Lower Tricuspid Annular Plane Systolic Excursion Research Articles

Clinical impact of the right ventricular impairment in patients following transcatheter aortic valve replacement

The right ventricular (RV) impairment can predict clinical adverse events in patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Limited reports have compared impact of the left ventricular (LV) and RV disorders. This retrospective study evaluated two-year major adverse cardiac and cerebrovascular events (MACCE) in patients following TAVR for severe AS. RV sphericity index was calculated as the ratio between RV mid-ventricular and longitudinal diameters during the end-diastolic phase. Of 239 patients, 2-year MACCE were observed in 34 (14%). LV ejection fraction was 58 ± 11%. Tricuspid annular plane systolic excursion (TAPSE) and RV sphericity index were 20 ± 3 mm and 0.36 (0.31–0.39). Although the univariate Cox regression analysis demonstrated that both LV and RV parameters predicted the outcomes, LV parameters no longer predicted them after adjustment. Lower TAPSE (adjusted hazard ratio per 1 mm, 0.84; 95% confidence interval, 0.75–0.93) and higher RV sphericity index (adjusted hazard ratio per 0.1, 1.94; 95% confidence interval, 1.17–3.22) were adverse clinical predictors. In conclusion, the RV structural and functional disorders predict two-year MACCE, whereas the LV parameters do not. Impact of LV impairment can be attenuated after development of RV disorders.

Right ventricular-pulmonary arterial coupling in patients with COVID-19: A systematic review and meta-analysis

Objectives: In this systematic review and meta-analysis, we assessed the association between right ventricular-pulmonary arterial (RV-PA) coupling and mortality in coronavirus disease 2019 (COVID-19). Methods: We performed a systematic literature search using MEDLINE (PubMed), Embase, Cochrane and Web of Science. We only included observational studies and randomized controlled trials in which, right ventricular function and pulmonary pressures were investigated, in adult patients with COVID-19. The primary outcome was mortality. The secondary outcome was pulmonary embolism (PE). Random-effects meta-analysis was performed. Mean differences (MD) and unadjusted hazard ratios (HRs) were pooled. Results: 21 studies were included in our systematic review for qualitative analysis, and eight of them qualified for quantitative analysis. Tricuspid annular plane systolic excursion (TAPSE) over pulmonary artery systolic pressure (PASP) (TAPSE/PASP) ratio was significantly lower in non-survivors compared with survivors (mean difference = – 0.28 [–0.38, –0.17], p < 0.00001; I2: 61%, p < 0.08). TAPSE was significantly lower in non- survivors compared with survivors (mean difference = – 3.53 [–4.72, –2.33], p < 0.00001; I2: 77%, p < 0.0005). Lower TAPSE was associated with increased mortality (HR = 0.77 [0.63, 0.94], p < 0.010; I2: 77%, p = 0.01). PASP was significantly higher in non-survivors compared with survivors (mean difference = 9.14 [6.67, 11.61], p < 0.00001; I2: 37%, p=0.18). One study demonstrated a higher risk of mortality for lower TAPSE/PASP in both intensive care unit (ICU) and non-ICU patients and, one study showed that TAPSE/PASP was significantly associated with a higher risk of PE. Conclusion: COVID-19 non-survivors have a significantly worse RV-PA coupling as compared to survivors.

Echocardiographic manifestations during the first 3 months after an episode of COVID-19 and their relationship with disease severity and persistence of symptoms

BackgroundCardiovascular manifestations in patients with COVID-19 are associated with dire outcomes. Long COVID syndrome is the persistence of symptoms after acute disease and is found in up to 40% of subjects. There is little information regarding subacute echocardiographic manifestations after COVID-19, and no study has included a Mexican mestizo population. MethodsThis cross-sectional study included subjects older than 18 with an episode of COVID-19 in the last 3 months. Those with previously known cardiovascular disease were excluded. The patient´s medical history and COVID-19 information were obtained from clinical charts. We performed a transthoracic echocardiogram in every subject and determined left ventricular (LV) index mass, LV ejection fraction (LVEF), left ventricular global longitudinal strain (LV GLS), right ventricular (RV) GLS, and tricuspid annular plane systolic excursion (TAPSE). A descriptive and comparative analysis was performed based on symptom severity and persistence. ResultsOne hundred subjects were included; 63% were classified with mild and 37% with moderate to severe COVID-19. The median of LVEF was 60% (55–60), LV GLS and RV GLS was impaired in 34% and 74% of patients, respectively. Patients with moderate to severe disease had significantly lower LVEF (Mean Difference: -3.3), TAPSE (mean difference: -1.8), and higher (worse) LV GLS (Mean Difference: 2.5) and RV GLS (mean difference: 2.9). Persistent symptoms were associated with lower TAPSE and higher RVGLS. ConclusionsPatients who recover from COVID-19 have a high prevalence of subtle RV and LV dysfunction using GLS analysis. A moderate to severe episode was associated with worse RV and LV function measured by RV GLS, TAPSE, and LV GLS. Subjects with persistent symptoms had worse RVGLS and TAPSE.

Abstract 14468: Which Measure of Right Ventricle Assessment Should Be Used in COVID19 to Predict In-Hospital Mortality?

Introduction: Right ventricle failure is one of the features of severe COVID19 which is associated with poor outcomes. Measurement of failing right ventricle (RV) is difficult, and the few measures that have been used to study RV include tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic pressure (RVSP) and RV dilation. There is limited data with regards to which of these parameters should be used to predict mortality in COVID19. Hypothesis: low TAPSE, high RVSP, and higher dilation are associated with higher in-hospital mortality. Methods: We performed a retrospective chart review of patient hospitalized with COVID-19 infection and underwent echocardiography (ECHO) within the Northeast Georgia Health System from March 2020 to December 2021. The primary outcome was in hospital mortality. RV dilation was classified as none, mild, moderate, and severe. TAPSE and RVSP were used as continuous variable in univariate analysis. We used multivariable cox regression model and adjusted for demographical characteristics and underlying co-morbidities, along with the three RV failure parameters. We used interaction terms between the parameters to identify which parameter correlated with mortality. For interaction, we classified TAPSE into 4 group - <1.2; 1.2 to 1.5; 1.5-1.8 and >1.8. Results: In total 7939 patients were identified with COVID-19 infection and of these, 3,109 underwent ECHO. Of these 56% were males and mean age was 65.6 years (SD 15.1 years). In hospital mortality was 25.9%. On univariate analysis, TAPSE (HR 0.71, 95%CI 0.61-0.84), RV dilation (HR 1.11, 95%CI 1.04-1.19) were strongly associated while RVSP (HR 1.01, 95%CI 1.00-1.01) was poorly associated with in-hospital mortality. On multivariable cox regression model with interaction, TAPSE < 1.2 along with moderate to severe RV dilation was associated with in hospital mortality (HR 1.88, 95%CI 1.25-2.8, p=0.002). Dilated RV was still associated with in-hospital mortality even when TAPSE was higher than 1.2 (HR 1.56, 95%CI 1.01-2.4, p=0.04). Conclusions: Moderate to severe Dilation of RV and TAPSE < 1.2 were strongly associated with an increase in mortality. Moderate to severe dilation of RV was also associated with increased mortality with TAPSE between 1.2 to 1.8.

Cardiac function in bronchiolitis: Not only a right ventricle matter.

Extrapulmonary manifestations of bronchiolitis have been previously studied, with some identifying right ventricle (RV) diastolic/systolic dysfunction. We hypothesized that severe cases of bronchiolitis would have cardiac dysfunction resulting an increase in N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) values and worse outcomes. Therefore, the objective was to evaluate the existence of cardiac dysfunction and to determine its association with severe bronchiolitis. This prospective cohort study included children hospitalized for bronchiolitis under 1-yearold between January 2019 and March 2020. At admission, an echocardiography was performed and plasma levels of NT-proBNP were measured. To analyze outcomes, the cohort was divided into two groups based on the need for positive pressure respiratory support (PPRS), and both were compared to healthy infants. bivariant analysis, significant differences p < 0.05. One hundred eighty-one patients were included; median age was 2 months. Seventy-three patients required PPRS. Compared to controls, patients requiring PPRS showed worse RV systolic function, with lower tricuspid annular-plane systolic excursion (p = 0.002) and parameters of worse right and left diastolic function (trans-tricuspid E and A wave [p = 0.004 and p = 0.04, respectively] and tricuspid tissue doppler imaging [TDI] e' [p = 0.003], trans-mitral E and mitral TDI a' [p = 0.02 and p = 0.005, respectively]). AnNT-ProBNP greater than 3582 pg/dl predicts the need for longer necessity of PPRS in patients younger than 2 months. In addition to the expected RV systolic dysfunction, patients with severe bronchiolitis have parameters of global diastolic worse function possibly secondary to intrinsic myocardial involvement. NT-ProBNP values at admission had strong discriminatory power to predict worse outcomes.

Low tricuspid annular plane systolic excursion is associated with a poor outcome in patients with COVID-19: A systematic review and meta-analysis.

Background: This systematic review and meta-analysis aimed to assess whether tricuspid annular plane systolic excursion (TAPSE) could be used as a prognostic tool in patients with coronavirus disease 19 (COVID-19).Methods:Studies on the relationship between TAPSE and COVID-19 since February 2021. Standardized mean difference (SMD) and 95% confidence intervals were used to assess the effect size. The potential for publication bias was assessed using a contour-enhanced funnel plot and Egger test. A meta-regression was performed to assess if the difference in TAPSE between survivors and nonsurvivors was affected by age, sex, hypertension or diabetes.Results:Sixteen studies comprising 1579 patients were included in this meta-analysis. TAPSE was lower in nonsurvivors (SMD −3.24 (−4.23, −2.26), P < .00001; I2 = 71%), and a subgroup analysis indicated that TAPSE was also lower in critically ill patients (SMD −3.85 (−5.31, −2.38,), P < .00001; I2 = 46%). Heterogeneity was also significantly reduced, I2 < 50%. Pooled results showed that patients who developed right ventricular dysfunction had lower TAPSE (SMD −5.87 (−7.81, −3.92), P = .004; I2 = 82%). There was no statistically significant difference in the TAPSE of patients who sustained a cardiac injury vs those who did not (SMD −1.36 (−3.98, 1.26), P = .31; I2 = 88%). No significant publication bias was detected (P = .8147) but the heterogeneity of the included studies was significant. A meta-regression showed that heterogeneity was significantly greater when the incidence of hypertension was <50% (I2 = 91%) and that of diabetes was <30% (I2 = 85%).Conclusion:Low TAPSE levels are associated with poor COVID-19 disease outcomes. TAPSE levels are modulated by disease severity, and their prognostic utility may be skewed by pre-existing patient comorbidities.Trial retrospectively registered (February 12, 2021):PROSPERO CRD42021236731

Right ventricular dysfunction in patients with non-severe ischemic mitral regurgitation qualified to cardiosurgery treatment

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right ventricular (RV) dysfunction worsens prognosis in patients (pts) after myocardial infarction (MI). Purpose The purpose of this study was to assess RV function as a predictor of mortality and hospitalizations due to exacerbation of HF in pts with ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery by-pass grafting alone (CABGa) or CABG with mitral reconstruction (CABGmr). Methods We prospectively analyzed 104 pts (M 57, 64 ± 7 years) with non-severe IMR, 3-24 weeks after MI. Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (non-severe ≥10-20 mm²). All the pts were qualified for CABG (multiple vessel coronary disease, ejection fraction (EF)-44 ± 8%). The patients were referred for CABGa (gr.1; n = 77) or CABGmr (gr.2; n = 27) based on clinical assessment, 2D and 3D echo at rest and exercise. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function (measured with M-mode imaging in the 4-chamber view). RV function was related to clinical outcome (median follow-up: 12 months). Results During the follow-up period of 12 months, 5 deaths (5 %) and 8 hospitalizations (8%) due to exacerbation of HF occurred. With use of the following cut-off points of TAPSE ≤ 12 mm (group I), and TAPSE &amp;gt;12 mm (group 2)—an association was found between the lower TAPSE and increased mortality. In group 1 (n =54 pts), 5 pts (9.2%) died and 6 pts was hospitalized due to HF (11.1%); in group 2 (n =50), no patient died, and 2 pts was hospitalized (4%). There was a significant difference (p = 0.02) in clinical outcomes between group I and II. ROC analysis identified TAPSE ≤12 mm as predictive cut-off for prediction adverse clinical outcome in all study group: (death: sensitivity 80%, specificity 76%, area under curve [AUC] = 0.807 (Fig.1); death and HF hospitalizations: sensitivity 69%, specificity 79%; AUC =0.767). Conclusion TAPSE is simple and useful quantitative measurement of RV function and have a predictive value in pts with non-severe IMR referred for cardiosurgery treatment. Abstract Figure 1

Association between cumulative blood pressure in early adulthood and right ventricular structure and function in middle age: The CARDIA study

ObjectiveCumulative blood pressure (BP) exposure is a known risk factor for cardiovascular disease. This study sought to investigate the association between cumulative BP from early adulthood to middle age and right ventricular (RV) structure and function in middle age.MethodsWe included 2844 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults). Cumulative BP over the 30‐years follow‐up was defined as the sum of the product of mean BP for each pair of consecutive examinations and the time interval between these two consecutive examinations in years. RV structure and function were assessed by echocardiography. The main analyses utilized logistic and linear regression models.ResultsIn fully adjusted models, higher cumulative systolic BP was independently associated with lower tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic velocity (RVS′), right ventricular early diastolic velocity (RVe′), and higher pulmonary arterial systolic pressure. Higher cumulative diastolic BP was independently associated with smaller RV basal diameter, lower TAPSE, RVS′, and RVe′. For categorical analyses of RV dysfunction, cumulative systolic BP was not related to systolic dysfunction. Per 1‐SD increase in cumulative systolic BP was associated with a higher risk of diastolic dysfunction, while an increase in cumulative diastolic BP was associated with a higher risk of systolic dysfunction and diastolic dysfunction.ConclusionsCumulative exposure to increased BP from early adulthood to middle age was associated with incipient RV systolic and diastolic dysfunction in middle age. Exposure to higher diastolic BP levels from early adulthood to middle age was associated with a smaller RV basal diameter in middle age.

Predictors of mortality and cardiovascular outcomes in Emery-Dreifuss muscular dystrophy in a long-term follow-up.

Emery-Dreifuss muscular dystrophy (EDMD) is an extremely rare muscular dystrophy due to either emerinopathy (EMD) or laminopathy (LMNA). The main risk for patients is that of cardiovascular complications. This study aimed to identify predictors of adverse clinical events in patients with EDMD in a long-term follow-up observation. A total of 45 patients with confirmed EMD or LMNA mutation were included in the study. The relationships between clinical parameters, the overall survival rate, and risk factors for disease progression were assessed. The primary endpoint was defined as death, while the secondary endpoint comprised death, resuscitated cardiac arrest (RCA), heart transplant (HTX), stroke, end-stage heart failure (ESHF), and hospitalization due to heart failure (HF). During a median length of follow-up observation of ten years (interquartile range, 5-15), ten patients (22%) died, one suffered RCA, two had HTX, and six suffered ischemic strokes (13%). Seven patients developed ESHF, and eight were hospitalized due to HF. The secondary endpoint occurred in 16 patients (36%). LMNA mutation (hazard ratio [HR], 6.01; 95% confidence interval [CI], 1.61-22.4; P = 0.008) and higher serum N-terminal fragment of B-type natriuretic peptide (NT-proBNP) concentration (HR, 1.29; 95% CI, 1.06-1.56 per 100 pg/ml; P = 0.01) increased the risk of death. Higher tricuspid annular plane systolic excursion (TAPSE) decreased the risk for the secondary endpoint (HR, 0.78; 95% CI, 0.68-0.90 mm; P <0.001). NT-proBNP >257 pg/ml and TAPSE <21 mm may be assumed as the best cut-off values for the primary and secondary endpoints, respectively. LMNA mutation and higher NT-proBNP concentration were associated with increased mortality in EDMD. Lower TAPSE was a predictor of a composite secondary endpoint in EDMD.

604 Echocardiographic assessment of right ventricular function and pulmonary pressures in hospitalized patients with COVID-19

Abstract Aims Pulmonary involvement in Coronavirus 19 disease (COVID-19) may affect right ventricular (RV) function and pulmonary pressures resulting in further deterioration of patient clinical status. However, the prognostic value of echocardiographic parameters including tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PASP), and TAPSE/PASP ratio has been poorly investigated in this clinical setting. Methods and results This is a multicentre Italian study including patients admitted for severe COVID-19 in seven Italian Hospitals. Transthoracic echocardiography (TTE) was performed within 48 h from admission in all cases. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. Of 1401 patients with severe COVID-19, 227 (16.1%) subjects underwent TTE within 48 h from admission and were included in this study. The mean age was 68 ± 13 years and 62.6% of patients were male. Intensive care unit (ICU) admission was reported in 73 patients (32.2%); ICU patients showed lower left ventricular ejection fraction (LVEF), lower TAPSE, and higher LV end systolic volume and PASP values than non-ICU patients. Also, ICU patients showed higher incidence of acute respiratory distress syndrome (82.2% vs. 30.5%; P &amp;lt; 0.001), acute cardiac injury (46.6% vs. 22.7%; P &amp;lt; 0.001), acute heart failure (34.2% vs. 9.1%; P &amp;lt; 0.001), and death (63.9% vs. 14.3%; P &amp;lt; 0.001) compared with non-ICU patients. By stratifying the study population into tertiles according to TAPSE, PASP, and TAPSE/PASP values, patients in the lower TAPSE and TAPSE/PASP ratio tertiles, and those in the higher PASP tertile, showed a significantly higher incidence of death during the hospitalization. At univariable logistic regression analysis, TAPSE, PASP, and TAPSE/PASP were significantly associated with a higher risk of death and PE, both in patients admitted or not to ICU. After propensity score weighting adjustment for multiple baseline potential confounders and further multivariable adjustment for LVEF value, the regression analysis showed that TAPSE, PASP and TAPSE/PASP were independently associated with risk of death (TAPSE: OR: 0.85, CI: 0.74–0.97, P = 0.017; PASP: OR: 1.08, CI: 1.03–1.13, P = 0.002; TAPSE/PASP: OR: 0.02, CI: 0.02 × 10−1—0.20, P &amp;lt; 0.001) and with the risk of PE (TAPSE: OR: 0.70, CI: 0.60–0.82, P &amp;lt; 0.001; PASP: OR: 1.10, CI: 1.05–1.14, P &amp;lt; 0.001; TAPSE/PASP: OR: 0.02 × 10−1, CI: 0.01 × 10−2—0.04, P &amp;lt; 0.001) during the hospitalization. The risk death according to TAPSE, PASP, and TAPSE/PASP ratio tertiles was estimated considering discharge alive as competing risk (Figure). The lowest TAPSE and TAPSE/PASP tertiles, and the highest PASP tertile, were significantly associated with poorer survival during the hosptialization (P &amp;lt; 0.001). Conclusions Echocardiographic evidence of RV systolic dysfunction, increased PASP and a poor RV-arterial coupling assessed by TAPSE/PAPS ratio may help to identify COVID-19 patients at higher risk of mortality and PE during the hospitalization.

Prognostic Implications of Right Ventricular Function and Pulmonary Pressures Assessed by Echocardiography in Hospitalized Patients with COVID-19.

Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. Methods and results: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74–0.97; PAPS: OR 1.08, CI 1.03–1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10−1–0.2) and PE (TAPSE: OR 0.7, CI 0.6–0.82; PAPS: OR 1.1, CI 1.05–1.14; TAPSE/PAPS: OR 0.02 × 10−1, CI 0.01 × 10−2–0.04). Conclusions: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization.

Abstract 10066: Right Ventricular Function as a Predictor of Mortality in Patients with Sepsis: A Systematic Review and Meta-Analysis

Introduction: Sepsis-associated myocardial dysfunction has been described in relation to left ventricular function and reported to have a variable correlation with mortality. However, the extent to which right ventricular (RV) dysfunction contributes to myocardial dysfunction and a poor prognosis in sepsis remains unknown. Our aim is to investigate the association between RV dysfunction and mortality in patients with sepsis. Methods: We performed a systematic review of the literature. We systematically searched Cochrane, Embase, MEDLINE, Scopus and Web of Science for full-text articles from inception to June 2020. Studies were included if they reported RV function and mortality in patients with sepsis using echocardiography. Data was extracted using a collection form designed a priori . Significance was determined by a two-tailed p value &lt; 0.05. The present study was registered in the PROSPERO (CRD42020204423). Hypothesis: RV dysfunction is associated to mortality in adult patients with sepsis. Results: Six studies including 526 patients were selected for final analysis. Patients had a mean age of 57 years, 45% were females, and there was an overall mortality of 37%. In three studies, transthoracic echocardiography was performed within 24h of sepsis diagnosis, and reported Tricuspid annular plane systolic excursion (TAPSE) in a total of 366 patients. In pooled analysis, survivors had a higher TAPSE compared to non-survivors ((SMD):1.89 (95%CI 0.14-3.655) p=0.03, Figure1). All other parameters of RV dysfunction assessed did not have a statistically significant difference between survivors and non-survivors (Figure 2-6). Conclusion: RV dysfunction as demonstrated by a lower TAPSE is associated with higher mortality in patients with sepsis and/or septic shock. This data suggest that RV dysfunction is an important contributor to sepsis-associated myocardial dysfunction and worsening prognosis in patients with sepsis.

Tricuspid Annular Plane Systolic Excursion as a Potential Marker of Hospital Utilization in Patients with Sickle Cell Disease

Objective: Pulmonary Artery Hypertension (PAH) is an independent risk factor for increased morbidity in Sickle Cell Disease (SCD) patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a surrogate measure for PAH. The objective of this study was to determine whether lower TAPSE values are associated with increased Emergency Department (ED) and hospital utilization. Methods: TAPSE measurements were retrospectively obtained from bedside echocardiograms from a convenience sample of 28 SCD patients presenting to the ED with SCD pain. TAPSE was considered abnormal if &lt;24.9mm, one standard deviation below the mean TAPSE for SCD patients. Medical records were reviewed to determine ED visits and hospital overnight stays over a two-year period. A t-test analysis and Pearson’s correlation were used for each variable. Results: The initial sample included 28 SCD patient encounters. TAPSE measurements were abnormal in 5 patients and normal in 23 patients. The mean number of ED visits/year for the abnormal and normal TAPSE group were 23.00 and 16.87, respectively (p=0.57) with moderate negative linearity (p=0.03). The mean number of hospitalized days for abnormal and normal TAPSE groups was 108.8 and 59.6, respectively (p=0.10) with moderate negative linearity (p=0.07). Conclusion: Lower TAPSE values (&lt;24.9mm) in SCD patients were associated with higher ED and hospital utilization. If findings are replicated in larger studies, TAPSE may serve as a marker of morbidity in SCD patients presenting to the ED.

Right ventricular function and iron deficiency in acute heart failure.

Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF. We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was defined, according to European Society of Cardiology criteria, as serum ferritin <100 mg/dL (absolute ID) or ferritin 100-299 mg/dL and transferrin saturation (TSAT) <20% (functional ID). The relationships among the exposures with right ventricular systolic function were evaluated by multivariate linear regression analyses. The mean age of the sample was 74.3 ± 10.6 years, 441 (48.8%) were female, 471 (52.2%) exhibited heart failure with preserved ejection fraction, and 677 (75.0%) showed ID. The mean LVEF, TAPSE, and TAPSE/PASP were 49 ± 15%, 18.6 ± 3.9 mm, and 0.45 ± 0.18, respectively. The median (interquartile range) amino-terminal pro-brain natriuretic peptide was 4015 (1807-8775) pg/mL. In a multivariable setting, lower TSAT and ferritin were independently associated with lower TAPSE (P < 0.05 for both comparisons). Transferrin saturation (P = 0.017), and not ferritin (P = 0.633), was independently associated with TAPSE/PASP. In AHF, proxies of ID were associated with right ventricular dysfunction. Further studies should confirm these findings and evaluate the pathophysiological facts behind this association.

Prognostic Value of Tricuspid Annular Plane Systolic Excursion and Right Ventricular Outflow Tract Fractional Shortening in Mechanically Ventilated Septic Patients

The authors aimed to explore whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow fractional shortening (RVOT-FS) were associated with long-term prognosis in mechanically ventilated septic patients. A prospective observational study. A tertiary hospital intensive care unit (ICU). One hundred eighty-one septic patients who were on mechanical ventilation. Echocardiography was performed within 24 hours of ICU admission. Several echocardiographic parameters, including TAPSE and RVOT-FS, as well as prognostic information, were collected. A Cox regression survival analysis showed that TAPSE was independently associated with one-year all-cause mortality (hazard ratio [HR] 0.407, 95% confidence interval [CI]: 0.200-0.827, p = 0.013), but ROVT-FS was not (HR 0.997, 95% CI: 0.970-1.025, p = 0.828). ROC analysis showed that the optimal cutoff value for TAPSE and RVOT-FS to determine one-year mortality was TAPSE <18 mm and RVOT-FS <40%. The one-year mortality in patients with low TAPSE (n = 88) and in patients with both low TAPSE and low RVOT-FS (n = 60) was 45.5% and 48.3%, respectively; p = 0.724. In a multivariate analysis, RVOT-FS did not add significant prognostic information to that provided by TAPSE <18 mm (p = 0.197). TAPSE was an independent predictor of one-year all-cause mortality in mechanically ventilated septic patients. RVOT-FS was not associated with one-year mortality and added no prognostic value to TAPSE in these patients.

Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies.

Right ventricular (RV) dysfunction and RV-pulmonary artery (PA) uncoupling are associated with the development of pulmonary congestion during exercise. However, there is limited information regarding the association between these right-sided cardiac parameters and pulmonary congestion in acutely decompensated heart failure (HF). We performed an individual patient meta-analysis from four cohort studies of hospitalized patients with HF who had available lung ultrasound (B-lines) data on admission and/or at discharge. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), RV-PA coupling was defined as the ratio of TAPSE to PA systolic pressure (PASP). Admission and discharge cohort included 319 patients (75.8 ± 10.1years, 46% women) and 221 patients (77.9 ± 9.0years, 47% women), respectively. Overall, higher TAPSE was associated with higher ejection fraction, lower PASP, b-type natriuretic peptide and B-line counts. By multivariable analysis, worse RV function or RV-PA coupling was associated with higher B-line counts on admission and at discharge, and with a less reduction in B-line counts from admission to discharge. Higher B-line counts at discharge were associated with a higher risk of the composite of all-cause mortality and/or HF re-hospitalization [adjusted-HR 1.13 (1.09-1.16), p < 0.001]. Furthermore, the absolute risk increase related to high B-line counts at discharge was higher in patients with lower TAPSE. In patients with acutely decompensated HF, impaired RV function and RV-PA coupling were associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay. Worse prognosis related to residual pulmonary congestion was enhanced in patients with RV dysfunction. TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure.

Pulmonary hypertension and right ventricular dysfunction in heart failure: prognosis and 15-year prospective longitudinal trajectories in survivors.

Systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/SPAP ratio trajectories are not fully characterized in chronic heart failure (HF). We assessed very long-term longitudinal SPAP, TAPSE and TAPSE/SPAP trajectories in HF patients, and their dynamic changes in outcomes. Prospective, consecutive, observational registry of real-life HF patients, performing echocardiography studies at baseline and according to a prospectively structured schedule after 1year, and then every 2 years, up to 15 years. Pulmonary hypertension (PH) was defined as SPAP ≥40 mmHg; right ventricular dysfunction (RVD) was defined at TAPSE ≤16 mm; and TAPSE/SPAP ratio was dichotomized at 0.36 mm/mmHg. The clinical endpoints were all-cause death, the composite endpoint of mortality or HF hospitalization and the number of recurrent HF hospitalizations. The study cohort included 1557 patients. Long-term SPAP trajectory Loess curves were U-shaped with a nadir at 7 years. TAPSE Loess curves showed a marked rise during the first year, with stabilization thereafter. TAPSE/SPAP ratio Loess splines were similar to the later with a smooth decline towards the end. Patients who died had higher SPAP, lower TAPSE and lower TAPSE/SPAP ratio in the preceding period than survivors. Baseline PH and/or RVD were independently associated with mortality and HF-related hospitalizations, and the persistence of one or both entities at 1year conferred a worse long-term prognosis. Long-term trajectories for SPAP, TAPSE and TAPSE/SPAP ratio are reported in patients with chronic HF. An increasing SPAP and declining TAPSE and TAPSE/SPAP ratio in the preceding period is associated with higher mortality.

P820 Echocardiographic assessment of late-onset right ventricular dysfunction following continuous-flow left ventricular assist device

Abstract Early right ventricular failure (RVF) remains one of the main factors associated with early mortality following continuous-flow left ventricular assist device (LVAD) implantation. However, late-onset RVF (LoRVF) has emerged as an increasing concern, but little is known about its incidence rate and the value of transthoracic echocardiography (TTE) to predict this complication during the LVAD follow-up. Methods and results We retrospectively analyzed the 1-year hemodynamic and clinical data from patients (p) that, between 2016 and 2018, underwent a right heart catheterization (RHC) after LVAD as bridge to transplantation (BTT). 73 p (84% males, 52 ± 12 years, 49% Heart Ware LVAD, 51% Heart Mate 3 LVAD), out of 187 LVAD implants, were studied. According to the Intermacs definition, LoRVF was assigned if the RHC showed a central venous pressure (CVP)&amp;gt;18 mmHg with cardiac index&amp;lt; 2.3 L/min/m2. Isolated LoRVF was assigned if LoRVF was present in the absence of elevated pulmonary capillary wedge pressure (PCWP) ≤15 mmHg. TTE was performed at the time of the RHC and the following parameters were obtained: parasternal long-axis left ventricular end diastolic diameter (LVEDD), basal (RVED1) and mid-cavity (EDRV2) end diastolic RV linear dimension in 4 chamber view, severity of tricuspid regurgitation (TR) and of mitral regurgitation (MR), tricuspid annular plane systolic excursion (TAPSE), and the position of the LVAD inflow cannula (IC). LoRVF was present in 16 p (22% of the studied population): 12 p (75%) presented a PCWP &amp;gt; 15 mmHg and 4 p (25%) presented isolated LoRVF. Symptoms and signs of venous congestion were present in 2/3 of the p with LoRVF and elevated PCWP. On the other hand, all the p with isolated LoRVF presented severe signs of venous congestion, and 50% of them could be successfully transplanted in high urgent status. P with LoRVF showed more dilated RV (RVED1 43.8 ± 9.2 vs 37.7 ± 5.3 mm, p = 0.02) and lower TAPSE (11 ± 2 vs 14 ± 2 mm p &amp;lt; 0.01) than the no LoRVF group. RVED1 showed a weak significant correlation with CVP (R = 0.3, p = 0.02). On the other hand, the presence of an elevated PCWP was not related to etiology of the cardiomyopathy, type and speed of LVAD, position of the IC, LVEDD, nor the presence of MR &amp;gt; mild. Conclusion LoRVF is a frequent complication during LVAD support as BTT and most of the cases are associated with persistent elevated PCWP. Isolated LoRVF, which is not associated with high PCWP, has a bad prognosis. RV evaluation with TTE during the clinical follow-up can be useful to detect LoRVF. However a persistent elevated PCWP is not associated with echocardiographic signs of incomplete unloading of the LV by the LVAD.

Preoperative Right Ventricular Echocardiographic Parameters Predict Perioperative Cardiovascular Complications in Patients Undergoing Non-Cardiac Surgery

Transthoracic echocardiography is frequently ordered before non-cardiac surgery (NCS), but the impact of preoperative echocardiography on perioperative outcomes in patients undergoing NCS is unknown. The present study aimed to evaluate the predictive value of preoperative right ventricular echocardiograhic parameters for the occurrence of perioperative cardiovascular complications (PCC) in patients undergoing NCS. We reviewed the data of 660 patients aged ≥18 years and over (mean age 66.3±15 yr) who underwent preoperative comprehensive echocardiography before elective NCS between January 2015 and February 2019. Only patients who had undergone echocardiography before NCS were included. Echocardiographic measurements of right ventricular function, including tricuspid annular plane systolic excursion (TAPSE), Tei index, right ventricular fractional area change, and pulmonary artery systolic pressure, were retrospectively evaluated. The primary outcome of the study was major PCC defined as cardiac death, non-fatal cardiac arrest, severe arrhythmias requiring treatment, acute heart failure, acute coronary syndrome, pulmonary thrombo-embolism, and cardio-embolic stroke. Eighty (80) patients (12.1%) experienced PCC. Patients with PCC were older, and had a higher prevalence of coronary artery disease, heart failure, and diabetes mellitus. Patients with PCC had lower TAPSE (16.9±4.4 vs 20.8±4.2 mm; p<0.001) than patients without PCC. Multivariate logistic regression analysis showed that older age (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.25-4.65; p<0.01), presence of diabetes (OR, 1.78; 95% CI, 0.95-3.46; p=0.03), and TAPSE <17.6mm (OR, 3.12; 95% CI, 1.12-5.46; p=0.03) were significant variables associated with PCC. This is the first study to demonstrate that preoperative reduced right ventricular systolic function, as measured by TAPSE, is associated with increased rates of perioperative adverse cardiac events in patients undergoing NCS.

Echocardiographic prediction of severe pulmonary hypertension in neonates undergoing therapeutic hypothermia for hypoxic-ischemic encephalopathy.

Among neonates undergoing whole body cooling for hypoxic-ischemic encephalopathy (HIE), to compare ventricular function in the presence and absence of pulmonary hypertension (PPHN) needing inhaled nitric oxide (iNO)/ECMO. This retrospective study included infants with HIE who underwent cooling. ECHO (<24 h age) measures, RV fractional area change (FAC), RV Tricuspid annular plane systolic excursion (TAPSE), myocardial performance indices (MPI), and the RV systolic to diastolic duration (S/D) ratio were evaluated. The iNO/ECMO group (n = 26) had lower TAPSE and RV FAC and higher RV MPI and S/D, compared with controls (n = 39). Area under the curve was highest for RV S/D, with fair sensitivity (95% CI) [76.9 (56.3-91%)] and negative predictive value [78.6 (63.3-88.6%)] for subsequent iNO/ECMO at cutoff >1.45. Infants with HIE undergoing cooling who progressed to iNO/ECMO for PPHN had RV dysfunction on early ECHO; S/D had the best predictive performance. RV S/D may be a useful early marker of PPHN in HIE.