Annular Systolic Velocity Research Articles

Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis of Observational Studies.

BackgroundSacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension.Methods and ResultsWe searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle‐Ottawa scale. Variables were pooled using a random‐effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33–2.18 mm; P=0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25–1.45 cm/s; P=0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38–9.03 mm Hg; P<0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data (P=0.026).ConclusionsThis meta‐analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle.RegistrationURL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021247970.

Impact of COVID-19 Pandemic and Lockdown on the Management of Upper Gastrointestinal Relationship between Mitral Annular Velocities and Left Atrial Appendage Emptying Velocity

Background: Mitral stenosis (MS) is a prevalent kind of valvular heart disease. Thromboembolism is one of the most severe complications, particularly when it is accompanied with atrial fibrillation (AF). When associated with Left atrial appendage (LAA) dysfunction, patients with sinus rhythm (SR) are also at risk for this condition. In mitral stenosis, LAA dysfunction is an independent predictor of thromboembolism. The aim of the study was to see if there is an association between mitral annular velocities measured with Doppler tissue imaging (DTI) and LAA function measured with transesophageal echocardiography (TEE), and to see if annular velocities can predict the presence of an inactive LAA in MS. Methods: This was an observational study carried out by the department of cardiology of the National Institute of Cardiovascular Diseases (NICVD). From January 2006 to December 2007, 60 MS patients were evaluated using transthoracic echocardiography and transesophageal echocardiography. The systolic (S-wave) and diastolic (Em- and Am-waves) annular velocities were measured. Inactive LAA was defined as a velocity of &lt;25 cm/sec for LAA emptying. Patients were divided into three groups. Group A (I) (n = 18): Sinus rhythm (SR) and LAA emptying velocity ≥25 cm/sec, group A (II) (n =22): SR and LAA emptying velocity &lt;25cm/sec and group B (n = 20): atrial fibrillation. Results: Thrombus was found in 14 patients, and spontaneous echo contrast (SEC) was found in 43. From group A to group B, S-wave and peak LAA emptying velocities decreased while SEC frequency and density increased. There was a positive correlation between LAA emptying versus S-wave &amp; Am wave velocity (p&lt;0.001, r= 0.708 and p&lt;0.001, r=0.495, respectively). Only S-wave was found to be an independent predictor of inactive LAA in multivariate regression analysis (p = 0.001, odds ratio = 0.133, 95%ci =0.032-0.556). The cutoff value of S-wave in patients with SR for predicting the presence of inactive LAA was.........

Interventricular Septal Output While Supported on LVAD Therapy

Purpose The effects of left ventricular unloading on septal function in patients with left ventricular assist devices (LVADs) have not been well characterized. The purpose of this study was to evaluate the relationship between markers of septal function with echocardiography in relationship to RV dysfunction and late RV failure after LVAD implantation. Methods A retrospective study was conducted of patients supported on centrifugal-flow LVADs implanted over a 10-year period. Echocardiographic data (quantitative and qualitative measures of RV function and LV remodeling) were collected pre-operatively and up to two years following LVAD implantation. Interventricular septum (IVS) measurements were taken at end-systole and end-diastole. Interventricular-septal output (ISO) was calculated using the formula: (IVSs-IVSd)*heart rate. Results 110 patients (65% male, mean age 57±14yrs) were included. 83 patients (77%) received a HeartWare and 25 patients (23%) received a HeartMate 3. An immediate and sustained reduction in both lateral annulus systolic velocity (RVS’) and TAPSE were observed after implant (P<.0001). However, while LVEF rose slightly on average over the follow-up period, ISO gradually decreased over time (P<.0001), driven by a diminishment of IVSs-IVSd. While ISO was not predictive of late RV failure, a decrease in ISO by 25% or greater from pre-implant to hospital discharge was associated with late RV failure (OR 4.8; 95% CI 1.4-16.5; P=0.012). Conclusion RV function is known to be influenced by unique mechanical ventricular interdependence and we demonstrate that measurement of ISO may be a useful marker in assessing RV dysfunction and predicting RV failure in patients following LVAD implantation. The effects of left ventricular unloading on septal function in patients with left ventricular assist devices (LVADs) have not been well characterized. The purpose of this study was to evaluate the relationship between markers of septal function with echocardiography in relationship to RV dysfunction and late RV failure after LVAD implantation. A retrospective study was conducted of patients supported on centrifugal-flow LVADs implanted over a 10-year period. Echocardiographic data (quantitative and qualitative measures of RV function and LV remodeling) were collected pre-operatively and up to two years following LVAD implantation. Interventricular septum (IVS) measurements were taken at end-systole and end-diastole. Interventricular-septal output (ISO) was calculated using the formula: (IVSs-IVSd)*heart rate. 110 patients (65% male, mean age 57±14yrs) were included. 83 patients (77%) received a HeartWare and 25 patients (23%) received a HeartMate 3. An immediate and sustained reduction in both lateral annulus systolic velocity (RVS’) and TAPSE were observed after implant (P<.0001). However, while LVEF rose slightly on average over the follow-up period, ISO gradually decreased over time (P<.0001), driven by a diminishment of IVSs-IVSd. While ISO was not predictive of late RV failure, a decrease in ISO by 25% or greater from pre-implant to hospital discharge was associated with late RV failure (OR 4.8; 95% CI 1.4-16.5; P=0.012). RV function is known to be influenced by unique mechanical ventricular interdependence and we demonstrate that measurement of ISO may be a useful marker in assessing RV dysfunction and predicting RV failure in patients following LVAD implantation.

The effect of intravenous ferric carboxymaltose on right ventricular function - insights from the IRON-CRT trial.

Ferric carboxymaltose (FCM) improves left ventricular function in heart failure with reduced ejection fraction (HFrEF). Yet, the effect of FCM on right ventricular (RV) function remains insufficiently elucidated. This is a pre-defined analysis of the IRON-CRT trial in which symptomatic HFrEF patients with iron deficiency and reduced left ventricular ejection fraction (LVEF) despite optimal medical therapy and cardiac resynchronization therapy (CRT) underwent 1:1 randomization to FCM or placebo in a double-blind fashion. RV function was measured as the change from baseline to 3-month follow-up in RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and pulsed Doppler peak velocity at the RV lateral annulus (RV S'), systolic pulmonary artery pressure (SPAP) and its coupling to the right ventricle (TAPSE/SPAP ratio). The RV contractile reserve was measured as the change in TAPSE during incremental pacing at 70, 90 and 110 bpm. A total of 75 patients underwent randomization and received FCM (n=37) or placebo (n=38). At baseline 72.5% had RV dysfunction and 70% had RV dilatation. At 3-month follow-up, patients receiving FCM had a significant improvement in RV FAC (+4.1% [+1.4% - +6.9%] vs. -2.2% [-4.9% - +0.6%] in the placebo group, p=0.002) and TAPSE (+0.98 mm [+0.28 mm - +1.62 mm] vs. -0.19 mm [-0.85 mm - +0.48 mm] in the placebo group, p=0.020), but not RV S'. Patients receiving FCM had a numerically lower SPAP (p=0.073) and significant improvement in TAPSE/SPAP ratio (+0.097 [+0.048 - +0.146] vs. +0.002 [-0.046 - +0.051] in the placebo group, p=0.008). At baseline both groups had diminished RV contractile reserve during incremental pacing, which was attenuated at 3-month follow-up in the FCM group (p=0.004). Patients manifesting more RV function improvement were more likely to exhibit higher degrees of LVEF improvement (p < 0.05 for all). Treatment with FCM in HFrEF patients results in an improvement in RV function and structure and improves the RV contractile reserve.

Ventricular Myocardial Function and Central Hemodynamics in Patients with Secondary Atrial Septal Defect and Persistent or Paroxysmal Atrial Fibrillation

Background. Atrial fibrillation (AF) is the world’s most frequent arrhythmia associated with significant morbidity and mortality. Non-invasive multimodal imaging provides all necessary information for tactical decisions about radiofrequency catheter ablation and other methods of pharmacological and invasive AF treatment. Survival of patients with congenital heart diseases (CHDs) has grown over the past years. Still, there is a significant gap in evidence-based data regarding management of such patients with AF. Previously in Ukraine there were no studies of echocardiography parameters in patients with CHDs with paroxysmal or persistent AF, namely, those to find predictors for successful AF treatment before atrial septal defect (ASD) surgical or percutaneous closure.&#x0D; The aim. To evaluate ventricular myocardial function and central hemodynamics in patients with secondary ASD and paroxysmal or persistent AF compared to patients with paroxysmal or persistent AF without CHD.&#x0D; Methods. Weexamined54patients(36[66.7%]menand18[33.3%]women)aged61.4±9.8yearswithsecondaryASDand paroxysmal or persistent AF. Control group included 56 patients (38 [67.9%] men and 18 [32.1%] women) without CHD with non-valvular paroxysmal or persistent AF. All the patients underwent transthoracic and transesophageal echocardiography with tissue Doppler imaging and speckle-tracking echocardiography for longitudinal myocardial strain evaluation.&#x0D; Results. The patients in the study and control groups were comparable in terms of age and gender as well as comorbidities and cardiovascular risk factors. There were significant differences in the left heart remodeling indices and central hemodynamics alteration grades, for instance, the patients of the study group had significantly higher grade of left ventricular (LV) hypertrophy. Patients with ASD also had significantly more dilated LV and left atrium (LA) cavities and higher combined indices of LV filling pressure – E/E’ (14.9±4.2 vs. 9.6±5.3, p&lt;0.0001) and E/Vp (2.84±0.44 vs. 2.25±0.61, p&lt;0.0001), explaining more frequent AF in patients with ASD. The study group patients also had significantly higher systolic (sPAP) (52.4±2.8 vs. 44.6±3.2, p&lt;0.0001) and mean (mPAP) (38.6±4.3 vs. 31.7±1.9, p&lt;0.0001) pulmonary artery pressure compared to control group, as well as significantly worse all known indices of right ventricle (RV) myocardial function and right chambers overload. Global RV longitudinal strain strongly correlated with RV fractional area change (r = 0.75; p&lt;0.0001), and especially highly with tricuspid annular plane systolic excursion (r = 0.97; p&lt;0.0001) and tricuspid annular peak systolic velocity S’ (r = 0.98; p&lt;0.0001) during tissue Doppler imaging, making it trustworthy and valuable predictor of RV myocardial dysfunction and its potential restoration after defect correction. Patients with ASD much more often had significant moderate-to-severe functional tricuspid regurgitation (92.6% vs. 53.4%, p&lt;0.0001) with significantly higher central venous pressure indices (16.4±2.4 vs. 10.2±2.5, p&lt;0.0001) as per significantly wider inferior vena cava (IVC) (1.89±0.31 vs. 1.43±0.42, p&lt;0.0001) and it’s higher inspiratory collapse. IVC diameter strongly correlated with integral RV filling pressure (that is, right atrial pressure) index E/E’ (r = 0.98; p&lt;0.0001). Also, study group demonstrated significantly more frequent LA appendage thrombosis (40.7% vs. 21.4%, p=0.029) along with much more marked spontaneous contrast phenomenon and lower LA appendage expulsion rate (26.7±5.1 vs. 34.3±7.2, p&lt;0.0001).&#x0D; Conclusions. Stratification of patients with ASD complicated by paroxysmal or persistent AF for radiofrequency catheter ablation requires thorough echocardiographic examination with targeted certain indices evaluation aiming at earlier intervention in order to earlier diagnosis and invasive or surgical treatment in this specific patient group, namely LV hypertrophy grade, left chambers dilation with LV global systolic function evaluation, pulmonary hypertension grade as per sPAP and mPAP evaluation, as well as combined right chambers overload grade indices, including RV myocardial function by all methods including speckle-tracking echocardiography.

Preconception lifestyle intervention in women with obesity and echocardiographic indices of cardiovascular health in their children

Improving maternal lifestyle before conception may prevent the adverse effects of maternal obesity on their children's future cardiovascular disease (CVD) risk. In the current study, we examined whether a preconception lifestyle intervention in women with obesity could alter echocardiographic indices of cardiovascular health in their children. Six years after a randomized controlled trial comparing the effects of a 6-month preconception lifestyle intervention in women with obesity and infertility prior to fertility care to prompt fertility care, 315 of the 341 children conceived within 24 months after randomization were eligible for this study. The intervention was aimed at weight loss (≥5% or until BMI < 29 kg/m2). Children underwent echocardiographic assessment of cardiac structure and function, conducted by a single pediatric cardiologist, blinded to group allocation. Results were adjusted for multiple variables including body surface area, age, and sex in linear regression analyses. Sixty children (32 girls, 53%) were included, mean age 6.5 years (SD 1.09). Twenty-four children (40%) were born to mothers in the intervention group. Children of mothers from the intervention group had a lower end-diastolic interventricular septum thickness (-0.88 Z-score, 95%CI -1.18 to -0.58), a lower left ventricle mass index (-8.56 g/m2, 95%CI -13.09 to -4.03), and higher peak systolic and early diastolic annular velocity of the left ventricle (1.43 cm/s 95%CI 0.65 to 2.20 and 2.39 cm/s 95%CI 0.68 to 4.11, respectively) compared to children of mothers from the control group. Children of women with obesity, who underwent a preconception lifestyle intervention, had improved cardiac structure and function; a thinner interventricular septum, lower left ventricle mass, and improved systolic and diastolic tissue Doppler velocities. Despite its high attrition rates, our study provides the first experimental human evidence suggesting that preconception lifestyle interventions may present a method of reducing CVD risk in the next generation. LIFEstyle study: Netherlands Trial Register: NTR1530 ( https://www.trialregister.nl/trial/1461 ). This follow-up study was approved by the medical ethics committee of the University Medical Centre Groningen (METC code: 2008/284).

Changes in echocardiographic parameters of the donor's heart before and after heart transplantation and their relationship with post-transplant survival.

BackgroundHeart transplantation is now widely performed in China, but the current entry criteria for heart transplantation donors are simple and lack reliable standards; there are still no studies on the effect of preoperative echocardiographic parameters of heart transplantation donors on the prognosis of the recipient. Therefore, the aim of this study is twofold: (I) to observe the characteristics of changes in echocardiographic parameters of the donor’s heart before and after heart transplantation and (II) to study the relationship between the changes in echocardiographic parameters of the donor’s heart pre- and post-transplant and transplant recipient survival.MethodsA total of 29 patients who underwent orthotopic heart transplant in our hospital from October 2016 to October 2019 were enrolled in this study. All recipients were followed up until April 2020. Echocardiographic data were collected pre-transplantation (donor) and at 1 week and 1 month post-transplant (recipient).ResultsCompared with the pretransplanted donor’s heart, there was an increase in the interventricular septal diameter, left ventricular posterior wall diameter, right atrium diameter and right ventricular diameter, while a decrease was found in the tricuspid annular systolic displacement and tricuspid annular peak systolic velocity at 1 week post-transplant. The survival curve showed that the postoperative survival time in the right atrium/ventricle ≥32 mm group was better than that in the right atrium/ventricle <32 mm group. The survival curve also showed that the postoperative survival time in the right atrium/ventricle enlargement <2 mm group was better than that in the right atrium/ventricle enlargement ≥2 mm group.ConclusionsIn the early post-transplant period, ventricular myocardial thickening, right heart enlargement and a decrease in right heart function were observed in the post-transplanted heart compared to the pretransplanted donor’s heart. Postoperative survival was higher among heart transplant patients who received a heart with right atrium/ventricle ≥32 mm. Postoperative survival was lower among heart transplant patients whose right atrium/ventricle was dilated ≥2 mm at 1 month postoperatively compared with the pretransplanted donor’s heart.

Cardiac Doppler Parameters and Progress in Clinical Manifestation of Primary Lower Extremity Varicose Veins: A Prospective Study in China.

ObjectiveTo investigate the features of cardiac Doppler parameters in patients with primary lower extremity varicose veins in China.Materials and MethodsWe performed a prospective statistical analysis of cardiac Doppler parameters between 129 Chinese patients with varicose veins and normal controls. Furthermore, we evaluated the relationship between cardiac Doppler and the progress or severity of lower extremity varicose veins.ResultsCompared with normal controls, patients with primary varicose veins had significantly lower early mitral and tricuspid diastolic inflow and annular velocities (E- and e′-waves), significantly higher late mitral and tricuspid diastolic inflow and annular velocities (A- and a′-waves), significantly higher mitral systolic annular velocities (s′-wave), and significantly lower mitral and tricuspid E/A ratio. There was no significant association between deep venous reflux (DVR) of the lower extremities and cardiac Doppler parameters. The relationship between Clinical Etiological Anatomical Pathophysiological (CEAP) clinical class and cardiac Doppler parameters showed on that: In comparison with normal control, all cardiac Doppler parameters of C2 clinical class patients were basically unchanged, but the cardiac Doppler parameters of the C3 or higher CEAP class patients changed. Hence, we found a potential CEAP grade cut-off value (C3) linked to statistical changes in cardiac Doppler parameters.ConclusionCardiac Doppler parameters in patients with primary varicose veins could indeed be different from those of normal people, especially for C3 class or higher CEAP clinical class patients. Therefore, for those patients, pre-operative echocardiography can be used to evaluate cardiac hemodynamic changes, but large-scale clinical promotion requires further large sample studies.

Correlation Between Glycated Hemoglobin (HbA1c) and Post-Systolic Index Measured by Speckle-Tracking Echocardiography in Patients with Non-apparent Coronary Artery Disease.

Glycated hemoglobin (HbA1c) is a useful biomarker for the diagnosis of diabetes and also for determination of individuals with an increased risk of a severe disease. Some subtle changes in myocardial contractile function is measurable by post-systolic index (PSI) which is defined as late systolic shortening after aortic valve closure. The aim of our study was to determine the relationship between HbA1c and PSI in patients with non-apparent coronary artery disease (CAD) on angiograms. This study was a historical cohort study on 85 consecutive patients with a left ventricular ejection fraction ≥ 50% and non-apparent CAD on angiogram. Patients were divided into two groups based on their HbA1c levels, regardless of the diagnosis of diabetes in these patients, to patients with an HbA1c level of equal or higher than 5.7% and those with an HbA1c of less than 5.7%. A speckle-tracking echocardiography was performed for all patients and global longitudinal strain, PSI, left ventricular diameters, left atrial volume, pulsed-Doppler-derived transmitral early (E wave) and late (A wave) diastolic velocities, and tissue-Doppler-derived mitral annular early diastolic (e') and peak systolic (s') velocities were determined. PSI, E/e' ratio, and A wave were higher and e' velocity was lower in patients with HbA1c ≥ 5.7% than those with a level of < 5.7% (P value = 0.04, 0.001, 0.014, and 0.004, respectively). Other echocardiographic variables were not different between two groups. Multiple linear regression analysis showed the association between HbA1c and PSI was independent of other demographic, biochemical, and echocardiographic variables (B = 35.674, 95% CI 10.741-60.606, P value = 0.006). Our study showed PSI is more pronounced in individuals with an HbA1c > 5.7% than those with a lower value in the absence of CAD. Because PSI is an important indicator of adverse outcome and increased mortality, these data can underline the importance of an abnormal HbA1c level and its association with subtle cardiac dysfunction, irrespective of the diagnosis of diabetes in patients with non-apparent CAD.

A Novel Three-Dimensional and Tissue Doppler Echocardiographic Index for Diagnosing and Prognosticating Heart Failure With Preserved Ejection Fraction.

IntroductionThe diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. In this study, a novel echocardiography index based on three-dimensional and tissue Doppler echocardiography for diagnosing and estimating prognosis in HFpEF.Materials and MethodsPatients with symptoms and/or signs of heart failure and normal left ventricular ejection fraction (LVEF ≥50%) who underwent right heart catheterization were screened. Patients were divided based on pulmonary capillary wedge pressure (PCWP) of ≥15 mmHg and PCWP <15 mmHg. A diagnosis of HFpEF was confirmed by PCWP of ≥15 mmHg according to ESC guidelines. A novel index was calculated by the ratio between stroke volume standardized to body surface area (SVI) and tissue Doppler mitral annulus systolic peak velocity S' (SVI/S'). Its diagnostic and prognostic values were determined.ResultsA total of 104 patients (mean age 64 ± 12 years) were included. Of these, 63 had PCWP ≥15 mmHg and 41 patients had PCWP <15 mmHg. Compared to the PCWP <15 mmHg group, the ≥15 mmHg group had a significantly lower SVI/S' (P < 0.001). Logistic regression showed that SVI/S' was associated with high PCWP measured invasively. The SVI/S' had an area under the curve of 0.761 for diagnosing classifying between PCWP ≥15 mmHg and <15 mmHg. Kaplan–Meier analysis showed that the lower SVI/S' group showed a poorer prognosis.ConclusionsSVI/S' is a non-invasive index calculated by three-dimensional and tissue Doppler echocardiography. It is a surrogate measure of PCWP and can be used to diagnose and determine prognosis in HFpEF.

Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction.

AimsDiastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but current algorithms do not detect all patients. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients referred for DST.Methods and ResultsWe identified candidate parameters in 22 patients referred for exercise right heart catheterization with simultaneous echocardiography. Elevated exPAWP (≥25 mmHg) was present in 14 patients, and was best identified by peak septal systolic annular velocity <9.5 cm/s [exS', area under the receiver operating characteristic curve (AUC) 0.97, 95% confidence interval 0.92–1.0] and mean pulmonary artery pressure/cardiac output slope ≥3.2 mmHg/L [mPAP/CO, AUC 0.88 (0.72–1.0)]. We propose a decision tree to identify patients with elevated exPAWP. Applying this decision tree to 326 patients in an independent non-invasive DST cohort showed that patients labeled as “high probability of HFpEF” (n = 85) had reduced peak oxygen uptake [13.0 (10.7–15.1) mL/kg/min, p < 0.001 vs. intermediate/low probability], high H2FPEF score [53 (40–72) %, p < 0.001 vs. intermediate/low probability], and typical clinical characteristics. The diagnostic yield of DST increased from 11% using exercise E/e', to 62% using the decision tree.ConclusionIn DST for suspected HFpEF, exS' was the most accurate echocardiographic parameter to identify elevated PAWP. We propose a decision tree including exS' and mPAP/CO for interpretation of DST. Application of this decision tree revealed typical HFpEF characteristics in patients labeled as high probability of HFpEF, and substantially reduced the number of inconclusive results.

Pulmonary artery pulsatility index by echocardiography predicts mortality in patients with pulmonary hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with an elevated mortality risk due to right ventricular failure. Pulmonary arterial pulsatility index (PAPi) based on invasively acquired parameters has emerged as a potentially valuable hemodynamic risk predictor. Whether non-invasively derived PAPi (PA pulse pressure/ RA pressure) is valuable is unclear. Purpose To assess whether PAPi measured non-invasively by transthoracic echocardiography acts as a prognostic hemodynamic biomarker of patient risk. Methods Consecutive patients undergoing transthoracic echocardiography for known or suspected PH over a one year period were included. PA systolic and diastolic pressure were estimated in standard fashion from peak tricuspid and end-pulmonary regurgitant Doppler profiles. Right atrial pressure was estimated based on 2D &amp; Doppler assessment of the inferior vena cava hepatic vein. In those patients with PH (mean PA pressure &amp;gt; 20 mm Hg), PAPi was divided into 3 groups based on prior publications with invasive data as &amp;lt;1.5, 1.5 to 3 and &amp;gt;3. Mortality was assessed over 5 years. Results Of 1,045 patients enrolled 64% had PH. Patients with the lowest PAPi (table) had higher NT-proBNP levels, larger right ventricles, worse right heart systolic function (cardiac output, TAPSE, systolic annular velocity, free wall systolic strain) and greater degrees of tricuspid regurgitation (Table). In patients with PH, PAPi was inversely associated with death (figure, p &amp;lt; 0.0001) with each group of PAPi correlating with incrementally worse survival. Patients with a PAPi of &amp;lt;1.5 had worst right heart size and dysfunction on echo (table) and worst survival (figure). Conclusions In patients with PH, low PAPi derived non-invasively by transthoracic echocardiography is associated with markers of right heart failure, right ventricular dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with known or suspected PH and maybe a useful predictor of outcome. Abstract Table Abstract Figure

One-year cardiac follow-up of COVID-19 pneumonia: dynamics of right heart echocardiographic parameters three months and one year after discharge

Funding AcknowledgementsType of funding sources: None.BackgroundCOVID-19 affects firstly the respiratory system, however the cardiovascular system is also damaged. To study the long-term effect of COVID-19 pneumonia on cardiovascular system, in particular on echocardiography (EchoCG) parameters of right heart is important for patients rehabilitation.PurposeTo compare EchoCG parameters of right heart in patients with proven COVID-19 pneumonia 3 months and one year after discharge.MethodsA total of 116 patients with confirmed COVID-19 pneumonia were included from April 2020 to July 2021. All patients underwent clinical examination including transthoracic EchoCG 3 months ±2 weeks and one year ±3 weeks after discharge. Mean age of patients was 49.0 ± 14.4 years (19-84 years), females were 49.6%. During hospitalization, chest computed tomography (CT) detected mild lesions in 31.3%, moderate lesions in 33.3%, severe lesions in 29.3% and critical lesions in 6.1%.ResultsThe rate of resolution of lung abnormalities according to CT was 55.9%. Mean body mass index was 28.7 ± 5.8 kg/m2 3 months after discharge, and it significantly increased to one year after discharge – 29.4 ± 6.1 kg/m2 (p < 0,001). The mean anteroposterior right ventricular (RV) diameter index decreased over the observation period (13.5 ± 1.9 vs 13.0 ± 1.5 mm/m2, p <0.001), as well as the indices of end-diastolic and end-systolic RV area (8.0 ± 1.8 vs 7.5 ± 1.5 cm2/m2 and 3.8 ± 1.1 vs 3.3 ± 0.8 cm2/m2, respectively, both p < 0.001). The basal RV diameter increased (30.4 ± 5.4 versus 31.1 ± 4.1 mm, p = 0.045), the mid-cavitary RV diameter did not change (25.8 ± 5.4 and 25.8 ± 4.2 mm, p = 0.852), and the base to apex RV length decreased (69.5 ± 8.8 vs 63.9 ± 8.3 mm, p < 0.001). Basal and mid RV sphericity indices (RVSI) increased (0.44 ± 0.07 vs 0.49 ± 0.07 and 0.37 ± 0.07 vs 0.41 ± 0.07, respectively, both p < 0.001). The systolic excursion of the fibrous ring of the tricuspid valve (TAPSE) (22.7 ± 3.2 and 22.8 ± 2.3 mm, p = 0.637) and the tricuspid annular peak systolic velocity S" did not change significantly (10.4 ± 2.6 and 10,1 ± 3.0 cm/s, p = 0.289). The fraction of change in the RV area (FAC RV) increased (52.6 ± 8.2 vs 55.0 ± 8.9%, p = 0.019). The right ventricular outflow tract velocity time integral (RVOT VTI) decreased (18.1 ± 4.0 vs 16.4 ± 3.7 cm, p < 0.001). There were tendencies to increase in the systolic pulmonary artery pressure (PAPs) (22.5 ± 7.1 and 23.3 ± 6.3 mm Hg, p = 0.076) and to increase of the right atrium (RA) long axis dimension (48.7 ± 6.5 vs 49.5 ± 6.3 mm, p = 0.074).ConclusionsCompared to three months after discharge, in patients one year after COVID-19 pneumonia EchoCG showed the anteroposterior RV diameter and the end-diastolic RV area decreased, the FAC RV increased. However, increase of the basal and mid RVSI, decrease in the RVOT VTI and tendencies to increase of the PAPs and the RA long axis dimension was observed. A subgroup analysis is planned depending on the severity of lung damage during hospitalization.

Variability of right ventricular linear measurements of size and function using a standardized echocardiographic protocol

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular size and function have a prognostic value not only in right heart conditions (pulmonary hypertension, congenital heart disease), but also in left ventricular (LV) disease states. The right ventricle (RV) has a unique shape, for which a simple geometrical model is not achievable as is the case for the LV. In clinical practice simple measurements are used for the RV, since these are considered to be most reliable and reproducible: linear cavity dimensions, tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler systolic velocity s’ at the tricuspid annulus. The latest RV quantitation guidelines made important modifications to RV measurements, in particular, by shifting from the apical 4-chamber view to the RV focused apical view. Very scarce data exist on the variability of these measurements. Purpose In this study we aim to analyze the intra and inter-observer variability of the linear measurements of RV size and function using a standardized methodology. Methods A mixed cohort, randomly selected from the echocardiographic database, comprising 50 patients, was retrospectively analyzed. We measured linear diameters (basal = 1, longitudinal = 2, mid = 3) in apical RV-focused view, TAPSE and s’. Based on computer simulations, we propose a step-by-step approach: tracing the longitudinal diameter as perpendicular to the mid of the basal and generally parallel with the interventricular septum, and the mid as perpendicular to the middle of the longitudinal (Figure). Two observers measured independently the same images at baseline, three (inter-observer) and six months (intra-observer). Results The longitudinal diameter had the lowest relative bias (3% inter and 4% intra-observer), followed by the basal (7% and 2%), and mid (6% and 6%). The limits of agreement (LOA) were small for s’ (-3 to 1 intra and -1 to 1mm inter-observer), TAPSE (-6 to 5 and -3 to 3mm), and larger for diameters (1=-5 to 10 and -8 to 6; 2=-13 to 17 and -11 to 6; 3=-11 to 7 and -9 to 4mm). ICCs for individual measurements were very good (1= 0.94 intra and 0.94 inter; 2 = 0.78 and 0.94; 3: 0.72 and 0.56; TAPSE: 0.86 and 0.94; s’=0.94 and 0.98), p &amp;lt; 0.001 for all (Table). Conclusion A systematic approach to linear RV-focused apical view measurements may lead to reproducible results. It is essential that size measurements be performed in the RV focused view. Our study shows best consistency and reproducibility for the basal diameter and the linear functional parameters. Echocardiographic laboratories may benefit from implementing a consistent analysis protocol and assessing its reproducibility. Abstract Figure: linear RV measurements Abstract Table: variability results

Prevention of stroke and atrial arrhythmia consequences in hypertrophic cardiomyopathies: a clinical challenge that could be best managed by a better echocardiographic left atrial characterization

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a need to better predict the risk of atrial arrhythmia (AA) and stroke in patients with hypertrophic cardiomyopathy (HCM). Purpose We sought to look at atrial remodeling and atrial function by echocardiography in a HCM-cohort to assess the association with occurrence of AA and stroke. Methods We retrospectively studied 216 patients diagnosed for HCM (mean age 52 ± 16 years) from 2015 to 2020. All patients underwent transthoracic echocardiography with the assessment of left atrial volume (LAV) and peak left atrial strain (PLAS). Patients were followed-up for 2,9 years for the development of a composite endpoint comprising occurrence of atrial arrhythmias and/or stroke. Results 78 patients had an event (24 stroke and 54 documented atrial arrhythmia). Univariate comparison analysis showed that LAV (37.2 ± 15.7 vs. 47 ± 20 ml/m², p = 0.0001) and anteroposterior LA diameter (41.7 ±7.58 vs. 45.8 ± 8.9 mm; p = 0.0006) were significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (27.1 ± 9.77 vs. 20.4 ± 10.5%; p &amp;lt; 0.0001). Other echographic parameters associated with the composite endpoint were mean E/e" ratio (0.65 [0.55-0.85] vs. 0.60 [0.45-0.75]; p = 0.0204) and tricuspid annular peak systolic velocity (S") (cm/s) (13.3 ± 2.92 vs. 12.2 ± 3.26; p = 0.0148). NTproBNP level (216 vs. 818 ; p &amp;lt; 0.0001), history of hypertension (42.3% vs. 62.3%; p = 0.005) and age at diagnosis (50.3 ± 16.7 vs. 57.1 ± 14.4; p = 0.0035) were the clinical parameters different between groups. In a multivariable analysis, PLAS was the only independent maker associated with the occurrence of AA and stroke, particularly for stroke with an odd ratio of 0.53 ([0.32-0.86]; p = 0.00097). Interestingly, 19 of 28 stroke patients (67%) did not experience any documented AA. Conclusion The decrease of PLAS is strongly associated with the risk of stroke, even in patients without documented atrial arrhythmia. Its use to guide the indication for an implantable holter monitoring and perhaps a prophylactic oral anticoagulation in HCM requires further investigation. Abstract Figure. Impaired PLAS in an HCM patient

Right ventricular mechanics in anthracycline chemotherapy: insights into the PROACT PLUS study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): South Tees Research and Development Fund Background Anthracyclines are highly effective chemotherapy agents used in the treatment of many breast and haematological malignancies. However, one of the well-recognised associated risks with their use includes cardiotoxicity which can lead to heart failure and poor prognosis. Most studies have focused on the effects of these agents on the left ventricular systolic function. Right ventricular (RV) mechanics in anthracycline chemotherapy have so far been neglected. Purpose The PROACT PLUS study is an observational, prospective, cohort study which assesses the effects of anthracyclines on the RV systolic and diastolic measures using 2 dimensional conventional echocardiography and speckle tracking imaging (STE). Methods From October 2018 to March 2020, patients with a new diagnosis of lymphoma or breast cancer undergoing anthracycline chemotherapy were recruited into the PROACT PLUS study. Echocardiography was performed pre-chemotherapy (V1) and 1 month post chemotherapy (V2). Using vendor-independent software (TomTec Imaging Systems, 2D Cardiac Performance Analysis, Unterschleisshiem, Germany), offline analysis of tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), tricuspid annular systolic velocity (S’), RV global longitudinal strain (RV GLS), RV myocardial longitudinal strain (RV myoGLS), RV free wall strain (RV FWS), RV- and RV free wall peak systolic (PS) strain-rates, end-systolic (ES) strain-rates, early-diastolic (ED) strain-rates and late-diastolic (LD) strain-rates were measured. This study was ethically approved by the Health Research Association (REC reference 18/EM/0177). Results 62 patients were recruited into this study. Of these, 7 passed away during treatment and 5 failed to attend their follow-up appointment at V2. Of the remaining patients, a significant deterioration in the RV GLS (-25.4% vs. -22.5%, p &amp;lt; 0.0001), RV myoGLS (-22.4% vs. -20.9%, p = 0.005), RV ED strain-rate (1.08 1/s vs. 0.9 1/s, p = 0.01) and RV free wall ED strain-rate (1.24 1/s vs. 1.07 1/s, p = 0.02) was seen between V1 and V2. No statistical significant change was observed in the conventional and other strain measures of RV function. A total number of 6 patients developed left ventricular systolic dysfunction at V2 with ≥ 10% drop in the LV ejection fraction (LVEF) to &amp;lt; 53%. In this group of patients, there was a statistical significant reduction in the RV FWS (-25.5% vs. -22.7%, p = 0.03) which was not evident in the group of patients with preserved LVEF. Conclusion These findings suggest that adverse effects of anthracyclines are not purely confined to the LV, and RV systolic and diastolic changes are evident during treatment with anthracyclines, emphasising the global effect of these agents. A comprehensive RV assessment needs to be taken into consideration during the assessment of cardiotoxicity in patients undergoing chemotherapy treatment.

Evaluation of right ventricular contractile reserve in healthy subjects using stress echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Background The assessment of right ventricular (RV) systolic functional augmentation in healthy subjects is not well described. The objective of this study was to evaluate normal augmentation of RV systolic functional parameters in relation to maximum predicted oxygen uptake (VO2) during stress echocardiography in healthy adults. Methods Untrained healthy volunteers were recruited prior starting their first time London Marathon and underwent cardiopulmonary exercise test with echocardiography focussed on left ventricular assessment. Patients with satisfactory RV windows were included in this analysis. 20 participants with good RV delineation were evaluated retrospectively at baseline and at peak level of exercise. We defined RV systolic function by tricuspid lateral annular systolic velocity (RVS’) using Doppler tissue imaging, Tricuspid Annular Plane Systolic Excursion (TAPSE) using M-mode echocardiography, and Fractional Area Change (FAC) using 2D echocardiography to calculate the percentage of change in RV area between systole and diastole. All parameters were evaluated at baseline and at peak stress. Results There was statistically significant augmentation of all RV systolic functional parameters between baseline and peak stress (10.3 ± .8 vs 16.4 ± .7 cm/s, p &amp;lt;.000), (21 ± 2.6 vs 32 ± 3.3, mm, p &amp;lt;.000) and (41 ± 2.7, % vs 55 ± 5.1, %, p&amp;lt;.000) for RVS’, TAPSE and FAC respectively. At peak stress, RVS’ increased by 59 ± 11.1, %, TAPSE by 53 ± 15.4, %, and FAC by 34 ± 11.8, %. Mean peak VO2 was 107 ± 17, %. The augmentation of RV longitudinal function showed moderate correlation with peak VO2 throughout exercise for the RVS’ and TAPSE (r= .54, p 0.001), (r=.45, p0.04) respectively, and this was not observed in FAC (r=.15, p&amp;gt;.05). Conclusion In normal individuals, we have demonstrated that the RV augments by 59% for RVS’, 53% for TAPSE, and 34% for FAC. Longitudinal RV augmentation by RVS’ and TAPSE was correlated with maximum exercise capacity suggesting that these parameters could be able to predict VO2 peak values in larger context. Abstract Figure.

A left systolic dysfunction study in a group of breast cancer patients and its clinical impact

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) &amp;gt;10% to a value &amp;lt;50% or as a relative reduction of global longitudinal strain (GLS) &amp;gt;15%. Purpose We aim to evaluate the frequency of CTRCD and its clinical impact on BC patients. Methods Retrospective study of patients with BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. We analysed their baseline characteristics and outcomes based on the type of treatment received, and focusing specially on parameters of ventricular function. Results We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%). At the end of A therapy, there was a significant decrease in LVEF (64,2 ± 5,4% vs 62.6 ± 5,3%, p &amp;lt; 0.05) and in GLS (-20,7 ± 1.9% vs -18.8 ± 2.2%, p &amp;lt; 0.001) compared to baseline. No change in tricuspid annular systolic velocity (S") (p = 0,842) was observed. At 2 years of follow-up, this group of patients had no significant difference in LVEF (64,58 ± 5,58 vs 62,63 ± 6,48, p = 0,053) but maintained a significant lower GLS (-20,84 ± 2,13 vs -18,51± 2,52, p &amp;lt; 0,001) compared to baseline. A significant decrease in S’ (14,36 ± 2,55 vs 13,25 ± 2,26, p &amp;lt; 0,05) was observed. During T therapy, there was a significant decrease in LVEF (65,04 ± 5,41 vs 59,30 ± 6,21, p &amp;lt; 0,001), in GLS (-21,21 ± 2,75 vs -17,89 ± 2,77, p &amp;lt; 0,001) and in S’ (14,39 ± 3,05 vs 12,19 ± 1,62, p &amp;lt; 0,001) compared to baseline. At the end of T therapy (with or without A), this group of patients maintained a significant decrease in LVEF (65,11 ± 5,65 vs 61,29 ± 6,39, P &amp;lt; 0,001) and in GLS (-21.41%±2,86 vs -19.54%±3,50, p &amp;lt; 0,01). S’ returned to normal values (p = 0,10). At 2 years of follow-up, this group of patients maintained a significant decrease in LVEF (65,00 ± 5,99 vs 61,18 ± 6,30, p &amp;lt; 0,05) but GLS (p = 0,235) returned to normal values. No change in S’ was observed (p =0,379). During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment. Conclusions Treatment with A was associated with a decrease in LV systolic function at the end of therapy. A decrease in right ventricular (RV) systolic function was observed at 2 years of follow-up. Treatment with T was associated with a decrease in RV and LV systolic function during therapy. CTRCD occurred in 27%, mainly on patients with both A and T therapy, a frequency within literature data. CTRCD had clinical impact leading to HF and suspension of chemotherapy.

Association between cardiovascular risk factors and cancer therapy-related cardiac dysfunction in patients with breast cancer

Abstract Funding Acknowledgements Type of funding sources: None. Background Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in breast cancer (BC) patients. The clinical relevance of CTRCD and its cardiovascular risk factors (CVRF) remains unclear. Purpose Our aim was to investigate the impact of baseline CVRF on ventricular systolic function in BC patients. Methods Retrospective study of patients with BC treated with anthracyclines (A) and/or trastuzumab between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. CTRCD is defined as a reduction of LVEF &amp;gt;10% to a value &amp;lt;50% or as a relative reduction of GLS &amp;gt;15%. Results We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%). LVEF at baseline was 64,7 ± 5,7%. At baseline, hypertension was present in 34,4% (44), dyslipidaemia in 29,9% (38), overweight (BMI: 25-30kg/m2) in 33,6% (43), obesity (BMI: &amp;gt;30kg/m2) in 28,1% (36), diabetes in 13 (10,2%) and smoker status in 11 (8,6%). No one had ischemic heart disease. During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD from which 9 (7%) suffered clinical heart failure. After multivariate analysis, in the group treated with T (with or without A), the BMI &amp;gt;25 kg/m2 was the only CVRF associated to the development of CTRCD (p &amp;lt; 0,01). In the group treated with A, no CVRF was associated with CTRCD. During follow-up, BMI &amp;gt;25kg/m2 was not associated to a lower survival (log-rank p test = 0.627). In the baseline TTE did not occur statistically significant differences between the groups according to the absence or presence of CVRF. Nonetheless, some statistically significant differences occurred during follow-up. In hypertensive patients, treated with T, the TTE at 2 years of follow-up had a significant decrease in LVEF (5,9 ±2,8; p = 0,047) compared to non-hypertensive patients. In diabetic patients, treated with A, there was a significant decrease in tricuspid annular systolic velocity (S") in the TTE after chemotherapy (2,8 ±1,4; P = 0,049) compared to non-diabetic. The group of patients with dyslipidaemia treated with A had a significant decrease in GLS in the TTE after chemotherapy (1,5 ± 0,7; p = 0,037) compared to patients without dyslipidaemia; The same group treated with T (without A) revealed a significant decrease in S’ in the TTE during T therapy (5,2 ± 1,6; p = 0,034). The group of patients with BMI &amp;gt;25 kg/m2 treated with T (without A) showed a significant decrease in the GLS during T therapy (5,1 ± 1,6; p = 0,021) and in the LVEF at 2 years of follow-up (15,3 ± 5,7; p = 0,036) compared to patients with BMI &amp;lt;25 kg/m2. Conclusions In our cohort, a high BMI was an independent risk factor for CTRCD among patients treated with T. This finding is in agreement with literature data. These results should encourage further research into the mechanisms linking overweight/obesity to CTRCD.

Evaluation of right and left ventricular function in patients with ischemic heart disease complicated by mitral insufficiency.

Aim To evaluate the right and left ventricular function and their interaction in patients with ischemic heart disease (IHD) complicated with mitral valve insufficiency (MVI) according to data of echocardiography (EchoCG) with the strain in gray scale, vector and diagram analyses.Material and methods The study included 118 patients evaluated with EchoCG at the preoperative stage of treatment; 71 of these patients had ischemic MVI (group 1) and 47 patients had uncomplicated IHD (group 2 or comparison group). Mean age of patients was 64±10 years. All patients underwent a surgery in an appropriate volume for myocardial revascularization supplemented with mitral valve plasty or replacement in patients with MVI. Standard EchoCG parameters and data obtained by postprocessing the EchoCG gray-scale images using the strain in gray scale, vector and diagram analyses were evaluated.Results In patients with complicated IHD, both global and local left ventricular (LV) systolic function and the right ventricular (RV) fractional area change (FAC) were significantly decreased. At the same time, there were no significant differences in the tricuspid annular plane systolic excursion (TAPSE) measured in M-mode and in the tricuspid annular systolic wave velocity (VSta), which also characterize the RV systolic function. The global longitudinal strain, the velocities of LV volume change and RV area change, and the long axis change velocity were informative for the right and left chambers, whereas the velocities of LV volume and RV area changes better detected RV disorders. The Pearson's correlation analysis used to identify the most significant parameters of interventricular interaction showed the presence of a strong inverse correlation, in the group of MVI patients, between the RV FAC and the degree of LV diastolic dysfunction (Е / e') - r= -0,62; p=0.000, as well аs the degree of MVI (vena contracta) - r= -0.58; p=0.001. In the comparison group of IHD patients without MVI, the correlation of RV FAC with E / e' was absent (r=0.28; p=0.192). The volume change velocity (dVol / dt) moderately correlated with the RV end-systolic and end-diastolic area in IHD patients but not in IHD patients with MVI. The RV area change velocity (dS / dt) evaluated during systole and diastole moderately significantly correlated with the LV end-diastolic volume.Conclusion Additional overload of left heart chambers in ischemic MVI is a factor that influences the development of the systemic and pulmonary circuit disorders. Recording and evaluation of global longitudinal strain, LV volume change velocity, and long axis change velocity with simultaneous recording of the segmental myocardial displacement velocity serve as highly informative criteria for disorders of LV and RV function. The vector analysis allows quantitative estimation of the local segmental myocardial function. Decreased velocities of the free RV wall segmental displacements during systole and diastole are characteristic of systolic and diastolic dysfunction in patients with IHD complicated with mitral regurgitation.