Baseline Right Ventricular Function Research Articles

Biventricular Function is Impaired in Right Ventricular Septal Pacing-A Prospective Study Using Myocardial Strain Imaging.

Left ventricular (LV) dysfunction is known to occur after right ventricular (RV) pacing; the effect on RV function is less well studied. The aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameters of speckle-tracking derived RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular systolic velocity (RV S'). Thirty-two (32) consecutive patients with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited. Echocardiography was performed prior to implantation, at 1 day, 1 month and 1 year after implantation, with 29 patients completing follow-up. After 1 year, three patients (10%) with otherwise normal RV parameters developed abnormal RV strain patterns. Compared to 1 day after implantation, at 1 year significant reductions were observed in mean RV GLS (-24.8 to -21.8%) RV S' (15.1 to 12.2 cm/s), TAPSE (24.2 to 21.9 mm), RV GLS (-24.8 to -21.8%), left ventricular ejection fraction (LVEF) (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p<0.01. There was a non-significant reduction for RV FWS (-29.0 to -26.7%, p=0.06) and there was no change in RV FAC (49.1 to 46.9%, p=0.24). We report abnormalities of RV strain developing 1 year after pacemaker insertion. Measurement of myocardial strain is emerging as an additional method to detect patients at risk of RV dysfunction in those who have undergone pacemaker implantation.

Differences in right ventricular function and response to targeted therapy between patients with IPAH and PAH-CHD.

Background and aims: Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disorder characterized by elevated pulmonary vascular resistance (PVR) and pulmonary arterial pressure (PAP). Right heart failure is a life-threatening complication of PAH and predicts a poor prognosis. PAH associated with congenital heart disease (PAH-CHD) and idiopathic PAH (IPAH) are two prevalent PAH subtypes in China. In this section, we set out to explore baseline right ventricular (RV) function and its response to targeted agents between IPAH and PAH-CHD. Methods and results: Consecutive patients diagnosed with IPAH or PAH-CHD by right heart catheterization (RHC) in the Second Xiangya Hospital from November 2011 to June 2020 were included. All patients received PAH-targeted therapy and the RV function was assessed by echocardiography at baseline and during follow-up. A total of 303 patients (age, 36.23 ± 13.10years; women, 213 (70.3%); mean PAP [mPAP], 63.54 ± 16.12mmHg; PVR, 14.74 ± 7.61WU) with IPAH (n = 121) or PAH-CHD (n = 182) were included in this study. Compared with PAH-CHD, patients with IPAH had worse baseline RV function. As of the latest follow-up, forty-nine patients with IPAH and six patients with PAH-CHD died. Kaplan-Meier analyses showed better survival in PAH-CHD versus IPAH. After PAH-targeted therapy, patients with IPAH had less improvement in 6MWD, World Health Organization functional class, and RV functional parameters compared with patients with PAH-CHD. Conclusion: Compared with patients with PAH-CHD, patients with IPAH had worse baseline RV function, unfavourable prognosis, and inadequate response to targeted treatment.

Abstract 12518: Echocardiographic Features and Natural History of Right Ventricular Dysfunction in Cardiac Sarcoidosis With or Without Pulmonary Involvement

Introduction: Cardiac sarcoidosis (CS) is a non-ischemic disease which can present with right ventricular (RV) dysfunction, but there is a paucity of research describing RV function and natural history in CS. Methods: We queried a registry of 512 CS patients for those with baseline and follow-up echocardiography (TTE). Demographics, medications, and baseline/follow-up TTE data were collected. RV-pulmonary arterial (RV-PA) coupling was approximated by ratio of tricuspid annular plane systolic excursion to estimated pulmonary artery systolic pressure (TAPSE:ePASP). Results: Our query yielded 343 CS patients with mean age 56y (σ=12y), who were predominantly male (67%) and white (90%) with a median follow-up 4y (interquartile range 4.1y). Most had pulmonary sarcoidosis (68%). Baseline TTE data showed left ventricular ejection fraction 48% (σ=14), abnormal RV function with RV systolic pressure (ePASP) 34 mmHg (σ=11), TAPSE 21mm (σ=5), RV S′ 0.14 m/s (σ=0.07), and RV-PA uncoupling (TAPSE:ePASP 0.69 mm/mm Hg, σ=0.25). Baseline RV function parameters did not differ by pulmonary involvement of sarcoidosis. 92% received immunosuppression and 65% received neurohormonal blockade. In long-term follow-up, the overall cohort demonstrated a trend towards worsening of both RV S’ and RV-PA coupling (P=.02 and P=.003 for linear trend, respectively) but stable ePASP (P=.11). Trends in both non-invasive ePASP and RV-PA coupling were similar in patients with and without pulmonary involvement (P=.48 and P=.79, respectively). Conclusions: In our large CS cohort with extensive follow-up, metrics of RV function and RV-PA coupling are often abnormal at CS diagnosis. Echocardiographic measures of PASP tend to remain stable but markers of RV dysfunction, including RV-PA coupling, tend to worsen throughout the disease course irrespective of pulmonary sarcoidosis. More granular phenotyping of pulmonary hypertension in CS is required to better understand this relationship.

Evolution and clinical implications of right ventricular dysfunction in ischemic cardiomyopathy with or without coronary artery bypass surgery

Abstract Background The Surgical Treatment of Ischemic Heart Failure (STICH) trial demonstrated that coronary artery bypass grafting (CABG) provides additional survival benefits to patients with ischemic cardiomyopathy. However, it remains unclear whether this benefit is affected by preoperative right ventricular (RV) function and how post-therapeutic evolution of RV function influences long-term outcomes. Purpose We sought to investigate the implications of baseline RV function on therapeutic decision-making in patients with ischemic cardiomyopathy, and to evaluate the prognostic implications of post-therapeutic evolution of RV function. Methods Patients with available baseline echocardiographic RV function assessed by experienced Echocardiography Core Laboratory physicians were included from the hypothesis 1 of the STICH trial. The primary outcome was long-term all-cause mortality. Results A total of 1042 patients were included, among them 757 (72.7%) had normal RV function, 143 (13.7%) mild right ventricular dysfunction (RVD), and 142 (13.6%) moderate to severe RVD. After a median follow-up of 9.8 years, patients with RVD had a higher risk of all-cause mortality compared with patients with normal RV function [mild RVD: adjusted hazard ratio (aHR) 1.32; 95% confidence interval (CI) 1.06–1.64; moderate to severe RVD: aHR, 1.74; 95% CI 1.39–2.18]. Although no significant interaction was detected between RVD degree and treatment allocation (P for interaction = 0.399), a gradually decreasing survival benefit associated with CABG was observed among patients with normal RV function (aHR: 0.79; 95% CI: 0.65–0.96), mild RVD (aHR: 0.85; 95% CI: 0.56–1.29), and moderate to severe RVD (aHR: 0.97; 95% CI: 0.67–1.43). Among 746 patients with available RV function assessed at baseline and post-therapeutic 4-month follow-up, there was a gradient of increasing risk for all-cause mortality across patients with consistent normal RV function, recovery of RVD (aHR: 1.20; 95% CI: 0.88–1.64), newly developed RVD (aHR: 1.59; 95% CI: 1.18–2.14), and consistent RVD (aHR: 2.06; 95% CI: 1.60–2.67). Independent predictors of RVD recovery included baseline left ventricular ejection fraction (per 1-percent increment, adjusted odds ratio: 1.04; 95% CI: 1.00–1.09) and mitral regurgitation ≥ grade 2 (adjusted odds ratio: 0.42; 95% CI: 0.21–0.84). Conclusions Baseline RVD was associated with an increased risk of long-term mortality in patients with ischemic cardiomyopathy, and adding CABG to medical therapy might provide limited survival benefits in patients with moderate to severe RVD. A gradient of increasing risk for mortality was observed across different categories of RV function evolution, which emphasizes the necessity of pre- and post-therapeutic RV assessment for prognostic evaluation. Funding Acknowledgement Type of funding sources: None.

Right ventricular ejection fraction assessed by computed tomography in patients undergoing transcatheter tricuspid valve intervention

Abstract Background The role of right-ventricular (RV) function in patients with tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI) is poorly understood. Although cardiac computed tomography (CCT) provides elaborate three-dimensional (3D) visualization of the entire anatomy of the RV and theoretically allows to assess the global RV systolic function. Nevertheless, the utility of the functional assessments of the RV using CCT remains unclear in patients undergoing TTVI. Purpose This study investigated the association of right-ventricular ejection fraction (RVEF) assessed by CCT with clinical outcome in patients undergoing TTVI. Methods We retrospectively assessed 3D-RVEF by using pre-procedural CCT images in patients undergoing TTVI with either edge-to-edge repair or annuloplasty device. RV dysfunction (RVD) was defined as a CT-RVEF &amp;lt;45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within one year after TTVI. Results Of 157 patients, 58 (36.9%) presented with CT-RVEF &amp;lt;45%. Patients with CT-RVEF &amp;lt;45% were more likely to be male, to have a previous history of coronary artery disease, and had higher EuroSCORE II and a lower LVEF compared to those with CT-RVEF ≥45%, while the severity of TR was comparable between the groups. Among the patients with CT-RVEF &amp;lt;45%, acute procedural success was achieved in 93.1%, and in-hospital mortality was 1.7%, which were comparable to those with CT-RVEF ≥45%. Patients with CT-RVEF &amp;lt;45% had an improvement in New York Heart Association functional class at follow-up compared to baseline; however, CT-RVEF &amp;lt;45% was associated with a higher risk of the composite outcome (adjusted hazard ratio: 3.23; 95% confidence interval: 1.52–6.88; p=0.002) (Figure 1). Furthermore, CT-RVEF had an additional value to stratify the risk of the composite outcome beyond two-dimensional transthoracic echocardiographic (TTE) assessments (Figure 2). In addition, patients with CT-RVEF &amp;lt;45% exhibited an attenuated association between a reduction in TR to &amp;lt;3+ and a lower incidence of the composite outcome after TTVI compared to those with CT-RVEF ≥45%. Conclusions TTVI is safe and feasible regardless of baseline RV function, while RVD, defined as 3D-RVEF &amp;lt;45%, is associated with a higher risk of the composite outcomes within one year after TTVI. Furthermore, our findings suggest that the prognostic benefits of TR reduction might be attenuated in patients with RVD. Given the additional prognostic value of CT-RVEF to the conventional echocardiographic assessments, the assessments of 3D-RVEF with CCT may refine the patient selection for TTVI. Funding Acknowledgement Type of funding sources: None.

P237 INFLUENCE OF HEART RATE ON LEFT AND RIGHT VENTRICULAR LONGITUDINAL STRAIN IN PATIENTS WITH CHRONIC HEART FAILURE

Abstract Background Myocardial deformation evaluated by two–dimensional speckle tracking echocardiography (STE) is a useful tool to evaluate both left and right ventricular function. However, there are no conclusive data about the relationship between strain measures and heart rate (HR). Aim of the Study To analyse changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of HR in patients with and without chronic heart failure (CHF). Methods. We enrolled 45 patients. Of the 38 patients diagnosed with CHF, 21 were carrying an ICD (Group 1), and 17 an ICD with CRT (Group 2). Group 3 included 7 participants without CHF with sinus node dysfunction that were carrying a pacemaker. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR, together with other echocardiographic parameters. Worsening or improvement of strain measures was defined as a relative change from baseline of 10%. Results The reproducibility of strain measurements was assessed in all the images obtained at the different HRs for 19 of the study participants. A high degree of reproducibility was observed for LVGLS (ICC = 0.96; 95% CI, 0.93 – 0.97) as well as for RVGLS (ICC = 0.91; 95%CI, 0.86 – 0.94) and RVfwLS (ICC = 0.91; 95%CI, 0.85 – 0.94). When analysed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed (left panels of the figure). Patients with worsening of LVGLS (76% overall) were more likely to present lower baseline LV function and maximum relative changes of LVGLS correlated significantly with the E/e’ ratios (r = –0.56; p &amp;lt; 0.001). Only few patients (18% for RVGLS and 16% for RVfwLS) exhibited HR–related worsening of RV strain measures, which was associated with lower levels of baseline RV function and higher pulmonary systolic pressures. Finally, 21 (47%) and 25 (56%) of the participants responded with improvements in RVGLS and RVfwLS, respectively. Right panels of the figure show the trend of left and right measures in the different groups. Conclusions Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality at rest in patients diagnosed with CHF.

Influence of Heart Rate on Left and Right Ventricular Longitudinal Strain in Patients with Chronic Heart Failure

Over the past years, a number of studies have demonstrated the relevance of strain assessed by two-dimensional speckle tracking echocardiography (STE) in evaluating ventricular function. The aim of this study was to analyze changes in left (LV) and right ventricular (RV) longitudinal strain associated with variations of heart rate (HR) in participants with and without chronic heart failure (CHF). We enrolled 45 patients, 38 of these diagnosed with CHF and carrying an implantable cardioverter defibrillator, and seven patients with pacemakers and without CHF. The frequency of atrial stimulation was increased to 90 beats/min and an echocardiogram was performed at each increase of 10 beats/min. Global LV and RV longitudinal strain (LVGLS and RVGLS, respectively) and RV free wall longitudinal strain (RVfwLS) were calculated at each HR. When analyzed as continuous variables, significant reductions in LVGLS were detected at higher HRs, whereas improvements in both RVGLS and RVfwLS were observed. Patients with a worsening of LVGLS (76% overall) were more likely to present lower baseline LV function. Only a few patients (18% for RVGLS and 16% for RVfwLS) exhibited HR-related deteriorations of RV strain measures, which was associated with lower levels of baseline RV function and higher pulmonary systolic pressures. Finally, 21 (47%) and 25 (56%) participants responded with improvements in RVGLS and RVfwLS, respectively. Our findings revealed heterogeneous RV and LV responses to increases in HR. These findings might ultimately be used to optimize cardiac functionality in patients diagnosed with CHF.

Abstract 8898: Biventricular Function is Impaired in RV Septal Pacing - A Prospective Study Using Myocardial Strain Imaging

Introduction: Left ventricular (LV) dysfunction is observed after right ventricular (RV) pacing from both apical and septal positions. Hypothesis: The primary aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameter of speckle-tracking derived RV global longitudinal strain (RVGLS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (RV S’). Secondary aims included assessing the impact on LV function and the correlation of pacing burden with echocardiographic parameters. Methods: Thirty-two consecutive patients (mean age 75 ± 10 years) with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited at a tertiary hospital in Melbourne, Australia. 3 patients were excluded due to poor image quality. Echocardiography was performed prior to implantation, at 1-day, 1-month and 1-year post-implantation, with 29 patients completing follow-up. Results: Compared to 1-day post-implantation, at 1-year a significant decline was noted in mean RV S’ (15.1 to 12.2cm/s), TAPSE (24.2 to 21.9mm), RV GLS (-24.8 to -21.8%), LVEF (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p &lt;0.01. There was no change in RV FAC (49.1 to 46.9%). Fourteen patients (44%) required a high proportion of ventricular pacing, defined as ≥10% at 1 year. These patients had a greater deterioration in RVGLS (5.0 vs 1.0%) and LVGLS (4.6 vs 0.68%), p &lt;0.05. Changes in RV S’ (3.1 vs 2.7cm/s), TAPSE (1.5 vs 3.1mm), RV FAC (1.9 vs 5.64%) and LVEF (9.5 vs 5.6%) were not significantly different from those in patients with &lt;10% ventricular pacing. Conclusions: RV and LV systolic function declined in all patients after 1 year of RV septal pacing. Further, patients with a high burden of ventricular pacing had a larger deterioration in RVGLS and LVGLS. Myocardial strain may be more useful than conventional echo parameters in detecting RV and LV dysfunction associated with RV septal pacing.

Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study

BackgroundCOVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection.MethodsPatients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.ResultsFor the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P < .001), while patients with reduced LVEF at baseline (<50%) had a significant increase (42.5% ± 5.9% vs 49.3% ± 13.4%, P = .02), and those with normal LVEF had no change. Patients with normal LVLS (<−18%) at baseline had a significant reduction of LVLS at follow-up (−21.6% ± 2.6% vs −20.3% ± 4.0%, P = .006), while patients with impaired LVLS at baseline had a significant improvement at follow-up (−14.5% ± 2.9% vs −16.7% ± 5.2%, P < .001). Patients with abnormal RV global longitudinal strain (>−20%) at baseline had significant improvement at follow-up (−15.2% ± 3.4% vs −17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019).ConclusionsOverall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.

Prognostic value of galectin-3 and right ventricular function for long-term mortality in heart failure patients treated with cardiac resynchronization therapy

Recently, associations between the biomarker galectin-3 and numerous pathological processes involved in heart failure (HF) and right ventricular (RV) function have been observed. We aimed to assess the long-term prognostic ability of galectin-3 and RV function parameters for all-cause mortality in HF patients treated with cardiac resynchronization therapy (CRT). We prospectively studied 63 symptomatic HF patients with a left ventricular (LV) ejection fraction (EF) ≤ 35%. The median serum galectin-3 concentration was 13.4 ng/mL (IQR 11.05, 17.15). A detailed assessment of LV and RV geometry and function was performed with echocardiography. CRT defibrillator implantation was achieved in all patients without major complications. The follow-up lasted 5 years. In the multivariable Cox regression model, independent predictors for all-cause mortality were log baseline galectin-3 and baseline RV function expressed as tricuspid annular plane systolic excursion with HR 2.96 (p = 0.037) and HR 0.88 (p = 0.023), respectively. Analysis of subgroups defined by galectin-3 concentration and CRT response showed that patients with high baseline galectin-3 concentrations and a lack of response to CRT had a significantly lower probability of survival. In our patient cohort, the baseline galectin-3 concentration and RV function were independent predictors of long-term all-cause mortality in HFrEF patients following CRT implantation.

Impact of right ventricular function and ventriculo-arterial coupling in prognosis after percutaneous edge-to-edge mitral repair

Abstract Background Left ventricular systolic function is widely used as selection criteria for appropriateness of percutaneous edge-to-edge mitral repair in patients with significant mitral regurgitation (MR) and high surgical risk. Although right ventricular (RV) systolic function and ventriculo-arterial coupling (VAC) have demonstrated its relevance in heart failure prognosis as well, few data are available regarding this procedure. Purpose To study the value of baseline RV function and VAC determined by transthoracic echocardiogram (TTE) on imaging and clinical prognosis. Methods We evaluated all the consecutive patients in which a percutaneous mitral edge-to-edge repair with the MitraClip system was performed between 2010 and 2020 in our tertiary university hospital. Baseline RV function was considered depressed if TAPSE &amp;lt;16 mm, tissue Doppler S'&amp;lt;9.5 cm/s or fractional area change (FAC) &amp;lt;35% on TTE. VAC was calculated as ratio of TAPSE by pulmonary artery systolic pressure (PASP) from the same studies. Follow-up echocardiographic measurements were evaluated and clinical events were collected from medical records. Results We included 88 patients (64.8% males, 76±10 years) with MR grade ≥3. MR etiology was classified as functional 44.3%, organic in 35.2% and mixed in 20.5%. Previous to the procedure left ventricular systolic function was mildly depressed (LVEF 44.5±15.3%) and 33 patients (37.5%) showed an impaired RV systolic function. At 6 months TTE the prevalence of RV dysfunction lower to 27.3%. Patients with initial RV systolic dysfunction showed greater improvement in TAPSE (3.2 vs −0.53 mm; p=0.052) and FAC (8 vs 0.2%; p=0.016) at 6 months compared to those with normal baseline RV function. However, this variable was not associated with any relevant clinical event during the follow up. Baseline VAC demonstrated a significant inverse correlation with change in TAPSE (r −0.42; p=0.018), FAC (r −0.37; p=0.024) and S' (r −0.52; p=0.041) at 6 months. Among patients with initial RV impairment, VAC was lower in those who persisted with RV systolic dysfunction at 6 months (0.41 vs 0.49; p=0.054). Moreover, VAC was significantly associated with NYHA class ≥3 (0.48 vs 0.63; p=0.042) and cardiovascular hospitalization (0.53 vs 0.63; p=0.07), with a correlation with number of admissions (r −0.27; p=0.053). Conclusion In a percutaneous mitral edge-to-edge repair population previous presence of RV systolic dysfunction was not associated with clinical events during the follow up. Conversely, VAC was able to identify RV systolic function recovery and was associated with functional class and cardiovascular hospitalizations. Funding Acknowledgement Type of funding sources: None.

Study of correlation between 2D echocardiographic assessment of right ventricle and outcome of acute heart failure patients

BackgroundHospital length of stay (LOS) is a key determinant of heart failure hospitalization costs and performance of medical care quality. Right ventricular (RV) dysfunction predicted poor outcome in patients with acute heart failure (AHF). AimTo study the effect of right ventricular function on length of hospital stay as a predictor in patients with acute heart failure. MethodsA prospective cohort study was conducted in Cardiology Care Units (CCUs) in Zagazig University Hospital and Shark El Madina Hospital from September 2019 to February 2020, we included in this study 99 patients admitted with AHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) and S' velocity were collected. Clinical comorbidities including worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. ResultsThere was statistically significant correlation between WRF, right ventricular systolic dysfunction identified by TAPSE<16 mm and S' <9.5 cm/s and poor outcome in patients with acute heart failure including prolonged LOS. ConclusionRight ventricular (RV) systolic dysfunction as assessed by TAPSE and S' velocity and diastolic dysfunction were independent predictors of longer LOS in AHF patients. WRF had high prevalence among patients with AHF and associated with poor outcome in AHF patients and prolonged LOS.

The Impact of Right Ventricular Dysfunction on Length of Hospital Stay in Patients With Acute Heart Failure.

Background: Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs and performance of medical care quality. Right ventricular (RV) dysfunction predicted poor outcome in patients with acute heart failure (AHF). Aim: To study the effect of right ventricular function on length of hospital stay as a predictor in patients with acute heart failure. Methods: A prospective cohort study was conducted in CCUs in Zagazig University Hospital and Shark El Madina Hospital from September 2019 to February 2020, we included in this study 99 patients admitted with AHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) and S` velocity were collected. Clinical comorbidities including worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Results: There was significant correlation between WRF and poor outcome in patients with AHF including prolonged LOS. There is significant correlation between right ventricular systolic dysfunction identified by TAPSE

Right ventricular assessment in patients undergoing transcatheter or surgical aortic valve replacement

Transcatheter aortic valve replacement (TAVR) is an alternative treatment option to surgical aortic valve replacement (SAVR) in selected high-risk patients. In this study, we aimed to evaluate the prognostic value of right ventricular (RV) functional imaging to predict clinical response to TAVR and SAVR. One hundred and ten patients with symptomatic severe aortic valve stenosis (AVS) undergoing successful TAVR and 32 controls undergoing SAVR were prospectively enrolled. Six months follow up (FU) included two-dimensional (2D) transthoracic echocardiography (TTE) with RV deformation imaging. Baseline TTE showed no significant differences between groups (TAVR and SAVR) in conventional left ventricular (LV) and RV functional parameters (LV ejection fraction [LV-EF]: p = .21; tricuspidal annular plane systolic excursion [TAPSE]: 1.8 ± 0.5 cm, 1.9 ± 0.4 cm, p = .21), and RV strain (right ventricular-global longitudinal strain [RV-GLS] -11.6 ± 5.2%, -11.5 ± 6.5%, p = .70). At FU LV function was unchanged in both groups (p > .05); RV function was significantly improved after TAVR (RV-GLS: -11.6 ± 5.2%, -13.4 ± 6.1%, p = .005; TAPSE: 1.8 ± 0.5 cm, 1.9 ± 0.3 cm, p = .05), and worsened after SAVR (RV-GLS: -11.5 ± 6.5%, -8.9 ± 5.2%, p = .04; TAPSE: 1.9 ± 0.4 cm, 1.5 ± 0.3 cm, p < .001). Functional New York Heart Association (NYHA) class remained unchanged in patients after SAVR (p = .21), and improved after TAVR (p < .001). Baseline RV function was linked with clinical response to TAVR (TAPSE, p < .0001; RV-GLS, p = .04), and the development of RV-GLS was associated with functional worsening after SAVR (p = .05). Baseline RV function and changes of right heart mechanics are closely associated with functional improvements after AVR. SAVR, but not TAVR, seems to have detrimental effects on RV-function.

Relative Importance of Baseline and Longitudinal Evaluation in the Follow-Up of Vasodilator Therapy in Pulmonary Arterial Hypertension

ObjectivesThe aim of this study was to evaluate the relative value of baseline and follow-up echocardiographic assessment of pulmonary artery systolic pressure (PASP) and right ventricular (RV) function in assessing response to vasodilator therapy in pulmonary arterial hypertension (PAH). BackgroundRoutine follow-up of PASP and RV function is widely obtained in patients undergoing treatment for PAH, but the value of this reassessment is uncertain. MethodsOf 162 prospectively recruited patients with PAH, 96 were included in this analysis of patients with ≥3 sequential echocardiographic studies. PASP and RV function (including right ventricular free wall strain [RVFWS]) were measured at baseline and on follow-up 2-dimensional echocardiography. Univariate and multivariate Cox regression with nested models was used to determine incremental and independent predictors of all-cause mortality. ResultsChanges between visits were minimal for all parameters (RVFWS, p = 0.46; RV end diastolic area, p = 0.48; tricuspid annular plane systolic excursion, p = 0.32; PASP, p = 0.66; right atrial area, p = 0.39; and inferior vena cava, p = 0.25). Over 3 years of follow-up, 29 patients died. Baseline RVFWS was an independent predictor of outcome (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.83 to 0.97; p = 0.007), incremental to PASP and other clinical covariates (C statistic = 0.74, p = 0.001). Those who died showed no differences in RVFWS (p = 0.50), PASP (p = 0.90), and tricuspid annular plane systolic excursion (p = 0.83) between visits. When baseline measures and follow-up time were accounted for, mean changes in RVFWS (HR: 0.78; 95% CI: 0.63 to 0.96; p = 0.002), right atrial area (HR: 1.20; 95% CI: 1.07 to 1.40; p = 0.003), and inferior vena cava (HR: 66.5; 95% CI: 8.5 to 520.5; p < 0.001) over follow-up were significant in predicting outcome. ConclusionsIn PAH, baseline RV function (RVFWS) is a strong predictor of outcome, independent of PASP. Changes throughout therapy appear minimal, and only changes in RVFWS, inferior vena cava, size, and right atrial area were associated with outcome.

Interplay Between RV Function and CRT, Which One Affects the Other?

Background: Cardiac resynchronization therapy (CRT) is an established treatment of heart failure with reduced EF (HFrEF) and wide QRS complex. Nearly 30% of candidates are non-responders. One of the suggested mechanisms of inadequate response is the reduced baseline RV function; also the effect of CRT on right ventricular systolic function has not been well studied. We examined the effect of CRT on right ventricular (RV) dimensions and overall systolic function and whether RV function prior to CRT could have an impact on CRT response. Methods: 30 patients with a mean age of 51.9 ± 9.2 years including 9 (30%) females, with advanced HF (EF 120 ms, or non-LBBB > 150 ms, with NYHA class III or ambulatory class IV) were enrolled and underwent CRT implantation. Standard two dimensional (2D) echocardiography, tissue Doppler imaging, for assessment of Left ventricular (LV) end-diastolic (LVEDV), and end-systolic volumes (LVESV), ejection fraction, RV maximum basal (RVD1 basal), maximum mid (RVD2 mid) transverse, maximum longitudinal (RVD3 long) diameters, TAPSE, fractional area change (FAC), right ventricle index of myocardial performance(RIMP) and tricuspid lateral annular systolic velocity (S’), were done before CRT implantation and at the end of the follow up period (6 months). Patients presenting with reduction of LVESV of >15% were considered responders. Results: 20 (67%) cases were responders. Both groups were similar regarding demographic, clinical, ECG, and echocardiographic criteria at baseline however, the RA volume and RV transverse diameters were smaller and systolic function parameters were significantly better in the responders group prior to CRT compared to non-responders (NR) group. At the end of the follow up, only the responders group had further significant reduction in RV basal, mid and longitudinal diameters together with significant improvement in RV systolic function, in contrast to non-responders group who showed more RV dilatation and more decline of RV systolic function, compared to baseline readings(with P value 40 % has 85% sensitivity and 90 % specificity (P value= 0.004). TAPSE of >20 mm has 85% sensitivity and 80 % specificity (P value=0.002), S' of >10 cm/s % has 85% sensitivity and 70 % specificity (P value=0.001) and RIMP of <0.52 has 85% sensitivity and 70 % specificity (P value=0.003) in predicting CRT response. Conclusions: CRT induces RV reverse remodeling and improves RV systolic function particularly in cardiac volumetric responders. RV systolic dysfunction before CRT implantation could identify patients that might not benefit from CRT thus helping proper patient selection and optimizing CRT response.

The Short-Term Effect of Right Ventricular Mid-septal Pacing on Right Ventricular Function

Background: Right ventricular (RV) apical pacing is associated with left ventricular (LV) dyssynchrony and dysfunction. However, the effect of pacing on RV function, in particular with leads positioned in the RV mid-septum, remains unknown. We investigated the short-term effect of pacing on RV function Methods: We enrolled 24 patients with normal baseline LV and RV function requiring permanent pacemaker insertion. Echocardiography was performed prior to implantation (baseline) and at 1 month. We assessed RV tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue Doppler-derived systolic velocity (S’), RV fractional area change (FAC) and RV global longitudinal strain (GLS) using speckle tracking Results: Mean age was 73.8 ± 9.5 years. 1-month percent ventricular pacing average was 32% (range 0-100%). 17 patients had atrioventricular nodal dysfunction and 7 had sick sinus syndrome. There was a small but statistically significant decline in RV GLS 1 month following pacemaker insertion(Table). There was also a trend towards decline of RV function on all other measured parameters. Conclusions: RV mid-septal pacing may be associated with a slight decline of RV function early after pacemaker insertion, which may be identified by strain analysis. Longer-term follow-up is under way to assess if this predicts long-term RV dysfunction.

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study.

The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes.

Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome. Peripartum cardiomyopathy patients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.

Meta-Analysis of the Relation of Baseline Right Ventricular Function to Response to Cardiac Resynchronization Therapy

Right ventricular (RV) dysfunction has been associated with adverse clinical outcomes in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) improves left ventricular (LV) size and function in patients with markedly abnormal electrocardiogram QRS duration. However, relation of baseline RV function with response to CRT has not been well described. In this study, we aim to investigate the relation of baseline RV function with response to CRT as assessed by change in LV ejection fraction (EF). A systematic search of studies published from 1966 to May 31, 2015 was conducted using PubMed, CINAHL, Cochrane CENTRAL, and the Web of Science databases. Studies were included if they have reported (1) parameters of baseline RV function (tricuspid annular plane systolic excursion [TAPSE] or RVEF or RV basal strain or RV fractional area change [FAC]) and (2) LVEF before and after CRT. Random-effects metaregression was used to evaluate the effect of baseline RV function parameters and change in LVEF. Sixteen studies (n= 1,764) were selected for final analysis. Random-effects metaregression analysis showed no significant association between the magnitude of the difference in EF before and after CRT with baseline TAPSE (β = 0.005, p = 0.989); baseline RVEF (β = 0.270, p = 0.493); baseline RVFAC (β=-0.367, p = 0.06); baseline basal strain (β=-0.342, p= 0.462) after a mean follow-up period of 10.5months. In conclusion, baseline RV function as assessed by TAPSE, FAC, basal strain, or RVEF does not determine response to CRT as assessed by change in LVEF.