Evaluation Of Right Ventricular Performance Research Articles

Right ventricular global dysfunction score: a new concept of right ventricular function assessment in patients with heart failure with reduced ejection fraction (HFrEF).

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

Cover Image, Volume 5, Issue 6

The cover image is based on the Research Article Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study by Vishal V. Bhende et al., https://doi.org/10.1002/hsr2.909.

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.

Evaluation of Right Ventricular Performance in Ischemic Patients with or without Significant Right Coronary Artery Disease

Evaluation of Right Ventricular Performance in Ischemic Patients with or without Significant Right Coronary Artery Disease

Evaluation of right ventricular performance and impact of continuous positive airway pressure therapy in patients with obstructive sleep apnea living at high altitude

Obstructive sleep apnea syndrome (OSAS) can lead to alterations in right ventricular (RV) performance and pulmonary vascular haemodynamics. Additionally, altitude-related hypoxia is associated with pulmonary vasoconstriction, and the effect of high-altitude on the pulmonary circulation in OSAS patients can be further altered. We sought to assess alterations in RV morphology and function in OSAS patients living at high altitude by way of 2-dimensional speckle tracking echocardiography (2D-STE), real-time 3- dimensional echocardiography (RT-3DE) and cardiac biomarkers. We also evaluate the impact of continuous positive airway pressure (CPAP) treatment on RV performance. Seventy-one patients with newly diagnosed OSAS and thirty-one controls were included in this study. All individuals were assessed for cardiac biomarkers as well as underwent 2D-STE and RT-3DE. Forty-five OSAS patients underwent CPAP therapy for at least 24 weeks and were studied before and after CPAP treatment. RT-3DE was used to measure RV volume, and calculate RV 3D ejection fraction (3D RVEF). Peak systolic strain was determined. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide, and cardiac troponin T were also measured. Right atrium volume index, RV volume, RV volume index, systolic pulmonary artery pressure (sPAP), pulmonary vascular resistance (PVR) and level of serum CRP were significantly higher in OSAS group, while OSAS patients showed lower 3D RVEF and RV longitudinal strains. Compared to the patients with sPAP < 40 mmHg, RV longitudinal strains in patients with sPAP ≥ 40 mmHg were lower. Both RV global longitudinal strain and sPAP were associated with apnea–hypopnea index. Patients treated with 6 months of CPAP therapy had significant improvement in RV geometry and performance. RV structural abnormalities and RV function impairments were observed in OSAS patients living at moderate high altitude compared to control highlanders. The reversibility of these changes after application of CPAP were further confirmed.

A Novel Method for Evaluation of Right Ventricular Performance during Left Ventricular Assist Device Implantation

Left ventricular assist devices (LVAD) are utilized in patients diagnosed with advanced heart failure. Right ventricular (RV) failure can affect up to 20% of patients undergoing LVAD implantation. In this case study, we evaluated perioperative RV performance with simultaneous use of Swan-Ganz catheterization and high-fidelity conductance catheters to generate real time RV pressure- volume (PV) loops. A 75- year old male patient undergoing LVAD implantation was chosen for evaluation. A high-fidelity conductance catheter was advanced into the RV. The catheter was removed on postoperative day one. Data obtained from the catheter were used to evaluate RV work, contractility, diastolic function, and compliance. These results were compared to standard measurements of the patient's clinical status and biventricular performance. Consent and IRB approval was obtained as part of an ongoing study. The patient developed RV dysfunction in the immediate perioperative period, as demonstrated by increasing central venous pressure to pulmonary artery pressure ratio, decreased cardiac index, and evidence of elevated filling pressures by echocardiogram. Using a high-fidelity catheter, we demonstrated a uniform reduction in preload recruitable stroke work and Starling contractile index on postoperative day one. Pressure-volume loops initially demonstrated appropriate ventricular unloading, however RV dysfunction was exposed with changes in loading conditions over time (figure 1). Pressure-volume loop analysis represents a novel method for evaluation of RV performance during LVAD implantation. Compared to standard monitoring, PV loops provide increased granularity in understanding RV function.

Right Ventricular Response During Exercise in Patients with Chronic Obstructive Pulmonary Disease.

Right ventricular (RV) pump function is of essential clinical and prognostic importance in a variety of heart and lung diseases. While the evaluation of RV performance at rest has been implemented in the clinical setting, it is unknown whether this assessment during exercise may provide additional benefit. With this aim, we evaluated the exercise-induced pulmonary arterial systolic pressure (PASP) increase during exercise in patients with severe chronic obstructive pulmonary disease (COPD) as an expression of RV contractile reserve. Cardiopulmonary exercise testing (CPET) with synchronic echocardiography was performed in 81 patients. Patients were classified into two groups according to an exercise-induced PASP increase above 30mmHg (High PSAP) or below 30mmHg (Low PSAP) during maximal exercise. Patients were then followed for three years. Sixteen patients (20%) had low PSAP and 65 (80%) showed high PSAP. These were not significant clinical and functional differences. Low PSAP was associated with a significantly lower peak VO2 (mean (SD), 35 (2) % predicted) compared to high PSAP response (peak VO2 45 (3) % predicted), p=0.045. Factors associated with mortality were age and exercise-induced PASP. Seventeen patients died during the three years of follow-up (7 (39%) in the low PSAP group and only 10 (1%) in the high PSAP group, p=0.041). Cardiopulmonary exercise testing with a synchronic echocardiography may be a useful tool for the assessment of RV contractile reserve in severe COPD patients. Exercise-induced PSAP emerges as a possible prognostic factor in these patients.

Utility of Tricuspid Annular Plane Systolic Excursion, Tricuspid Annular Peak Systolic Velocity, and Speckle Tracking Echocardiography in the Evaluation of Right Ventricular Performance in Acute Respiratory Distress Syndrome

Utility of Tricuspid Annular Plane Systolic Excursion, Tricuspid Annular Peak Systolic Velocity, and Speckle Tracking Echocardiography in the Evaluation of Right Ventricular Performance in Acute Respiratory Distress Syndrome

A Novel Bilayer Approach to Ventricular Septal Deformation Analysis by Speckle Tracking Imaging in Children with Right Ventricular Overload

The aim of this study was to evaluate functional differences between the left and right sides of the ventricular septum in children with right ventricular overload. Radial, longitudinal, and circumferential strain on both sides of the ventricular septum were compared using speckle-tracking echocardiography in patients with preoperative atrial septal defects (n= 22), postoperative tetralogy of Fallot (n= 23) and age-matched normal controls (n= 44). The duration between peak strain of the left and right ventricular septum (TLt-Rt) was also evaluated. Radial and circumferential strain in the control group were significantly higher on the left than the right ventricular septum (41.3 ± 12.8% vs 22.6 ± 6.8% and -28.0 ± 5.4% vs -22.5 ± 4.8%, respectively; P < .0001 for both), whereas longitudinal strain did not significantly differ (-22.0 ± 4.9% and -20.7 ± 5.2%, respectively). TLt-Rt was 52.9 ± 35.6, 33.4 ± 29.0, and 38.7 ± 31.0 msec for radial, longitudinal, and circumferential strain, respectively. Longitudinal and circumferential strain on both sides were significantly increased in patients with atrial septal defects compared with controls (P < .05), although radial strain was similar on both sides. Radial strain on the right side was significantly increased in patients with tetralogy of Fallot compared with controls (P < .05), whereas that on the left side was significantly reduced (P < .001). Longitudinal strain on both sides was significantly decreased (P < .01 and P < .001 for the left and right sides, respectively). In addition, TLt-Rt in patients with tetralogy of Fallot was significantly increased with radial and circumferential deformation (P < .05 for both). Deformation of both sides of the ventricular septum functionally differed. Bilayer analysis of theventricular septum can help in the evaluation of right ventricular performance under volume and pressure overload.

Utility of Right Ventricular Free Wall Speckle-Tracking Strain for Evaluation of Right Ventricular Performance in Patients with Pulmonary Hypertension

The objectives of this study were to test the utility of right ventricular (RV) speckle-tracking strain as an assessment tool for RV function in patients with pulmonary hypertension (PH) compared with conventional echocardiographic parameters and to investigate the relationship of the findings obtained with RV speckle-tracking strain with the hemodynamic parameters of RV performance. Forty-five prospective consecutive patients with PH were studied. RV free wall longitudinal speckle-tracking strain (RV-free) and RV septal wall longitudinal speckle-tracking strain (RV-septal) were calculated by averaging each of three regional peak systolic strains along the entire right ventricle. The conventional echocardiographic parameters-RV fractional area change, RV myocardial performance index, tricuspid annular plane systolic excursion, and tricuspid annular peak systolic velocity-were also studied. For comparison, 22 age-matched volunteers with normal ejection fractions were studied. RV-free in patients with PH was significantly lower than that in normal controls, but RV-septal in the two groups was similar. Importantly, multivariate analysis revealed that RV-free was an independent echocardiographic predictor of hemodynamic RV performance items, including mean pulmonary artery pressure (β=-0.844, P= .001) and pulmonary vascular resistance (β= -0.045, P < .001). RV-free was also correlated with RV ejection fraction and RV end-systolic volume measured by cardiac magnetic resonance imaging and with 6-min walking distance (r= 0.60, r= 0.56, and r= 0.49, respectively, P < .05). Furthermore, the improvement in RV-free 5 ± 3 months after adding medical treatment was significantly correlated with that in 6-min walking distance (r= 0.68, P < .0001). RV-free has the potential to allow for noninvasive follow-up of patients with PH.

Cardiac resynchronization therapy: relevance of right ventricular function evaluation

Heart failure constitutes one of the major public health problems with an incidence that approaches 10 per 1000 population after 65 years of age.1 The majority of clinical trials have focused mostly on left ventricular (LV) failure and have led to established therapeutic approaches that are included in the current guidelines.2,3 In contrast, right ventricular (RV) failure is poorly understood and its therapeutic management is largely empirical. Chronic LV failure is the most frequent cause of RV dysfunction.4 Importantly, the presence of RV dysfunction is a strong and independent predictor of mortality in patients with chronic LV heart failure.5,6 Therefore, routine evaluation of RV performance in patients with LV heart failure is mandatory in order to refine the therapeutic management of these patients. Cardiac resynchronization therapy (CRT) is an established treatment for patients with chronic LV heart failure. By restoring the atrio-, inter-, and intra-ventricular synchronicity, CRT improves LV diastolic filling, increases LV stroke volume, decreases mitral regurgitation, and induces favourable LV reverse remodelling.7,8 In addition, several studies have shown a significant improvement in RV dimensions and function after CRT.9,10 Finally, this improvement in both LV and RV performance leads to improved survival of heart failure patients treated with CRT.8,11 The mid- and long-term response to CRT is influenced by several pathophysiological factors. Left ventricular dyssynchrony, extent … *Corresponding author. Tel: +31 71 526 2020; fax: +31 71 526 6809, Email: j.j.bax{at}lumc.nl

Pressure-volume loops: feasible for the evaluation of right ventricular function in an experimental model of acute pulmonary regurgitation?

Pressure-volume loop measurements by cardiac catheterization constitute a highly reliable method for the direct beat-to-beat functional analysis of the heart. We aimed to prove its feasibility for the instantaneous evaluation of right ventricular performance in a novel experimental model of pulmonary regurgitation (PR). Four-month-old sheep (n=18, weighing 35-45 kg) were operated via left anterior thoracotomy. A transannular patch (TAP) was sutured to the right ventricular outflow tract (RVOT). Pulmonary valve annulus was transsected through an incision over the patch without the need for cardiopulmonary bypass. Baseline right ventricular function was obtained by inserting conductance catheters through the pulmonary artery before and immediately after surgical induction of PR. All animals survived. Pressure-volume loop analysis presented immediate significant elevations in pressure and volume loading of the right ventricle. Maximum developed pressure incremented from 26.9+/-1.1 mmHg to 30.5+/-0.9 mmHg (P<0.01). End-diastolic volume [62.4+/-3.4-102.7+/-8.6 ml (P<0.01)] increased as well. Peak rate of pressure rise increased during ejection phase, and heart rate rose from 427.1+/-21.4 mmHg/s to 492.6+/-24.7 mmHg/s (P<0.01) and from 89.0+/-3.0/min to 93.0+/-3.3/min (P=0.04), respectively. Right ventricular ejection fraction decreased from 74.1+/-2.7% to 56.6+/-3.0% (P<0.01). Our results demonstrate that the conductance catheter method is feasible for the evaluation of acute right ventricular volume overload in this new model of PR with TAP augmentation of RVOT.

233 Comprehensive evaluation of right ventricular performance by tissue Doppler echocardiography in first acute myocardial infarction. The role of ventricular interdependence

233 Comprehensive evaluation of right ventricular performance by tissue Doppler echocardiography in first acute myocardial infarction. The role of ventricular interdependence

The evaluation of right ventricular performance in different clinical models of heart failure

To evaluate the role of right ventricular function in different clinical models of heart failure. 22 patients with pulmonary hypertension (PH) in WHO class III and IV (group A) were evaluated by echocardiography, brain natriuretic peptide (BNP) measurements and right heart catheterization at baseline and after a mean follow-up of 15±4 months. 63 patients with chronic heart failure of different etiology, NYHA class IIIb–IV, followed-up for 18±3 months (group B), underwent echocardiography, BNP measurements, right heart catheterization at study entry and follow-up. In group A patients, among hemodynamic parameters consistent with severe PH, right atrial pressure significantly increased (from 6.7±4.8 to 10±6.5 mmHg, p<0.01); BNP showed a negative correlation with right ventricular ejection fraction (r2=0.46). In group B, mean left and right ventricular (thermodilution) ejection fraction (RVEF) were 21±7% and 18±9%; BNP showed significant correlations with pulmonary wedge pressure (r=0.48, p=0.02) and right ventricular function indices (RVEF and tricuspidal annular plane systolic excursion). A multiparametric right ventricular evaluation is useful even if several diagnostic and prognostic variables which were investigated in this study are not likely to show the same prognostic role in right and biventricular models of heart failure.

Right ventricular ejection fraction in the preoperative risk evaluation of candidates for pulmonary resection

The major determinants of postoperative morbidity and mortality after lung resection are the physiologic and functional statuses of the pulmonary and cardiac systems. In our previous study, serial measurements of right ventricular performance after pulmonary resection demonstrated significant right ventricular dysfunction in the postoperative period. This study evaluates the preoperative measurement of right ventricular ejection fraction as a predictor of postoperative complications. In addition to conventional cardiopulmonary functional tests, right ventricular function was assessed with a thermodilution technique at rest and during exercise in 18 patients before and 3 weeks after lobectomy or pneumonectomy. The patients were grouped according to severity of right ventricular functional defect: right ventricular ejection fraction of at least 45% (group Ia, n = 8), right ventricular ejection fraction less than 45% (group Ib, n = 10), exercise-induced increases in right ventricular ejection fraction (group IIa, n = 8), and exercise-induced decreases in right ventricular ejection fraction (group IIb, n = 10). Postoperative cardiopulmonary morbidity was recorded for two patients (25%) in group Ia, three patients (30%) in group Ib, no patients (0%) in group IIa, and five patients (50%) in group IIb. Postoperative hospital stay was 28.9 ± 8.5 days in group Ia, 29.9 ± 20.2 days in group Ib, 19.4 ± 8.0 days in group IIa, and 37.5 ± 15.9 days in group IIb ( p < 0.05, group IIa vs group IIb). Although resection-induced changes in forced expiratory volume in 1 second did not differ significantly between group Ia and group Ib, these values appeared to be increased in groups IIa (not statistically significant) and IIb (significantly, p < 0.05). The measured postoperative values of forced expiratory volume in 1 second and vital capacity were significantly higher than the predicted postoperative values ( p < 0.05) in group IIa, but not in groups Ia, Ib, and IIb. We conclude that evaluation of right ventricular performance is useful in determining which patients are at increased risk for medical complications after lung resection. Exercise-induced change in right ventricular ejection fraction may be a better indicator of high risk among candidates for pulmonary resection than the absolute value of this parameter. (J T horac C ardiovasc S urg 1996;112:364-70)

Assessment of right heart function

Growing recognition of the contribution of right heart function to cardiac output in a variety of pathologic conditions lends a new outlook to cardiac assessment, especially when cardiac output is inadequate for physiologic needs. Signs and symptoms of right heart dysfunction made by physical assessment can be validated by radiologic techniques as well as a newly available bedside method of thermodilution determination of right ventricular ejection fraction and right ventricular end-diastolic and end-systolic volumes. Assessment of right ventricular function can aid clinical decision making when pressure readings obtained by usual hemodynamic monitoring techniques are altered by changes in intrathoracic pressure or ventricular compliance. This article reviews physical assessment of right heart function, signs and symptoms of right heart dysfunction, radiographic evaluations and their limitations and introduces the thermodilution evaluation of right ventricular performance. Clinical examples are presented to illustrate the utility of this new technique along with selected nursing diagnoses and outcome criteria.

Bedside evaluation of right ventricular performance using a rapid computerized thermodilution method.

In 34 patients, we assessed the reproducibility and accuracy of a new, computerized, thermodilution method that determines right ventricular ejection fraction (RVEF). We compared the results from this new algorithm with simultaneous results from the conventional plateau thermodilution method and from both first-pass and gated nuclear techniques. Using this new method improved the reproducibility of thermal determinations of RVEF. Although the thermal values were lower, the correlations between thermal and nuclear measurements were close [r = .92 (first-pass technique), r = .81 (gated technique)]. This new method seems particularly appropriate for serial monitoring of RV performance.

Right ventricular function.

A review was made of 69 cases manifesting congestive right-side heart failure among 1, 910 cases who had undergone cardiac catheterization at the Department of Pediatrics, Tenri Hospital. Hemodynamic and angiographic studies were made in 32 cases which had undergone corrective surgery of tetralogy of Fallot at ages between l to 14 more than 2 years earlier. The circulatory responses to exercise were also studied in 21 patients to evaluate the pumping performance of the heart. Although all patients but 2 with operatively corrected tetralogy of Follot are quite asymptomatic, there were elevations of RVEDP noted despite the absence significant residual pulmonary stenosis at rest. In addition, patients revealed abnormal hemodynamic response to exercise. It was also noted that among patients with residual pulmonary stenosis a large systolic pressure gradient across the right ventricular outflow tract appeared during exercise. In addition to the evaluation of residual pulmonary stenosis by routine catheterization, the clinical importance of the evaluation of right ventricular performance in response to exercise following operative correction of tetralogy of Fallot was identified as an essential feature in long-term medical management.