Assessment Of Right Ventricle Function Research Articles

Current trends and latest developments in echocardiographic assessment of right ventricular function: load dependency perspective.

Right ventricle (RV) failure is a common complication of many cardiopulmonary diseases. Since it has a significant adverse impact on prognosis, precise determination of RV function is crucial to guide clinical management. However, accurate assessment of RV function remains challenging owing to the difficulties in acquiring its intricate pathophysiology and imaging its complex anatomical structure. In addition, there is historical attention focused exclusively on the left ventricle assessment, which has led to overshadowing and delayed development of RV evaluation. Echocardiography is the first-line and non-invasive bedside clinical tool for assessing RV function. Tricuspid annular plane systolic excursion (TAPSE), RV systolic tissue Doppler velocity of the tricuspid annulus (RV S'), and RV fractional area change (RV FAC) are conventional standard indices routinely used for RV function assessment, but accuracy has been subject to several limitations, such as load-dependency, angle-dependency, and localized regional assessment. Particularly, load dependency is a vexing issue, as the failing RV is always in a complex loading condition, which alters the values of echocardiographic parameters and confuses clinicians. Recently, novel echocardiographic methods for improved RV assessment have been developed. Specifically, "strain", "RV-pulmonary arterial (PA) coupling", and "RV myocardial work" are newly applied methods for RV function assessment, a few of which are designed to surmount the load dependency by taking into account the afterload on RV. In this narrative review, we summarize the latest data on these novel RV echocardiographic parameters and highlight their strengths and limitations. Since load independency is one of the primary advantages of these, we particularly emphasize this aspect.

Using Speckle Tracking Analysis, Does Age Affect RV Longitudinal Strain?

Introduction: The right ventricle (RV) is increasingly crucial in clinical settings, but traditional echocardiography is challenging to evaluate its function. Advanced techniques like speckle tracking improve RV functional assessment. According to previous studies, RV free wall longitudinal strain measurements vary with age necessitating further research. Aim: This study aimed to evaluate the effects of age on RV longitudinal strain using speckle tracking (ST) analysis. Methods: 103 healthy adult volunteers, mean age 37.1±11.9 years (range: 20-66), underwent comprehensive speckle tracking analysis, to determine age-related changes in RV dimensions and function. Results: showed a significant decrease in global and segmental (basal, mid, and apical) FWLS with age (p < .001). Conclusion: These significant differences in free wall longitudinal strains among age groups by 2D-ST analysis indicate the need for age-adjusted measures in RV function evaluation. Conventional techniques may ignore minor changes, leading to underestimated RV function assessment. The findings also suggest that advanced techniques allow early identification of RV dysfunction by detecting subclinical dysfunction before anomalies revealed by traditional echocardiography occur.

Right ventricular myocardial work by echocardiography: non-invasive assessment of right ventricle function in patients with pulmonary hypertension

Abstract Background Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study and analyze the right ventricular (RV) function non-invasively, using RV pressure-strain loops. The association between these novel indexes of RVMW and invasive hemodynamic parameters has not yet been extensively studied, namely in precapillary pulmonary hypertension (PH) population. In right heart catheterization, stroke volume directly reflects right ventricular function in response to its load, and has prognostic implication in PH. Objectives To evaluate the relationship between RVMW and stroke volume index (SVi) measured invasively by right heart catheterization (RHC), in a cohort of patients with group I and group IV PH. Methods A prospective registry of pre-capillary PH patients evaluated in a single tertiary center was used. Echocardiography and RHC were performed in the same day. Dedicated software for left ventricle myocardial work was used for the RV. RV global myocardial work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW; work contributing to myocardial shortening during systole and lengthening during isovolumic relaxation), RV global wasted work (RVGWW; work contributing to myocardial lengthening during systole and shortening during isovolumic relaxation), and RV global work efficiency (RVGWE; relation between RVGCW and RVGWW) were estimated. Pearson’s correlation was applied to assess correlations between continuous variables. Results 17 pts (80% women, mean age 67 ± 10 years) were included. The average of mean pulmonary arterial pressure (mPAP) was 33 mmHg (± 9,5), of pulmonary vascular resistance (PVR) was 5,7 WU (± 5,1) and of SVi was 40,7 ml/m2 (± 10,8). Conventional echocardiographic parameters for the evaluation of RV systolic function, such as TAPSE, annular tricuspid s’ velocity and fractional area change (FAC), did not correlate with SVi. Moreover, right ventricle-pulmonary artery (RV-PA) coupling and RV GLS also did not correlate with this invasive parameter of right ventricle function. Of the RVMW indexes, RVGWW and RVGWE strongly correlated with SVi: as this invasive parameter decreases, RVGWW (r = -0,560, p = 0,019) increases significantly, whereas RVGWE (r= 0,539, p = 0,026) declines (Fig 1). In our population, RVGWI and RVGCW didn’t correlate significantly with SVi. Conclusions Finding non-invasive methods to evaluate RV function is essential in patients with RV hemodynamic overload, since conventional echocardiographic parameters do not perform well, and RV function is central in prognosis assessment in this population. Novel echocardiographic assessment of RVMW seems to provide a promising index of RV function in PH patients, as demonstrated with its correlation with SVi.Figure 1:Correlation of RVMW with SVi.

Real-time Three-dimensional Echocardiography: A Feasible and Accurate Method for Measuring Right Ventricular Function in Pulmonary Hypertension

Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension (PH). The complex geometry and mode of contractility means the right ventricle (RV) inlet and outlet are not in line; hence, 2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients. Three-dimensional echocardiography (3DE) allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography. This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points: (1) acquiring an RV data set for 3DE imaging, including details of all available 3DE systems and software utilized in daily practice; (2) the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH; and (3) the prognostic value of 3DE-derived RV function in such patients.

Right ventricular contraction patterns in healthy children using three-dimensional echocardiography.

The right ventricle (RV) has complex geometry and function, with motion along three separate axes-longitudinal, radial, and anteroposterior. Quantitative assessment of RV function by two-dimension echocardiography (2DE) has been limited as a consequence of this complexity, whereas newer three dimensional (3D) analysis offers the potential for more comprehensive assessment of the contributors to RV function. The aims of this study were to quantify the longitudinal, radial and anteroposterior components of global RV function using 3D echocardiography in a cohort of healthy children and to examine maturational changes in these parameters. Three-dimensional contours of the RV were generated from a cohort of healthy pediatric patients with structurally normal hearts at two centers. Traditional 2D and 3D echo characteristics were recorded. Using offline analysis of 3D datasets, RV motion was decomposed into three components, and ejection fractions (EF) were calculated (longitudinal-LEF; radial-REF; and anteroposterior-AEF). The individual decomposed EF values were indexed against the global RVEF. Strain values were calculated as well. Data from 166 subjects were included in the analysis; median age was 13.5 years (range 0 to 17.4 years). Overall, AEF was greater than REF and LEF (29.2 ± 6.2% vs. 25.1 ± 7.2% and 25.7 ± 6.0%, respectively; p < 0.001). This remained true when indexed to overall EF (49.8 ± 8.7% vs. 43.3 ± 11.6% and 44.4 ± 10%, respectively; p < 0.001). Age-related differences were present for global RVEF, REF, and all components of RV strain. In healthy children, anteroposterior shortening is the dominant component of RV contraction. Evaluation of 3D parameters of the RV in children is feasible and enhances the overall understanding of RV function, which may allow improvements in recognition of dysfunction and assessment of treatment effects in the future.

Evaluating the feasibility of using artificial intelligence for right ventricle function analysis in a routine clinical setting

Abstract Funding Acknowledgements Type of funding sources: None. Background Evaluation of right ventricle (RV) function has clinical value when investigating patients with symptomatic heart failure. However, the assessment of RV function using two-dimensional echocardiography (Echo) is operator-dependent and is time-consuming. Technological advances have enabled the use of artificial intelligence (AI) based algorithms for functional analysis with high reproducibility, facilitated by manufacturer-neutral platform. Purpose We sought to determine the feasibility of using an AI-based application to measure RV function in patients referred for diagnostic evaluation of heart failure, and to compare the results with operator-generated (Human) measurements in order to assess the accuracy and efficiency of the AI. Methods We conducted a study on 190 consecutive patients, comparing the analysis times and accuracies of tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) measurements using both Human and AI-based methods on three consecutive heart beats of the same Echo clip. The participants manually measured TAPSE in M-mode and FAC by tracking the RV endocardium in diastole and systole, while the AI automatically assessed these parameters in a single apical RV-centered 4-chamber view. The results of these measurements were then compared to determine the accuracy and efficiency of the AI. Results The measurement feasibility by the AI was 92% (n=175) on the RV clips. The main reasons for exclusion were poor image quality and insufficient representation of the RV free wall. The analysis time for TAPSE and FAC was significantly shorter for the AI compared to the Human (14±4 seconds vs. 101±21 seconds, p&amp;lt;0.001). Figure 1 shows that there was a significant correlation between TAPSE and FAC measurements made by AI and Human (R=0.66 and 0.64, p&amp;lt;0.001), but there was a mean bias of 3.3 mm (±23.7 mm) for TAPSE and 3.9% (±16.7%) for FAC between the two methods. Conclusions The AI-based application demonstrated good feasibility and significantly reduced analysis time for measuring TAPSE and FAC in patients referred for diagnostic evaluation of heart failure. However, the measurement bias between AI and Human was not negligible, warranting further investigation to determine the cause of this discrepancy and whether this AI-based application is an alternative to the manual method for assessing RV function.

Assessment and diagnosis of right ventricular failure-retrospection and future directions.

The right ventricle (RV) has a critical role in hemodynamics and right ventricular failure (RVF) often leads to poor clinical outcome. Despite the clinical importance of RVF, its definition and recognition currently rely on patients' symptoms and signs, rather than on objective parameters from quantifying RV dimensions and function. A key challenge is the geometrical complexity of the RV, which often makes it difficult to assess RV function accurately. There are several assessment modalities currently utilized in the clinical settings. Each diagnostic investigation has both advantages and limitations according to its characteristics. The purpose of this review is to reflect on the current diagnostic tools, consider the potential technological advancements and propose how to improve the assessment of right ventricular failure. Advanced technique such as automatic evaluation with artificial intelligence and 3-dimensional assessment for the complex RV structure has a potential to improve RV assessment by increasing accuracy and reproducibility of the measurements. Further, noninvasive assessments for RV-pulmonary artery coupling and right and left ventricular interaction are also warranted to overcome the load-related limitations for the accurate evaluation of RV contractile function. Future studies to cross-validate the advanced technologies in various populations are required.

Comprehensive Echocardiographic Assessment of Right Ventricle Function in a Rat Model of Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a progressive disease caused by vasoconstriction and remodeling of the small arteries in the lungs. This remodeling leads to increased pulmonary vascular resistance, worsened right ventricular function, and premature death. Currently approved therapies for PAH largely target pulmonary vasodilator pathways; however, recent emerging therapeutic modalities are focused on other novel pathways involved in the pathogenesis of the disease, including right ventricle (RV) remodeling. Imaging techniques that allow longitudinal assessment of novel therapeutics are very useful for determining the efficacy of new drugs in preclinical studies. Noninvasive trans-thoracic echocardiography remains the standard approach to evaluating heart function and is widely used in rodent models. However, echocardiographic evaluation of the RV can be challenging due to its anatomical position and structure. In addition, standardized guidelines are lacking for echocardiographyin preclinical rodent models, making it difficult to carry out a uniform assessment of RVfunction across studies in different laboratories. In preclinical studies, the monocrotaline (MCT) injury model in rats is widely used to evaluate drug efficacy for treating PAH. This protocol describes the echocardiographic evaluation of the RV in naïve and MCT-induced PAH rats.

A Comprehensive Assessment of Right Ventricular Function in Chronic Thromboembolic Pulmonary Hypertension.

While chronic thromboembolic pulmonary hypertension (CTEPH) results from macroscopic and microscopic obstruction of the pulmonary vascular bed, the function of the right ventricle (RV) and increased RV afterload are the main determinants of its symptoms and prognosis. In this review, we assess RV function in patients diagnosed with CTEPH with a focus on the contributions of RV afterload and dysfunction to the pathogenesis of this disease. We will also discuss changes in RV function and geometry in response to treatment, including medical therapy, pulmonary endarterectomy, and balloon pulmonary angioplasty.

785 ACCURATE ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BECOMES MORE CHALLENGING IN PATIENTS WITH SEGNIFICANT TRICUSPID REGURGITATION: A CASE REPORT OF RIGHT VENTRICULAR DYSFUNCTION AFTER TRICLIP IMPLANTATION

Abstract Introduction anatomically and functionally different from the left ventricle, the right ventricle (RV) plays an increasingly recognized role in determining symptoms and outcomes in multiple conditions. Due to RV complex anatomy and mechanics, the evaluation of its size and function is challenging. The ideal imaging technique should be capable of comprehensive, accurate and reproducible assessment of RV morphology and contraction. In the absence of a single reliable 2DE measure of the RV systolic function, several surrogate echocardiographic parameters have been proposed for clinical use, from one-dimensional (TAPSE) to 3D techniques. Clinical Case we report a case of an 82-year-old female patient who was admitted to our hospital because of dyspnoea, with a history of atrial fibrillation, hypertension, diabetes mellitus, chronic kidney disease, and a last year hospitalization for heart failure. A transthoracic echocardiography (TTE) was performed, showing a high-grade tricuspid valve regurgitation. Further investigation using transoesophageal echocardiography (TEE) showed, in four chambers view, dilatation of right sections and confirm TR was significant, so screening for TriClip implantation was performed. The exam was diagnostic for massive TR, moderate Mitral Regurgitation, and the estimated PAPs about 50 mmHg, so, in the absence of anatomical exclusion elements, severe pulmonary hypertension and poor RV function, transcatheter treatment with TriClip was offered. We had evaluated RV function, obtaining a FAC about normal limit (which should be corrected by valvular regurgitation), and a reduced Strain value. The patient received an edge-to-edge reparation of the tricuspid valve using the TriClip XTR (Clip) system with 2 clips placed. The post-interventional echocardiographic results were an optimal correction of valvular regurgitation, with, however, a clear right ventricular disfunction. Those finding were confirmed by further echocardiographic follow up exams, even during inotropic treatment by low dobutamine dose. Conclusion estimating RV function remains challenging because of the complex geometry of the RV. In the presence of significant TR, the accurate assessment of RV function becomes even more challenging because of the load and angle dependency of TAPSE, RVFAC and RVEF. Significant TR result in a reduction in RV afterload, which may preserve the markers of TV function even when contractility is impaired. 2d-STE in less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.

Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study.

Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically.RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022.All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery,where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001,respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01and 10.3 ± 4.83 h, respectively. RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.

MORPHOLOGIC CHARACTERISTICS AND FUNCTION OF RIGHT VENTRICLE IN PATIENTS WITH ISOLATED RIGHT BUNDLE BRANCH BLOCK

Background: The prevalence of right bundle branch block (RBBB) is estimated in 0.2 to 1.3% of healthy people. RBBB had independent association with decreased right ventricle (RV) function, which is considered as predictor of adverse cardiovascular outcomes. The aim of this study is to evaluate RV structure and function in patients with isolated RBBB (without structural heart disease) using two-dimensional echocardiography. Methods: A cross-sectional study conducted at Chitwan Medical College, Bharatpur from 1st January 2022 to 30th June 2022. Consecutive adult patients aged ≥18 years with isolated RBBB classified into complete RBBB (CRBBB) and Incomplete RBBB (IRBBB) based on electrocardiographic findings. The echocardiographic evaluation was done to assess RV dimension and function. Results: A total of 52 patients with isolated RBBB were included with mean age of the study population was 45.3 ± 9.3 years, (28 ,53.8%) had CRBBB, whereas the remaining (24, 46.2%) had IRBBB. Among the parameters used to assess RV function; mean RV-Fractional area change (P&lt;0.001), Tricuspid annular plane systolic excursion(P&lt;0.02) and Pulsed Doppler peak velocity at the lateral annulus RV(P&lt;0.001) were significantly lower, while Pulsed Doppler myocardial performance index(P&lt;0.001) was significantly high in CRBBB group as compared to IRBBB group. Similarly, Right atrium and RV dimensional parameters were significant higher in CRBBB compared to IRBBB group. Conclusions: Isolated RBBB is not as benign as it was considered and has deteriorating effect on RV morphology and function. Therefore, patients with Isolated RBBB need follow-up with passing age and more attention toward RV structural and functional analysis.

The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.

The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.

EACVI survey on the multi-modality imaging assessment of the right heart.

The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate the use of different cardiac imaging modalities for the evaluation of the right heart. Delegates from 250 EACVI registered centres were invited to participate in a survey which was also advertised on the EACVI bulletin and on social media. One hundred and thirty-eight respondents from 46 countries across the world responded to the survey. Most respondents worked in tertiary centres (79%) and echocardiography was reported as the commonest imaging modality used to assess the right ventricle (RV). The majority of survey participants (78%) included RV size and function in &gt;90% of their echocardiographic reports. The RV basal diameter obtained from the apical four-chamber view and the tricuspid annular plane systolic excursion were the commonest parameters used for the echocardiographic assessment of RV size and function as reported by 82 and 97% respondents, respectively. Survey participants reported arrhythmogenic cardiomyopathy as the commonest condition (88%) where cardiac magentic resonance (CMR) imaging was used for right heart assessment. Only 52% respondents included RV volumetric and ejection fraction assessments routinely in their CMR reports, while 30% of respondents included these parameters only when RV pathology was suspected. Finally, 73% of the respondents reported pulmonary hypertension as the commonest condition where right heart catheterization was performed. Echocardiography remains the most frequently used imaging modality for the evaluation of the right heart, while the use of other imaging techniques, most notably CMR, is increasing.

Accuracy of new transthoracic 3D echocardiographic automated algorithm for right ventricle quantification in children with congenital heart disease

Management of many congenital heart diseases (CHD) depends on right ventricle (RV) assessment for which cardiac magnetic resonance (CMR) remains the gold standard. The objective of this study was to assess feasibility and reproducibility of a new semi-automated algorithm to quantify RV (4D auto RVQ) from 3D transthoracic echocardiography (3D TTE) in a pediatric population, and to compare measurements with those obtained from CMR. In all, 90 infants were prospectively included (age 7.5 years, 3–18). Fifteen healthy infants and 75 patients with CHD (30 repaired TOF, 25 ASD, 8 dilated pulmonary valve stenosis, 7 tricuspid regurgitation, 3 APVR, and 2 repaired TAC). All patients underwent 2D and 3D TTE (Vivid E95, GE Healthcare). RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV), RV ejection volume (RVEV) and RV ejection fraction (RVEF) were analyzed by 4D auto RVQ and compared with measurements from 18 patients who underwent CMR exams for the follow up of their cardiopathy. 4D auto RVQ was feasible in 87 infants (96.7%). In 3 patients 4D auto RVQ was unable to detect RV contouring due to inadequate image quality. Manual contour adjustment was necessary in 81 cases (80%). Mean time of analysis including the time of manual adjustment was 62 seconds. RV was enlarged in 65 of 75 patients with CHD (mean 95 ml/m 2 , 62–165 ml/m 2 ). Good correlation for RVEDV, RVESV, RVEV and RVEF was found between 4D auto RVQ and CMR (r = 0.89–0.99, all P < 0.0001). 4D auto RVQ underestimated RVEDV/BSA of 8 ml/m 2 and RVEF by 6%, and overestimated RVESV/BSA of 9 ml/m 2 . Intraobserver and interobserver variability were low (4.7% and 8.9% respectively) ( Fig. 1 ). 4D auto RVQ is a promising tool for assessment of RV volume and function in children. Such simple and non-invasive exam could reduce the practice of CMR imaging during the follow up of children with CHD.

Right Ventricular Dysfunction Is Associated With Increased Mortality in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Issues With the Method.

To the Editor: We read with interest the article published by Maharaj et al.1 The authors’ aim was to investigate the correlation between echocardiographic parameters and survival in patients supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). The authors retrospectively collected clinical and echocardiographic data from 17 patients over 1 year period. The echocardiograms were a mixture of transthoracic (TTE) and transesophageal (TEE) scans. Visual assessment and right ventricle (RV) fractional area change (FAC) were used as the parameters for RV systolic function as measured by two independent blinded experts, and an average was used for statistical analysis. In patients who did not survive, significant RV dysfunction by visual assessment was more prevalent in nonsurvivors. In addition, median value for FAC in nonsurvivors was significantly lower (11.3% [10.3–15] vs. 30.1% [27.6–31.4], respectively). RV FAC is performed by tracing the endocardial border area of the RV in end systole (ESA) and end diastole (EDA), and it is calculated as EDA − ESA/EDA.2 This method renders FAC open to intra- and interobserver variabilities. A previous study demonstrated FAC to exhibit limited and nonstatistically significant intraobserver (r, 0.56; p = 0.06) and interobserver (r, 0.46; p = 0.16) agreements.2 In addition, mean intra- and interobserver differences were high (mean, 1.86%; 95% CI, −9.25% to −12.96%; and mean, 4.00%; 95% CI, −7.72% to −15.72%, respectively). FAC variability was worst compared with other RV systolic function parameters (e.g., Tricuspid annular plane systolic excursion and velocity). Where FAC is used for RV systolic function assessment, intra- and interobserver variabilities should be assessed and cited providing a guide to results reliability. The authors used a mixture of TEE and TTE to obtain FAC. The two modalities were considered comparable, and thus, values from both modalities were incorporated in the FAC comparison. A recent study compared TTE and TEE in the assessment of RV function using the same parameters in 100 patients undergoing cardiac surgery.3 The TTE and TEE were performed in close temporal proximity under the same loading conditions. The study demonstrated that RV parameters had fair agreement between modalities but not identical. FAC comparison demonstrated correlation concordance coefficient between TTE and TEE of 0.31 (95% CI, 0.12–0.48), suggesting limited agreement and that FAC results are not interchangeable between the two modalities. This result casts a shadow on the feasibility of incorporating FAC from TTE and TEE in the same statistical comparison. Association between a continuous independent parameter (e.g., RV FAC) and categorical dependent parameter (e.g., mortality) requires in-depth statistical analysis. Logistic regression is the most commonly statistical method used to investigate such association.4 A multivariate model is constructed to incorporate all likely and significantly different independent parameters to investigate which parameters predict outcome. Furthermore, receiver operator curve (ROC) analysis is usually performed to establish sensitivity and specificity of the independent parameter in predicting the dependent parameter.5 Without such analysis, association between FAC and mortality could not be convincingly established. Fractional area change is a method of RV systolic function assessment with high observer variability. FAC is not interchangeable between TTE and TEE. Further statistical analysis is required to establish association between RV FAC and outcome.

Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach

<h2>Abstract</h2> As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.

Long-term performance of untreated fresh autologous pericardium as a valve substitute in pulmonary position

Background:Pulmonary regurgitation is imminent after transannular patch (TAP). We analyze the long-term performance of untreated autologous pericardium (UAP) as valve substitute at pulmonary position in patients requiring TAP.Material and Methods:This cross-sectional study include patients operated between 2007 and 2012 (n = 92). A sample of 19 patients was selected for this study which had a follow-up of more than 3 years. This includes patients with no TAP (n = 4) and with TAP and valve substitute, a monocusp (n = 11) or a tricuspid valve (n = 4) at neopulmonary annulus. Patients underwent echocardiography for assessment of right ventricle function and 18 fluoro-deoxyglucose PET CT scan for measurements of valve substitute at neopulmonary annulus. The target to blood ratio (TBR) of uptake of glucose by monocusp was measured at the cooptation edge of the neopulmonary valve.Results:The median age of the patients is 14 (9 – 37). RV function is preserved (TAPSE 18.9 (10.6 – 22.8)) at a mean follow-up of 4 years (3-9). The measurements of monocusp shows a shrinkage in height of the cusp by 35.5% (70% – 1.0%) and length by 7% (-44% - +104%). There was less shrinkage observed in patients below 15 years of age. The TBR of monocusp was 0.945 (0.17 – 3.35) with a strong correlation between the TBR values of aortic valve leaflet and monocusp leaflet of same patient.Conclusion:The UAP is functional and successful as a valve substitute at neo pulmonary annulus at long-term follow-up. It has resisted calcification and has shown uptake of glucose in physiological limits.

Assessment of right ventricle function by transthoracic echocardiography in septic shock at the emergency department

Assessment of right ventricle function by transthoracic echocardiography in septic shock at the emergency department

Right ventricular function declines prior to left ventricular ejection fraction in hypertrophic cardiomyopathy

BackgroundThe right ventricle (RV) in hypertrophic cardiomyopathy (HCM) tends to be neglected, as previous efforts have predominantly focused on examining the prognostic value of left ventricular (LV) abnormalities. The objectives of this study were to assess RV function in HCM, changes over time, and association with clinical outcomes.MethodsTwo hundred and ninety HCM patients with preserved LV ejection fraction (LVEF ≥ 55%) and 30 age- and sex-matched controls underwent cardiovascular magnetic resonance (CMR). All patients were followed up for clinical events for a median duration of 4.4 years. Sixty-three patients had a follow-up CMR undertaken at a median interval of 5.4 years. Main study measures and outcomes were RV function (RV ejection fraction (RVEF) and RV strain) at baseline, temporal changes in RV function over time and prognostic value of RV dysfunction for predicting cardiovascular outcomes in HCM.ResultsWhen compared to controls, HCM patients exhibited lower RV and LV peak global longitudinal systolic strains on feature-tracking analysis of cine images, while RVEF and LVEF were within the normal range. On follow-up CMR, both RV and LV strain parameters decreased over time. RVEF decreased at follow-up (65 ± 7% to 62 ± 7%, P < 0.001) but the change in LVEF was not significant (68 ± 10% to 66 ± 8%, P = 0.30). On clinical follow up, reduced RVEF was an independent predictor of non-sustained ventricular tachycardia (NSVT) [HR 1.10 (95% CI 1.06–1.15), P < 0.001] and composite cardiovascular events (NSVT, stroke, heart failure hospitalisation and cardiovascular death) [HR 1.07 (95% CI 1.03–1.10), P < 0.001]. RV longitudinal strain was an independent predictor of NSVT [HR 1.05 (95% CI 1.01–1.09), P = 0.029]. Patients with RVEF < 55% showed an increased risk of NSVT and composite cardiovascular events. In contrast, LVEF and LV global longitudinal strain were not predictive of such events on multivariable analysis.ConclusionsIn HCM, RV function, including RV strain, and LV strain decrease over time despite preserved LVEF. Reduction in RV but not LV function is associated with adverse cardiovascular outcomes. Assessing RV function in early HCM disease might have a role in risk stratification to prevent future cardiovascular events.