Independent Predictor Of Right Ventricular Dysfunction Research Articles

Association between CHA2DS2-VASc Score and Right Ventricular Dysfunction in Patients with Acute Pulmonary Embolism

Background: Acute right ventricular dysfunction (RVD) is a leading cause of death in the setting of acute pulmonary embolism (PE). Therefore, several studies investigated the predisposing factors of RVD. However, at present, little is known about the clinical predictors of RVD in the patients presented with acute PE.
 Objective: To assess the association of CHA2DS2-VASc Score with the PE severity, RVD and the in-hospital mortality in patients presented with acute PE.
 Methods: This study was conducted on 50 patients admitted with acute PE at Tanta University Hospitals. We studied the association of different variables including demographic data, common risk factors, clinical presentation, management and the in-hospital mortality with the PE clinical subgroups (massive, sub-massive and non-massive) based on the severity of clinical presentation and also the association of these variables with the thromboembolic risk (high, moderate and low) based on the CHA2DS2-VASc scores. The independent predictors of the RVD were then investigated by the univariate and multivariate regression analyses.
 Results: The massive PE presentation was associated with higher CHA2DS2-VASc scores (P value = 0.02). Also, the incidence of RVD was higher among the high risk group of patients (CHA2DS2-VASc scores ≥3) with P value = 0.009. TAPSE, MPI, FAC, and E`/A` ratio were found to be more significant in the high risk group (P value = 0.032, 0.002, 0.007 and 0.001), respectively. The independent predictors of RVD were demonstrated to be tachycardia, lower systolic blood pressure and CHA2DS2-VASc score (P value = 0.022, 0.007, 0.021), respectively. The CHA2DS2-VASc score predicted the presence of RVD with 66.7 % sensitivity and 78.6% specificity as demonstrated by the receiver operating characteristic (ROC) analysis, with area under the curve (AUC) of 0.776 (CI 0.636-0.882, P value < 0.001). This study demonstrated no statistically significant difference between the different risk groups regarding the in-hospital mortality.
 Conclusion: Being independent of other factors, the CHA2DS2-VASc score can be used as a new, simple, and reliable tool to predict the development of RVD in patients with acute PE.

Evaluation of CHA2DS2-VASc score and R2CHADS2 score in patients with acute pulmonary thromboembolism and right ventricular dysfunction

Background and Aim: Acute pulmonary embolism (APE) is one of the fatal emergencies. Imaging methods are not available to all physicians as an emergency and depend on the individual. For this reason, besides imaging methods, more easily applicable and individual-independent parameters are investigated to help the diagnosis. Some scoring systems are also used according to the patient's current disease status. R2CHADS2 score is used more in patients with chronic renal failure (CRF). The aim of the study was to compare CHA2DS2-VASc and R2CHADS2 scores in patients with APE and right ventricular dysfunction (RVD). Methods: The study was conducted retrospectively. The patient group of the study consisted of 392 patients diagnosed with APE. Patients with nonmassive pulmonary embolism and submassive pulmonary embolism (SPE) without RVD were defined as Group 1 (n = 213) and massive pulmonary embolism and SPE with RVD were defined as Group 2 (n = 179). CHA2DS2-VASc and R2CHADS2 scores were compared as a scoring system in patients. Results: CHA2DS2-VASc scores and R2CHADS2 scores were evaluated in the two groups. The R2CHADS2 score was statistically significant in Group 2 (P < 0.001). There was a statistically significant difference between the groups in terms of CRF and estimated glomerular filtration rate (15 [7.2%] vs. 29 [16.4%], P < 0.001, and 57.6 vs. 46.4 mL/min/1.73 m2, P < 0.001). Conclusions: Our findings show that the CHA2DS2-VASc score and R2CHADS2 are independent predictors of RVD in patients with APE. However, the R2CHADS2 scoring system is observed better than the CHA2DS2-VASc scoring system in patients with APE and RVD.

Assessment of right ventricular dysfunction in patients with mitral stenosis: A speckle tracking study.

Although it is affected at an early stage, there is a lack of studies investigating right ventricular (RV) function in patients with mitral stenosis (MS). We aimed to investigate the correlation between conventional echocardiographic variables and tricuspid annular plane systolic excursion (TAPSE), used as an indicator of RV dysfunction. We enrolled 59 consecutive patients with MS and assigned them in group 1 if TAPSE ≤16, or group 2 if: TAPSE >16. The mean age of the patients was 42.2 ± 8 years, and 74.6% were females. In univariate analysis, maximal mitral valve gradient, mean mitral valve gradient, systolic pulmonary arterial pressure, RV strain, and RV strain rates were associated with RV dysfunction. In multivariate analysis, both strain variables were found to be independent predictors of RV dysfunction. Kaplan Maier survival analysis showed that patients with lower RV strain had more rehospitalization rate during the one-year follow-up period. RV dysfunction is common in patients with MS and is associated with higher rehospitalization rate and morbidity. Evaluation of RV strain and strain rate for early detection of RV dysfunction and prediction of rehospitalization may be an appropriate approach in mitral stenosis.

P5553Right ventricular involvement in hypertrophic cardiomyopathy: insights from a tertiary centre

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure (HF) and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict. Objectives To assess the prevalence and prognostic value of right ventricular (RV) involvement in patients (pts) with HCM. Methods Retrospective single-centre study of consecutive pts with HCM evaluated in a specialized consultation. Selected those submitted to cardiac magnetic resonance imaging (CMR) as the gold-standard for RV assessment. The primary endpoint (PE) was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned HF admission. Results Of a total of 181 pts, 104 fulfilled the inclusion criteria (mean age at first consultation 62.1±9.7 years, 63.5% male). Septal asymmetric phenotype was the most frequent (73.1%) and 24 pts (23.1%) had rest LV outflow tract obstruction. Mean value of maximum wall thickness was 18.8±4.6 mm. Regarding CMR parameters (Fig A), 5.8% had RV dysfunction and 2.9% RV free wall hypertrophy; no patient presented RV dilation. Late gadolinium enhancement (LGE) of joint points was observed in 47.1%. During follow-up (FU, mean 56.6±29.5 months), survival free of RV dysfunction was 94.3%. Only 5 pts developed RV compromise assessed by echocardiographic parameters: TAPSE 12.0±3.4 mm and pulsed tissue Doppler systolic annular velocity (tricuspid S') wave 7.3±0.9 cm/s. These pts were significantly older (p&lt;0.01) and had higher values of average tissue doppler E/E' ratio at diagnosis (p&lt;0.01). Global RV involvement (at diagnosis or during FU) were associated with increased values of indexed left atrial area (p&lt;0.01), LV dysfunction (p=0.01), LGE of joint points (p=0.01) and higher values of NT-proBNP (p=0.01). In multivariate logistic regression, left atrial enlargement was the only independent predictor of global RV dysfunction (OR 1.9, 95% CI 1.1–3.2, p=0.01) and average E/E' ratio an independent predictor of RV dysfunction during FU (OR 1.3, 95% CI 1.1–1.5, p&lt;0.01). PE rate was 10.6%. It was significantly higher in pts with global RV involvement and there was a significant difference in survival analysis (Fig B). Average E/E' ratio (OR 1.5, 95% CI 1.1–1.9, p=0.01) and RV ejection fraction (OR 0.8, 95% CI 0.7–0.9, p=0.01) were independent predictors of the outcome. Conclusions Although not common, RV dysfunction was associated with a higher rate of cardiovascular events. Average E/E' ratio, as a measure of left ventricular filling pressure, was a risk factor for both RV dysfunction and PE. Higher values of RV ejection fraction were protective of adverse events occurrence. Together, these results support a potential role of RV function in the risk stratification of HCM pts.

Association between multidrug resistance-1 C3435T gene polymorphism and right ventricular dysfunction in patients with chronic obstructive pulmonary disease: cross-sectional study.

Right ventricular (RV) dysfunction may develop over the course of chronic obstructive pulmonary disease (COPD) and is an important predictor of morbidity and mortality. Polymorphism of the multidrug resistance-1 (MDR-1) gene has been correlated with worse clinical findings among patients with COPD. Our aim here was to investigate the relationship between MDR-1 C3435T gene polymorphism and RV dysfunction in COPD patients. This was a cross-sectional study investigating the relationship between RV dysfunction and genetic defects in COPD patients. Forty-one consecutive patients diagnosed with COPD and hospitalized due to acute exacerbation were enrolled. Polymorphism was analyzed using the strip assay technique. RV parameters were evaluated, and RV dysfunction was identified via transthoracic echocardiography. Patients were categorized into three groups according to gene polymorphism: MDR-1 CC (wild type, n = 9), MDR-1 CT (heterozygote mutant, n = 21) or MDR-1 TT (homozygote mutant, n = 11). The study included 14 males and 27 females (mean age 65 ± 11 years). The mean systolic pulmonary artery pressure was 31.4 ± 8 mmHg in the wild-type group, 42.2 ± 12 mmHg in the heterozygote mutant group and 46.5±14 mmHg in the homozygote mutant group (P = 0.027). Presence of RV dilatation was significantly different among the three groups (33%, 71%, and 100%, respectively; P = 0.005). In multiple logistic regression analysis, MDR-1 C3435T gene polymorphism (OR = 9.000, P = 0.019) was an independent predictor of RV dysfunction after adjustment for potential confounders. MDR-1 C3435T gene polymorphism was associated with RV dysfunction in patients with COPD.

Evaluation of acute pulmonary embolism by sixty-four slice multidetector CT angiography: Correlation between obstruction index, right ventricular dysfunction and clinical presentation

IntroductionMDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. ObjectiveTo investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. MethodsAmong 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calculated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. ResultsDyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35%±19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r=0.66, p<0.001) and the RVD-ratio (r=0.628, p<0.001). The mean OI was significantly higher in patients with RVD (p<0.001). A CT OI>43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825; p<0.001). ConclusionThe mean OI correlated linearly with PA diameter and RVD-ratio. OI>43% proved to be an independent predictor of RVD.

Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: Analysis of magnetic resonance imaging data from 218 patients

The aim of the present study was to identify the factors associated with right ventricular (RV) dilatation and dysfunction in patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot. From April 2002 to June 2013, 218 patients with repaired tetralogy of Fallot underwent magnetic resonance imaging; 165 (76%) underwent transannular repair and 36 (17%) underwent nontransannular repair. Linear regression analyses were used to identify the predictors for RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction. On univariable analysis, male sex, ventricular septal defect (VSD) closure through the right ventricle, larger pulmonary artery index, and greater PR fraction were associated with greater RV volume indexes. Multivariable analyses identified male sex (β = 17.55, P < .001 for RV EDVI; β = 14.08, P = .001 for RV ESVI), VSD closure through RV (β = 8.49, P = .048 for RV ESVI), longer interval since repair (β = 1.29, P = .014 for RV EDVI), and greater PR fraction (β = 1.92, P < .001 for RV EDVI; β = 1.38, P < .001 for RV ESVI) as independent predictors for greater RV volume indexes. On univariable analysis, male sex, VSD closure through the right ventricle, and greater PR fraction were associated with a lower RV ejection fraction. Multivariable analysis identified male sex (β = -3.10, P = .018), VSD closure through the right ventricle (β = -3.05, P = .020), and greater PR fraction (β = -0.27, P < .001) as independent predictors for a lower RV ejection fraction. Male sex, VSD closure through the right ventricle, longer interval since repair, and greater PR fraction were independent predictors of RV dilatation after tetralogy of Fallot repair. Male sex, VSD closure through the right ventricle, and greater PR fraction were also independent predictors of RV dysfunction.

Clot burden score in the evaluation of right ventricular dysfunction in acute pulmonary embolism: Quantifying the cause and clarifying the consequences

IntroductionPulmonary angiography by computed tomography (CT) is the method of choice for the detection of acute pulmonary embolism (PE). Studies have shown that the severity of PE can be estimated by clot burden scores. ObjectiveTo evaluate the correlation between an angiographic clot burden score (Qanadli score–QS) and parameters of right ventricular dysfunction (RVD) in patients admitted for PE. MethodsWe performed a retrospective study of 107 patients (60% female) admitted to an intensive care unit for PE (intermediate/high risk) between January 1, 2007 and September 30, 2011. Images from 16-slice multidetector CT angiography were reviewed in 102 patients and the QS calculated. Based on a cut-off of 18 points established by ROC curve analysis, two groups were formed (A<18 points vs. B≥18 points) and the clinical, laboratory, ECG, echocardiographic and CT angiography parameters were compared. The statistical analysis was performed using SPSS. ResultsThe overall mean age was 61.4 years. With regard to symptoms at admission, there was a greater prevalence in group B of fatigue, chest pain and syncope (p=0.017), with higher Geneva and Wells scores and shock index.In terms of ECG parameters, heart rate and percentage of right bundle branch block, T-wave inversion (V1–V3) and S1Q3T3 pattern (p=0.034) were higher in group B, as was the ECG score (p=0.009).Laboratory tests revealed that group B had higher troponin and d-dimers, with lower creatinine clearance by the MDRD formula (p=0.020) and PO2/FiO2 ratio. Echocardiography showed higher pulmonary artery systolic pressure in group B, and CT angiography revealed larger right ventricular (RV) diameters and higher RV/LV ratio (p=0.002), and greater superior vena cava, azygos vein and coronary sinus diameters in this group. Pulmonary artery (PA) diameter and the PA/aorta ratio were similar. Interventricular septal bowing and reflux of contrast into the inferior vena cava (p=0.001) were greater in group B, and QS>18 was an independent predictor of RVD (RV/LV ratio>1) (OR: 10.85; p<0.001) (area under the curve on ROC analysis: 0.79; p<0.001).The percentage of patients receiving fibrinolytic treatment was higher in group B (p=0.045), and in-hospital mortality was similar in both groups (overall 4.9%). ConclusionsQS>18 points proved to be an independent predictor of RVD in PE, and correlated linearly with variables associated with higher morbidity and mortality.

O valor da carga embólica na avaliação de disfunção ventricular direita no tromboembolismo pulmonar agudo: quantificando a causa e clarificando as consequências

IntroductionPulmonary angiography by computed tomography (CT) is the method of choice for the detection of acute pulmonary embolism (PE). Studies have shown that the severity of PE can be estimated by clot burden scores. ObjectiveTo evaluate the correlation between an angiographic clot burden score (Qanadli score - QS) and parameters of right ventricular dysfunction (RVD) in patients admitted for PE. MethodsWe performed a retrospective study of 107 patients (60% female) admitted to an intensive care unit for PE (intermediate/high risk) between January 1, 2007 and September 30, 2011. Images from 16-slice multidetector CT angiography were reviewed in 102 patients and the QS calculated. Based on a cut-off of 18 points established by ROC curve analysis, two groups were formed (A<18 points vs. B ≥18 points) and the clinical, laboratory, ECG, echocardiographic and CT angiography parameters were compared. The statistical analysis was performed using SPSS. ResultsThe overall mean age was 61.4 years. With regard to symptoms at admission, there was a greater prevalence in group B of fatigue, chest pain and syncope (p=0.017), with higher Geneva and Wells scores and shock index.In terms of ECG parameters, heart rate and percentage of right bundle branch block, T-wave inversion (V1-V3) and S1Q3T3 pattern (p=0.034) were higher in group B, as was the ECG score (p=0.009).Laboratory tests revealed that group B had higher troponin and d-dimers, with lower creatinine clearance by the MDRD formula (p=0.020) and PO2/FiO2 ratio. Echocardiography showed higher pulmonary artery systolic pressure in group B, and CT angiography revealed larger right ventricular (RV) diameters and higher RV/LV ratio (p=0.002), and greater superior vena cava, azygos vein and coronary sinus diameters in this group. Pulmonary artery (PA) diameter and the PA/aorta ratio were similar. Interventricular septal bowing and reflux of contrast into the inferior vena cava (p=0.001) were greater in group B, and QS>18 was an independent predictor of RVD (RV/LV ratio>1) (OR: 10.85; p<0.001) (area under the curve on ROC analysis: 0.79; p<0.001). The percentage of patients receiving fibrinolytic treatment was higher in group B (p=0.045), and in-hospital mortality was similar in both groups (overall 4.9%). ConclusionsQS >18 points proved to be an independent predictor of RVD in PE, and correlated linearly with variables associated with higher morbidity and mortality.

Usefulness of cardiac biomarkers in the prediction of right ventricular dysfunction before echocardiography in acute pulmonary embolism

BackgroundThe aim of this study was to investigate a useful cardiac biomarker for predicting echocardiographic right ventricular (RV) dysfunction in patients with acute pulmonary embolism (APE). MethodsA total of 84 patients with APE were divided into two groups: patients with RV dysfunction (group I, n=51, 61.8±15.1 years) versus without RV dysfunction (group II, n=33, 66.8±13.6 years). Cardiac biomarkers were compared between the groups. ResultsThe level of N-terminal pro-brain-type natriuretic peptide (NT-proBNP), cardiac specific troponin T (cTnt), and I (cTni) was significantly elevated in group I compared to group II, but the level of creatine kinase and high-sensitivity C-reactive protein was not different. By receiver operating characteristic curve analysis, the area under the curve to predict RV dysfunction was 0.912 for NT-proBNP, 0.797 for cTnt, and 0.766 for cTni. The optimal cut-off value to predict RV dysfunction was 620.0pg/mL for NT-proBNP (sensitivity: 90.2%, specificity: 75.8%), 0.016ng/mL for cTnt (sensitivity: 82.4%, specificity: 78.8%), and 0.055ng/mL for cTni (sensitivity: 86.3%, specificity: 66.7%). NT-proBNP>620pg/mL and cTnt>0.016ng/mL were independent predictors of RV dysfunction on multivariate analysis after adjustment for the baseline characteristics. ConclusionsNT-proBNP, cTnt, and cTni were significant serologic predictors of RV dysfunction in APE. Measurements of NT-proBNP, cTnt, and cTni are simple and useful in the risk stratification or treatment of APE.

Assessment of Right Ventricular Function in Acute Pulmonary Embolism Using ECG-Synchronized MDCT

The purpose of this article is to determine the independent predictors of right ventricular (RV) dysfunction in patients with acute pulmonary embolism (PE) and to assess the relationship between RV ejection fraction (EF) and PE load. Breath-hold CT of the chest was performed for 64 patients with PE (33 men and 31 women; mean [± SD] age, 58.6 ± 16.5 years). In addition, ECG-synchronized cardiac CT was performed to determine the RV and left ventricular (LV) EFs. PE load was determined using the Qanadli obstruction index. Multivariable regression analysis was performed to determine independent predictors of RV dysfunction (defined as EF < 35%). In addition, the relationship between RV EF and PE load was assessed by receiver operating characteristic (ROC) curves. RV dysfunction was independently predicted by a PE load greater than 50% (odds ratio, 40.17; 95% CI, 4.22-382.67) and an LV EF less than 45% (odds ratio, 31.18; 95% CI, 2.00-487.09; p < 0.05 for both). Curve analysis revealed that a PE load greater than 50% had a sensitivity of 82% and a specificity of 85% to identify an RV EF less than 35%. Conversely, an RV EF less than 35% had a sensitivity of 93% and a specificity of 67% to predict a PE load greater than 50%. RV dysfunction (defined as RV EF < 35%) in patients with acute PE is highly sensitive to define a PE load greater than 50%. Furthermore, RV dysfunction is independently predicted by an obstruction index greater than 50% or an LV EF less than 45%. Assessment of RV function by ECG-synchronized CT may become useful for guiding therapy.