Parameters Of Right Ventricular Systolic Function Research Articles

Association Between Right Ventricular Systolic Parameters Measured by Echocardiography and Stroke Volume Derived From Pulmonary Artery Catheter in Ischemic Cardiogenic Shock

Objective: To determine the right ventricular (RV) systolic function echocardiographic parameter best associated with native stroke volume (SV) by thermodilution via pulmonary artery catheter (PAC) in patients admitted to intensive care with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS).Design, Setting, and Participants: Observational cohort study of 43 prospectively identified patients admitted to a tertiary cardiac intensive care unit in London, UK.Interventions: Simultaneous collection of comprehensive transthoracic echocardiographic, clinical, and PAC-derived hemodynamic data. Seven RV systolic function parameters were correlated with the PAC-derived SV.Measurements and Main Results: The median age was 61 [52, 67], and 36 patients (84%) were male. The median PAC-derived SV and LVEF were 57 ml [39, 70] and 31% [22, 35], respectively. The RV outflow tract velocity time integral (RVOT VTI) and tricuspid plane systolic excursion (TAPSE) correlated significantly with the PAC-derived SV (r = 0.42, p = 0.007, r = 0.37, p = 0.02, respectively). The RVOT VTI was independently associated with and predicted low PAC-derived SV (OR = 1.3, p = 0.03) with a good area under the curve (AUC = 0.71, p = 0.02). The RVOT VTI < 12.7 cm predicted low PAC-derived SV with a sensitivity of 66% and specificity of 72%.Conclusion: RVOT VTI is the echocardiographic RV systolic function parameter that best correlates with PAC-derived native SV in patients with STEMI complicated by CS. This parameter can help guide the hemodynamic management of this cohort.

Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes

Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17mm, FAC <35%, FWLS >-20%) considered. Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P<.005). Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.

Echocardiographic parameters as adjuncts to the Pulmonary Embolism Severity Index in predicting 30-day mortality in acute pulmonary embolism patients.

The Pulmonary Embolism Severity Index (PESI) is a validated tool to predict 30-day all-cause mortality in patients with acute pulmonary embolism (PE) but includes only clinical variables. We aimed to determine the effectiveness of PESI extended with an echocardiographic parameter. This cross-sectional observational study included consecutive patients with acute PE diagnosed with computed tomography pulmonary angiography. Of 117 subjects (57 men, 48.7%), at a median age of 69 (59-80) years, 16 patients died during the 30-day follow-up. Six modified models of PESI with an additional single echocardiographic parameter were created, which increased the predictive value of PESI (area under the curve [AUC] 0.8608): tricuspid annular plane systolic excursion (TAPSE) <18 mm, right ventricular (RV) free wall longitudinal strain (RVFWLS) >-23%, 60/60 sign, RV global longitudinal strain (RVGLS) >-16%, pulmonary ejection acceleration time (AcT) <67 ms, and thrombus in right heart cavities (AUC 0.8657 to 0.8976, respectively, all markers P <0.001). TAPSE, AcT, RVFWLS, and RVGLS showed significant correlations with the PESI score, but not a thrombus in the right heart cavity or the 60/60 sign. As PESI adjuncts, they independently predicted fatal outcomes: thrombus with hazard ratio (HR) 10.04 (95% confidence interval [CI], 2.81-37.12; P <0.001) and the 60/60 sign with HR 4.07 (95% CI, 1.27-12.81; P <0.001). The quantitative echocardiographic parameters of RV systolic function and pulmonary artery blood flow are associated with the PESI score and thus increase its predictive value to a limited extent. PE- specific findings: a thrombus in the right heart cavity and the 60/60 sign are effective adjuncts to the PESI score.

Significant disagreements between conventional functional metrics and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction

Abstract Background The conventional echocardiographic parameters of the right ventricular (RV) systolic function (e.g., tricuspid annular plane systolic excursion - TAPSE, fractional area change – FAC, free wall longitudinal strain – FWLS) only partially portray the complex functional characteristics of the RV; therefore, they may fail to capture the full spectrum of RV dysfunction and associated adverse clinical outcomes. 3D echocardiography-derived RV ejection fraction (RVEF) is a well-validated and reproducible parameter that overcomes these limitations. Purpose We aimed to investigate the discordance between TAPSE, FAC, FWLS and RVEF in RV systolic function grading and associated outcomes. Methods Two retrospective databases from different centers including consecutive patients with various cardiac diseases who underwent clinically indicated 2D and 3D echocardiography (n=750) were analysed. Patients were followed up for the occurrence of all-cause mortality. RVEF was measured by a single, commercially available 3D software package. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE&amp;lt;17 mm, FAC&amp;lt;35%, FWLS&amp;gt;-20%). RVEF &amp;lt;45% served as the "ground truth" of RV dysfunction. Results Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 42 (8%) had reduced FWLS. Among patients with reduced RVEF (n=239), 109 (46%) had normal TAPSE, 61 (26%) had normal FAC, and 98 (41%) had normal FWLS. Correspondingly, sensitivity and specificity for discrimination of RV systolic dysfunction (RVEF&amp;lt;45%) were 66% and 70% for TAPSE, 71% and 76% for FAC, and 89% and 69% for FWLS on ROC analysis, respectively (Figure 1). During the median follow-up time of 3.5 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE (HR [95% CI]: 0.911 [0.881 - 0.942]), FAC (0.940 [0.924 - 0.957]), FWLS (1.101 [1.071 - 1.133], and RVEF (0.928 [0.913 - 0.944]) were all significant predictors of mortality (p&amp;lt;0.001). Interestingly, combining the conventional functional measures based on how many of them indicate dysfunction shows that outcomes are the worst if at least two parameters are impaired and gradually better if only one or none of them (Kaplan-Meier curves, Figure 2, log-rank p&amp;lt;0.001). Conclusion Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS show the closest association with the RVEF cut-off. Our results emphasize a multiparametric approach in the assessment of RV function, especially, if 3D echocardiography is not available.Figure 1.Figure 2.

Right heart echocardiography findings in hypoxic pneumonia patients during the COVID-19 pandemic in a South African population.

The right ventricle is affected by Coronavirus disease 19 (COVID-19) via multiple mechanisms, which can result in right ventricular dysfunction (RVD). This study aimed to provide an assessment of right heart function using conventional echocardiography and advanced strain imaging, in patients with hypoxic pneumonia during the COVID-19 pandemic. This study was an observational, prospective, single-centre study, including adults with hypoxic pneumonia, in two groups: COVID-19 pneumonia; and non-COVID-19 pneumonia. Bedside echocardiography was performed according to a pre-specified protocol and all right heart measurements were done as per standard guidelines. Right ventricular free wall strain (RVFWS) was measured using Philips® QLAB 11.0 speckle tracking software. Descriptive and comparative statistics were used to analyse data. Spearman Rank Order Correlations were used to determine the correlation between right ventricular (RV) parameters and clinical parameters. Univariate and multivariate logistic regression analyses were performed to characterize the predictors of in-hospital mortality. We enrolled 48 patients with COVID-19 pneumonia and 24 with non-COVID-19 pneumonia. COVID-19 patients were significantly older with a higher frequency of hypertension and diabetes and a trend towards a lower severity of illness score. Mean RVFWS yielded the highest estimates for the prevalence of RVD (81%), with no difference between the two pneumonia groups. Median Tricuspid Annular Plane Systolic Excursion (TAPSE) and right ventricular systolic excursion velocity (RVS') were not significantly different between COVID-19 (TAPSE 17.2 and RVS' 12), and non-COVID-19 pneumonia (TAPSE 17.8 and RVS' 12.1) with P values of 0.29 and 0.86, respectively. Non-COVID-19 pneumonia patients with moderate to severe hypoxaemia (PF < 150) were at greater risk of an elevated RV Systolic Pressure >30 mmHg respiratory rate = 3.25 (CI 1.35-7.82) on admission. Troponin levels discriminated between COVID-19 survivors (6 ng/L) and non-survivors (13 ng/L), P = 0.04. The mortality rate for COVID-19 was high (27%) compared to non-COVID-19 pneumonia (12%). Patients with COVID-19 pneumonia had a similar admission prevalence of RVD when compared to patients with non-COVID-19 pneumonia. Despite preserved traditional parameters of RV systolic function, RVFWS was diminished in both groups, and we propose that RVFWS serves as an important marker of the subclinical disease of RV.

Hypertrophy of the right ventricle by pulmonary artery banding in rats: a study of structural, functional, and transcriptomics alterations in the right and left ventricles.

Introduction: Right ventricular remodeling with subsequent functional impairment can occur in some clinical conditions in adults and children. The triggering factors, molecular mechanisms, and, especially, the evolution over time are still not well known. Left ventricular (LV) changes associated with right ventricular (RV) remodeling are also poorly understood. Objectives: The study aimed to evaluate RV morphological, functional, and gene expression parameters in rats submitted to pulmonary artery banding compared to control rats, with the temporal evolution of these parameters, and to analyze the influence of RV remodeling by pulmonary artery banding in rats and their controls over time on LV geometry, histology, gene expression, and functional performance. Methods: Healthy 6-week-old male Wistar-EPM rats weighing 170-200g were included. One day after the echocardiogram, depending on the animals undergoing the pulmonary artery banding (PAB) procedure or not (control group), they were then randomly divided into subgroups according to the follow-up time: 72h, or 2, 4, 6, or 8weeks. In each subgroup, the following were conducted: a new echocardiogram, a hemodynamic study, the collection of material for morphological analysis (hypertrophy and fibrosis), and molecular biology (gene expression). The results were presented as the mean ± standard deviation of the mean. A two-way ANOVA and Tukey post-test compared the variables of the subgroups and evolution follow-up times. The adopted significance level was 5%. Results: There was no significant difference among the subgroups in the percentage of water in both the lungs and the liver (the percentage of water in the lungs ranged from 76% to 78% and that of the liver ranged from 67% to 71%). The weight of the right chambers was significantly higher in PAB animals in all subgroups (RV PAB weighed from 0.34 to 0.48g, and control subjects, from 0.17 to 0.20g; right atrium (RA) with PAB from 0.09 to 0.14g; and control subjects from 0.02 to 0.03g). In the RV of PAB animals, there was a significant increase in myocyte nuclear volume (97μm3-183.6μm3) compared to control subjects (34.2μm3-57.2μm3), which was more intense in subgroups with shorter PAB follow-up time, and the fibrosis percentage (5.9%-10.4% vs. 0.96%-1.18%) was higher as the PAB follow-up time was longer. In the echocardiography result, there was a significant increase in myocardial thickness in all PAB groups (0.09-0.11cm compared to control subjects-0.04-0.05cm), but there was no variation in RV diastolic diameter. From 2 to 8weeks of PAB, the S-wave (S') (0.031cm/s and 0.040cm/s), and fractional area change (FAC) (51%-56%), RV systolic function parameters were significantly lower than those of the respective control subjects (0.040cm/s to 0.050cm/s and 61%-67%). Furthermore, higher expression of genes related to hypertrophy and extracellular matrix in the initial subgroups and apoptosis genes in the longer follow-up PAB subgroups were observed in RV. On the other hand, LV weight was not different between animals with and without PAB. The nuclear volume of the PAB animals was greater than that of the control subjects (74μm3-136μm3; 40.8μm3-46.9μm3), and the percentage of fibrosis was significantly higher in the 4- and 8-week PAB groups (1.2% and 2.2%) compared to the control subjects (0.4% and 0.7%). Echocardiography showed that the diastolic diameter and LV myocardial thickness were not different between PAB animals and control subjects. Measurements of isovolumetric relaxation time and E-wave deceleration time at the echocardiography were different between PAB animals and control subjects in all subgroups, but there were no changes in diastolic function in the hemodynamic study. There was also increased expression of genes related to various functions, particularly hypertrophy. Conclusion: 1) Rats submitted to pulmonary artery banding presented RV remodeling compatible with hypertrophy. Such alterations were mediated by increased gene expression and functional alterations, which coincide with the onset of fibrosis. 2) Structural changes of the RV, such as weight, myocardial thickness, myocyte nuclear volume, and degree of fibrosis, were modified according to the time of exposure to pulmonary artery banding and related to variations in gene expression, highlighting the change from an alpha to a beta pattern from early to late follow-up times. 3) The study suggests that the left ventricle developed histological alterations accompanied by gene expression modifications simultaneously with the alterations found in the right ventricle.

Discordance between conventional functional parameters and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EFOP-3.6.3-VEKOP-16-2017-00009 project. Background The conventional echocardiographic parameters of the right ventricular (RV) systolic function (e.g., tricuspid annular plane systolic excursion - TAPSE, fractional area change - FAC) only partially portray the complex functional characteristics of the RV; therefore, they may fail to capture the full spectrum of RV dysfunction and associated adverse clinical outcomes. 3D echocardiography-derived RV ejection fraction (RVEF) is a well-validated and reproducible parameter that overcomes these limitations. Purpose We aimed to investigate the discordance between TAPSE, FAC and RVEF in RV systolic function grading and associated outcomes. Methods Two retrospective databases from different centers including consecutive patients with various cardiac diseases who underwent clinically indicated 2D and 3D echocardiography (n=750) were analysed. Patients were followed up for the occurrence of all-cause mortality. RVEF was measured by a single, commercially available 3D software package. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE&amp;lt;17 mm, FAC&amp;lt;35%). RVEF &amp;lt;45% served as the "ground truth" of RV dysfunction. Results Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 49 (10%) had both reduced TAPSE and FAC. Among patients with reduced RVEF (n=239), 108 (45%) had normal TAPSE, 57 (24%) had normal FAC, and 38 (16%) had both normal TAPSE and FAC. Correspondingly, sensitivity and specificity for discrimination of RV systolic dysfunction (RVEF&amp;lt;45%) were 66% and 70% for TAPSE, and 71% and 76% for FAC on ROC analysis, respectively (Figure 1). During the median follow-up time of 3.7 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE (HR [95% CI]: 0.911 [0.881–0.942]), FAC (0.940 [0.924–0.957]), and RVEF (0.928 [0.913–0.944]) were all significant predictors of mortality (p&amp;lt;0.001). Interestingly, combination of the functional assessments based on either TAPSE or FAC with RVEF separates four risk groups that differ significantly in terms of all-cause mortality (Kaplan-Meier curves, Figure 2, log-rank p&amp;lt;0.05). Conclusion Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. This phenomenon may hinder the proper risk stratification of patients with RV systolic dysfunction.

Obstructive Sleep Apnea and Right Ventricular Remodeling: Do We Have All the Answers?

Obstructive sleep apnea (OSA) syndrome is a very important sleep-related breathing disorder related to increased cardiovascular and overall morbidity and mortality. It is associated with multisystemic target organ damage due to micro- and macrovascular changes, resulting in carotid and coronary atherosclerosis, increased arterial stiffness, retinal damage, microalbuminuria, and cardiac remodeling. The latter consists of left ventricular (LV) hypertrophy, as well as diastolic and systolic dysfunction. The increasing burden of evidence shows that OSA also induces right ventricular (RV) remodeling that is more difficult to diagnose, but may also contribute to cardiovascular morbidity and mortality in these patients. Conventional echocardiographic parameters for assessment of RV systolic and diastolic functions are often not sensitive enough to detect subclinical and subtle changes in the RV function. Data published over last decade showed that the RV function, particularly systolic, is impaired in OSA patients and related with its severity. However, the introduction of speckle tracking echocardiography and the particularly longitudinal strain enabled the earlier detection of functional and mechanical changes even when conventional echocardiographic parameters of RV systolic function remained unchanged. The 3D echocardiography provided the possibility to evaluate the entire RV, with its unique shape, and determine 3D RV ejection fraction, which is comparable with results obtained by cardiac magnetic resonance. The use of this modality also provided a new insight into RV systolic (dys)function in OSA patients. In addition to weight loss, which has been proven very helpful in OSA patients, the only approved therapeutic approach is continuous positive airway pressure (CPAP) therapy. It is very important to assess if this therapy induces any improvement in cardiac structure and function. Limited data on this topic show that RV longitudinal strain is a more sensitive parameter rather than other conventional RV indexes in the detection of improvement in RV systolic function and mechanics. The aim of this review article is to summarize the current understanding of RV structural, functional, and mechanical changes in patients with OSA. Furthermore, we sought to provide the current knowledge regarding the effect of CPAP therapy on RV reverse remodeling in OSA patients.

963 PRELIMINARY OBSERVANIONAL STUDY ON CARDIAC REMODELING IN PATIENTS UNDERGOING EDGE-TO-EDGE TRANS-CATHETER MITRAL VALVE REPAIR WITH MITRA CLIP DEVICE

Abstract Preliminary Observational Study on Cardiac Remodeling in Patients Undergoing Edge-to-Edge Trans-catheter Mitral Valve Repair with MitraClip Device Considering the current interest to the new trans-catheter mitral valve repair, it has been our aim to investigate the remodeling of left ventricular (LV), left atrium (LA) and right ventricular (RV) in a cohort of 24 patients with severe organic (13 cases) or functional (11 cases) mitral regurgitation (MR), on a 6 months follow-up. Their mean age was 78,54 ± 7,64 years, and STS score 4,69 ± 2,39 and EuroSCORE II of 5,10 ± 3,28%, and a corresponding ASA score of 3, due to age, co-morbidity and impaired cardiac function (NHIA III/IV). In our study we used advanced techniques of 3D- echocardiography, for the advantage of images independent from the cutting sections, probe angles, and operators skills: this method accuracy is comparable to that of cardiac magnetic resonance imaging. In detail, all enrolled patients underwent transthoracic 3D, spackle tracking imaging, to assess valve anatomy, and suitability for MitraClip treatment according to the EVEREST anatomic eligibility criteria. They were on optimized medications and, when necessary, previously treated with percutaneous angioplasty and stent implantation. Our results, in both functional and organic cases of MV regurgitation, can be summarized in a statically significant improvement of the NHYA class, reduction in the degree of MV and tricuspid valve insufficiency, decrease in LV end-diastolic diameter and diastolic volume, and mainly in a corrected direction of LV outflow towards the high pressure aortic system: so we explain the unchanged left ventricular ejection fraction. The LA remodeling was present with a significant reduction in LA volume only in patients without atrial fibrillation, while in its function there was a reduced peak strain. Regard the indicative parameters of afterload on the right heart chambers, the derived systolic pulmonary arterial pressure decreased, and in case of tricuspid regurgitation, a significant decrease in the maximal velocity of the blood flow was observed. There was also a statistically significant reduction in the right atrial area, and in RV size, both correlated with a reduced back flow in the RA. About the RV volumetric remodeling there was no statistically significant improvement in the end-diastolic RV volume, most probably of its better compliance towards a low pressure inflow. An improvement in RV systolic function parameters was obtained in terms of increased ejection fraction, decreased free wall strain, and decreased velocity at the tricuspid annular. In Conclusion, the clinical improvement observed after Mitral Clip repair consist in decreased overload to the left chambers, facilitating their reverse remodeling, and in the LV function. In perspective, we are planning to perform pre-operative models of MV repair, where we can calculate the reduced volume of regurgitated blood and the increase in the LVEF physiological outflow, in order to better tailor the indications to this procedure.

Indicators of the Right Ventricle Systolic and Diastolic Function 18 Months after Coronary Bypass Surgery.

Objective. Right ventricular (RV) dysfunction after coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. In previous studies, the parameters of RV systolic function were mainly assessed, while the dynamics of RV diastolic function after surgery was practically not studied. The aim of this study was to study the dynamics of indicators of systolic and diastolic RV function after CABG as well as to identify factors associated with their presence. Methods. The study included 160 patients who underwent CABG and 36 volunteers with no history of coronary artery disease (CAD) as a control group. Echocardiographic examination of patients was performed to assess systolic and diastolic RV dysfunction before surgery and 18 months after CABG. A level of s’t < 10 cm/sec or TAPSE < 16 mm was considered as a sign of existing RV systolic dysfunction. RV diastolic dysfunction was defined as an Et/At ratio < 0.8 or >2.1 and/or an Et/et’ ratio > 6. Results. In CAD patients 18 months after CABG, there was an increase in the frequency of the right ventricular systolic (from 7.5% to 30%, p < 0.001) and diastolic (from 41.8% to 57.5%, p < 0.001) dysfunction. An increase in TAPSE (p = 0.007), a decrease in e’t (p = 0.005), and the presence of RV systolic dysfunction before surgery (p = 0.023) was associated with a significant increase in the likelihood of detecting RV systolic dysfunction 18 months after CABG (χ2(3) = 17.4, p = 0.001). High values of At before surgery (p = 0.021) and old myocardial infarction (p = 0.023) were significantly associated with an increased likelihood of detection of RV diastolic dysfunction 18 months after CABG (χ2(2) = 10.78, p = 0.005). Conclusions. This study demonstrated that in CAD patients 18 months after CABG, there was an increase in the frequency of right ventricular systolic and diastolic dysfunction. We also established the initial clinical, echocardiographic parameters, and perioperative complications associated with the presence of these changes in the postoperative period. The clinical and prognostic significance of the presence of systolic and/or diastolic RV dysfunction in patients 18 months after CABG remains to be explored.

Right Ventricular Myocardial Work Characterization in Patients With Pulmonary Hypertension and Relation to Invasive Hemodynamic Parameters and Outcomes

Noninvasive evaluation of indexes of right ventricular (RV) myocardial work (RVMW) derived from RV pressure-strain loops may provide novel insights into RV function in precapillary pulmonary hypertension. This study was designed to evaluate the association between the indexes of RVMW and invasive parameters of right heart catheterization and all-cause mortality. Noninvasive analysis of RVMW was completed in 51 patients (mean age 58.1 ± 12.7 years, 31% men) with group I or group IV pulmonary hypertension. RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were compared with parameters derived invasively during right heart catheterization. Patients were followed-up for the occurrence of all-cause death. The median RVGWI, RVGCW, RVGWW, and RVGWE were 620 mm Hg%, 830 mm Hg%, 105 mm Hg% and 87%, respectively. Compared with conventional echocardiographic parameters of RV systolic function, RVGCW and RVGWI correlated more closely with invasively derived RV stroke work index (R=0.63, p <0.001 and R=0.60, p <0.001, respectively). Invasively derived pulmonary vascular resistance correlated with RVGWW (R=0.63, p <0.001), RVGWE (R=0.48, p <0.001), and RV global longitudinal strain (R=0.58, p <0.001). RVGCW (hazard ratio 1.42 per 100 mm Hg% <900 mm Hg%, 95% confidence interval 1.12 to 1.81, p=0.004) and RVGWI (hazard ratio 1.46 per 100 mm Hg% <650 mm Hg%, 95% confidence interval 1.09 to 1.94, p=0.010) were significantly associated with all-cause mortality, whereas RV global longitudinal strain, RVGWE, and RVGWW were not. In conclusion, indexes of RVMW were more closely correlated with invasively derived RV stroke work index and peripheral vascular resistance than conventional echocardiographic parameters of RV systolic function. Decreased values of RVGCW and RVGWI were associated with all-cause mortality, whereas conventional echocardiographic parameters of RV function were not.

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure.

AimThe severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF.MethodsA total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR.ResultsA total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)].ConclusionWith cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.

Effect of the number of parity on right heart chamber quantification.

Pregnancy is a process that can cause several physiologic changes to the cardiovascular system such as ventricular hypertrophy and dilation of cardiac chambers. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the four independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10-1.20), body mass index (OR: 1.05, CI: 1.02-1.08), smoking (OR: 1.87, CI: 1.28-4.02), and giving a birth (OR: 3.94 CI: 1.82-8.81). There was also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Tricuspid annular plane systolic excursion (TAPSE) is not an appropriate parameter for the evaluation of right ventricular systolic function after lung transplant

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Tricuspid annular plane systolic excursion (TAPSE) is a widely used parameter for the assessment of right ventricular (RV) systolic function in candidates for lung transplant (LT). However, its accuracy after surgery is not well established. In our study, we aim to evaluate the feasibility of TAPSE after LT and compare it with other classic parameters of RV function. Methods. 144 patients underwent LT between January 2014 and June 2017 in our center. Mean age was 55 years (65 % men). Double LT was performed in 65%, being most common etiology pulmonary fibrosis followed by chronic pulmonary obstructive disease. 9% of LT candidates had severe pulmonary hypertension (PH), defined as mean pulmonary artery pressure (PAP) over 45 mmHg on right heart catheterization. We retrospectively analyzed echocardiographic studies at baseline and 4 weeks after LT in 94 patients. Nine of them had prior severe pulmonary hypertension. We measured RV fractional area change (FAC) and systolic displacement of tricuspid annulus-TAPSE as main parameters of RV systolic function, as well as right atrium (RA) area. Results. We found a significant improvement in RV FAC (39 ± 9% vs. 44 ± 6%, p &amp;lt; 0.001) and a reduction in RA area (16 ± 6 cm2 vs. 12 ± 5 cm2; p &amp;lt; 0.001) after lung transplant in the global study group. This was remarkably significant when prior severe pulmonary hypertension was present (RV FAC 24 ± 9% vs. 43 ± 6%, RA area 27 ± 8 cm2 vs. 14 ± 4 cm2; p &amp;lt; 0.000). However, postoperative TAPSE was significantly lower (21 ± 3 mm vs. 17 ± 2 mm; p &amp;lt; 0.000), and it did not show any significant change in the PH subgroup (p = 0.89). We found a good correlation between TAPSE and RV FAC on pre-transplant echocardiographic study (r = 0.76; p &amp;lt; 0.000), whereas this relation did not remain after LT (r = 0.26; p 0.06). Conclusion. Right ventricular systolic function globally improved after LT, and this is particularly pronounced in candidates with severe PH. In contrast, TAPSE paradoxically deteriorates on post-surgery echocardiogram. According to our findings, TAPSE may not be a reliable parameter for the assessment of RV systolic function after lung transplant.

Acute right systolic ventricular dysfunction in permanent cardiac pacing. Insight from RV PACE trial (Right Ventricular function assessment in Permanent cArdiac paCing by Echography)

Permanent right ventricular (RV) pacing is now clearly linked to heart failure and decrease in LVEF, in non neglected proportion. Several trials and observations reported the worse impact of this heart pacing mode on left ventricular functions, but rare are those that studied RV systolic function. In this observational prospective trial, we evaluate echographic systolic RV function, before and immediately after cardiovascular implantable electronic device (CIED) implantation and at 6 months of follow-up. In this intermediate analysis, we report impact of RV pacing on systolic RV function. Between February 2020 and February 2021, we enrolled 174 [114 (65%) male, 38 (21%) with AF] consecutive patients underwent RV permanent pacing (CRT, Hisian and left bundle branch pacing excluded) in prospective study for evaluation of echographic parameters of RV systolic function (TAPSE, RV S’, RV global longitudinal strain and RV free wall strain) and severity of tricuspid regurgitation (TR). Transthoracic echography (TTE) was performed (by 3 physicians) at baseline (just before procedure) and immediately after implantation. At baseline, mean LVEF was 56% ± 15.6. TAPSE (22.8 ± 6.29 vs. 19.3 ± 5.47 mm; P < 0.001) and tissue Doppler on lateral tricuspid annular (RV S’) (12.1 ± 3.28 vs. 11.2 ± 3.28 cm/s; P < 0.001) measured before and immediately after implantation show a significant decrease in RV function. The same finding is reported for Global RV Strain (−20 ± 0.6 vs. −18 ± 0.5%; P < 0.001) and RV free wall strain (−25 ± 0.7 vs. −23 ± 0.6%; P < 0.001). TR after CEID implantation is more severe in comparison with basal echography [TR stage 1/2: 132 (89%) vs. 110 (79%); P < 0.01] (Fig. 1). Permanent RV pacing immediately decrease RV systolic function assessed traditional echocardiographic parameters and RV strain. TR also gets worsened.

Right ventricular myocardial work characterisation in patients with pulmonary hypertension: association with invasive haemodynamic parameters

Abstract Background Non-invasive evaluation of indices of right ventricular (RV) myocardial work derived from RV pressure-strain loops may provide novel insights into RV function in pre-capillary pulmonary hypertension. Purpose This study was designed to evaluate the association between the indices of RV myocardial work and invasive haemodynamic parameters in a patient cohort with pulmonary arterial hypertension (Group I) or chronic thromboembolism pulmonary hypertension (Group IV). Methods The non-invasive analysis of echocardiography-derived RV myocardial work (Figure 1, upper panel) was completed in 51 patients (mean age 58.1±12.7 years, 31% male) with Group I (78%) or Group IV (22%) pulmonary hypertension. Conventional echocardiographic measurements of RV systolic function, RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW) and RV global work efficiency (RV GWE) were compared with parameters derived invasively during right heart catheterisation (RHC). Results The median RV GWI, RV GCW, RV GWW and RV GWE were 620 (443 to 857) mmHg%, 830 (650 to 1206) mmHg%, 105 (54 to 169) mmHg% and 87 (82 to 93)%, respectively. Compared to pulmonary artery systolic pressure and conventional echocardiographic parameters of RV systolic function (RV global longitudinal strain [GLS], tricuspid annular plane systolic excursion and RV fractional area change), RV GCW and RV GWI correlated more closely with invasively-derived RV stroke work index (R=0.63, P&amp;lt;0.001 and R=0.60, P&amp;lt;0.001, respectively) (Figure 1, lower panels). Invasively-derived pulmonary vascular resistance (PVR) correlated with RV GWW (R=0.63, P&amp;lt;0.001), RV GWE (R=0.48, P&amp;lt;0.001) and RV GLS (R=0.58, P&amp;lt;0.001). RV GLS correlated more closely with invasively-derived stroke volume index (R=−0.57, P&amp;lt;0.001) than RV GCW, RV GWI and RV GWE (R=0.34, P=0.016, R=0.48, P&amp;lt;0.001 and R=0.47, P&amp;lt;0.001, respectively). Conclusions In a patient cohort with Group I and Group IV pulmonary hypertension, indices of RV myocardial work were more closely correlated with invasively-derived RV stroke work index and PVR than conventional echocardiographic parameters of RV systolic function. Funding Acknowledgement Type of funding sources: None. Figure 1. Method and correlations

Effect of the number of parity on right heart chamber quantification

Abstract Introduction Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. Methods This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. Results In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the 4 independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10 – 1.20), body mass index (OR: 1.05, CI: 1.02 to 1.08), smoking (OR: 1.87, CI: 1.28 to 4.02), and giving a birth (OR: 3.94 CI: 1.82 – 8.81). There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. Conclusion Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes. Funding Acknowledgement Type of funding sources: None.

The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases.

Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.

The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases.

Right ventricular (RV) systolic function represents an important independent predictor of adverse outcomes in many cardiovascular (CV) diseases. However, conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), RV myocardial performance index (MPI), and fractional area change (FAC)) are not always able to detect subtle changes in RV function. New evidence indicates a significantly higher predictive value of RV longitudinal strain (LS) over conventional parameters. RVLS showed higher sensitivity and specificity in the detection of RV dysfunction in the absence of RV dilatation, apparent wall motion abnormalities, and reduced global RV systolic function. Additionally, RVLS represents a significant and independent predictor of adverse outcomes in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP, and amyloidosis, but also in patients with connective tissue diseases and patients with coronary artery disease. Due to its availability, echocardiography remains the main imaging tool for RVLS assessment, but cardiac magnetic resonance (CMR) also represents an important additional imaging tool in RVLG assessment. The findings from the large studies support the routine evaluation of RVLS in the majority of CV patients, but this has still not been adopted in daily clinical practice. This clinical review aims to summarize the significance and predictive value of RVLS in patients with different types of cardiomyopathies, tissue connective diseases, and coronary artery disease.

Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study.

BackgroundLow cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood.Methods and ResultsParticipants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow‐up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow‐up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable‐adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow‐up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age.ConclusionsHigher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age‐related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.