Normal Right Ventricular Function Research Articles

English

BACKGROUND A significant number of patients with acute Inferior wall infarction will have RV dysfunction and most of them have occlusion of either right or left circumflex coronary artery. But RV assessment is not done routinely in echocardiographic examination. Patients present with inferior wall myocardial infarction (IWMI) subsequently develop right ventricular myocardial infarction (RVMI) and have poor prognosis. In this study we wanted to evaluate the incidence of RVMI and the role of echocardiography in assessing RV function and its impact in predicting infarct related artery by angiographic analysis in acute IWMI after thrombolysis. METHODS 86 patients with acute IWMI after thrombolysis were randomly selected. Echocardiographic examination of RV function was performed within 72 hours after thrombolysis. We applied RV echo parameters like FAC (Fractional Area Change %), TAPSE (Tricuspid Annular Plane Systolic Excursion), RV S’ (RV Systolic Excursion Velocity) and MPI (Myocardial Performance Index) to assess RV function. 48 patients underwent coronary angiogram which included 10 patients with normal RV function, rest with RV dysfunction. RESULTS Among 86 patients, we compared 64 patients of RV dysfunction with 22 patients having normal function. Echo indices were significantly lower in RV dysfunction group. FAC ( 27 ± 5.95 vs 45 ± 5.4 ) TAPSE (8.5 ± 2.0 19.59 ± 2.8 ), RV S’ ( 5.78 ± 1.26 vs 17.2 ± 3.5 ) and RVMPI (0.22 ± 0.03 vs 0.57± 0.03). Angiographic analysis of 28 of 38 patients with RV dysfunction showed significant proximal lesion in RCA as compared to only 2 among 10 patients with normal RV function. CONCLUSIONS Conventional echo examination will underestimate RV dysfunction hence we applied echo parameters like FAC, TAPSE, RV S’ and RVMPI and a significant proportion of thrombolysed acute IWMI patients were found to have RV dysfunction and it was also helpful in the prediction of infarct related artery which would be predominantly a critical proximal RCA occlusion. KEY WORDS RVMI (Right Ventricular Myocardial Infarction), FAC (Fractional Area Change %), TAPSE (Tricuspid Annular Plane Systolic Excursion), RV S’ (RV Systolic Excursion Velocity) ,MPI (Myocardial Performance Index), IRA ( Infarct Related Artery)

Ultrasound and Influenza: The Spectrum of Lung and Cardiac Ultrasound Findings in Patients with Suspected Influenza A and B

In patients with influenza, cardiac and lung ultrasound may help determine the severity of illness and predict clinical outcomes. To determine the ultrasound characteristics of influenza and define the spectrum of lung and cardiac findings in patients with suspected influenza A or B, we conducted a prospective observational study in patients presenting to the emergency department at a tertiary care academic institution. An ultrasound protocol consisting of cardiac, lung and inferior vena cava scans was performed within 6 h of admission. We compared the ultrasound findings in cases with positive and negative influenza polymerase chain reaction, while controlling for comorbidities. We enrolled 117 patients, 41.9% of whom (49/117) tested positive for influenza. In those with influenza, ultrasound confirmed preserved left ventricular and right ventricular (RV) function in 81.3% of patients. The most common cardiac pathology was RV dilation (10.4%), followed by left ventricular systolic dysfunction (8.3%). Patients with negative influenza polymerase chain reaction with RV dysfunction demonstrated higher hospital admission than those those with normal RV function (45.1%, 23/51, vs. 17.9%, 5/28; p = 0.016). B-lines were prevalent in both influenza and non-influenza groups (40.8% and 69.1%, respectively; p = 0.013). Lung consolidation was identified in only 8.25% of patients with influenza. In conclusion, in patients with influenza we were unable to define distinct ultrasound features specific to influenza A or B, suggesting that ultrasound may not be beneficial in diagnosing influenza nor in evaluating its severity.

Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients

IntroductionRight ventricle (RV) dilation in combination with elevated central venous pressure (CVP), which is a state of RV congestion, is seen as a sign of RV failure (RVF). On the other hand, RV systolic function is usually assessed by tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). This study aimed to investigate the prevalence and prognostic value of RVF and RV systolic dysfunction (RVSD) in septic patients.MethodsMechanically ventilated sepsis and septic shock patients were included. We collected haemodynamic and echocardiographic parameters as well as prognostic information including mechanical ventilation duration, length of ICU stay and 30-day mortality. RVF was defined as a right and left ventricular end-diastolic area ratio ≥ 0.6 in combination with CVP ≥ 8 mmHg. RVSD was defined as TAPSE < 16 mm or FAC < 35%.ResultsA total of 215 patients were enrolled in this study, and the patients were divided into 4 groups: patients with normal RV function (normal, n = 101), patients with RVF but without RVSD (RVF only, n = 38), patients with RVSD but without RVF (RVSD only, n = 44), and patients with combined RVF–RVSD (RVF/RVSD, n = 32). The RVF/RVSD group and RVSD only group had a lower cardiac index than the RVF only group and normal groups (p < 0.05). At 30 days after ICU admission, 50.0% of patients had died in the RVF/RVSD group, which was much higher than the mortality in the RVF only group (13.2%) and normal group (13.9%) (p < 0.05). In a Cox regression analysis, the presence of RVF/RVSD was independently associated with 30-day mortality (HR 3.004, 95% CI:1.370–6.587, p = 0.006). In contrast, neither the presence of RVF only nor the presence of RVSD only was associated with 30-day mortality (HR 0.951, 95% CI:0.305–2.960, p = 0.931; HR 1.912, 95% CI:0.853–4.287, p = 0.116, respectively).ConclusionThe presence of combined RVF–RVSD was associated with 30-day mortality in mechanically ventilated septic patients. Additional studies are needed to confirm and expand this finding.

Neurodevelopmental outcome following hypoxic ischaemic encephalopathy and therapeutic hypothermia is related to right ventricular performance at 24-hour postnatal age

ObjectiveOur aim was to determine whether right ventricular (RV) dysfunction at 24-hour postnatal age predicts adverse developmental outcome among patients with hypoxic ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).DesignNeonates≥35 weeks...

Femoral Vein Pulsatility: What Does It Mean?

In this report, the clinical evolution of a 72-year-old patient transferred to the surgical intensive care unit after cardiac surgery is described. The presence of a pulsatile Doppler signal of the common femoral vein was noted after surgery. On postoperative day 5, diuretics in addition to a combination of inhaled epoprostenol and milrinone were associated with normalization of femoral vein pulsatility. The observations seen in peripheral venous flow reinforce the hypothesis that pulsatility of the common femoral vein represents an associated echocardiographic sign of right ventricular dysfunction and may be used to monitor systemic venous congestion. Pulsatility in the venous system may be improved by reducing volume overload and improving right ventricular function.

Global longitudinal strain in heart failure with reduced ejection fraction: Prognostic relevance across disease severity as assessed by automated cluster analysis

BackgroundEjection fraction (EF) is still widely used to categorize heart failure (HF) patients but has limitations. Global longitudinal strain (GLS) has emerged as a new prognosticator in HF, independent of EF. AimWe investigated the incremental predictive benefit of GLS over different risk profiles as identified by automated cluster analysis of simple echocardiographic parameters. Methods and resultsIn 797 HFrEF patients (age 66 ± 12y; mean EF 30 ± 7%), unsupervised cluster analysis of 10 routine echocardiographic variables (without GLS) was performed. Median follow-up was 37 months. End-point was all-cause mortality. Association between risk profiles, GLS, and mortality was assessed by Cox proportional-hazard modeling with interaction term.Cluster analysis allocated patients to 3 different risk phenogroups (PG): PG-1 (mild diastolic dysfunction [DD], moderate systolic dysfunction, no pulmonary hypertension, normal right ventricular [RV] function); PG-2 (moderate DD, mild pulmonary hypertension, normal RV function); PG-3 (severe DD, advanced systolic dysfunction, pulmonary hypertension, RV dysfunction). Compared to PG-1, PG-2 and PG-3 showed increased adjusted-hazard ratio (1.71; 95% CI:1.05–2.77, P = 0.30; and 2.58; 95% CI:1.50–4.44, P < 0.001, respectively). GLS was independently associated with outcome in the whole population (adjusted-HR: 1.11; 95% CI: 1.05–1.17, P = 0.001); however, profile membership modified the relationship between GLS and outcome which was no longer significant in PG-3 (P for interaction = 0.003). ConclusionsWithin HFrEF populations, clustering of routine echocardiography parameters can automatically identify patients with different risk profiles; further assessment by GLS may be useful for patients with not advanced disease.

Electromechanical delay in right bundle branch block: suggestive predictor of right ventricular systolic function

Background: RV dysfunction is a powerful predictor of prognosis in cardiopulmonary diseases. Recognition of RV dysfunction is clinically important, because impairment of RV systolic function is independently associated with adverse outcomes. ECG may serve as a simple tool for detection of underlying RV dysfunction in patients with RBBB.Methods: Patients with complete RBBB (n=225) who underwent ECG and echocardiography were screened from May 2017 to Jan 2019. Demographic, comorbidity data, ECGs and echocardiography were obtained. QRS and R’ duration was measured. RV dysfunction was defined by RV FAC&lt;35%, TAPSE&lt;17 and RV TEI Index&gt;0.54.Results: As compared to normal RV function, patients with RV dysfunction showed reduced TAPSE and RV FAC and increased RV systolic pressure, RV dimension and RV myocardial performance index (all p&lt;0.05). The R′ duration was significantly associated with RV FAC (r=-0.615, p&lt;0.001), RV systolic pressure (r=0.138, p=0.008), RV dimension (r=0.189, p&lt;0.001) and RV Myocardial Performance Index (r=0.190, p&lt;0.001). On ROC curve analysis, V1R′ duration&gt;100 ms was associated with RV dysfunction with 40% sensitivity and 90% specificity (AUC: 0.883; p&lt;0.001). Lead V1 QRS duration&gt;137 ms and the ratio of R′:QRS duration was also useful for predicting RV dysfunction (all p&lt;0.001). Conclusions: In patient with RBBB, the electromechanical delay has a correlation with RV systolic dysfunction. R′ prolongation in lead V1 can be a useful marker to determine the presence of underlying RV dysfunction as a non-expensive tool.

Right Ventricular Dysfunction and Short-Term Outcomes Following Left-Sided Valvular Surgery: An Echocardiographic Study.

BackgroundThe prognostic value of echocardiographic evaluation of right ventricular (RV) function in patients undergoing left‐sided valvular surgery has not been well described. The objective of this study is to determine the role of broad echocardiographic assessment of RV function in predicting short‐term outcomes after valvular surgery.Methods and ResultsPreoperative echocardiographic data, perioperative adverse outcomes, and 30‐day mortality were analyzed in patients who underwent left‐sided valvular surgery from 2006 to 2014. Echocardiographic parameters used to evaluate RV function include RV fractional area change, tricuspid annular plane systolic excursion, systolic movement of the RV lateral wall using tissue Doppler imaging (S'), RV myocardial performance index, and RV dP/dt. Subjects with at least 3 abnormal parameters out of the 5 aforementioned indices were defined as having significant RV dysfunction. The study included 269 patients with valvular surgery (average age: 67±15, 60.6% male, 148 aortic, and 121 mitral). RV dysfunction was found in 53 (19.7%) patients; 30‐day mortality occurred in 20 patients (7.5%). Compared with normal RV function, patients with RV dysfunction had higher 30‐day mortality (22.6% versus 3.8%; P=0.01) and were at risk for developing multisystem failure/shock (13.2% versus 3.2%; P=0.01). Multivariate analyses showed that preexisting RV dysfunction was the strongest predictor of increased 30‐day mortality (odds ratio: 3.5; 95% CI, 1.1–11.1; P<0.05).ConclusionsPreoperative RV dysfunction identified by comprehensive echocardiographic assessment is a strong predictor of adverse outcomes following left‐sided valvular surgery.

Assessment of right ventricular systolic function by two dimensional speckle tracking echocardiography in rheumatic mitral valve disease

We assessed the Right Ventricular (RV) systolic function using two dimensional (2D) speckle tracking echocardiography (STE) in Mitral valve disease before and after intervention. 90 patients divided into 3 groups of Mitral stenosis [MS], Mitral regurgitation [MR] and MS with MR were the study subjects. All the patients were subjected to conventional echocardiography and measurement of Right ventricular global longitudinal strain (RVGLS). Prior to intervention, subjects who demonstrated normal RV function by conventional methods, it was found that RVGLS was impaired significantly in the MS and MS with MR groups but normal in the MR group. After intervention, the RVGLS improved significantly in the MS group but not in the other groups. Right ventricular systolic pressure (RVSP) had a significant negative correlation to RVGLS in all 3 groups.

Abstract 14882: Outcomes of Heart Failure in Hypoplastic Left Heart Syndrome and the Impact of Recovery

Introduction: Survival for children with hypoplastic left heart syndrome (HLHS) and right ventricular (RV) dysfunction (dysfxn) remain poor. We describe outcomes of HLHS patients with RV dysfxn and the long-term impact of interval normalization. Methods: The SickKids Heart Failure (HF) Database is a retrospective cohort of HF patients from 2001 to 2017. We included patients with HLHS and at least mild RV dysfxn on echocardiogram lasting &gt;30 days, or death or transplant within 30 days of onset of dysfxn. We defined normalization as normal RV function (fxn) lasting &gt; 30 days after dysfxn onset. The primary endpoint was death or transplant. Descriptive statistics and time to event analysis were used. Results: We identified 99 patients with a median (IQR) age at onset of dysfxn of 2.6 (1 - 5.3) months. Of these, 51 (52%) had normalization of RV fxn for a median (IQR) duration of 3.5 (0.8 - 9.1) years and 28 (55%) had multiple periods of normal fxn. Of those who normalized, 4 (8%) normalized within a few months post Glenn procedure and 6 (13%) had normal fxn at last follow up. Patients with and without normalization had similar frequency of severe dysfxn (41 vs 52%, p=0.6). Normalization of RV fxn correlated with improved transplant free survival (78 % vs. 14 %, p&lt;0.001, Figure 1C) independent of surgical stage (p=0.03, figure 1D). Table 1 shows risk factors independently associated with transplant-free survival, including angiotensin converting enzyme inhibition. Conclusions: HLHS patients with RV dysfxn have poor transplant-free survival, especially those at interstage, but outcomes improve in those with persistent normalization of fxn. Factors predicting normalization need further study

Abstract 14130: Effect of Angiovac on Right Ventricular Function Following Removal of Right Atrial Masses in Patients With and Without Malignancy

Introduction: The AngioVac thrombectomy system (AngioDynamics Inc, Queensbury, NY) is an FDA approved device for removal of thrombi and emboli. Prior studies have shown procedural success for removal of right atrial (RA) and caval masses. This study aims to assess the effect of AngioVac on right ventricular (RV) function in patients undergoing removal of RA masses. Methods: Retrospective institutional study of patients undergoing removal of RA masses with AngioVac at a single tertiary medical center were included. Right ventricular fractional change (RVFC) and tricuspid annular plane systolic excursion (TAPSE) values were collected from echocardiograms before and after AngioVac or obtained manually if not present in the report. Paired 2-sample t test was done to assess for a significant difference between the two values. Results: The mean difference in RVFC before and after AngioVac was 1.6%, with a p-value of 0.327. Ten of the 28 patients had active malignancy, with a mean difference in RVFC of 0.8% and a p value of 0.683. The mean difference in the TAPSE group was 0.07mm and a p value of 0.48. Eight of the 19 patients had active malignancy, with a mean difference in TAPSE of 0.2mm corresponding to a p-value of 0.24. There was no significant difference in left ventricular ejection fraction before and after AngioVac (mean difference of 2.5%, p-value of 0.11). Conclusions: These findings suggest that use of the AngioVac device for removal of RA masses does not cause significant derangements in RV function by echocardiographic assessment. It is a well-tolerated procedure in patients with preprocedural normal RV function. These findings also further assess the use of AngioVac in patients with both right sided cardiac masses and active malignancy.

Abstract 17332: Prognostic Impact of Right Ventricular Function and Tricuspid Regurgitation in Functional Mitral Regurgitation: A Meta-Analysis

Introduction: Right ventricular dysfunction and tricuspid regurgitation grade are associated with cardiovascular mortality in the general population, primary MR, and other cardiovascular diseases. Hypothesis: The objective of this study was to investigate the prognostic importance of RVD, and TR in patients with functional mitral regurgitation (FMR) Methods: A systemic review and meta-analysis were performed using MEDLINE, Scopus, and Embase to assess the prognostic value of RVD and TR grade for mortality. RVD was defined as a TAPSE ≤ 16 mm or tissue Doppler-derived tricuspid lateral annular systolic velocity (S′TDI) &lt; 10 cm/s.Hazard ratios were extracted from multivariate models reporting on the association of RVD and TR with mortality and described as pooled estimates with 95% confidence intervals. Data were pooled across studies using the DerSimonian-Laird random-effects model. Results: A total of 9 nonrandomized studies met the inclusion criteria with eight studies having at least 12 months follow-up. Among the above studies, a total of 1325 patients (74.1% being male) were eligible for being included in our meta-analysis with an overall survival of 68.2% (n = 903). Of the enrolled patients, RVD was present in 39.1% and moderate-severe TR in 32.8%. RVD was significantly associated with mortality compared to normal RV function (HR, 1.89, 95% CI, 1.51-2.38, p &lt; 0.001, I2 =0). Additionally, patients with moderate-severe TR showed increased risk of mortality compared with those in the none-mild TR group (HR, 1.71. 95% CI, 1.36-2.15, p &lt; 0.001, I2 =0) Conclusions: This meta-analysis demonstrates the prognostic importance of RVD and TR grade in predicting all-cause mortality in patients with FMR. RV function and TR parameters may therefore be useful in the risk stratification of patients with FMR.

Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery.

The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.

Estrogen Signaling and Portopulmonary Hypertension: The Pulmonary Vascular Complications of Liver Disease Study (PVCLD2).

Portopulmonary hypertension (POPH) was previously associated with a single-nucleotide polymorphism (SNP) rs7175922 in aromatase (cytochrome P450 family 19 subfamily A member 1 [CYP19A1]). We sought to determine whether genetic variants and metabolites in the estrogen signaling pathway are associated with POPH. We performed a multicenter case-control study. POPH patients had mean pulmonary artery pressure >25mm Hg, pulmonary vascular resistance >240 dyn-sec/cm-5 , and pulmonary artery wedge pressure ≤15mm Hg without another cause of pulmonary hypertension. Controls had advanced liver disease, right ventricular (RV) systolic pressure <40 mm Hg, and normal RV function by echocardiography. We genotyped three SNPs in CYP19A1 and CYP1B1 using TaqMan and imputed SNPs in estrogen receptor 1 using genome-wide markers. Estrogen metabolites were measured in blood and urine samples. There were 37 patients with POPH and 290 controls. Mean age was 57 years, and 36% were female. The risk allele A in rs7175922 (CYP19A1) was significantly associated with higher levels of estradiol (P=0.02) and an increased risk of POPH (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.12-4.91; P=0.02) whereas other SNPs were not. Lower urinary 2-hydroxyestrogen/16-α-hydroxyestrone (OR per 1-ln decrease=2.04; 95% CI, 1.16-3.57; P=0.01), lower plasma levels of dehydroepiandrosterone-sulfate (OR per 1-ln decrease=2.38; 95% CI, 1.56-3.85; P<0.001), and higher plasma levels of 16-α-hydroxyestradiol (OR per 1-ln increase=2.16; 95% CI, 1.61-2.98; P<0.001) were associated with POPH. Genetic variation in aromatase and changes in estrogen metabolites were associated with POPH.

P1751 Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

Abstract Background Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (&amp;lt;40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome). Methods A total of 1264 HFrEF patients (Mean age: 68 ± 13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12-40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4 ± 7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n = 290, with CRDs n = 109) patients died (n = 386) or underwent HTx (n = 13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P = 0.001). Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P &amp;lt; 0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P &amp;lt; 0.001), TAPSE (HR 0.964, P = 0.003), RAA (HR 1.030, P &amp;lt; 0.001), and RVD (HR 1.029, P &amp;lt; 0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders. With the cut-off values (sPAP &amp;gt; 40mmHg, TAPSE &amp;lt; 12mm, RAA &amp;gt; 25cm², and RVD &amp;gt; 36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n = 427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n = 467) and severe RV dysfunction (≥3 parameters abnormal, n = 94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616 , 95% CI 1.232-2.119, P = 0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845-3.824, P &amp;lt; 0.001). Conclusions RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

A COVID-19 Case Complicated by Acute Pulmonary Embolism Underwent EKOS Thrombolysis with Favorable Outcome

We report a case of a 53 year-old man who presented with simultaneous COVID-19 infection and acute saddle pulmonary embolus with right heart strain. He underwent bilateral pulmonary artery ultrasound accelerated (EKOS) thrombolysis with successful resolution of pulmonary artery thrombus.His respiratory status significantly improved and follow-up echocardiography demonstrated normalization of right ventricular function and size.In the setting of critically ill COVID-19 patients who demonstrates respiratory deterioration with other clinical evidence of venous thrombosis, pulmonary embolism and subsequent ultrasound assisted catheter-directed thrombolysis (USAT) may be considered.

161 Impact of right ventricular dysfunction on outcome in heart failure patients with mid-range ejection fraction with and without chronic respiratory diseases

Abstract Background The impact of right ventricular (RV) dysfunction on outcome of heart failure patients with mid-range left ventricular ejection fraction (HFmrEF, 40-49%) is not well characterized yet. In this study, we observed the association between echocardiography defined RV dysfunction with outcomes and if the outcome was jointly affected by co-existed chronic respiratory diseases (CRD: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome) in HFmrEF patients Methods 1090 HFmrEF patients referred to our department between 2009 and 2017 were included in this study. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (15-38) months. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed with the use of multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results Mean age was 69 ± 13 years and 73.4% were male. The proportion of NYHA functional class III or IV was 24.8%. CRD was identified in 209 (19.2%) patients. 280 patients (25.7%, without CRD: 204, with CRD: 76) died and 2 patients (without CRD) underwent HTx. All-cause mortality/HTx was significantly higher in HFmrEF patients with CRD than without CRD (36.4% vs. 23.4%, P &amp;lt; 0.001). Besides CRD, Cox regression analysis showed that age, body mass index, and cardiac risk factors and comorbidities including diabetes, atrial fibrillation, dyslipidemia, coronary artery disease, kidney dysfunction (eGFR &amp;lt;60ml/min/1.73qm), anemia were associated with increased all-cause mortality/HTx (all P &amp;lt; 0.05). Multivariable Cox regression models showed that sPAP (HR 1.015, P = 0.002) and TAPSE (HR 0.962, P = 0.004) were independent determinants of all-cause mortality/HTx in patients without CRD, while sPAP served as independent determinant of all-cause mortality/HTx In patients with CRD (HR 1.018, P = 0.026) after adjusted for above mentioned confounders. Patients without CRDs were further grouped into those with normal (sPAP ≤ 40mmHg and TAPSE≥14mm, n = 513); mild to moderate (sPAP &amp;gt; 40mmHg or TAPSE &amp;lt; 14mm, n = 387) and severe RV dysfunction (sPAP &amp;gt; 40mmHg and TAPSE &amp;lt; 14mm, n = 88). Severe RV dysfunction was independently associated with a 2-fold increased all-cause mortality/HTx as compared to normal RV function (HR 2.209, 95% CI 1.455-3.355, P &amp;lt; 0.001). Conclusions Increased sPAP and reduced TAPSE are independent determinants of all-cause mortality in HFmrEF patients without CRD, and sPAP is an independent determinant of all-cause mortality in HFmrEF patients with CRD. Moreover, HFmrEF patients with severe RV dysfunction face a 2-fold increased all-cause mortality, as compared to patients with normal RV function and no CRD.

Prevalence and prognostic impact of right ventricular systolic dysfunction in heart failure patients with reduced LVEF

Echocardiography is the most performed imaging modality to evaluate heart failure patients. Right ventricular (RV) systolic dysfunction is a major prognostic factor. Evaluate the prevalence of RV systolic dysfunction in heart failure patients with reduced LVEF as well as their clinical, electrical and echocardiographic profile and prognosis. Retrospective and descriptive study collecting heart failure patients with reduced LVEF during a period of 5 months (between October 2017 and February 2018). Our population was divided into 2 groups, the group 1 has a normal RV function and the group 2 has an RV systolic dysfunction defined as TAPSE using M mode imaging of less than 15 mm and systolic velocity S’ of lateral tricuspid annulus using tissue Doppler imaging of less than 9.5 cm/s. Then, were studied clinical, electrical and echocardiographic characteristics of each group. Statistical analysis was performed using SPSS 2.0 software. One hundred and four patients were collected. The group 1 is made of 83 patients (79.8%), 42.2% are diabetic, 45.8% are hypertensive, 4.8% are dyslipidemic, 33.7% are smokers, 26.5% are class I NYHA, 60.2% class II NYHA, 13.3% class III NYHA, no patient is class IV NYHA, 7.2% in atrial fibrillation, mean LVEF is of 35% and mean systolic pulmonary artery pressure is of 45 mmHg. The group 2 is made of 21 patients (20.2%), 33.3% are diabetic, 42.9% are hypertensive, 4.8% are dyslipidemic, 57.1% are smokers, 9.5% in class I NYHA, 57.1% in class II NYHA, 28.6% in class II NYHA, 4.8% in class IV NYHA, 33.3% are in atrial fibrillation, mean LVEF is of 27%, all patients are in pulmonary artery hypertension and mean systolic pulmonary artery pressure is of 45 mmHg. In heart failure with reduced LVEF, RV systolic dysfunction is a prognostic factor. Actually, RV free wall strain gives the most accurate prognostic value.

P180 Pulmonary valve stenosis and pulmonary trunk aneurysm in old female with syncope

Abstract A 77-year-old female, known hypertensive and dyslipidemic on treatment presented with three episodes of syncope in the last two months. On examination; there was grade 4/6 harsh systolic murmur on the lateral sternal border. Transthoracic echocardiography was difficult because of mesocardia and abnormal rotation of the heart due to enlarged right sided chambers. There is mild left ventricular hypertrophy with normal ejection fraction, no left sided valvular disease. The right ventricle was hypertrophied and dilated with normal RV function. The pulmonary valve was thickened with significant systolic flow aliasing through the valve with significant regurgitation and huge main pulmonary trunk aneurysm (59 mm at its wideset diameter) (Figure 1). Transthoracic approach did not allow a correct alignment of the Doppler CW and the correct estimate of pulmonary valvulopathy; TEE was performed with a correct visualization of the valve in deep transgastric projection at 90 degrees. The valve was thickened, fibrotic, degenerated with systolic doming of leaflets (Figure 2) and peak systolic gradient ∼ 70 mmHg (Figure 3). 3D reconstruction of the valve showed a tricuspid valve (Figure 4) with a valve area ∼ 0.9 cm2 using planimetry in MPR (Figure 5). CT scan was performed which confirmed the main pulmonary trunk aneurysm ∼ 60 mm (Figure 6). Therefore, in light of the clinical and instrumental picture, the patient was referred to heart team discussion for the plan of surgical intervention. Discussion According to the ESC guidelines for grown up congenital heart disease in 2010, this pulmonary valve should be intervened upon as it is severe symptomatic PS (1), but there are 2 problems with this case; the first is significant associated PR, so no place for balloon dilatation here, the second problem is the pulmonary artery aneurysm (PAA). The dilemma of management of pulmonary PAA is that all the available data are about aortic aneurysms. Indications for intervention for PAA include: Absolute PAA diameter ≥ 5.5 cm, Increase in the diameter of the aneurysm of ≥ 0.5 cm in 6 mo, Compression of adjacent structures, Thrombus formation in the aneurysm sack, Evidence of valvular pathologies or shunt flow Verification of PAH, Signs of rupture or dissection (2). Surgery could include: Aneurysmorrhaphy only decreases the diameter of the vessel (3). Aneurysmectomy and repair or replacement of the right ventricular outflow tract is commonly used technique recently and mostly suits connective tissue disorders (6). Also, Replacement of the PA and the pulmonary trunk with a conduit (Gore-Tex or Dacron tubes, homografts, or xenografts) starting in the right ventricular outflow tract with replacement of the pulmonary valve (4). Conclusion PAA management is currently challenging because there are no clear guidelines on its optimal treatment. The presence of significant pulmonary valve dysfunction could affect the decision making of the associated PAA management. Abstract P180 Figure.

P779 Use of right ventricular strain analysis to detect right ventricle subtle dysfunction in patients with left ventricular ischemic cardiomyopathy

Abstract Back ground Right ventricular (RV) systolic dysfunction is an independent prognostic marker of several cardiovascular diseases. Cardiac magnetic resonance imaging (CMR) is a gold standard for evaluation of RV ejection fraction and RV structure. However, the CMR is not available in all institution. So some researchers use strain echocardiography to evaluate RV systolic function Purpose Evaluation of different RV functions and prevalence of RV dysfunction in patients with ischemic cardiomyopathy (ICM) (EF &amp;lt; 50%), using echocardiographic conventional methods and RV strain analysis Methods All our patients had ischemic cardiomyopathy (ICM) (EF&amp;lt; 50), patients with previous inferior myocardial infarction were excluded. A standard comprehensive transthoracic echocardiographic assessment of the RV dimensions, conventional systolic parameters: TAPSE, fractional area change FAC, S" velocity, myocardial performance index (RV MPI- RV Tie index ) and diastolic parameters (E/A, E/E", DT). 2 Dimensional speckle tacking echocardiography (2D-STE) for right ventricular global strain analysis (RVGLS): RVGLS total and RVGLS free wall (RVGLS total is a measurement obtained from the average value of all six segments values and RVGLS free wall is the average value from three RV free wall segments) , RV and LV peak systolic strain rate (RV SRs, LV SRs) and early diastolic strain rate (RV SRe, LV SRe) were measured. Results : we enrolled 50 patients (out of 1026 patients over one year ) 37 males (74%) , mean age 60.8 ± 7.4 years, according to RV strain analysis patients were divided into two groups, group I : patients who had normal RV function (RV free wall peak systolic strain PSS ≤-20%), and group II : had impaired RV function (RV free wall PSS &amp;gt;-20%) . there was no statistically significant difference between the two groups as regards LV dimensions, LV EF, LV GLS , LV SRs, RV dimensions nor other RV conventional parameters as TAPSE, FAC, S", or RV MPI. However mean RV GLS in group (I) was -17.52 ± 8.60 % vs -11.66 ± 3.25 % in group (II), (p = 0.003). Mean RV SRs in group (I) was -1.02 ± 0.27 /s vs -0.74 ± 0.38 /s in group (II), (p = 0.001) There was a statistically significant correlation between RV MPI and RV GLS (r = 0.315, p = 0.026), RVSRs and RV GLS (r = 0.656, p &amp;lt; 0.001) and between RV SRs and RVGLS free wall (r = 0.631, p &amp;lt; 0.001). There was a statistically significant correlation between RV SRs and RVGLS free wall in group (I) (r = 0.693, p &amp;lt; 0.001) and in group (II) (r = 0.819, p &amp;lt; 0.001). There was no agreement between TAPSE and RV GLS free wall (Kappa 0.063, p 0.2). MPI was the only conventional parameter that correlated with RV GLS free wall (p0.026). Conclusion RVGLS is a global, more sensitive parameter of RV systolic function compared to commonly used conventional parameters,it correlates better with RV systolic function and may have a more prognostic power for detection of subtle RV dysfunction.