Parameters Of Right Ventricle Function Research Articles

Prognostic Value of Strain by Speckle Tracking Echocardiography in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy.

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (-13 ± 6% vs. -23 ± 6%, p < 0.001) and RV free wall longitudinal strain (-15 ± 5% vs. -25 ± 7%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.

Incremental Prognostic Value of Right Ventricular-pulmonary Artery Coupling to a Clinical Risk Score in Tricuspid Regurgitation: the TRIO-RV Score

There are limited data evaluating echocardiographic parameters of risk in tricuspid regurgitation (TR) patients. We sought to evaluate the incremental prognostic value of quantitative right ventricle (RV) function and RV-pulmonary artery (RV-PA) coupling to an established clinical risk score in TR patients. We retrospectively identified patients with ≥moderate TR from January 1st, 2019 to June 30th, 2019. Univariable and multivariable cox proportional hazards regression were used to test the association of right ventricular free wall strain (RVFWS), RVFWS indexed to right ventricular systolic pressure (RVSP), and the TRIO risk score with mortality. A novel TRIO-RV risk score was developed by incorporating RVFWS/RVSP into the clinical TRIO risk score. Among 417 patients, age 73±11.5 years, 47% female, TRIO score was 3.5±2. TRIO score was low-risk in 213 (51%), intermediate-risk in 162 (39%), and high-risk in 42 (10%). During median follow up of 3.96 years (IQR 1.66-4.34 years), death occurred in 157 patients (38%). Baseline TRIO risk category was associated with mortality (p<0.001). After adjustment by TRIO risk score, both RVFWS <18.6% (adjusted HR 3.08, 95% CI 2.01-4.72, p<0.001) and RVFWS/RVSP <0.43 %/mmHg (adjusted HR 2.76, 95% CI 1.75-4.35, p<0.001) remained significantly correlated with mortality. With the addition of RVFWS/RVSP, 151 (40%) patients with low- and intermediate-risk TRIO scores were reclassified to a higher-risk TRIO-RV score. The ChiSquare value increased in sequential models predictive of mortality for the TRIO score alone, the TRIO score plus RVFWS <18.6%, and the TRIO score plus RVFWS/RVSP <0.43 %/mmHg (model ChiSquare 38.3, 72.2, and 82.3, respectively). Quantitative parameters of RV function are associated with mortality in TR patients even after correction for an existing clinical risk score. Incorporating RVFWS/RVSP into the TRIO clinical risk score, the TRIO-RV score, reclassifies a substantial number of low- and intermediate-risk patients into higher risk categories and improves risk stratification.

Role of Speckle Tracking in Detection and Short Term Follow Up of Right Ventricular Systolic Dysfunction in Patients with Acute Inferior STEMI

Abstract Background The right ventricle (RV) is a thin-walled chamber characterized by functioning under low oxygen demands and pressure. RV is perfused throughout the cardiac cycle in both systole and diastole. These factors make RV less susceptible to infarction compared to the left ventricle. Successful primary PCI in patients with RV infarction has shown to regain the RV systolic function and is associated with better in-hospital morbidity and mortality. Speckle tracking derived strain provides accurate assessment of the RV global and segmental myocardial function. Objective To assess RV systolic function in inferior STEMI using 2D echocardiography speckle tracking derived longitudinal strain early after primary PCI and follow up 3 months later. Methods This prospective cohort study was conducted at Ain Shams University Hospitals. 50 patients underwent successful (PCI) after inferior STEMI. Another 50 healthy individuals were examined “to obtain reference values for RV FWS”. Results RV function parameters showed good prognosis 3 months after primary PCI: TAPSE (39 patients “78%” showed improvement Vs 11 “22%” that had no change), also Fractional area change (FAC) (42 patients “84 %” improved Vs 8 non improved patients “16%”) finally Free wall strain showed the better improvement (44 patients “88 %” improved). Conclusion Among the echo Doppler parameters, FAC and. RV speckle tracking derived strain parameters were the most sensitive in assessment of RV function impairment and recovery after inferior STEMI.

Relationship between Plasma D-Dimer Level and Pulmonary Hypertension as well as Right Ventricle Dysfunction in Patient Post Pneumonia COVID-19

Background: High rate of coagulopathy and pulmonary thromboembolism in coronavirus disease 2019 (COVID-19), which is represented by an increase in plasma D-Dimer levels is believed to be related to pulmonary hypertension (PH) and right ventricle (RV) dysfunction. Objective: To evaluate the relationship between plasma D-Dimer levels with PH and RV dysfunction assessed from transthoracic echocardiography (TTE) in patients post COVID-19 pneumonia. Methods: Observational research with a cross-sectional design. Estimated mean pulmonary arterial pressure (mPAP) was calculated from Mahan's formula obtained from pulmonary artery acceleration time (PAAT) and RV function was assessed from RV free wall strain (RV FWS), tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC). D-Dimer levels during hospitalisation were obtained from medical records and actual D-Dimer was obtained at the time of echocardiography. Results: Total 40 patients post-COVID-19 pneumonia underwent TTE in a median of 11 days after negative PCR. There was a significant correlation between peak D-Dimer levels with mPAP (r=0.526, p&lt;0.001), RV FWS (r=-0.506, p=0.001), TAPSE (r=-0.498, p=0.001), and FAC (r=0.447, p=0.004). Multivariate analysis found peak D-Dimer ≥4530 µg/L independently associated with PH with odds ratio (OR) 6.6, (95% CI 1.1-10; p=0.048), but not with RV dysfunction. Conclusion: Peak D-Dimer level correlates with echocardiographic parameters of RV function and mPAP in patients with COVID-19 infection. Peak D-Dimer ≥4530 µg/L might increase risk of PH, but not RV dysfunction in patient post pneumonia COVID-19.

Artificial intelligence-driven echocardiographic classification identifies Brugada Syndrome patients at higher arrhythmic risk

Abstract Background Mounting evidence exists to support the hypothesis that patients with Brugada Syndrome (BrS) present morphological and structural anomalies localized to the right ventricle (RV), but this has not been investigated in a large cohort and the association with clinical outcomes are unknown. Purpose To investigate the role of echocardiography-derived RV parameters in a large, single-center cohort of patients with BrS. Methods We prospectively enrolled n=492 consecutive patients (379 males, 77%; age 46±14 years) with confirmed BrS who underwent an echocardiogram during their last visit at the outpatient clinic for inherited arrhythmogenic disorders. Comprehensive 2D and color Doppler echocardiographic evaluation was performed using the standard clinical protocol. Unsupervised clustering analysis using cluster package sorted body surface area-corrected morphological (RVOT linear dimensions and RV diastolic area) and functional measurements of RV (fractional area shortening [FAC], tricuspid annular plane systolic excursion [TAPSE]), blinded to other variables. We performed clustering with a hierarchical cluster algorithm (h-cluster) and the optimal number of clusters (k=2) was determined using fviz_nbclust-derived plots. Results All n=492 patients were classified into 2 stable clusters () with the best robustness. The Cluster 1 echocardiograms exhibited normal RV morphological and functional parameters. The Cluster 2 echocardiograms showed a dilatation of the RVOT (PLAX 17.2±2.1 vs. 15.6±2.1, p&amp;lt;0.001; PSAX 18.3±2.2 vs. 16.9±2.2, p&amp;lt;0.001) compared to Cluster 1, while the RV diastolic area was not different (9.9±1.5 vs. 9.9±1.6, p=0.801). Importantly, RV function as assessed by TAPSE was not different between the two groups, but Cluster 2 patients showed a significantly impaired radial contraction (RV FAC 40.1±3.4% vs. 48.6±3.8%, p&amp;lt;0.001). We then investigated the clinical characteristics of patients based on clusters. Patients in Cluster 1 were younger (43.2±12.8 years vs. 47.5±14.0 years, p&amp;lt;0.001) and had significantly less arrhythmic symptoms such as syncope (13% vs. 20%, p=0.046) and life-threatening arrhythmic events (2% vs. 7%, p=0.017). Importantly, no significant differences in terms of gender (77% males in both groups, p=1.000), pattern type (43% with spontaneous type 1 pattern in Cluster 1 vs. 47%, p=0.494) nor genetic status were observed. Multivariate logistic regression confirmed that at parity of age and arrhythmic syncope, Cluster 2 was independently associated with an increased incidence of life-threatening arrhythmic events (odds ratio 3.71, 95% confidence interval 1.31-10.53, p=0.039). Conclusions We constructed a novel, echocardiography-guided classification of patients with BrS using unsupervised clustering analysis. Our data suggest that RV structural abnormalities are associated with a higher incidence of life-threatening arrhythmic events in patients with BrS, independently of arrhythmic syncope or age.

Assessment of global and segmental strain in heterozygous APE1/Ref-1 transgenic mice using cardiac magnetic resonance imaging

Abstract Background Apurinic/apyrimidinic-endonuclease1(APE1/Ref-1) is a redox factor necessary for DNA binding and transcription regulator in ROS generation. The association between APE1/Ref-1 and heart failure(HF) has been observed in previous studies. Heterozygous APE1/Ref-1 transgenic mice displayed endothelial cell dysfunction with systemic hypertension. Global strain(GS) measures the myocardium's deformation along its axis and is known to be a sensitive marker of subclinical HF in hypertensive patients with preserved ejection fraction. Purpose This study aims to investigate the functional dynamics and GS of the heart in heterozygous APE1/Ref-1 mice to help identify the association between APE1/Ref-1 and early signs of HF and translate to clinical applications. Methods A study was conducted to assess the functional parameters of both the left ventricle(LV) and right ventricle (RV) and perform LV global and segmental strain analysis using cardiac magnetic resonance imaging(CMR) in heterozygous APE1/Ref-1 transgenic mice(n=4) and wild type mice (n=4) of age 10-12 weeks. A 7T CMR scanner and FSE T1 sequence were used to acquire short-axis views of mouse cardiac images. LV and RV functional parameters including ejection fraction(EF), stroke volume(SV), cardiac output, peak filling rate, peak emptying rate and strain indices including global circumferential strain, global radial strain, segmental circumferential strain, and segmental radial strain were calculated with a software dedicated to analyzing CMR images. Global LV and RV function was quantified both manually and using an AI-based algorithm of LV and RV segmentation. The strain analysis was performed using the strain medical image tracking toolbox module. Additionally, reproducibility testing was done to validate the accuracy of AI-driven calculations. Results We found that heterozygous APE1/Ref-1 mice displayed a decrease in SV(8.00±0.01ul vs 9.75±0.96ul, p=0.01) and LVEF(58.75±2.63% vs 66.50±2.89%, p=0.007) compared to controls while the functional parameters of RV were similar. Interestingly, the circumferential strain rate of LV was significantly reduced in APE1/Ref-1 mice compared to controls(p&amp;lt;0.001), particularly in the systolic phase. In addition, the study showed that manually-calculated and AI-derived indices were within an acceptable margin of error, rendering the AI system reproducible and reliable in calculating volumetric parameters and strain of the mice's hearts. Conclusions This study demonstrated that LV global circumferential strain rate, along with SV and LVEF decreased in heterozygous APE1/Ref-1 transgenic mice. These parameters could serve as markers for assessing early functional changes of mice hearts in a non-invasive manner. Volumetric and strain indices measured by AI-based analysis of mouse CMR images are reproducible parameters for cardiovascular research in small animals.LV strain analysis of mice CMRTable of volumetric parameters

Association between early changes of left atrial volume and right ventricular function after transcatheter edge-to-edge repair for mitral regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Transcatheter edge-to-edge repair (TEER) has recently become a therapeutic option for patients with severe mitral regurgitation (MR) who are unsuitable for surgery, in order to improve clinical outcomes. MR is a determinant of structural and functional changes of all cardiac chambers. The left atrium (LA) and the right ventricle (RV) play an important role in the pathogenesis of symptoms in patients affected by severe MR. Recent data suggests that reverse changes of left ventricle (LV), as well as LA and RV, are associated to reduced morbidity and mortality. Purpose The aim of the study is to test the association between changes of LAV and RV function early after TEER. Methods This is a retrospective study that enrolled patients with chronic functional severe MR, at high surgical risk, who underwent TEER between February 2015 and July 2022. We evaluated the changes of LA and RV function between baseline and before discharge and their relation with symptoms. Results A total of 52 patients were included (mean age 65.2 ± 10.2 years; 69% males, mean left ventricular ejection fraction [LVEF] 28.8 ± 5.7%). No differences of baseline clinical and echocardiographic characteristics were detected between the groups of patients who had LA volume (LAV) reduction (n = 31) and those who did not (n = 21), including symptoms assessed with New York Heart Association (NYHA) classification. However, the former group had a significant higher LA size (LAVI 76.6 ± 18.2 vs. 61.2 ± 17.6 mL/m2, p = 0.004). In the overall population, we observed a significant increase in tricuspid annular plane systolic excursion (TAPSE), S’ wave at Tissue Doppler and ratio between TAPSE and pulmonary artery systolic pressure (TAPSE/PASP), as well as a decrease of PASP (respectively, p = 0.034, p = 0.003, p &amp;lt; 0.001 and p &amp;lt; 0.001). Compared to patients who did not have LAV reduction, those who had showed a significant increase of TAPSE/PASP (from 0.40 ± 0.17 to 0.52 ± 0.21 mm/mmHg, p = 0.002), S’ wave (from 8.7 ± 1.6 to 9.4 ± 1.7 cm/s, p = 0.005) and a decrease of PASP (from 50.3 ± 14.3 to 38.9 ± 11.5 mmHg, p &amp;lt; 0.001). The absolute change of LAV from baseline to discharge was associated with the change of PASP (b coefficient 0.55, 95% confidence interval 0.09, 1.02, p = 0.022) and TAPSE/PASP (b coefficient −4.06, 95% confidence interval −7.78, −0.33, p = 0.033), even after adjustment for covariates (respectively, b coefficient 0.61, 95% confidence interval 0.07, 1.14, p = 0.027 and b coefficient −4.82, 95% confidence interval −9.43, −0.23, p = 0.040). Finally, NYHA class significantly improved in the group of patients whose LAV reduced (p = 0.011). Conclusion In this retrospective study, an association between early changes of LA structure and RV functional parameters has been described. After TEER, RV function improved, especially in patients who had LAV reduction. In the latter, we observed an improvement of NYHA functional class.

P267 ASSOCIATION BETWEEN EARLY MODIFICATION OF LEFT ATRIAL VOLUME AND RIGHT VENTRICULAR FUNCTION AFTER TRANSCATHETER EDGE–TO–EDGE REPAIR FOR MITRAL REGURGITATION

Abstract Background Transcatheter edge–to–edge repair (TEER) for severe mitral regurgitation (MR) is a therapeutic option in patients at high surgical risk. Post procedural reverse remodeling of the left ventricle, the left atrium (LA) and the right ventricle (RV) was shown to be associated with reduced symptoms and mortality. Methods In this retrospective study we have assessed consecutive patients with functional severe MR from February 2015 to July 2022. LA and RV structure and function have been evaluated before the procedure and at the discharge and they were correlated with symptoms. Results In the present study, 52 patients (69% males, mean age 65.2±10.2 years and mean left ventricular ejection fraction 28.8±5.7%) were included. No differences about baseline clinical and echocardiographic characteristics were reported in the group of patients who had LA volume reduction (n=31) and those who did not (n=21). In the overall population we have detected a significant increase of tricuspid annular plane systolic excursion (TAPSE), S‘ wave at Tissue Doppler and the ratio between TAPSE and systolic pulmonary artery pressure (SPAP), together with a significant reduction of SPAP (respectively, p=0.034, p=0.003, p&amp;lt;0.001 and p&amp;lt;0.001). Compared to patients who did not have LA volume reduction, the other group showed a significant increase of TAPSE/SPAP (from 0.40±0.17 to 0.52±0.21 mm/mmHg, p=0.002) and S’ wave (from 8.7±1.6 to 9.4±1.7 cm/s, p=0.005) and a reduction of SPAP (from 50.3±14.3 to 38.9±11.5 mmHg, p&amp;lt;0.001). LA volume modification from baseline to the discharge was associated with the modifications of SPAP (B coefficient 0.55, 95% confidence interval 0.09, 1.02, p=0.022) and TAPSE/SPAP (B coefficient –4.06, 95% confidence interval –7.78, –0.33, p=0.033), even at the multivariable analysis (respectively, B coefficient 0.61, 95% confidence interval 0.07, 1.14, p = 0.027 e B coefficient –4.82, 95% confidence interval –9.43, –0.23, p=0.040). Lastly, NYHA class improved in the group of patients who had LA volume reduction (p=0.011). Conclusion In this retrospective study an association between early modification of LA volume and RV functional parameters has been described. After TEER, RV function improved, particularly in the group of patients who had LA volume reduction. The latter have shown an improvement of symptoms at the discharge.

Prognostic Value of Right Ventricular Dysfunction in Patients With Decompensated Chronic Heart Failure

Aim To determine the incidence rate and the practical significance of right ventricular dysfunction (RVD) in the development of cardiovascular complications in patients with decompensated chronic heart failure (DCHF).Material and methods This prospective, single-site observational study included 171 patients older than 18 years with NYHA functional class (FC) II-IV chronic heart failure (CHF) who were hospitalized for DCHF. Standard and extended 2D and 3D echocardiography (EchoCG) was performed for all patients on admission. Additionally, functional characteristics of the right ventricle (RV) were evaluated in the 3D mode followed by autonomic 3D processing with a EchoPac station (USA). RVD was taken as a disorder of two or more RV functional parameters according to results of 2D EchoCG, or a reduced RV free wall strain according to results of 2D speckle-tracking EchoCG, or a reduced RV ejection fraction (EF) according to results of 3D EchoCG. Statistical analysis was performed with a SPSS Statistics v. 26.0 software.Results The incidence rate of RVD in general population of patients with DCHF was 75.4 % (n=129). A higher prevalence of RVD was observed in patients with CHF with a low left ventricular (LV) EF (90.1 %). Patients with RVD had a more severe clinical status (significantly higher FC and higher Clinical Condition Scale (CCS) scores), more frequent atrial fibrillation (AF), and higher concentrations of uric acid and total bilirubin. RVD significantly correlated with male sex (odds ratio (OR), 2.05; 95 % confidence interval (CI), 1.01–4.19; р=0.046) and AF (OR, 3.52; 95 % CI, 1.71–7.26; р&lt;0.001). Patients with RVD had lower values of both LV and RV function. Lower LV EF and AF increased the probability of RVD by 1.06 times (95 % CI, 0.90–0.98; р=0.001) and by 2.63 times (95 % CI, 1.08–6.40; р=0.001), respectively. Evaluation of the predictive significance of RV parameters measured by 2D and 3D EchoCG showed only effects of RV EF (2D) and RV global longitudinal strain (GLS) (3D) on all-cause hospitalization. RVD as evaluated by accepted criteria did not influence adverse outcomes.Conclusion The determined incidence, correlations, and the predictive value of RVD in patients with DCHF indicated the appropriateness of assessing the RV function to optimize the management of patients regardless of the CHF phenotype.

Utility of portal vein pulsatility fraction in patients undergoing corrective surgery for tetralogy of Fallot.

Right ventricle dysfunction is common after corrective surgery for tetralogy of Fallot and is associated with significant morbidity and mortality. We aimed to determine whether an increased portal vein pulsatility fraction (PVPF) was associated with worse clinical outcomes. In a prospective, observational, single-centre study, PVPF and other commonly used parameters of right ventricle function were assessed in patients of all ages undergoing corrective surgery for tetralogy of Fallot intraoperatively, with transesophageal echocardiography, before and after bypass, and post-operatively, with transthoracic echocardiography, at days 1, 2, at extubation, and at ICU discharge. The correlation was tested between PVPF and mechanical ventilation duration, prolonged ICU stay, mortality, and right ventricle function. The study included 52 patients, and mortality was in 3 patients. PVPF measurement was feasible in 96% of the examinations. PVPF in the immediate post-operative period had sensitivity of 73.3% and a specificity of 74.3% in predicting the occurrence of the composite outcome of prolonged mechanical ventilation, ICU stay, or mortality. There was a moderate negative correlation of PVPF with right ventricle fractional area change and right ventricle global longitudinal strain (r = -0.577, p < 0.001 and r = 0.465, p < 0.001, respectively) and a strong positive correlation with abnormal hepatic vein waveform (rho = 0.749, p < 0.001). PVPF is an easily obtainable bedside parameter to assess right ventricular dysfunction and predict prolonged mechanical ventilation, prolonged ICU stay, and mortality.

332 RIGHT VENTRICULAR STRAIN IN FABRY CARDIOMYOPATHY: PROGNOSTIC IMPLICATIONS

Abstract Left ventricular (LV) hypertrophy is the main feature of Fabry cardiomyopathy (FC), but the right ventricle (RV) is also frequently affected. Previous studies failed to demonstrate an independent association between RV hypertrophy or conventional parameters of RV function and the occurrence of adverse outcomes in patients with FC. Nevertheless, if RV free wall strain (RV-FWS), assessed by 2D speckle tracking analysis, may provide a better prognostication is currently unexplored. We retrospectively evaluated the association between RV-FWS and the occurrence of cardiovascular events in a cohort of 28 patients with FC. The study endpoint comprises the occurrence of cardiovascular mortality, severe heart failure symptoms, new-onset atrial fibrillation, bradyarrhythmias requiring pacemaker implantation and sustained ventricular tachyarrhythmias. The median value of RV-FWS was 21.4% (interquartile range:17.1-23.9%) and a total of 18 (64%) patients showed reduced RV-FWS (&amp;lt;23%). During a median follow-up of 49 (IQR: 37-51) months, 17 (61%) patients met the study endpoint. A ROC-curve analysis confirmed the previously defined threshold of reduced RV-FWS (23%) as the best cut-off for predicting cardiovascular outcomes at 4 years (area under curve: 0.76; p-value=0.018), but with a lower predictive value in comparison to left-sided parameters (Panel A). Kaplan-Meier survival curves showed significantly lower event-free survival at 4 years in patients with impaired RV-FWS as compared to patients with preserved RV-FWS (log rank p=0.013) (Panel B). On univariable Cox regression analysis, RV-FWS expressed as continuous variable was significantly associated with the study endpoint (Hazard ratio [HR]: 0.85, 95% CI: 0.75-0.96, p=0.009). RV-FWS retained an independent association with outcomes after alternative adjustment for age (p=0.048) or indexed LV mass (p=0.036). Conversely, RV-FWS was not significantly associated with cardiovascular events, after correcting for LV global longitudinal strain or indexed left atrial volume (p=0.401 and p=0.208; respectively). In Conclusion, impaired RV-FWS was not independently associated with the occurrence of cardiovascular events in FC, confirming previous observations that prognosis is mainly driven by the severity of LV cardiomyopathy.

Partial anomalous pulmonary venous return in adults: Insight into pulmonary hypertension

BackgroundPartial anomalous pulmonary venous return (PAPVR) is a rare condition that may lead to pulmonary arterial hypertension (PAH). We sought to determine the prevalence of PAPVR, the follow-up rate of incidentally discovered PAPVR, the repercussions of volume and pressure overload on the right ventricle (RV), and the prevalence and predictors of PAH. Methods and resultsFifty PAPVR patients aged ≥18 years were included. All underwent transthoracic echocardiography and multislice imaging. PAPVR prevalence was 0.2% (23/13,606 chest computed tomography reports). Of the 26 incidentally diagnosed patients, 14 (54%) did not have a cardiac follow-up. Seven (14%) patients had PAH, of whom one third (28%) had Eisenmenger syndrome. The left-to-right shunt ratio (Qp/Qs) was the only predictor of PAH. PAPVR-induced volume overload led to increased right chamber volumes (RV basal diameter 45±8 mm, RV mid-diameter 38±9 mm, RV/left ventricle ratio 1.2 ± 0.2, indexed RV end-diastolic area 14±4 cm2/m2, indexed RV end-systolic area 8.6 ± 3.2 cm2/m2) and increased RV functional parameters (tricuspid annular plane systolic excursion 27±5 mm, fractional area change [FAC] 42 ± 10%, global longitudinal strain [GLS] −22 ± 5). In contrast, PAH-induced pressure overload had no impact on right heart volumes, but on RV functional parameters, which were decreased compared to non-PAH patients (FAC 35 ± 13% vs. 43 ± 10%, p = 0.049; GLS -18 ± 5 vs. −23 ± 4%, p = 0.01). ConclusionsPAPVR prevalence was 0.2%. When incidentally diagnosed, its management was often neglected despite potentially serious consequences (14% PAH). Only the Qp/Qs ratio was predictive of PAH. PAPVR-induced volume overload was shown to increase right heart volumes, while PAH-induced pressure overload caused alterations of RV functional parameters.

Portopulmonary Hypertension in Nontransplanted Patients: Results of the Largest US Single-Institution Registry

ObjectiveTo explore clinical characteristics, risk profiles, and outcomes of patients with portopulmonary hypertension (PoPH) who have contraindications to liver transplant (LT). MethodsFrom the largest US single-institution registry of patients with PoPH, we analyzed 160 patients who did not receive LT between 1988 to 2019. Pulmonary arterial hypertension (PAH)–pertinent characteristics, hemodynamic features, treatments, and risk stratification were compared at baseline, first follow-up visit, and censor/death time. ResultsMedian survival for the entire cohort was 27.5 months from the diagnosis of PoPH. Overall survival was 89%, 77%, 51%, and 38% at 6 months, 1 year, 3 years, and 5 years, respectively. Survival was significantly affected by the severity of liver disease (P<.001). Most patients received PAH-specific therapies (136 [85%]), predominantly monotherapy (123 [77%)]. With treatment, significant improvements were noted in World Health Organization functional class (P=.04), 6-minute walk distance (P<.001), right ventricular function (P<.001), pulmonary vascular resistance (P<.001), and Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) Lite 2 score (P=.02) univariately. Per European Society of Cardiology risk stratification, no patient met full criteria for low risk at baseline or at follow-up. In a multivariate Cox risk model, 6-minute walk distance, right atrial pressure, pulmonary capillary wedge pressure, bilirubin level, and Model for End-Stage Liver Disease–sodium score of 15 or higher were associated with increased risk of death. ConclusionPatients with PoPH who did not undergo LT had a poor prognosis. This persisted despite use of PAH-specific therapies and significant improvements in hemodynamics, echocardiography parameters of right ventricle function, 6-minute walk distance, and World Health Organization functional class.

The effect of the location of arteriovenous fistula on the right ventricle in end stage renal disease patients indicated for hemodialysis

Abstract Background End-stage renal disease (ESRD) has significantly increased in developing countries such as Egypt [1]. There are many sites for arteriovenous fistula (AVF) creation. The most common sites for AVF are radio-cephalic AVF (RC-AVF) followed by brachio-cephalic AVF (BC-AVF) [2]. To date, there are no significant studies discussing the possible correlation between the AVF location and abnormalities in the right ventricle (RV) in hemodialysis (HD) patients. Objective To determine the best location for AVF in order to ensure the least possible hazardous side effects of the AVF on the RV. Methods Our study, designed as an interventional study, included 50 ESRD patients referred for primary AVF construction to start HD for the first time. Patients were divided into two groups, 25 patients each. one group underwent a RC-AVF construction and the other had a BC-AVF. We assessed the RV by two dimensional transthoracic echocardiography (2D TTE) twice for each patient, firstly just before the AVF surgery and secondly three months after AVF construction. Results There was a statistically significant difference in between study groups regarding change in RV Tei index (p=0.001) with a decrease in the radial group (Mean ± SD = −0.19±0.2) and an increase in the brachial group (Mean ± SD = 0.02±0.12), and regarding the right ventricular outflow tract proximal diameter (p&amp;lt;0.001) with a decrease in the radial group (Mean ± SD = −2.32±5.49) and a larger increase in the brachial group (Mean ± SD = 2.94±3.14). Changes in the other RV dimensions and functional parameters did not show statistically significant difference. Conclusion After three months follow up, despite the fact that all the RV parameters remained within the normal range, the RV indices with the RC-AVF were associated with either improvement or less decline than with the BC-AVF. Funding Acknowledgement Type of funding sources: None.

Behavior of right atrial strain in patients with advanced idiopathic pulmonary arterial hypertension after initiation of specific combined therapy

Abstract Background Right atrial (RA) function has emerged as an important determinant of outcome in pulmonary arterial hypertension (PAH). However, studies exploring RA function and assessing its behavior in response to specific PAH combination therapy, independent of RA size in patients with PAH is not adequately investigated. Purpose Assess the behavior of strain based measures of RA in response to combined PAH therapy, independent of RA size in patients with PAH. Methods RA peak longitudinal strain (PLS) and peak active contraction strain (PACS) were retrospectively assessed in 38 patients with advanced idiopathic pulmonary arterial hypertension (IPAH) who were referred to Aswan heart Centre and not receiving proper GDMT; at baseline and during follow-up after initiation of specific PAH combination therapy in the form of either Sildenafil/Bosentan or Sildenafil/Macitentan. Results Most of the patients were females with median (IR) age 34 (27–39) years. All patients presented with dyspnea WHO-FC III. At baseline, all patients were receiving only monotherapy in the form of sildenafil. Median (IR) time to echocardiographic follow-up was 11 (8–18) months. Patients presented with markedly right ventricle (RV) and RA enlargement, depressed RV systolic function, and reduced RA strain parameters compared with values previously reported in healthy controls. Among various baseline associations of the RA PLS, the strongest were with baseline RA area (rho: −0.659; p&amp;lt;0.001) and RVEF by CMR (rho: 0.570; p&amp;lt;0.001). At follow up; RA PLS and PACS significantly increased (16.6 vs 24 and 7.06 vs 11.42, respectively: p&amp;lt;0.001); however, RA area did not show significant decrease. Only RV TDI &amp; FAC showed significant improvement among different RV function parameters measured by echocardiography. During the follow up period, 11 out of 38 patients (28.9%) were hospitalized. RA PLS change was significantly lower in the hospitalized group than the non-hospitalized group (4.40 vs 10.2; p=0.014). RA PLS change was independently associated with hospitalization in the multivariate regression analysis (95% CI: −0.061 to −0.010; p=0.008). Conclusion Initiation of specific PAH combination therapy in undertreated patients with IPAH showed improvement in RA strain parameters despite no change in RA area during follow up. Funding Acknowledgement Type of funding sources: None.

Aşikâr pulmoner hipertansiyonu olmayan sistemik sklerozlu hastalarda tırnak kapilaroskopi bulguları ve modifiye Rodnan skoru sağ ventrikül fonksiyonlarında bozulma ile ilişkilidir

Objective: Although nailfold capillaroscopy (NC) and modified Rodnan skin score (mRSS) have already been studied in a variety of contexts related to Systemic Sclerosis (SSc) progression, there is limited data about the relationships between NC, mRSS, and right ventricle (RV) function in SSc patients without overt pulmonary arterial hypertension (PAH). In this study, we examined the relationship between RV function and clinical SSc parameters such as NC pattern and mRSS. &#x0D; Material and Method: Thirty two patients with SSc and twenty healthy participants as a control group were enrolled in this study. Patients with SSc were assessed for digital ulcers, Raynaud’s phenomenon, and severity of skin involvement by a rheumatology specialist. Also, all participants underwent echocardiographic examinations by cardiology specialists. The echo parameters were measured considering the criteria of the American Society of Echocardiography guidelines. &#x0D; Results: Systolic pulmonary arterial pressure (sPAP) was statistically higher in the SSc group (26.4±3.2 vs 30.8±3.6 mmHg, p

Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach

<h2>Abstract</h2> As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.

Right ventricular free wall strain for detection of anthracycline induced cardiac toxicity.

Anthracycline agents are routinely used for treatment of many types of malignancy, while imposing the risk for cardiotoxicity (AT-CMP). Although the right ventricle (RV) is more susceptible to cardiotoxicity, most of the studies have focused on left ventricle (LV) function for monitoring AT-CMP. In this study, we have focused on RV function before and after chemotherapy using two-dimensional speckle tracking Echocardiography. In this prospective study, newly diagnosed and untreated cancerous patients without previous cardiovascular diseases were enrolled. For all patients, baseline echocardiography was performed before the initiation of the anthracycline regimen and after 6months of follow up when the chemotherapy was stopped. Several parameters of LV and RV function were measured using 3D echocardiography and STE techniques. 60 patients were enrolled in the study. There was a significant decrease (P = 0.001) in RV fractional area change (53.57% ± 4.36 vs. 45.66% ± 6.19), RV Global longitudinal strain (GLS) (- 22.93% ± 1.95 vs. - 18.53 ± 2.75), and RV free wall strain (FWLS) (- 25.75% ± 3.01 VS. - 20.30 ± 3.78). There was a significant decline in LVEF (59.42 ± 6.36% vs. 51.1 ± 6.31%) and LV-GLS (- 21.1 ± 1.8% vs - 18.6 ± 2.6%) (both P = 0.001) as well. Among the parameters changed following chemotherapy, RV-FWLS was dropped to a pathological level in 25% of patients showing the highest potential for detection of anthracyclines effect on the myocardium. Anthracycline therapy can induce subclinical RV dysfunction. In this clinical setting, RV free wall strain shows a great ability to exhibit deleterious effects of anthracyclines on the myocardium. This finding needs to be confirmed in future and larger studies.

Recovery of right ventricular function and strain in patients with ST-segment elevation myocardial infarction and concurrent chronic total occlusion

The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO-PCI) at follow-up, but not in no-RCA. Only RV FWLS was different among groups at baseline, which was lower in IRA-RCA than no-RCA (− 26.0 ± 8.3% versus − 31.0 ± 6.4%, p = 0.006). Baseline RVEF, RV end-diastolic volume and TAPSE were associated with RVEF at 4 months. RV function parameters were not predictive of 4 year mortality, although RV GLS showed additional predictive value for New York Heart Association Classification > 1 at 4 months. In conclusion, RV parameters significantly improved in patients with acute or chronic RCA occlusion, but not in no-RCA patients. RV FWLS was the only RV parameter able to discriminate between acute ischemic and non-ischemic myocardium. Moreover, RV GLS was independently predictive for functional status.

Age- and Sex-Specific Changes in CMR Feature Tracking-Based Right Atrial and Ventricular Functional Parameters in Healthy Asians.

Cardiovascular magnetic resonance (CMR) is the reference standard for non-invasive assessment of right-sided heart function. Recent advances in CMR post-processing facilitate quantification of tricuspid annular (TA) dynamics and longitudinal strains of the right ventricle (RV) and right atrium (RA). We aimed to determine age- and sex-specific changes in CMR-derived TA dynamics, and RV and RA functional parameters in healthy Asian adults. We studied 360 healthy subjects aged 21–79 years, with 30 men and 30 women in each of the six age groups. Functional parameters of RV and RA were measured on standard four-chamber cine CMR using fast feature tracking: (1) TA peak velocities (systolic velocity S′, early diastolic velocity E′, late diastolic velocity A′) and TA plane systolic excursion (TAPSE); (2) RV global longitudinal strain (GLS) and strain rates; and (3) RA phasic longitudinal strains and strain rates. S′ and TAPSE exhibited negative correlations with age. RV GLS was significantly higher in females than in males but not associated with age in both sexes. Females had similar E′, lower A′, and higher E′/A′ ratios compared to males. Positive associations of E′ and E′/A′, and negative association of A′ with age were observed in both sexes. Females had higher RA reservoir and conduit strains compared to males. There were significantly negative and positive associations between RA conduit and booster strains, respectively, with age. Age- and sex-specific reference ranges were established, and associations revealed, for fast CMR feature tracking parameters of right heart function in a large normal Asian population.