Fractional Area Change Values Research Articles

Prognostic value of right ventricular free wall strain in patients with sepsis.

Right ventricular systolic dysfunction (RVSD) in patients with sepsis is an area of growing interest, but its prognostic significance remains unclear and additional tools are needed to improve our understanding. Right ventricular free wall strain (RV-FWS) is a relatively new parameter to assess RV function. This study aimed to investigate the potential correlation between impaired RV-FWS and prognostic outcomes in patients with sepsis. We prospectively assessed right ventricular function in patients with sepsis within the initial 24 h of their hospital admission. RV-FWS, right ventricular global strain (RV-GS), fractional area change (FAC), and tricuspid annular plane systolic excursion (TAPSE) were examined. RVSD was defined as impaired RV-FWS. Moreover, the association between RVSD and 30-day mortality rate was assessed. This study included 89 patients. Among them, 27 (30.3%) succumbed to their illness within 30 days. The nonsurviving patients demonstrated significantly lower absolute RV-FWS (-19.7% ± 2.4% vs. -21.1% ± 2.1%, P = 0.008) and RV-GS (-17.7% ± 1.2% vs. -18.4% ± 1.4%, P = 0.032) values than the surviving patients. However, TAPSE and FAC values were not significantly different between the two groups. The optimal cutoff values for RV-FWS, RV-GS, FAC, and TAPSE were -19.0%, -17.9%, 36.5%, and 1.55 cm, respectively. Kaplan-Meier survival curves revealed that patients with impaired RV-FWS and RV-GS demonstrated lower 30-day survival rates, and the predictive performance of RV-FWS (hazard ratio [HR]: 3.97, 95% confidence interval [CI]: 1.85-8.51, P < 0.001) was slightly higher than FAC and TAPSE. However, multivariable Cox regression analysis revealed no association between impaired RV-FWS and mortality outcomes (HR: 1.85, 95% CI: 0.56-6.14, P = 0.316). Impaired RV-FWS is not associated with short-term mortality outcomes, and RV strain imaging is of limited value in assessing the prognosis of sepsis.

Tricuspid Annular Plane Systolic Excursion (TAPSE) for the Assessment of Right Ventricular Function in Adult and Pediatric Cardiac Surgery: Modified Two-dimensional and M-mode TAPSE by Transesophageal Echocardiography Compared to M-mode TAPSE by Transthoracic Echocardiography

To compare transesophageal echocardiography-guided 2-dimensional and M-mode tricuspid annular plane systolic excursion (TAPSE) to transthoracic echocardiography (TTE)-guided M-mode TAPSE in terms of accuracy, interobserver, and intra-observer variability. A prospective, observational study. Adult and pediatric operating rooms. Adult and pediatric patients (42 each) undergoing cardiac surgeries. None. Modified midesophageal (Mod-ME), deep transgastric, and transgastric TAPSEs were analyzed for reliability and were compared to TTE TAPSE in both adult and pediatric groups. Modified ME TAPSE showed good method agreement with TTE TAPSE (bias=-0.97, p=0.08 (adult); bias=0.17, p=0.71 [pediatric]), and showed a moderate correlation with right ventricular (RV) fractional area change (FAC) (r=0.41, p=0.006, [adult]; r=0.57, p < 0.001, [pediatric]), with acceptable interobserver variability (percentage error =10.56 [adult]; 4.42 [pediatric]) and intraobserver variability (percentage error=13.1 [adults]; 12.24 [pediatric]). Transgastric TAPSE poorly agreed with TTE TAPSE and had higher interobserver and intraobserver variability. Deep transgastric TAPSE had good method agreement with TTE TAPSE and had acceptable interobserver and intra-observer variability. Modified ME TAPSE is a reliable and reproducible measure of RV function before pericardiotomy in both adult and pediatric cardiac surgery. Right ventricular FAC values reflected the RV systolic function better than TAPSE after pericardiotomy. Deep transgastric TAPSE is reliable and reproducible but is less accurate than Mod-ME TAPSE.

Right Ventricular Subclinical Dysfunction in SLE Patients Correlates with Metabolomic Fingerprint and Organ Damage.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease, and several studies have suggested possible early RV involvement. Aim of the study was to evaluate the 3D echo parameters of the right ventricle (RV) and the metabolomic profile to correlate both with SLE severity. Forty SLE patients, free of cardiovascular disease, were enrolled and the following 3D parameters were evaluated: the RV ejection fraction (RV-EF), longitudinal strain of the interventricular septum (Septal LS), longitudinal strain of the free wall (Free-LS) and the fractional area change (FAC). In addition, a metabolomic analysis was performed. Direct correlations were observed between TAPSE values and the RV 3D parameters. Then, when splitting the population according to the SDI value, it was found that patients with higher cumulative damage (≥3) had significantly lower FAC, RV-EF, Septal LS, and Free-LS values; the latter three parameters showed a significant correlation with the metabolic profile of the patients. Furthermore, the division based on SDI values identified different metabolic profiles related to the degree of RV dysfunction. The RV dysfunction induced by the chronic inflammatory state present in SLE can be identified early by 3D echocardiography. Its severity seems to be related to systemic organ damage and the results associated with a specific metabolic fingerprint constituted by 2,4-dihydroxybutyric acid, 3,4-dihydroxybutyric acid, citric acid, glucose, glutamine, glycine, linoleic acid, oleic acid, phosphate, urea, and valine.

Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy

BackgroundRight ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker.MethodsRetrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model.Results98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (−21.6 ± 6.6% vs −31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%.ConclusionsIn NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

Validation of an artificial intelligence-based tool for automated evaluation of RV size and function from ultrasound examinations

Funding AcknowledgementsType of funding sources: Private company. Main funding source(s): Study sponsored by DiA Imaging AnalysisBackground The assessment of the right ventricular (RV) function is an essential part of every transthoracic echocardiographic examination. It plays an important role in the diagnosis and management of many diseases and conditions. In covid-19 patients, there is evidence showing that enlarged RV and abnormal Free Wall Strain (FWS) correlate with high mortality. Assessment of the RV in the Point of Care settings can assist the differential diagnosis and provide important clinical information in early stages, close to the onset of symptoms, however, it is done qualitatively by visual estimation and thus subjective and requires high level of expertise. The presented study aims to validate the use of a novel artificial intelligence tool (LVivo RV by DiA imaging analysis) that uses deep learning and image processing algorithms to automatically evaluate RV size and function from apical 4 chamber (4CH) focused or modified ultrasound clips.Methods A retrospective study of 100 patients who underwent routine echocardiographic examination was conducted in three medical centers in US and Israel. The apical 4CH focused or modified clips were interpreted by experts to evaluate RV size and function. The End Diastolic Area (EDA) measured manually by two sonographers and the FWS measured by semi-automated Velocity Vector Imaging software (VVI by Siemens) were compared to the same parameters obtained automatically by the LVivo RV, using linear regression and Bland Altman analysis.Results 100 cases were included, 39% females and 61% males. Mean age was 64.7 [19-92]. Mean BMI was 28.1 [6.8-17.6]. 74% had pulmonary hypertension and 19% had lung disease. 36% were considered abnormal by their fractional area change values and 64% were considered normal. Three cases were non-interpretable by the physicians thus excluded from the analysis. The LVivo RV was able to process 99% of the cases. Excellent correlation was obtained for EDA between the sonographers" average of manual measurements and the automated EDA by LVivo RV with r = 0.92 (p < 0.0001, 95%CI 0.88-0.94). The bias and limits of agreement for EDA were 0.87 ± 5.76cm^2. For FWS, 4 cases were manually excluded due to insufficient image quality. The Bland Altman analysis for FWS showed small bias and limits of agreement of 0.7 ± 12.2%. A very good correlation of r= 0.78, (95% CI 0.69-0.85) was found, indicating good compatibility between the methods. The specificity and sensitivity for FWS were 80% and 77% respectively, using an optimal cutoff value of -16%, and the overall agreement was 79%.Conclusions The performance of LVivo RV demonstrated a very good agreement with manual and semi-automated quantitative methods for RV assessment. LVivo RV provides fast, accurate, objective and reproducible results and has the potential to be used at the Point of Care settings as a powerful tool for RV size and function evaluation. Figure.

Systemic right ventricle in elderly patients with congenitally corrected transposition of the great arteries: Clinical profile, cardiac biomarkers, and echocardiographic parameters.

Objective:The number of patients with congenitally corrected transposition of the great arteries (ccTGA) surviving to old age is increasing. This study therefore sought to characterize “geriatric” systemic right ventricle (sRV) in terms of clinical profile, cardiac biomarkers, and echocardiography-derived function when compared with findings in younger patients.Methods:A single-center cross-sectional study of adults with ccTGA was performed. Patients underwent clinical assessment; transthoracic echocardiography; and venous blood sampling including N-terminal pro–B-type natriuretic peptide (NTproBNP), galectin-3, and soluble suppression of tumorgenicity 2 (sST2) measurements. In the echocardiographic study, the sRV function was assessed using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), systolic pulsed-wave Doppler velocity (s′), and longitudinal strain (LS).Results:Ten patients with ccTGA aged 60 years or older and 53 patients younger than 60 years of age were included. There were significantly more individuals with hypertension (40% vs. 5.7%), dyslipidaemia (50% vs. 5.7%), and atrial fibrillation (70% vs. 20.7%) in the older group; similarly, we found higher NTproBNP (2706 pg/mL vs. 784.7 pg/mL; p<0.001), and galectin-3 (10.15 ng/mL vs. 7.24 ng/mL; p=0.007) concentrations in elderly ccTGA individuals, while sST2 content did not vary significantly according to age. Upon echocardiographic assessment, lower sRV FAC (28.6% vs. 36.1%; p=0.028) and LS (−12% vs. −15.5%; p=0.017) values were observed in patients aged 60 years or older. TAPSE and s’ did not differ between the age groups.Conclusion:Careful screening for acquired comorbidities, particularly atrial fibrillation, in elderly ccTGA patients is warranted. Examining selected cardiac biomarkers and echocardiography-derived parameters are useful in the assessment of the aging sRV.

Echocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation Patients and Comparison With Normal Control Subjects

Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population. A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects. Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P<.0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P<.0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P<.0001). Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population.

Value of Semiquantitative Assessment of Right Ventricular Systolic Function with A Modified Subcostal Echocardiographic View

Background: the assessment of right ventricular function (RVF) is an important component of routine echocardiography study. Tricuspid annular plane systolic excursion (TAPSE) is easy and validated method of RVF but in many patients, this method may be difficult to apply due to inadequate apical window. So, we proposed that Subcostal Echocardiographic assessment of Tricuspid annular Kick (SEATAK) could be comparable to TAPSE. Aims of the study: they were to assess of RVF with a new arising method SEATAK, to determine the sensitivity & specificity of SEATAK and correlation between SEATAK & TAPSE with the degree of RVF. Patients and Methods: this study included 100 consecutive patients presented to our echocardiography lab with different clinical indications. Right ventricular function was assessed by the following parameters: RV Myocardial Performance Index (RIMP), TAPSE, Peak Systolic velocity of right ventricular basal free wall by TDI (TASVTDI), SEATAK and Fractional Area Change (FAC) as reference method for RVF assessment. Results: according to RVF using FAC, the patient were classified into 2groups,group with FAC ≥35% and other with FAC <35%. There was a significant statistical difference between both study groups according to TAPSE (cm), SEATAK (cm), P-Value ˂0.05. SEATAK was significantly correlated with TAPSE, TASV-TDI, and FAC values. SEATAK cutoff value ≥1.60 cm has the highest combined sensitivity and specificity of 86% &67% respectively for normal RVF (FAC ≥35%). Positive& negative predictive values are 72% &83%, respectively. Area under the curve equals 0.79, P-Value < 0.001. Conclusion: SEATAK is correlated with TAPSE, TASV-TDI & FAC for evaluation of RVF with cut-off value of SEATAK for prediction of normal RVF is ≥1.60 with sensitivity and specificity of 86% &67% respectively

The effects of urgent percutaneous coronary intervention on right ventricular systolic functions in non-ST-elevation acute coronary syndromes.

Although the importance of the right ventricle (RV) involvement has been known for many years in patients with ST-elevation myocardial infarction (STEMI), it is scarce in non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to investigate the effects of urgent percutaneous coronary intervention (PCI) on the RV systolic functions in patients with NSTE-ACS. Ninety-five patients diagnosed with NSTE-ACS and who underwent urgent PCI were prospectively investigated. RV systolic functions were analyzed and compared before and after PCI in all patients by using RV index of myocardial performance (RIMP), tricuspid annular plane systolic excursion (TAPSE), two-dimensional (2D) RV fractional area change (FAC), and isovolumic acceleration (IVA) parameters with transthoracic echocardiography. Among 95 NSTE-ACS patients, 31 had impaired RIMP, 13 had impaired TAPSE, 8 had decreased 2D FAC, and 32 had impaired IVA values at baseline. There was a significant increase in 2D FAC and IVA values after PCI. The right ventricular functions may also be affected in patients with NSTE-ACS, and urgent PCI has a significant effect on the recovery of right ventricular systolic functions in patients with NSTE-ACS.

High-Dose Insulin Administration Improves Left Ventricular Function After Coronary Artery Bypass Graft Surgery

To test the hypothesis that the intravenous administration of high doses of insulin while maintaining normoglycemia (GIN therapy) improves myocardial function after coronary artery bypass graft (CABG) surgery. A prospective, randomized clinical trial. A university hospital. Forty patients undergoing elective CABG surgery. Patients were randomized to the GIN or control group. Applying the principles of the hyperinsulinemic-normoglycemic clamp technique in the GIN group, insulin was administered at 5 mU/kg/min during surgery. Glucose 20% was infused at a rate adjusted to maintain blood glucose (BG) between 4.0 and 6.0 mmol/L. Patients in the control group received insulin on a sliding scale, also aiming at normoglycemia. Systemic hemodynamic parameters included heart rate, mean arterial pressure, pulmonary artery wedge pressure, vascular resistance index, and cardiac index (CI). Left ventricular function was assessed by transesophageal echocardiography using the myocardial performance index (MPI) as a parameter of global left ventricular function, the fractional area change (FAC) for systolic function, and flow propagation velocity for diastolic function before and after surgery. All patients receiving GIN therapy were hyperinsulinemic (3,474 ± 1,204 pmol/L) and normoglycemic, showing a lower mean BG concentration (4.9 ± 0.5 mmol/L) than patients in the control group (8.2 ± 2.0 mmol/L). Patients receiving GIN therapy had an increased CI after surgery compared with the control group (p = 0.005). The GIN therapy was associated with improved MPI and FAC values when compared with standard care. Also, there was no difference in the parameters indicating left ventricular diastolic function. Intraoperative GIN therapy improves global and systolic left ventricular function after CABG surgery.

Preserved left ventricular structure and function in mice with cardiac sympathetic hyperinnervation

Cardiac-specific overexpression of nerve growth factor (NGF), a neurotrophin, leads to sympathetic hyperinnervation of heart. As a consequence, adverse functional changes that occur after chronically enhanced sympathoadrenergic stimulation of heart might develop in this model. However, NGF also facilitates synaptic transmission and norepinephrine uptake, effects that would be expected to restrain such deleterious outcomes. To test this, we examined 5- to 6-mo-old transgenic (TG) mice that overexpress NGF in heart and their wild-type (WT) littermates using echocardiography, invasive catheterization, histology, and catecholamine assays. In TG mice, hypertrophy of the right ventricle was evident (+67%), but the left ventricle was only mildly affected (+17%). Left ventricular (LV) fractional shortening and fractional area change values as indicated by echocardiography were similar between the two groups. Catheterization experiments revealed that LV +/-dP/dt values were comparable between TG and WT mice and responded similarly upon isoproterenol stimulation, which indicates lack of beta-adrenergic receptor dysfunction. Although norepinephrine levels in TG LV tissue were approximately twofold those of WT tissue, TG plasma levels of the neuronal norepinephrine metabolite dihydroxyphenylglycol were fivefold those of WT plasma. A greater neuronal uptake activity was also observed in TG LV tissue. In conclusion, overexpression of NGF in heart leads to sympathetic hyperinnervation that is not associated with detrimental effects on LV performance and is likely due to concomitantly enhanced norepinephrine neuronal uptake.