Global Longitudinal Strain Free Wall Research Articles

Evolution and prognostic relevance of right ventricular morphofunctional parameters in patients undergoing isolated tricuspid valve surgery

Abstract Background Right ventricular (RV) function is key in evolution after isolated tricuspid valve surgery (ITVS). Right ventricular-pulmonary artery coupling (RV-PA coupling), determined with echocardiography as the ratio TAPSE/sPAP, has merged as a relevant functional parameter in many clinical scenarios. Purpose Our aim is to evaluate the prognostic relevance of RV-PA coupling in patients undergoing ITVS. Methods We carried out a retrospective study involving all the patients undergoing ITVS at our tertiary centre. Several RV function measurements were assessed from the baseline echocardiogram (TAPSE, fractional area change (FAC), systolic pulmonary artery pressure (sPAP), tricuspid annulus tissue Doppler velocity (RVS´) and free-wall global longitudinal strain (FW-GLS)) and RV-PA coupling was calculated. Association between RV morphofunctional variables and mortality during one year follow-up was determined. Results 45 patients were included (68 years-old, 51,1% female). The most common TR etiology was functional (51.1%) and 42.2% had previous left-sided valvular surgery. The median Tri-Score was 2 (1-4) points and the most frequent procedure was biological valve replacement (65%). Baseline echocardiographic parameters were as follows: basal 52 (48 – 53.5) mm, mid 40 (36-45.5) mm and longitudinal 73 (68-80) RV diameters, TAPSE 18.1 (15.5-20.7) mm, RVS´ 10.1 (9-12.5) cm/s, FAC 0.5 (0.43-0.57), sPAP 35 (31.5-37.5) mmHg, and FW-GLS - 21.1 (17.2-25) %. During the follow-up 8 (18%) patients died. Solely TAPSE (16 vs 19, p= 0.047) and RV-PA coupling (0.35 vs 0.5; p= 0.035) showed significant differences in mortality among RV echocardiographic parameters. An RV-PA coupling <0.375 mm/mmHg appeared to be the best mortality predictor (RR 1.45; p= 0.04) one year after the intervention (Figure). Conclusions In our series RV-PA coupling has proved to be the best echocardiographic prognostic factor in ITVS, so it could be considered a relevant parameter in risk stratification previous to this surgery. Figure. Kaplan Meier curves of mortality after ITVS by RV-PA coupling.Figure

Echocardiographic two-dimensional strain evaluation of right ventricular function in healthy adults

Objective: To explore the feasibility of using two-dimensional speckle tracking echocardiography for measuring right ventricular strain and function in healthy adults, and to analyze the impact of age and gender. Methods: This study is a cross-sectional study. Healthy adults who underwent physical examination in the Physical Examination Center of Beijing Hospital from January 1, 2020 to January 1, 2021 were included. Two researchers independently measured various right ventricular longitudinal strain indices using the Echopac software, including (global longitudinal strain (GLS), apical longitudinal strain (ALS), midventricle longitudinal strain (MLS), basal longitudinal strain (BLS), free wall GLS (FWGLS), free wall ALS (FWALS), free wall MLS (FWMLS) and free wall BLS (FWBLS)) as well as tricuspid annular plane systolic excursion (TAPSE) and right ventricle-fraction of area change (RVFAC). The above indicators were taken as the average of two physicians. The consistency of the measurements by two physicians was evaluated by the within-group correlation coefficient (ICC). Results: A total of 233 subjects were included, including 137 males, aged (58.5±14.2) years. ICC values was all above 0.8 with excellent agreement. The values of FWGLS and GLS in healthy adults were -26.63% and -21.89%, respectively. There was no statistically significant difference in TAPSE ((2.06±0.41)cm vs. (2.10±0.39)cm, P=0.510) and RVFAC ((51.17±9.91)% vs. (50.89±8.65)%, P=0.826) between males and females. The values of various right ventricular long axis strain indicators (GLS, ALS, MLS, BLS, FWGLS, FWMLS, FWMLS, FWBLS) in females aged 18 to 40 and 41 to 65 years were higher than those in males of the same age (all P<0.05), while there was no statistically significant difference in the values of various right ventricular long axis strain indicators between the sexes in subjects aged 65 years and above (all P>0.05). In females, the right ventricular GLS, ALS, MLS, FWGLS, FWALS, FWMLS, and FWBLS values in the groups aged 18 to 40 and 41 to 65 years were significantly higher than those in the group aged 65 years and above (all P<0.05). In contrast, no significant differences were found in these indices among different age groups in males (all P>0.05). Conclusions: Using two-dimensional speckle tracking technology in echocardiography to measure right ventricular strain indicators is feasible and highly reproducible. Gender and age have an impact on right ventricular strain indicators.

Cardiac Structural and Functional Remodeling After Transcatheter Mitral Valve in Valve Implantation: Early Changes and Prognostic Significance

BackgroundTranscatheter mitral valve-in-valve (MViV) replacement has emerged as an alternative to redo mitral valve (MV) surgery for the management of failed bioprosthetic MVs. The degree of cardiac remodeling assessed by echocardiography has been shown to have prognostic implications in degenerative mitral regurgitation patients undergoing MV surgery. The impact of transcatheter MViV in patients with degenerative bioprosthetic MV failure on cardiac remodeling and its associated prognosis remains undescribed. ObjectivesThe aim of this study is to describe the early anatomic and functional changes of the left-sided chambers and right ventricle by echocardiography posttranscatheter MViV intervention and their impact on mortality outcomes. Additionally, we sought to analyze the outcome of heart failure in bioprosthetic MV failure patients undergoing transcatheter MViV replacement. MethodsWe analyzed consecutive patients undergoing MViV intervention for symptomatic bioprosthetic MV failure. Echocardiograms before intervention and within 100 days postintervention were analyzed. A chart review was performed to obtain baseline characteristics, follow-up visits, 30-day heart failure and 1-year all-cause mortality outcomes. ResultsA total of 62 patients (mean age 69 ± 13 years, 61% male) were included in the study. Most patients were undergoing MViV intervention for prosthetic mitral stenosis n = 48 (77.4%) and the rest for mitral regurgitation or mixed disease. Compared with baseline, significant reductions were observed in median left atrial volume (LAV; 103 [81–129] ml vs. 95.2 [74.5–117.5] ml, p < 0.01) and mean (SD) left atrial conduit strain (9.1% ± 5.2% vs. 10.8% ± 4.8%, p = 0.039) within 100 days postintervention. Early reduction in right ventricular free wall global longitudinal strain and fractional area change also occurred postintervention. No significant change in left ventricular chamber dimensions or ejection fraction was observed. During the 1-year follow up period, 5 (8%) patients died. While baseline LAV was not associated with 1-year all-cause mortality (OR 0.98 CI 0.95–1.01; p = 0.27), a change in LAV in the follow up period was associated with all-cause mortality at 1 year (OR 1.06 CI 1.01–1.12; p = 0.023). At 30 days postintervention, 65% of patients had an improvement in their New York Heart Association functional class. ConclusionIn this retrospective study of patients undergoing transcatheter MViV intervention for failed bioprosthetic MVs, early reverse remodeling of the left atrium occurs within 100 days postintervention and reduction in LAV is associated with reduced all-cause mortality at 1 year. In addition, there is significant improvement in heart failure symptoms at 30 days following intervention but further investigation into the longitudinal remodeling changes and long-term outcomes is needed.

The effect of iron deficiency on RV function in acute decompensated heart failure patients

Abstract Background Iron deficiency is a major problem in heart failure (HF) patients. Although the negative impact of iron deficiency on left ventricular (LV) function is known, the effect on right ventricle function (RV) is unclear. In this study we aimed to investigate the effect of iron deficiency on RV function. Material and Methods A hundred patients hospitalized with acute decompensated HF (ADHF) regardless of LV ejection fraction (LVEF) were included in our study. The primary outcome was association between iron deficiency and TAPSE, RVEF, RV FAC, and RV TDI S’. The secondary outcome was impact of iron deficiency on RV free wall global longitudinal strain (GLS). Results The mean age of study population was 70±10 years-old and 64% were male. The prevalence of hypertension (HT), diabetes mellitus (DM), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) was 80%, 52%, 71%, and 18%, respectively. While the median LVEF was 35%, the proportion of patients with reduced EF (HFrEF), mildly-reduced EF (HFmrEF), and preserved EF (HFpEF) was 66%, 6% and 28%, respectively. On transthoracic echocardiography the median TAPSE was 16.4 mm, the mean FAC %37,2±7.8, the mean RV GLS %-16.4±5.1, and the mean RV TDI S’ was 10.6±2,9 cm per second. More than half of the patients (58%) had iron deficiency. There was no difference between patients with or without iron deficiency on neither demographics nor LVEF, RV FAC, RV TDI S’ and systolic pulmonary artery pressure (sPAP). The TAPSE (15.6 vs 17.2 mm, p = 0.05) and RV free wall GLS (-14.7% vs -18.2%, p = 0.005) was lower in HF patient with iron deficiency. Anemia was present in 56% of the patients and both TAPSE (15.3 vs 17.3 mm, p = 0.01) and RV GLS (-14.7% vs -18.6%, p = 0.01) were lower in patients with anemia. Conclusion RV dysfunction accompanying LV dysfunction adversely affects the prognosis. In patients with ADHF, iron deficiency causes subclinical RV dysfunction namely decreased RV free wall GLS before the right ventricle systolic functions parameters commonly used on echocardiography (RVEF, TAPSE, RV FAC, RV TDI S’) in daily practice deteriorate. In conclusion, screening for iron deficiency in HF patients facilitates early detection and treatment of iron deficiency which prevents RV dysfunction with iron replacement.Table 1Table 2

Resting RV-PA uncoupling as predictor of exercise induced pulmonary hypertension in patients with chronic thromboembolic pulmonary disease

Abstract Background and aim Chronic thromboembolic disease (CTED) refers to the presence of chronic thrombotic pulmonary vascular occlusion in the absence of pulmonary hypertension (PH) at rest but with exercise limitation caused by established vasculopathy. Symptoms after an acute pulmonary embolism (PE) with persistent lung perfusion defects need a complete diagnostic approach. Screening these symptomatic patients with resting echocardiography (echo) is challenging. The aim of this study is to analyze the echocardiographic predictors at rest of exercise induced PH (ex-PH) in patients with suspected CTED. Methods Symptomatic patients with confirmed perfusion defects in lung V/Q scintigraphy despite optimal anticoagulant therapy for at least 3 months after an acute PE were selected. Structural heart disease or pulmonary disease were excluded. Relevant PH at rest was ruled-out (mPAP &amp;lt;25 mmHg, PVR &amp;lt;3 Wu, PAWP &amp;lt;15 mmHg according to available definition at the time). A right heart catheterization with incremental exercise protocol (cycle ergometer), and simultaneous transthoracic echo were performed. Hemodynamic and echo parameters were collected at each exercise level. A mPAP/CO slope &amp;gt;3 mmHg·L−1·min−1 was considered an abnormal hemodynamic response to exercise. Right V-PA coupling was estimated as TAPSE/sPAP and RV free wall global longitudinal strain (RV-GLS)/sPSP ratios. Results 31 patients (32% women, mean age 51.8 ± 14.7 y) were included. Fourteen patients (45%) developed ex-PH. Baseline characteristics according to invasive hemodynamic response are shown in Table 1. Resting RV function (TAPSE and RV-GLS), but not size, was significatively impaired in the ex-PH cohort. Resting echo sPAP or TR max velocity did not achieve any difference between groups, although invasive sPAP did. Resting TAPSE/sPAP and RV-GLS/sPAP were significantly reduced in the ex-PH group. In ROC curve, resting TAPSE/sPAP showed an AUC 0.75 (CI 95% 0.56-0.95) to predict ex- PH. A cutoff point of &amp;lt;0.62 mm/mmHg at rest, showed a S 88% / E 71%, PPV 78.9 % and NPV 83.3%. Resting RV-GLS/sPAP ratio showed an AUC 0.859 (CI 95% 0.708 – 0.990) to predict ex- PH. A cutoff point of &amp;gt; - 0.67 %/mmHg, showed a S 75.0% / E 87.5%, PPV 78.2 % and NPV 82.4%. to predict ex- PH. Conclusions Exercise limitation appears to be attributable to ex-PH in up to 45% of symptomatic patients with persistent pulmonary thrombosis after a PE without relevant PH at rest. Echo derived parameters at rest, surrogates of RV-PA uncoupling, such as TAPSE/sPAP and RV-GLS/sPAP, could be of great interest to identify patients with abnormal hemodynamic response to exercise, and help in the initial non invasive diagnostic workup of these increasingly group of patients.ROC curvesTable 1Resting Echo values

Wpływ treningu i biegu półmaratońskiego na prawą komorę u biegaczy amatorów

Introduction. Endurance running may lead to heart remodelling. There are little data on the right ventricular (RV) changes in amateur athletes running shorter than marathon distances. The study aimed to investigate whether training and running a half marathon affect the anatomy and function of the RV in amateur runners and whether these changes affect the athlete’s competitive performance. Material and methods. The study included 45 recreational runners with a mean age of 32.96 (5.12) years, 27 men. Echocardiography was performed before the ten-weeks training period and before and after the half marathon run. The morphological and functional parameters of the RV were analysed, including two-dimensional, Doppler and speckle-tracking echocardiography. Results. In training period, the RV outflow tract (27.98 [5.46] vs. 30.07 [4.90]; p = 0.003) and the RV index of myocardial performance (0.36 [0.29; 0.45] vs. 0.39 [0.33; 0.52]; p = 0.017) increased significantly and no changes were found for E/e’. After the half marathon run, the absolute value of the RV free wall global longitudinal strain increased significantly (–25.89 [3.08] vs. –27.20 [3.42]; p = 0.008). Athletes who trained more intensively during the training period achieved significantly better half marathon results (r = –0.4; p ≤ 0.05). Conclusions. More enhanced physiological RV remodelling under exercise in amateur athletes results in better half marathon finishing times. The preparation period and 21.0975 kilometres run do not affect the diastolic function of the RV in recreational runners. The RV systolic function improves immediately after the half marathon performance.

Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study.

Sacubitril/valsartan was demonstrated to reduce hospitalization rate and mortality in patients with heart failure with reduced ejection fraction. Data on the effects of sacubitril/valsartan in patients with a systemic right ventricle are still lacking. Patients with transposition of the great arteries following Senning/Mustard procedure or congenitally corrected transposition of the great arteries with impaired systemic right ventricle systolic function were prospectively included. Primary end points included sacubitril/valsartan safety and efficacy. Primary efficacy end points were NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic function improvement. Secondary end points included New York Heart Association class, 6-minute walking distance, and quality of life change. Fifty patients (38±12 years, 60% male, 35% congenitally corrected transposition of the great arteries) were included and followed for 1 year. No major adverse events occurred. Two (4%) patients ceased treatment due to hypotension and 1 (2%) developed a nephrotic syndrome. The target dose was reached in 20 (42%) patients. NT-proBNP values decreased significantly immediately after treatment initiation, while returned to baseline at 1 year. Echocardiography showed progressive fractional area change increase (29.2±5.8 versus 34.9±5.1%; P<0.001), and right ventricle global longitudinal strain (-13.9 [-15.1, -11.8] versus -15.3 [-17.2, -13.4]%; P<0.001) and free-wall global longitudinal strain (-14.3 [-17.3, -12.3] versus -17.2 [-19.3, -15.8]%; P<0.001) raise, whereas tricuspid regurgitation severity improved only in transposition of the great arteries patients (P=0.006). Moreover, 3-dimensional echocardiography demonstrated right ventricle volumes reduction (end-diastolic volume: 181±63 versus 156±50 mL; P=0.002; end-systolic volume: 117±48 versus 89±33 mL; P<0.001), and significantly increased systemic right ventricle ejection fraction (35.6±8.1 versus 41.5±7.5%; P<0.001). Clinical improvement was suggested by New York Heart Association class change (P<0.001), increased 6-minute walking distance (425 [333, 480] versus 500 [443, 560] m; P<0.001) as well as improved quality of life at 1-year follow-up. Beneficial effects were observed irrespective of the underlying anatomy and were more pronounced in those on target dose. Our data showed that sacubitril/valsartan is well tolerated and is associated with systemic right ventricle remodeling and improved systolic function as well as improved clinical status, supporting its use in this complex population.

Unsuspected Subclinical Left Ventricular Dysfunction in Post-COVID Patients: A Real-world Observation.

Subclinical myocardial dysfunction may exist in post-COVID-19 patients and may carry significance in long term. Subjects of long-COVID-19 with historically and radiologically significant pulmonary involvement (without documented cardiac involvement) were evaluated on outpatient follow-up echocardiographically when they had disproportionate shortness of breath (SOB), fatigue, or high pulse rate as perceived by the physicians. The common acute-phase symptoms were noted and scored retrospectively. The assessment included spirometry and measurement of chronic obstructive pulmonary disease (COPD) assessment test (CAT) score with measurement of the left ventricular (LV) and right ventricular (RV) free wall global longitudinal strain as an adjunct to routine two-dimensional and Doppler echocardiography and spirometry. The results were evaluated statistically with respect to the history of hospitalization. The hospitalized (n = 15) and nonhospitalized (n = 10) patients were demographically similar. However, the nonhospitalized patients had higher total symptom score (p = 0.03), anosmia (p = 0.017), and ageusia (p = 0.0019). At follow-up (&gt;3 months of acute illness), the nonhospitalized patients had a better CAT score (p = 0.04), higher change in max pulse rate (p = 0.03), and higher forced expiratory volume in 1 second (FEV1) (p = 0.002), tricuspid annular plane systolic excursion (TAPSE) (p = 0.02), and left ventricular global longitudinal strain (LVGLS) (-17.15 ± 1.19 vs -13.11 ± 1.91) (p = 0.0001). Overall, the two groups formed distinct clusters. The LVGLS and the maximum pulse rate difference in the two chair test (2CT) seem to contribute maximally to the variance between the two groups in multivariate analysis. The subclinical myocardial dysfunction persisting in post-COVID patients (without suspected cardiac affection and lower neuroinflammatory symptoms in the acute phase) with significant pulmonary affection needs further evaluation. They demonstrate a higher max pulse rate difference in the 2CT. This real-world observation demands further investigations.

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure.

AimThe severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF.MethodsA total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR.ResultsA total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)].ConclusionWith cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.

Cardiac function is normal in most patients recovered from COVID-19

Abstract Background There are conflicting results regarding impaired cardiac function in patients that have recovered from COVID-19. Cardiovascular magnetic resonance (CMR) studies have revealed a very high frequency of cardiac involvement (78%) and ongoing myocardial inflammation (60%) in patients recently recovered from COVID-19. Findings are advocating further investigation of the long-term myocardial consequences of COVID-19 disease. Purpose We aimed to investigate left ventricular (LV) and right ventricular (RV) function by a comprehensive echocardiographic study in patients recovered from COVID-19 infection 3 months after admission to hospital. Methods All patients (n=92) had been hospitalized for COVID-19 and were examined with echocardiography three months after hospitalization. They were 59±13 years, and 43% were women. LV function was assessed by ejection fraction (EF) and global longitudinal strain (GLS) and RV function was measured by fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and RV GLS free wall. Tricuspid regurgitation pressure gradient was measured to estimate pulmonary artery pressure. Results LV EF was 63±6% and LV GLS was −18.6±2.2%. All patients had normal EF &amp;gt;53%, but 10 showed signs of subtle impaired LV function by LV GLS (≥ −16%). Only two of these did not have hypertension, LV hypertrophy, diabetes or other preexisting diagnosis of heart disease explaining subtle LV dysfunction. All had normal RV FAC (48±7%) and TAPSE (2.3±0.3 cm). We found modestly impaired RV longitudinal function (RV GLS free wall &amp;gt;−25%) in 30% patients, but none had RV GLS worse than −20%. One-third of all patients with reduced RV GLS had signs of elevated pulmonary arterial pressures, which might impact the assessment of RV function. Conclusions Traditional echocardiographic parameters showed normal function in all hospitalized COVID-19 patients three months after hospital admittance. Approximately one-third had subtle ventricular dysfunction detected by sensitive echocardiographic methods, but these findings could mostly be explained by systemic or pulmonary hypertension. We cannot, however, exclude that a slight reduction in cardiac function in a minority of our patients was caused by the COVID-19 infection. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): National Clinical Therapy Research in the Specialist Health Services, Norway

Non invasive ventilation and right ventricle function in cardiogenic pulmonary edema: an echocardiographic perspective to select the "right" ventilatory support

Abstract Funding Acknowledgements Type of funding sources: None. Background High-flow nasal cannulae oxygen therapy (HFNCOT) represents a better tolerated alternative to non-invasive pressure support ventilation (NIPSV) for acute cardiogenic pulmonary edema (ACPE) treatment. However, there are still few data on the effect of HFNCOT on cardiac function and hemodynamic. Purpose To assess and compare the effects of NIPSV and HFNCOT in ACPE setting on right ventricular (RV) systolic function and on indices of cardiac filling and output, as measured by echocardiography. Methods This is a cross-over controlled study, enrolling 15 consecutive patients admitted to our Cardiovascular Intensive Care Unit for ACPE and hypoxaemic, normo/hypocapnic acute respiratory failure, with P/F ratio &amp;lt; 200. Each patient received NIPSV, followed by HFNCOT. Full echocardiographic assessment and blood gas analysis (BGA) were performed 40 minutes from onset of each ventilation modality, respectively before NIPSV to HFNCOT switch and before HFNCOT interruption. In particular, RV function parameters, together with RV and atrial strain, were prospectively collected. Results In spite of not significant changes in BGA, RV function was significantly improved under HFNCOT, as compared to NIPSV, as assessed by the following parameters: tricuspid annular plane excursion (TAPSE) (P = 0.001), RV S’ wave (P = 0.007), RV fractional area change (RVFAC) (P = 0.006). Strain analysis confirmed the significant improvement in RV function, with free wall global longitudinal strain (GLS) and free wall and septum GLS significantly higher under HFNCOT, as compared to NIPSV (-21% vs -18% P &amp;lt; 0.001, and -15% vs -19% P = 0.008, respectively,), and a significant increase in right atrial positive longitudinal strain (P &amp;lt; 0.001). Conclusions NIPSV significantly affect RV function making more complex the management of patients presenting with ACPE. In this setting, HFNCOT represents a valuable alternative, providing similar respiratory outcomes while preserving good right ventricle performance.

The acute effects of an ultramarathon on biventricular function and ventricular arrhythmias in master athletes.

Endurance sports practice has significantly increased over the last decades, with a growing proportion of participants older than 40 years. Although the benefits of moderate regular exercise are well known, concerns exist regarding the potential negative effects induced by extreme endurance sport. The aim of this study was to analyse the acute effects of an ultramarathon race on the electrocardiogram (ECG), biventricular function, and ventricular arrhythmias in a population of master athletes. Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and at the end of the race. The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, R-wave amplitude in V1 and QTc duration were higher after the race (P < 0.001). Exercise-induced isolated premature ventricular beats were observed in 7% of athletes; none showed non-sustained ventricular tachycardia before or during the race. Left ventricular ejection fraction, global longitudinal strain (GLS), and twisting did not significantly differ before and after the race. After the race, no significant differences were found in right ventricular inflow and outflow tract dimensions, fractional area change, s', and free wall GLS. In master endurance athletes running an ultra-marathon, exercise-induced ventricular dysfunction, or relevant ventricular arrhythmias was not detected. These results did not confirm the hypothesis of a detrimental acute effect of strenuous exercise on the heart.

Assessment of right ventricular systolic function by tissue motion annular displacement in healthy dogs

Introduction/objectivesThere are few parameters for assessment of right ventricular (RV) systolic function on echocardiographic examination. Morphofunctional studies are limited by the irregular shape of the RV. Recently, tissue motion annular displacement (TMAD), a technique that evaluates valve annulus displacement toward the cardiac apex, has shown a good correlation with left ventricular global longitudinal strain (GLS) in healthy dogs. Therefore, the aim of this study was to evaluate the longitudinal systolic function of the RV of healthy dogs using TMAD. AnimalsA hundred healthy client-owned dogs. Materials and methodsCross-sectional study. Physical examination, electrocardiogram, blood pressure measurement, and echocardiography were recorded. The systolic function of the RV was evaluated by GLS free wall and TMAD. Data were compared with those derived from conventional echocardiography. ResultsTMAD values varied according to body weight. There was a correlation of TMAD in millimeters with all indices of RV systolic function, including GLS free wall (R:-0.239; p:0.017). TMAD had a correlation with age and heart rate; whereas there was no relationship with sex and blood pressure. The coefficient of variation for the intraobserver evaluation was lower for the TMAD in millimeters (9.9%) compared with the GLS free wall (17.9%). In addition, the mean time to perform TMAD (8.1 s) was lower than that of the GLS free wall (37.7 s). ConclusionsTMAD is a fast, reproducible, and promising method for assessing RV systolic function in healthy dogs. However, further studies are needed to understand the applicability of this technique in patients with heart disease.

Contribution of Speckle Tracking to Estimation of Pulmonary Hypertension by Standard Doppler Echocardiography in Patients with Systemic Sclerosis and MCTD

Objectives: Development of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) represents one of the most serious complications. The study aimed at assessing right ventricular (RV) global longitudinal strain and its relation to pulmonary artery pressure. Methods: Echocardiography was performed in 74 patients of whom 60 had SSc and 14 had mixed connective tissue disease (MCTD). Besides routine left and right ventricle assessment and pulmonary pressure estimation by Doppler echocardiography, RV fractional area change (FAC) and 2D strain of the RV free wall were evaluated. At the same time, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin T and auto-antibodies were measured and all patients had diffusing capacity of the lung for carbon monoxide (DLCO) determined. All patients with probable PAH underwent right heart catheterization. Results: Pulmonary hypertension was found to be unlikely in 59 patients (79.7%), possible in 10 patients (13.5%) and probable in 5 patients (6.7%). Significant associations were found between pulmonary artery systolic pressure (PASP) and RV free wall global longitudinal strain (r=0.292; p=0.023), between PASP and NT-proBNP (r=0.436; p=0.001) and between PASP and FAC (r=0.320; p=0.005). Pulmonary artery systolic pressure did not correlate with left ventricular systolic or diastolic function parameters in this cohort. Conclusion: Speckle tracking of the RV represents a useful additional tool in RV assessment in relation to PH in SSc and MCTD patients; right heart catheterization remains an essential method for PAH confirmation.

Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Speckle-tracking echocardiographic study.

Systemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE. A total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE. Although left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S') were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (- 18.5 ± 4.9 % vs. - 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: - 0.416, p = 0.018 and r: - 0.383, p = 0.031, respectively). The use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.