function in individuals with and without cardiac disease. Twenty-two patients presenting during evaluation for possible lung transplantation with end-stage pulmonary disease formed the basis of this study. There were 14 patients with chronic obstructive pulmonary disease and 8 with pulmonary fibrosis. Conventional transthoracic echocardiography and ultrafast CT were used for the assessment of RV and LV function. All patients had invasive assessment of right-sided hemodynamics and pulmonary function studies performed within 7-10 days of cardiac imaging. A qualitative assessment of RV size or function was possible in all but two patients by echocardiogram, but in 45%, the echocardiographic examination was described as suboptimal. In contrast, a quantitative assessment of ventricular volumes and systolic function was obtained in all patients by ultrafast CT. Pulmonary function parameters or hemodynamic measurements obtained during cardiac catheterization did not correlate with any assessment of RV function. We concluded that (1) ultrafast CT provides measurement of the RV and LV cavity dimension and systolic function; (2) invasive right-sided hemodynamics or pulmonary function studies do not predict RV function; and (3) echocardiography does not uniformly provide assessment of RV function in patients with chronic pulmonary disease.

Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.

Right Ventricular Diastolic Function in Congenital Heart Disease

The right heart contributes significantly to overall cardiac function. Right ventricular (RV) haemodynamics and function have been defined to be physiologically different from the left ventricle, and yet independently associated with outcomes in a spectrum of conditions. In particular, RV function has been shown to influence prognosis of patients undergoing surgery. The assessment of right heart function during the intra-operative and immediate postoperative periods plays an important role in the clinical management of patients having surgery. While a number of techniques are available for the assessment of the right heart intra-operatively, echocardiography remains the prime choice being least invasive, relatively safe, readily accessible and cost-effective. Advancements in the field of echocardiographic have improved ability to assess right heart function. This review examines the role echocardiography and advances in this imaging modality in the assessment of right heart function within the peri-operative setting.

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Accuracy and Interobserver Concordance of Echocardiographic Assessment of Right Ventricular Size and Systolic Function: A Quality Control Exercise

Funding Acknowledgements Stockholms Background In young adults born preterm, particularly those with bronchopulmonary dysplasia (BPD), chronic respiratory dysfunction is seen even later in Life, and may lead to pulmonary hypertension and right ventricular (RV) dysfunction. Little is known on RV function in young adult patients with BPD in comparison to healthy Controls . RV strain imaging based on 2D speckle tracking echocardiography (ECHO) allows analysis of myocardial deformation and may improve the assessment of RV function. Aims The purpose of this study was to evaluate RV function using conventional ECHO parameters and 2D-strain in young adults born preterm and with and without BPD, and in healthy controls. Methods 43 patients born preterm (21 with BPD and 22 without BPD) and 20 healthy age-matched Controls with mean age 23 +/- 1.7 y. RV size and function were assessed using conventional parameters (RV diameters, fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (PSV), RV myocardial performance index (MPI)) and 2D-strain of the RV free-wall and Total (free-wall and septum). Results No significant differences were found between the groups in the RV size, RV 2D-strain free-wall or Total, TAPSE or FAC%. Only RV MPI differed significantly between groups, however all values were within normal range (Table 1). There were significant correlations between RV 2D-strain and TAPSE, PSV and RV MPI and, but no correlation between RV 2-D strain and FAC%. RV free-wall strain was higher than RV total strain in all Groups. Conclusion RV function in young patients born preterm, with BPD did not differ significantly from the controls and the subjects born preterm with normal lung function. 2D-strain for RV evaluation was within normal range, suggesting that cardiac complications are rare in young BPD patients. RV MPI combining systolic and diastolic function variables may be a more sensitive measure to distinguish between BPD patients and other groups. Variables Controls mean (SD) without BPD mean (SD) with BPD mean (SD) p = value FAC, % 44 (4.4) 46 (5.6) 48 (5.7) 0.1 TAPSE, mm 23 (3.5) 24 (3.8) 25 (4.2) 0.25 RV MPI 0.2 (0.06) 0.3 (0.09) 0.4 (0.1) &amp;lt;0.05 RV strain Total. % -22 (2.5) -22 (3.3) -22 (2.5) 0.8 RV strain free wall, % -29 (5.6) -27 (4.3) -28 (4.7) 0.57 PSV, cm/s 15 (2.3) 14 (2.0) 15 (2.2) 0.26 Differences in right ventricular (RV) function between the study groups, (BPD – bronchopulmonary dysplasia).

Comprehensive Assessment of Right Ventricular Function in Patients with Pulmonary Hypertension with Global Longitudinal Peak Systolic Strain Derived from Multiple Right Ventricular Views

The importance of right ventricular (RV) function assessment has been a hot topic in cardiac surgery, and perioperative RV function is known to determine the outcome of cardiac surgery. However, RV echocardiographic assessment is challenging due to RV geometric changes. Currently, a 3D-derived RV assessment is recommended. Previous studies have shown that RV function is reduced more in surgical aortic valve replacement (SAVR) than in transcatheter aortic valve replacement (TAVR); however, RV assessment in these studies was mostly performed using 2-dimensional echocardiography. Moreover, very few studies have assessed the difference in RV function between full sternotomy (full-SAVR) and mini-sternotomy AVR (mini-SAVR). This study assessed RV function in three types of AVR using 3D RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (RVFAC). This is a prospective, observational study at a university hospital setting. Participants are adult patients who underwent TAVR, mini-SAVR, and full-SAVR. Sixty-seven patients were enrolled in this study (22, 22, and 23 patients in the TAVR, mini-SAVR, and full-SAVR groups, respectively). The % change (pre- and post-procedure) in 3D RVEF, RVFAC, and TPASE in TAVR, mini-SAVR, and full-SAVR were as follows: 3D RVEF: 4.51 ± 10.89 (TAVR), -13.67 ± 19.81 (mini-SAVR), and -8.36 ± 18.24 (full-SAVR) (p=0.003). 4.35 ± 12.33 (TAVR), -8.28 ± 23.88 (mini-SAVR), and -9.49 ± 20.92 (full-SAVR) (p<0.001). 10.46 ± 24.17 (TAVR), -22.14 ± 32.48 (mini-SAVR), and -32.48 ± 31.81 (full-SAVR) (p<0.001). Comparisons were adjusted for age, gender, central venous pressure, catecholamine amount, and each preoperative RV index. There was significantly more worsening of 3D RVEF, RVFAC and TAPSE after full-SAVR and mini-SAVR than after TAVR.

120 Cardiopulmonary Ultrasound in Sepsis: A Pilot Study

The Blind Men of Indostan and the Elephant in the Echo Lab

Cardiac Magnetic Resonance Imaging (cMRI) is the gold standard for right ventricular (RV) assessment due to its high spatial resolution. The American Society of Echocardiography (ASE) recommends eight structural and six functional quantitative parameters for evaluation of the RV. This study sought to simplify echocardiographic RV assessment by examining the relative diagnostic value of the echo recommended parameters by applying them to cMRI imaging of the RV. We applied ASE recommended measures of RV size and function to 56 cMRI's and compared them to RV volumetric analysis obtained from cMRI. Pearsons' correlation coefficient was used to compare ASE prescribed parameters to corresponding cMRI calculated RV end diastolic volume (RVEDV) and RV ejection fraction (RVEF). The diagnostic performance of each parameter in predicting abnormal RV size or function was analyzed using receiver operator characteristic curves. Youden-J index was used to determine optimal sensitivity/specificity cut-points. Stepwise regression modeling was performed to identify measurements independently associated with RV size or RVEF. RV end diastolic area (RVEDA) correlated best with RVEDV (r=.76, p<0.001) and RV fractional area change (RVFAC) correlated best with RVEF (r=.7, p<0.001). The best ASE parameter for identifying RV dilatation was RVEDA (Youden-J index=.84), the optimal cutoff was 32.3 cm2 which yielded sensitivity/specificity of 84% and 100%, respectively. The best parameter for diagnosing RV dysfunction was RVFAC (Youden-J index=.52), with an optimal cutoff of 42% leading to sensitivity/specificity of 64% and 88%, respectively. The area based echocardiographic parameters for RV size and function, RVEDA and RV fractional area change outperform linear measurements in predicting RV dilation and RV systolic dysfunction. These parameters should be examined in further echocardiographic based studies as the primary parameters to guide quantitative RV assessment.

Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 105 patients (76 men, mean age 65 ± 16 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2 ± 2 days prior to surgery (TTE1) , and 7 ± 4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12 ± 2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function, such as TAPSE, systolic velocity of tricuspid annulus (S"), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS). Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S’ and GLS; p &amp;lt; 0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function. Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. After 12 months, an improvement of the longitudinal function can be observed.

IntroductionTranscatheter Tricuspid valve replacement (TTVR) and Edge-to-edge repair (T-TEER) are novel treatment options for the management of right-sided heart failure in patients with severe and torrential tricuspid valve regurgitation (TR)....

We investigated factors associated with right ventricular (RV) function and size in hypertrophic cardiomyopathy (HCM) patients. Two hundred fifty-three consecutive HCM patients and 20 healthy volunteers underwent cardiac magnetic resonance examination. In addition to measuring RV function (ejection fraction—RVEF) and size (end-diastolic volume—RVEDV), each image was inspected for the presence of RV and left ventricular (LV) hypertrophy, and the maximal wall thickness of the left and right ventricles was recorded. HCM patients had higher RVEF and lower RVEDV than healthy volunteers and similar RV mass. The mean RV wall thickness was higher in HCM patients than in controls. LV late gadolinium enhancement (LGE) was present in 89.7% of patients, and RV LGE was present in 3.1% of patients (p < 0.0001). Univariate and multivariable analyses revealed that LVEF, peak LV outflow tract gradient, LV LGE, maximal LV wall thickness, and tricuspid regurgitation (TR) volume by magnetic resonance imaging were positive predictors of RVEF. In addition to TR volume, the only independent predictor of RVEF < 45% was LVEF (odds ratio = 0.80, 95% confidence interval 0.67–0.95). Multivariable analysis revealed that LVEDV and TR volume were positive predictors of RVEDV, whereas negative predictors were RVEF, maximal RV wall thickness, LV LGE, and age. Neither estimated systolic pulmonary artery pressure nor TR grade by echocardiography proved to be predictors of RVEF. There were no differences in either the maximal RV wall thickness or the maximal left ventricular (LV) wall thickness in patients stratified according to NYHA functional class (p = 0.93 and p = 0.15, respectively). There were no differences in mean RV wall thickness in patients categorised based on the number of clinical risk factors for sudden cardiac death (SCD), i.e., non-sustained ventricular tachycardia, family history of SCD, or unexplained syncope (p = 0.79). On the other hand, there was a weak positive association between RV hypertrophy and the estimated probability of SCD at 5 years (rho = 0.16, p = 0.01). RV systolic dysfunction measured as decreased RVEF was uncommon in HCM and was associated with poor LV systolic function. LV also had a significant impact on RV size.