Assessment Of Right Ventricular Strain Research Articles

Abstract 10864: Reduction in Right Ventricular Strain is Associated With Increased Mortality in Acute Pulmonary Embolism

Introduction: Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, problems exist in identifying RV dysfunction using conventional echocardiography. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function. Hypothesis: We hypothesized that RV strain analysis is prognostic of mortality in patients with acute PE. Methods: Retrospective cohort study of 177 patients with acute PE between 2010 and 2017. Strain analysis was retroactively applied. All echocardiograms were completed within 48 hours of diagnosis. RV global longitudinal strain (RVGLS) was applied using TomTec®. The primary outcome was all-cause mortality at 30 days and in-hospital mortality. T-test statistical analysis was performed. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for evaluation. Results: Study quality was sufficient to perform RVGLS analysis in 157 patients (90.2%). Mortality at 30 days and in-hospital mortality occurred in 12.7% and 8.9% of patients respectively. Comparing 30-day mortality, there was a significant reduction in RVGLS compared to survivors (13.0% ± 3.0% vs 19.6% ± 3.5%, p < 0.001). In-hospital mortality as well showed a significant difference (13.1% ± 3.3% vs 19.3% ± 3.7%, p < 0.001). Using ROC curves, we chose a RVGLS value of 17.5% (sensitivity 90%, specificity 74%) to predict 30-day mortality. Patients with RVGLS worse than 17.5% had 18 times higher risk of 30-day mortality compared to patients with RVGLS better than 17.5% (HR 18.4, 95% CI= 4.2-79.7, p < 0.001. Figure). Conclusions: RV strain have significant prognostic value in patients with acute PE, and identifying those at higher risk of death. Assessment of RV strain has promise for clinical applications.

Assessment of Right Ventricular Strain by Speckle Tracking Echocardiography for Prediction of Proximal Right Coronary Artery Lesion in Patients with Acute Inferior Wall Myocardial Infarction

Assessment of Right Ventricular Strain by Speckle Tracking Echocardiography for Prediction of Proximal Right Coronary Artery Lesion in Patients with Acute Inferior Wall Myocardial Infarction

Right Ventricular Longitudinal Strain Predicts Survival in Patients With Functional Tricuspid Regurgitation

BackgroundFunctional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Despite general consent that right ventricular (RV) dysfunction impacts outcome of patients with TR, it is still unknown which echocardiographic parameters most accurately reflect prognosis. In this study we aimed to evaluate the prevalence of RV dysfunction and its prognostic value in patients with TR. MethodsData from 1089 consecutive patients were analysed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change, and right ventricular free wall longitudinal strain (RV strain) were used to define RV dysfunction. Patients were followed for 2-year all-cause mortality. For prediction of survival, reclassification and C statistics of RV functional parameters using TR grade as reference model were performed. ResultsAmong the patients studied, 13.9% showed no TR, 61.2% had mild TR, 19.6% had moderate TR, and 5.3% had severe TR. The TR grade was associated with increased mortality (log rank, P < 0.001). Impaired RV strain and TAPSE were independent predictors for mortality (RV: hazard ratio [HR], 1.130; 95% confidence interval [CI], 1.099-1.160; P < 0.001; TAPSE: HR, 1.131; 95% CI, 1.085-1.175; P < 0.001). Both RV strain and TAPSE improved the reference model for survival prediction (RV: integrated discrimination improvement [IDI], 0.184; 95% CI, 0.146-0.221; P < 0.001; TAPSE: IDI, 0.057; 95% CI, 0.037-0.077; P < 0.001). ConclusionsEchocardiographic evaluation of RV function appears to useful for patients with TR. Assessment of RV strain provides additional value for prediction of 2-year mortality.

Assessment of right ventricular strain and strain rate before and after percutaneous atrial septal defect closure

Assessment of right ventricular strain and strain rate before and after percutaneous atrial septal defect closure

Acute Pulmonary Embolism

Pulmonary embolism (PE) is a frequently encountered clinical condition with both short- and long-term adverse consequences. An integrated approach to diagnosis is important to maximize early diagnosis but also to minimize the unnecessary utilization of diagnostic imaging. Comprehensive risk stratification with clinical features and assessment of right ventricular strain by diagnostic imaging and cardiac biomarker results are essential to guide initial management decisions. There is a growing treatment arsenal for acute PE, including increased anticoagulation and advanced therapeutic options such as catheter-based therapy. Despite such advances, mortality remains high, particularly among those who present critically ill with PE, and long-term physical and psychological effects can persist in many patients for years after the initial diagnosis. This review contains 7 figures, 6 tables, and 69 references. Key Words: anticoagulation, catheter-directed therapy, chronic thromboembolic pulmonary hypertension pulmonary embolism, computed tomography, echocardiography, fibrinolysis, risk stratification, venous thromboembolism

Acute Pulmonary Embolism

Pulmonary embolism (PE) is a frequently encountered clinical condition with both short- and long-term adverse consequences. An integrated approach to diagnosis is important to maximize early diagnosis but also to minimize the unnecessary utilization of diagnostic imaging. Comprehensive risk stratification with clinical features and assessment of right ventricular strain by diagnostic imaging and cardiac biomarker results are essential to guide initial management decisions. There is a growing treatment arsenal for acute PE, including increased anticoagulation and advanced therapeutic options such as catheter-based therapy. Despite such advances, mortality remains high, particularly among those who present critically ill with PE, and long-term physical and psychological effects can persist in many patients for years after the initial diagnosis. This review contains 7 figures, 6 tables, and 69 references. Key Words: anticoagulation, catheter-directed therapy, chronic thromboembolic pulmonary hypertension pulmonary embolism, computed tomography, echocardiography, fibrinolysis, risk stratification, venous thromboembolism

Assessment of right ventricular strain in children with repaired tetralogy of Fallot using speckle tracking imaging.

Assessment of right ventricular strain in children with repaired tetralogy of Fallot using speckle tracking imaging.

Intraoperative Assessment of Right Ventricular Strain During Lung Transplant Using Tissue Tracking Technology

Intraoperative Assessment of Right Ventricular Strain During Lung Transplant Using Tissue Tracking Technology

Multimodality Assessment of Right Ventricular Strain in Patients With Acute Pulmonary Embolism

Optimal risk stratification is essential in managing patients with an acute pulmonary embolism (PE). There are limited data evaluating the potential additive value of various methods of evaluation of right ventricular (RV) strain in PE. We retrospectively evaluated RV strain by computed tomography (CT), transthoracic echocardiography (TTE), electrocardiography (ECG), and troponin levels in consecutive hospitalized patients with acute PE (May 2007 to December 2014). Four-hundred and seventy-seven patients met inclusion criteria. RV strain on ECG (odds ratio [OR] 1.9, confidence interval [CI] 1.1 to 3.3; p = 0.03), CT (OR 2.7, CI 1.5 to 4.8, p <0.001), TTE (OR 2.8, CI 1.5 to 5.4, p <0.001), or a positive troponin (OR 2.7, CI 2.0 to 6.9, p <0.001) were associated with adverse events. In patients with ECG, CT, and TTE data, increased risk was only elevated with RV strain on all 3 parameters (OR 4.6, CI 1.8 to 11.3, p <0.001). In all patients with troponin measurements, risk was only elevated with RV strain on all 3 parameters plus a positive troponin (OR 8.8, CI 2.8 to 28.1, p <0.001) and was similar in intermediate-risk PE (OR 11.1, CI 1.2 to 103.8, p = 0.04). In conclusion, in patients with an acute PE and evaluation of RV strain by ECG, CT, and TTE, risk of adverse events is only elevated when RV strain is present on all 3 modalities. Troponin further aids in discriminating high-risk patients. Multimodality assessment of RV strain is identified as a superior approach to risk assessment.

TCT-599 RV/LV Ratio by Computed Tomography Poorly Predicts RV Dysfunction or Invasive Hemodynamics in Patients With Acute Pulmonary Embolism

Assessment of right ventricular strain using computed tomography (CT) in patients with pulmonary embolism (PE) has often relied on the ratio between the diameter of the right and left ventricles (RV/LV) in axial slices. The RV/LV ratio, measured in this manner, may be an unreliable marker of strain

Abstract 19604: Global Longitudinal Strain in Different Right Ventricular Walls Using Alternate Right Ventricular Apical Views: Validation and Establishment of Normal Values in Children

Introduction: Right ventricular (RV) function is an important prognostic factor in congenital and acquired heart disease. Quantitative measures of RV lateral wall function obtained from the apical 4 chamber (A4C) view are used to extrapolate global RV function. We aimed to use non-standard views of the RV to establish normal global longitudinal strain (GLS) in additional walls of the RV in healthy children to allow a more comprehensive RV assessment. Methods: A total of 88 healthy children (age 5-17 years) were recruited in a prospective, multi-institutional study. Images were acquired with the Vivid E-9 with post-processing performed using EchoPac (GE Ultrasound). RV views similar to LV apical 2 chamber (A2C) and apical 3 chamber (A3C) views were performed with care taken to exclude septal myocardium. GLS in the RV lateral (A4C), inferior (A2C) and posterior (A3C) walls were averaged over 3 cardiac cycles and calculated if at least 2 of 3 wall segments tracked. A global RV strain assessment was calculated by averaging the 3 available walls. Intraobserver variability was assessed. Results: GLS was measurable in 67% of lateral, 75% of inferior and 45% of posterior walls analyzed. The normal ranges for GLS across the pediatric age group are shown in figure 1. Overall, we observed a decrease in lateral wall GLS with increasing age; inferior and posterior GLS changed less with age. Average global RV strain was -31.3% +/- 2.4%. Intraobserver reliability in 15 patients showed coefficient of variance of 5.2%, 3.9% and 4% with no significant bias in the lateral, inferior and posterior walls. Conclusions: This report establishes reference values for inferior and posterior RV wall strain in children. We show that speckle tracking strain analysis is feasible in alternate walls of the RV allowing for more global assessment of RV function. Establishment of normal values in a larger cohort including younger children may improve future assessment of dysfunction in RV pathology.