Normal Right Ventricular Function Research Articles

Right ventricular dysfunction after surgical left ventricular restoration: prevalence, risk factors and clinical implications.

Surgical left ventricular (LV) restoration (SVR) induces changes in LV systolic and diastolic function that may affect postoperative right ventricular (RV) function. This study aimed to evaluate the long-term effect of SVR on RV function, with specific focus on determinants and prognostic implications of RV dysfunction. Eighty-six patients (age 60 ± 10 years, 73% male) with clinical and echocardiographic follow-up 2 years after SVR were included. RV dysfunction was defined as RV fractional area change <35%. The association between RV dysfunction at follow-up and clinical and echocardiographic characteristics and outcome was investigated. RV dysfunction at follow-up was present in 40% of patients and was associated with worse preoperative RV fractional area change (39 ± 9 vs 46 ± 7%, P < 0.01), pulmonary hypertension (18 vs 4%, P = 0.03) and higher follow-up LV filling pressures (E/E' ratio 23 ± 8 vs 15 ± 8, P = 0.02). At follow-up, patients with RV dysfunction were more frequently in New York Heart Association Class III or IV (30 vs 12%, P = 0.04) and 5-year mortality, heart transplantation and LV assist device implantation rate was increased (49 vs 17%, P < 0.01) as compared to patients with normal RV function. RV dysfunction after SVR was observed in 40% of patients and was associated with preoperative RV dysfunction, presence of pulmonary hypertension and an increase in LV filling pressures at follow-up. Patients with RV dysfunction after SVR had worse clinical functioning and outcome as compared to patients with normal RV function.

Assessment of acute pulmonary embolism outcome in hospital through Tricuspid Annular Plane Systolic Excursion versus Pulmonary Embolism Severity Index score

BackgroundIn-hospital mortality of acute pulmonary embolism ranging from 0 to 50%, depending upon hemodynamic status and right ventricular dysfunction. RV enlargement, in normotensive PE patients is considered as a predictor of poor clinical outcome, even in initially stable patients. Aim of the studyEvaluations of Tricuspid Annular Plane Systolic Excursion (TAPSE) as the prognostic tool for prediction of in hospital mortality in relation to the Pulmonary Embolism Severity Index (PESI) clinical risk score. Patients and methodsThis study was carried out in Dallah hospital Riyadh – Saudi Arabia including 50 patients diagnosed with APE. Those patients classified into three groups, Group I (20 patients) hemodynamically unstable, Group II (15 patients) hemodynamically stable with RV dysfunction and Group III (15 patients) hemodynamically stable with normal RV function. For all included patients TAPSE was measured, PESI risk score was calculated and recorded in the 1st day, 3rd day and 7th day of admission. ResultsReceiver operating characteristic (ROC) curve analysis of TAPSE determine that 14mm was the optimal cutoff value (AUC) 0.994, p<0.001 and for PESI determine that 124 points was the optimal cutoff value (AUC) 0.983, p<0.001. ConclusionTAPSE and PESI can be used as a good prognostic tool in acute PE during hospital course and TAPSE has higher accuracy than PESI in mortality prediction. TAPSE value ≤14mm can be used in judgment of thrombolytic therapy decision in hemodynamically stable APE patients.

Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

Background: Elevated afterload in chronic pulmonary artery hypertension (PAH) leads to sequence of events resulting in right ventricular (RV) hypertrophy, dilatation and eventual RV dysfunction. In last two decades, great emphasis has been laid on the right ventricular function for the prognosis of PAH. Hence, RV functional assessment is essential for assessing prognosis and monitoring therapeutic interventions in PAH patient. The purpose of this study to evaluate the prognostic value of pulse wave tissue Doppler imaging (PW – TDI) in chronic PAH patients. Methods: Eighty five patients (85) with chronic pulmonary artery hypertension were analysed. Patients were divided into two groups according to pulmonary artery systolic pressure by 2-D echocardiography as follows: group A (n=56) included mild to moderate PAH with pulmonary artery systolic pressure less than 70 mm of mercury and group B (n=29) included severe pulmonary artery pressure with pulmonary artery systolic pressure of more than equal to 70 mm of mercury. RV dysfunction were present in 8.9 % (n=5) & 24.1 % (n=7) of patients in group A and B respectively (p = 0.01). Tricuspid annulus plain systolic excursion (TAPSE) were measured at tricuspid annulus in M mode and pulse wave tissue Doppler imaging (PW – TDI) were performed and early diastolic annular velocities were recorded at the septal and lateral tricuspid annulus in all patients. Patients were followed for six months. Results: The present study demonstrates an inverse correlation between right ventricular (RV) performance indices e.g., TAPSE, RVPW – TDI early diastolic annular velocity (E`) and systolic pulmonary artery pressure in both groups of PAH patients. TAPSE was 20.45 mm and 18.13 mm (p<0.05) whereas E` lateral annular velocity was 16.05 cm/sec and 13.33 cm/sec (p < 0.05) for group A and B patients respectively. Similarly, TAPSE was 15.9 mm and 10.2 mm (p<0.05) whereas E` lateral annular velocity was 20.6 cm/sec and 13.6 cm/sec (p < 0.05) for normal RV function and RV dysfunction patients respectively. Lower TAPSE and RV TDI early diastolic annular velocities had more re-hospitalization (p < 0.05). Conclusion: The measurement of TAPSE by M-mode and RV TDI early diastolic annular velocities is a non-invasive, effective, simple and reproducible method that correlated well with pulmonary artery systolic pressure (PASP) and right ventricular function.

Abstract 13934: Echocardiographic Predictors of Change in Renal Function With Intravenous Diuresis for Decompensated Heart Failure

Title: Echocardiographic Predictors of Change in Renal Function with Intravenous Diuresis for Decompensated Heart Failure Background: Worsening or improved renal function occurs in a significant proportion of patients with decompensated heart failure who receive intravenous diuretic therapy. The direction of change in renal function has been difficult to predict with current biochemical, physical exam and imaging assessments. Hypothesis: We proposed the following hypotheses: (1) Patients with right ventricular (RV) dilation and systolic dysfunction would be more likely to experience improved renal function (IRF) with diuresis compared to those with normal RV size and function; (2) Patients with heart failure and a preserved left ventricular ejection fraction (LVEF) would be more likely to experience worsening renal function (WRF) with diuresis than those with a reduced LVEF (≤40%). Methods: Retrospective review of 363 patients admitted to a single center from January, 2011 to November, 2014 for decompensated heart failure who underwent intravenous diuresis and transthoracic echocardiography. Data regarding chamber quantification, right and left ventricular systolic function, valvular lesions and diastolic function were collected. Change in renal function was determined using validated GFR estimates based on serum creatinine. Results: Within our study population, 36.4% of patient experienced a decrease in eGFR by at least 10%, 34.7% had stable renal function and 28.9 had an improvement in eGFR by at least 10%. Patients with WRF were more likely to have a preserved LVEF (81/132; 61%) compared to those with stable (59/126, 47%) or improved (47/105, 45%) renal function (p-value 0.015). Patients with IRF were more likely to have a dilated, hypokinetic RV (p-value 0.008). Left atrial size, left ventricular internal diastolic dimension and diastolic dysfunction did not significantly predict change in renal function. Conclusions: Patients with WRF during diuresis for decompensated heart failure are more likely to have a preserved LVEF than those with stable or improved renal function. Those with IRF are significantly more likely to have a dilated, hypokinetic RV.

Impact of right ventricular function on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement

Right ventricular (RV) dysfunction was shown to be associated with adverse outcomes in a variety of cardiac patients and is considered a risk factor for adverse outcome according to the updated Valve Academic Research Consortium criteria. Our goal was to assess the impact of RV function at baseline on 1-year mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). All patients with severe AS treated with TAVR from May 2007 to March 2015 at our center were included in the present study, and baseline and procedural characteristics were recorded for each patient. The patients were categorized according to RV function at baseline as assessed by current guidelines, and a comparison of mortality rates up to 1 year was performed. Among 650 patients, 606 had adequate echocardiogram quality and 146 (24%) had RV dysfunction. There were significant differences between the 2 groups, as patients with RV dysfunction were younger (81±9 vs 84±7 years, P=.01) and were more likely to be male (65% vs 42%, P<.001). In addition, patients with RV dysfunction had higher rates of prior myocardial infarction (26% vs 16%, P=.02) and atrial fibrillation (51% vs 39%, P=.02). Echocardiographic parameters demonstrated higher rates of left ventricular ejection fraction <40% (40% vs 18%, P<.001), tricuspid regurgitation above moderate (16% vs 9%, P=.04), and higher pulmonary artery systolic pressure (50±17 vs 44±16 mm Hg, P<.001) among patients with severe AS and RV dysfunction compared with patients with normal RV function. Despite the unfavorable cardiac function, patients with severe AS undergoing TAVR have similar functional class (P=.22) and mortality rates at 1year (27% vs 23%, log-rank P=.45). Patients with severe AS and RV dysfunction have similar 1-year mortality and functional class after TAVR to patients with normal RV function. The presence of RV dysfunction does not correlate with outcome in patients with severe AS.

Can a Six-Minute Walk Distance Predict Right Ventricular Dysfunction in Patients with Diffuse Parenchymal Lung Disease and Pulmonary Hypertension?

Pulmonary hypertension (PH) is commonly observed in patients with diffuse parenchymal lung disease (DPLD). The purpose of this study was to explore the influence of the 6-minute walk test (6MWT) as a simple, non-invasive tool to assess right ventricular (RV) function in patients with DPLD and to identify the need for an echocardiogram (ECHO) to screen for PH. We retrospectively reviewed 48 patients with PH secondary to DPLD, who were evaluated in the PH clinic at the Mayo Clinic in Jacksonville, Florida, from January 1999 to December 2014. Fifty-two percent of patients had RV dysfunction. They had a significantly greater right heart pressure by ECHO and mean pulmonary arterial pressure (MPAP) from right heart catheterization (RHC) than those with normal RV function. A reduced 6-minute walk distance (6MWD) did not predict RV dysfunction (OR 0.995; 95% CI 0.980-1.001, p = 0.138). In addition, worsening restrictive physiology, heart rate at one-minute recovery and desaturation were not different between patients with and without RV dysfunction. However, there were inverse correlations between 6MWD and MPAP from RHC (r = -0.41, p = 0.010), 6MWD and RV systolic pressure (r = -0.51, p < 0.001), and 6MWD and MPAP measured by ECHO (r = -0.46, p =0.013). We also found no significant correlation between 6MWD and pulmonary function test parameters. Our single-center cohort of patients with PH secondary to DPLD, PH was found to have an impact on 6MWD. In contrast to our expectations, 6MWD was not useful to predict RV dysfunction. Interestingly, a severe reduction in the 6MWD was related to PH and not to pulmonary function; therefore, it may be used to justify an ECHO to identify patients with a worse prognosis.

The Short-Term Effect of Right Ventricular Mid-septal Pacing on Right Ventricular Function

Background: Right ventricular (RV) apical pacing is associated with left ventricular (LV) dyssynchrony and dysfunction. However, the effect of pacing on RV function, in particular with leads positioned in the RV mid-septum, remains unknown. We investigated the short-term effect of pacing on RV function Methods: We enrolled 24 patients with normal baseline LV and RV function requiring permanent pacemaker insertion. Echocardiography was performed prior to implantation (baseline) and at 1 month. We assessed RV tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue Doppler-derived systolic velocity (S’), RV fractional area change (FAC) and RV global longitudinal strain (GLS) using speckle tracking Results: Mean age was 73.8 ± 9.5 years. 1-month percent ventricular pacing average was 32% (range 0-100%). 17 patients had atrioventricular nodal dysfunction and 7 had sick sinus syndrome. There was a small but statistically significant decline in RV GLS 1 month following pacemaker insertion(Table). There was also a trend towards decline of RV function on all other measured parameters. Conclusions: RV mid-septal pacing may be associated with a slight decline of RV function early after pacemaker insertion, which may be identified by strain analysis. Longer-term follow-up is under way to assess if this predicts long-term RV dysfunction.

Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients

There is no comprehensive analysis of transthoracic echocardiographic findings of pulmonary embolism (PE). The aim of this study was to assess the frequency of right ventricular (RV) dysfunction (RVD), typical echocardiographic signs of acute PE (TES), and incidental abnormalities. A single-center, retrospective analysis was conducted of 511 consecutive patients (281 women; mean age, 64.0±18.6years) with PE confirmed by contrast-enhanced multidetector computed tomography who underwent transthoracic echocardiography for the assessment of left ventricular and RV alterations. TheMcConnell sign, the "60/60" sign, and right heart thrombus were regarded as TES. RVD included RV free wall hypokinesis and RV to LV end-diastolic ratio>0.9. Incidental echocardiographic alterations were also reported. RV enlargement, RV free wall hypokinesis, and interventricular septal flattening were found in 27.4%, 26.6%, and 18.4% of patients, respectively. Tricuspid regurgitation peak systolic gradient>30mmHg and pulmonary ejection acceleration time<80msec were measured in 46.6% and 37.2% of patients, respectively. RVD was found in 20.0% of patients, while normal RV function was present in 33.4% of patients. The McConnell sign, 60/60 sign, and right heart thrombus were found in 19.8%, 12.9%, 1.8% of subjects, respectively. All 16 hemodynamically unstable patients with PE presented enlarged hypokinetic right ventricle and at least one TES. However, in three of them, RV to LV end-diastolic ratio was <0.9. Incidental abnormalities were found in 9.6% of 364 stable patients with PE without RVD and TES. Transthoracic echocardiography showed no significant abnormalities suggestive of PE in 71% ofpatients with PE, while in approximately 10%, transthoracic echocardiography revealed incidental findings. The coexistence of an enlarged hypokinetic right ventricle with the McConnell sign together with the 60/60 sign seems to be the most useful echocardiographic criterion for RVD.

Prevalence and Prognostic Significance of Right Ventricular Systolic Dysfunction in Patients Undergoing Transcatheter Aortic Valve Implantation.

Cardiovascular magnetic resonance (CMR) can provide important structural information in patients undergoing transcatheter aortic valve implantation. Although CMR is considered the standard of reference for measuring ventricular volumes and mass, the relationship between CMR findings of right ventricular (RV) function and outcomes after transcatheter aortic valve implantation has not previously been reported. A total of 190 patients underwent 1.5 Tesla CMR before transcatheter aortic valve implantation. Steady-state free precession sequences were used for aortic valve planimetry and to assess ventricular volumes and mass. Semiautomated image analysis was performed by 2 specialist reviewers blinded to patient treatment. Patient follow-up was obtained from the Office of National Statistics mortality database. The median age was 81.0 (interquartile range, 74.9-85.5) years; 50.0% were women. Impaired RV function (RV ejection fraction ≤50%) was present in 45 (23.7%) patients. Patients with RV dysfunction had poorer left ventricular ejection fractions (42% versus 69%), higher indexed left ventricular end-systolic volumes (96 versus 40 mL), and greater indexed left ventricular mass (101 versus 85 g/m(2); P<0.01 for all) than those with normal RV function. Median follow-up was 850 days; 21 of 45 (46.7%) patients with RV dysfunction died, compared with 43 of 145 (29.7%) patients with normal RV function (P=0.035). After adjustment for significant baseline variables, both RV ejection fraction ≤50% (hazard ratio, 2.12; P=0.017) and indexed aortic valve area (hazard ratio, 4.16; P=0.025) were independently associated with survival. RV function, measured on preprocedural CMR, is an independent predictor of mortality after transcatheter aortic valve implantation. CMR assessment of RV function may be important in the risk stratification of patients undergoing transcatheter aortic valve implantation.

Right ventricular presystolic peak velocity represents right ventricular function in stable patients

Right ventricular (RV) function is difficult to be measured but plays a role in morbility and mortality of patients with cardiopulmonary diseases, so many echocardiographic parameters have been developed from M-mode, B-mode and Doppler tissue imaging (DTI) evaluation. Right ventricular presystolic peak velocity (RVPrP) measured with DTI of the tricuspidal annulus and its changes in RV dysfunction have never been assessed in a patient's cohort of stable patients with cardiovascular risk factors. RVPrP velocity could have a role in RV function evaluation; this study addresses such issue. Four hundred thirty-six consecutive patients were submitted to a complete echocardiographic examination with the contemporary evaluation of the following RV function indexes: Tricuspid Annulus Plane Systolic Excurtion (TAPSE), RV Systolic Peak (RVSyP) and RVPrP. Pulmonary artery systolic pressure (PASP), left ventricular and RV diastolic function were also evaluated. According to TAPSE and RVSyP taken alone or in combination, 113 patients had RV dysfunction, while 323 patients had normal RV function. RVPrP was reduced in patient's group with RV dysfunction with respect to patient's group with preserved RV function (16.48±7.3 cm/s vs. 23.98±8.4 cm/s, respectively, P<0.001). RVPrP was related with RVSyP (P<0.001) and with TAPSE (P=0.002). TAPSE and RVSyP revealed a poor concordance to define RV dysfunction. PASP was higher in patient's group with reduced RV function (P=0.033). The study showed RVPrP able to detect stable patients with RV dysfunction.

22. Comparison of conventional echocardiographic parameters of rv systolic function with cardiac magnetic resonance imaging

Nowadays, cardiac magnetic resonance (CMR) imaging is considered the gold standard for quantification of RV size and function. Multiple 2D Echocardiography (echo) parameters are recommended for quantification of systolic RV function including Fractional Area Change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Tissue Doppler velocity (TDI) of tricuspid annulus. The aim of our study was to compare the conventional 2-D echocardiographic parameters of RV systolic function with CMR derived RVEF and stroke volume (SV). The echo and cardiac magnetic parameters to assess the right ventricular function are different. Consecutive patients referred to CMR for RV assessment from January 2011 to December 2014 were screened. 69 patients with CMR and adequate echo were selected. 20 subjects with normal CMR were enrolled as a control group. Quantitative 2-D echo measures were compared with CMR RVEF (%) and SV (ml). The comparison was made using linear correlation for the echo variables with CMR variables. The mean age of patients was 38.2 + 5.4 (51% females) were enrolled. 84.1% of patients had normal RVEF by CMR. In patients, FAC% but not TAPSE or annular TDI, correlated with CMR derived RVEF ( R = 0.45, p = 0.0001) with fair agreement (kappa 0.43). However, FAC% did not correlate with CMR RV stroke volume. In contrast, in normal subjects, TAPSE had the best correlation with CMR derived RVEF ( R = 0.67, p = 0.0001). In patients, CMR reclassified RV function assessed by FAC% in 11 (16%). 6 (8%) patients who had abnormal RV function by FAC% were reclassified as normal while 5 (7%) with normal RV function by FAC% were reclassified as abnormal. In normal subjects, however, only one with abnormal RV function by TAPSE was reclassified as normal by CMR. The current quantitative 2-D echo parameters of RV systolic function assessment correlate poorly with CMR measured RVEF and SV and behave differently in comparison with CMR in patients with normal and abnormal RV function. CMR should be utilized more often to measure RVEF and volumes to complement routine 2-D echocardiography measurements for comprehensive and accurate evaluation of RV systolic function.

Non-invasive screening for pulmonary hypertension in idiopathic pulmonary fibrosis

BackgroundPulmonary hypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) that is associated with poor prognosis. Noninvasive screening for PH in IPF patients is challenging and a combination of several noninvasive determinations can improve discrimination. MethodsWe included 235 IPF patients who underwent right heart catheterization (RHC) as part of the lung transplant evaluation. We measured electrocardiographic (ECG) and echocardiographic variables as well as the pulmonary artery (PA) and ascending aorta (AA) diameters on chest CT. We recorded results of arterial blood gases (ABG), pulmonary function (PFT) and 6-min walk tests (6MWT). ResultsSeveral variables were predictors of PH in IPF patients in univariable models including a lower arterial oxygenation and 6MWT distance; worse right ventricular (RV) function, rightward deviation of the QRS axis and a higher FVC/DLCOc ratio, PA/AA diameter ratio, and estimated RV systolic pressure. In multivariable analysis, a worse RV function and higher PA/AA ratio remained predictors of PH (c-index 0.75 (0.65–0.84)). Similarly, a worse RV function, a higher PA/AA ratio and a rightward QRS axis deviation were independent predictors of precapillary PH (c-index 0.86 (0.76–0.92)). A combination of PA/AA diameter ratio <1.1, a QRS axis <90° and normal RV function showed a negative predictive value of 85% for precapillary PH. ConclusionsThere are significant differences in ECG, echocardiographic, chest CT, PFT and ABG parameters between IPF patients with and without PH. However, these noninvasive tests alone or combination have limited discrimination ability for PH screening in IPF.

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study.

The benefit of a cardiac rehabilitation (CR) program for patients with Chagas heart failure (CHF) remains unclear. Therefore, we aimed to investigate the effects of CR for CHF patients. A single-arm pilot study, including 12 patients with CHF, was performed. Patients participated in an 8-month physical exercise intervention, comprising aerobic, strength, and stretching exercises (3 times per week, 60 minutes per session). Nutritional and pharmaceutical counseling were also performed. Functional capacity (cardiopulmonary exercise test), muscle respiratory strength (manovacuometry), and body composition (anthropometry and skinfolds) were evaluated at baseline, and after 4 and 8 months of intervention. Cardiac function (echocardiography), biomarkers (lipid profile, glucose, and glycated hemoglobin) and quality of life (Minnesota Living with Heart Failure Questionnaire) were assessed at baseline and at the end of the intervention. Seven of 12 patients included in the study completed the 8-month follow-up period. Only 2 moderate adverse events occurred during the exercise training. Functional capacity improved after 4 months of CR, while left ventricular ejection fraction (LVEF) and respiratory strength improved after 8 months. Patients with right ventricular (RV) dysfunction at baseline exhibited an improvement in functional capacity after 4 months, and improvements in left ventricular (LV) diastolic pressure, respiratory strength, and quality of life at the end of follow-up. Conversely, those with normal baseline RV function demonstrated LVEF increases that were not observed in patients with RV dysfunction. CR was feasible, safe, and has important clinical benefits for patients with CHF, specifically for cardiac function and muscle respiratory strength.

THE COANDA EFFECT: HIDING THE TRUE ETIOLOGY OF HEART FAILURE

A 65 y/o tall, well-built male with treated hypertension presented to the hospital with 8 month history of worsening shortness of breath and multiple hospitalizations for heart failure symptoms. Echocardiogram showed normal LV and RV function, Grade I diastolic dysfunction, moderate LV thickness,

Abstract 12336: Non-invasive Screening for Pulmonary Hypertension in Idiopathic Pulmonary Fibrosis

Introduction: Pulmonaryhypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) that is associated with poor prognosis. Screening for PH in IPF patients proves to be challenging. Hypothesis: We hypothesized that combining several non-invasive studies can predict the presence of PH in IPF patients. Methods: We included 235 IPF patients who underwent right heart catheterization (RHC) as part of the lung transplant evaluation. We measured ECG and echocardiographic variables as well as the pulmonary artery (PA) diameter and ascending aorta (AA) diameters on chest CT. We recorded results of arterial blood gases (ABG), pulmonary function (PFT) and 6-min walk tests (6MWT). Results: Several variables were predictors of PH in IPF patients in univariate models including arterial oxygenation, 6MWT distance, worse right ventricular (RV) function, the QRS axis, FVC/DLCOc ratio, PA/AA diameter ratio and estimated RV systolic pressure. In multivariate analysis, RV function and PA/AA ratio remained predictors of PH (c-statistics 0.75 (0.65-0.84), accuracy 71.4%). Similarly, RV function, PA/AA ratio and QRS axis were independent predictors of precapillary PH (c-statistics 0.86 (0.76-0.92), accuracy 84.2%). A combination of PA/AA diameter ratio &lt;1.1, a QRS axis &lt;90° and normal RV function showed a negative predictive value of 85% for precapillary PH. Conclusions: There are significant differences in ECG, echocardiographic, chest CT, PFT and ABG parameters between IPF patients with and without PH. However, these noninvasive tests alone or combination are not accurate enough for PH screening in IPF.

Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function

ObjectiveDetermination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. MethodsA single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012. Patients291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms. Measurements and main resultsOf the 291 patients, 57% were male, with a mean age of 59±16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26–0.99, p<0.05; severe: OR 0.19, CI 0.06–0.65, p=0.008) and neurologic outcome (mild or moderate: OR 0.33, CI 0.17–0.65, p=0.001; severe: OR 0.11, CI 0.02–0.50, p=0.005) compared to patients with normal RV function after cardiac arrest. ConclusionsEchocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.

Right ventricular systolic dysfunction and its prognostic value in heart failure with preserved ejection fraction

Objective The prognostic impact of right ventricular systolic dysfunction (RVSD) in heart failure (HF) with preserved ejection fraction (HFPEF) is not suffi ciently understood. This pilot study evaluates the prevalence and prognostic impact of RVSD in HFPEF.Methods Ninety-fi ve consecutive patients, admitted due to HF within one year were included and followed up for 12 months. Patients were classifi ed based on left ventricular ejection fraction (LVEF) into two groups: HFPEF (LVEF > 40%; n = 54), and heart failure with reduced ejection fraction (HFREF) (LVEF ≤ 40%; n = 41). RVSD was defi ned as peak systolic tricuspid annular velocity (S’) < 10.8 cm/s. Results The prevalence of RVSD was 22% vs 59%, in HFPEF vs HFREF, respectively (P < 0.001). Patients with HFPEF and RVSD had signifi cantly higher one-year all-cause mortality compared to HFPEF with normal RV function (41.7% vs 4.8%, P = 0.004). The same trend was found in HFREF (33.3% vs 5.9%, P = 0.057). A similar outcome was observed in cardiovascular mortality (HFPEF 33.3% vs 0%, P = 0.002 and HFREF 20.8% vs 0%, P = 0.06). RVSD was the only independent predictor of all-cause one-year mortality in patients with HFPEF (HR 11.5, 95% CI 2.2 to 59.5, P = 0.004).Conclusion RVSD is an independent predictor of all-cause mortality in HFPEF. Patients with HFPEF and RVSD had signifi cantly higher one-year all-cause and cardiovascular mortality than those with normal RV function.

Abstract 183: In Patients Evaluated for Chest Pain or Dyspnea, Right Bundle Branch Block and/or Right Ventricular Dysfunction Are Associated With Inferior Long Term Outcomes Independent of Stress Test Results

Background: Association between right bundle branch block (RBBB) and/or right ventricular (RV) dysfunction or dilation and outcomes in patients evaluated with stress testing are not well investigated. Methods: Records of 404 consecutive patients referred for chest pain or dyspnea evaluation with stress echocardiogram at a single tertiary care center were reviewed. In 140 patients, baseline echocardiogram included assessment of RV dimensions and function. Demographic, clinical data, and outcomes were collected. ANOVA, chi-square, and logistic regression analyses were used. Mean follow up length was 76+/-18 months. Study was approved by the IRB. Results: Demographic data and co-morbidities, including DM, CAD, HTN and PVD, were similar in patients with RBBB and/or RV dilation or dysfunction. Baseline, pre-stress RV dysfunction or dilatation were associated with an approximate fourfold increase in mortality during follow up, regardless of stress test outcome (44% vs. 11%, p=0.0052). Ischemia during stress test was also more likely in patients with RV dysfunction or dilatation (44% vs. 15%, p=0.019). In patients with RV dilatation and/or dysfunction, RBBB on baseline ECG was noted in 33% vs. 8% in patients with normal RV size and function (p = 0.0159). However, baseline RBBB was not associated with increased mortality, ability to reach THR, or ischemia during stress test. Conclusions: RV dilation and/or dysfunction pre-stress testing was associated with increased mortality and ischemia on stress testing. Observed in 1/3 of our study patients RV dilatation and/or dysfunction, RBBB was not associated with worst outcomes. Additional studies investigating utility of pre-stress echocardiogram in assessment of RV dimensions and function are warranted.

0189 : Right ventricular dysfunction in patients presenting with an idiopathic dilated cardiomyopathy: predictive factors and prognostic value

Right ventricular (RV) dysfunction is a predictor of impaired prognosis in patients presenting with an idiopathic dilated cardiomyopathy (DCM). We intended to determine which parameters were associated with RV dysfunction and to analyze the prognostic role of RV dysfunction independently of the level of LV dysfunction (LVEF and end-diastolic diameter). 136 consecutive patients (73% men, mean age 59.0±13.2 years) with idiopathic DCM (LVEF 45%) were retrospectively enrolled. 34 patients (25%, group 1) presented with RV dysfunction defined as TAPSE δ15mm (tricuspid annular plane systolic excursion) and 102 (group 2) had normal RV function. Patients were followed for a mean time of 2.7±1.1 years for the occurrence of any major adverse cardiac event (MACE: cardiac death and hospitalization, heart transplantation). Mean LVEF was 27.5±8.7%. Mean TAPSE was 18.6±5,4mm with an interquartile range of 15-21,8mm. Multivariate predictors of RV dysfunction were LV outflow tract TVI (OR 0.8 (95% CI 0.7-0.9), p=0.003) and E-wave deceleration time δ145ms (OR 4.1 (95% CI 1.3-12.8), p=0.017). MACE-free survival at 1 and 2 years was 64% and 55% respectively in group 1, compared to 87% and 79% in group 2 (p=0.002). By multivariate analysis and after stratification using a propensity score, RV dysfunction emerged as an independent predictive factor of MACE (HR 3.2 (95% CI 1.3-7.6), p=0.009), along with right atrium area >20cm 2 and age. RV dysfunction defined by TAPSE 15mm is associated with a systolic (aortic TVI) and a diastolic (E-wave DT) LV function parameters. RV dysfunction in patients presenting an idiopathic DCM is an additional and independent prognostic factor independent of the level of LV dysfunction and dilatation.

Evaluation of right ventricle by speckle tracking and conventional echocardiography in rats with right ventricular heart failure.

Speckle tracking echocardiography (STE) has been reported to be a promising technique for evaluating right ventricular (RV) function in the clinical setting. On the other hand, the usefulness of STE for RV evaluation in small animal models has not been clarified, although the rat model is among the most commonly used animal models to develop novel effective treatments against pulmonary hypertension and RV heart failure (HF).We validated the use of STE and conventional echocardiographic variables for evaluating RV functions in a rat model by comparing the echocardiographic values of RVHF rats (n = 12) induced by monocrotaline injection with those of control rats (n = 12).Most conventional echocardiographic variables demonstrated that RVHF rats have significant RV dysfunction. The area under the curve (AUC) values to distinguish RV dysfunction in RVHF rats from normal RV function in control rats using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), peak tissue Doppler tricuspid annular velocities at systole (Sa), and at early diastole (Ea) were 0.71, 0.98, 0.79, 0.92, and 0.91, respectively. However, using STE analysis for RV evaluation, limited reproducibility was observed (variability 19-37 %, ICC 0.74-0.88) and the only circumferential strain showed significantly lower absolute values (P = 0.039, AUC = 0.76).To evaluate RV function in rat models, circumferential strain may be useful, however, the reproducibility and diagnostic utility were limited. Conventional echocardiographic variables such as TAPSE, tissue Doppler Sa, and Ea have superior diagnostic utility.