Preoperative Echocardiographic Parameters Research Articles

Prognostic relevance of baseline right ventricular echocardiographic evaluation in patients undergoing valvular surgery with tricuspid intervention

Abstract Background Tricuspid valve (TV) intervention is frequently performed both as part of multivalvular surgery and as an isolated procedure. Tricuspid regurgitation (TR) significantly worsen right ventricular (RV) function, which is a prognostic determinant in many clinical scenarios. Purpose Our aim was to evaluate the relevance of baseline right ventricular (RV) baseline echocardiographic in the prognosis after tricuspid valve surgery (TVS). Methods Retrospective observational study of patients undergoing TVS between 2009 and 2022 in our tertiary centre. Baseline right chambers echocardiographic parameters were evaluated: RV diameters (basal, mid and longitudinal), TAPSE, fractional area change (FAC), Doppler tissue velocity of the tricuspid annulus (RVS´) and free wall- (FW-) and 4 chambers- (4C-) global longitudinal strain (GLS). Likewise, systolic pulmonary artery pressure (sPAP) and left ventricular ejection fraction (LVEF) were collected among other variables. Association of echocardiographic parameters with major clinical events at year was explored. Results Finally 273 consecutive patients (71 ± 10.5 years old, 66.7% female) that underwent valvular surgery with tricuspid intervention were included. Multivalvular procedure was performed in 81.3% (50.6% mitral and tricuspid, 25.6% mitral, aortic and tricuspid and 5.1% aortic and tricuspid) and EuroScore was 5 [3-9]. The most common TV lesion was TR (97.8%), functional in 84.2%. The main surgical technique was tricuspid annuloplasty with prosthetic ring (57.9%). Preoperative echocardiographic parameters are presented in Table. Baseline LVEF was 59 [53-65]%. The most frequent postoperative complication was low output (23.4%) and there was an overall mortality rate of 8.3% during the first year of follow-up. Postsurgical low output state was associated with vena contracta TR (0,78 vs 0,66 cm; p <0.001) and 4C-GLS ((-15.7 vs -17.3%; p= 0.03). None of the baseline echocardiographic variables was associated with early mortality. Conclusions Baseline RV echocardiographic parameters were associated with postoperative low output but not mortality. The relatively preserved RV dimensions and function in our series may explain these findings. Table. Baseline RV echocardiographic variablesTable

Impact on preoperative estimation of atrial mechanical amplitudes with vdd leadless pacemaker

Abstract Background It would be useful to determine whether the device can sense the mechanical atrial amplitude (A4) before the implantation of a VDD leadless pacemaker (Micra AV^RT, Medtronic, US). Purpose To evaluate whether identifiable A4 is associated with preoperative echocardiographic parameters. Methods Echocardiographic measurements were performed to quantify atrial motion of the interventricular septum in patients who received a leadless pacemaker implantation. We visually divided the septum into five segments from the base to the apex. As shown in Figure 1, the myocardial velocity of each segment measured on tissue doppler imaging (TDI) was defined as EV1, EV2, EV3, EV4, and EV5 (m/s), respectively. After the implantation, amplitude of A4 was compared to the local EV. Results We retrospectively analyzed 30 patients who had Micra AV implanted into the right ventricular septum by imaging examination and had measurable EV for each segment. The mean age was 82.3±7.8 years, 15 (50%) patients were female, 11 (37%) patients had organic heart disease, and 23 (77%) patients had atrial ventricular block. The mean LVEF and A4 amplitude were 60.4 ± 8.9% and 2.7 ± 1.8 m/s^2, respectively, and the mean atrial mechanical sensing rate (AMSR) was 79.9±24.0%. The A4 amplitude was positively correlated to the AMSR (r=0.48), while the AMSR was significantly better in patients with A4 amplitude over 1.0 m/s^2 (88.0 ± 10.4% vs. 41.0 ± 33.6%, p=0.04). The A4 amplitude was correlated to the EV of the implantation site estimated from fluoroscopy and echocardiography (r=0.62) in Figure 2. 24 patients had local EV over 3.0 cm/s, and among them, 22 (92%) patients had A4 amplitude over 1.0 m/s^2. Conclusion Local EV over 3.0 cm/s, as determined by preoperative echocardiography, might predict high-frequency AMSR.

Left ventricular diastolic function assessed by speckle tracking echocardiography in patients with left ventricular aneurysm.

Speckle-tracking echocardiography (STE) parameters are an integral part of the assessment of left ventricular (LV) function. We aimed to evaluate established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm undergoing surgical ventricular repair (SVR). We retrospectively examined the data of 137 patients with anteroapical LV aneurysm who underwent SVR. In 27 patients, the correlation of STE parameters with invasive hemodynamic parameters was evaluated. Preoperative echocardiographic parameters were assessed for their association with outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. The late diastolic strain rate (GLSRa) showed a stronger correlation with mean pulmonary artery pressure (r = - 0.75, p < 0.001) than all other parameters. GLSRa was also significantly correlated with mean pulmonary capillary wedge pressure and LV end-diastolic pressure. In the multivariate model, GLSRa and the ratio of early diastolic filling velocity to GLSRa demonstrated incremental prognostic value in addition to clinical and echocardiographic parameters. Patients with GLSRa < 0.59s-1 had significantly shorter event-free survival than those with GLSRa > 0.59s-1 (6.7 vs. 10.9years, p < 0.001). Peak reservoir left atrial strain showed a weaker association with hemodynamic parameters and outcome compared to GLSRa. In patients with LV aneurysm, late diastolic strain rate and left atrial strain can be used for the assessment of LV diastolic function and have a predictive value for the outcome after surgical ventricular restoration.

Relationship between Preoperative Echocardiographic Parameters and the Incidence of Postoperative Complications in Patients Undergoing Clipping of Unruptured Intracranial Aneurysms: A Retrospective Cohort Study.

Background and Objectives: Preoperative echocardiography is widely performed in patients undergoing major surgeries to evaluate cardiac functions and detect structural abnormalities. However, studies on the clinical usefulness of preoperative echocardiography in patients undergoing cerebral aneurysm clipping are limited. Therefore, this study aimed to investigate the correlation between preoperative echocardiographic parameters and the incidence of postoperative complications in patients undergoing clipping of unruptured intracranial aneurysms. Materials and Methods: Electronic medical records of patients who underwent clipping of an unruptured intracranial aneurysm from September 2018 to April 2020 were retrospectively reviewed. Data on baseline characteristics, laboratory variables, echocardiographic parameters, postoperative complications, and hospital stays were obtained. Univariable and multivariable logistic regression analyses were performed to identify independent variables related to the occurrence of postoperative complications and prolonged hospital stay (≥8 d). Results: Among 531 patients included in the final analysis, 27 (5.1%) had postoperative complications. In multivariable logistic regression, the total amount of crystalloids infused (1.002 (1.001-1.003), p = 0.001) and E/e' ratio (1.17 (1.01-1.35), p = 0.031) were significant independent factors associated with the occurrence of a postoperative complication. Additionally, the maximal diameter of a cerebral aneurysm (1.13 (1.02-1.25), p = 0.024), total amount of crystalloids infused (1.001 (1.000-1.002), p = 0.031), E/A ratio (0.22 (0.05-0.95), p = 0.042), and E/e' ratio (1.16 (1.04-1.31), p = 0.011) were independent factors related to prolonged hospitalization. Conclusions: Echocardiographic parameters related to diastolic function might be associated with postoperative complications in patients undergoing clipping of unruptured intracranial aneurysms.

The factor related to the outcome of maze procedure in mitral valve replacement surgery

Objective: To evaluate the factors related to the outcome of Maze surgery to remove atrial fibrillation in mitral valve replacement surgery at Hanoi Heart Hospital.&#x0D; Methods: Study on all patients with simple mitral valve disease and atrial fibrillation who were assigned to have mitral valve replacement surgery with Maze IV surgery from 01/2022 to 07/2023. Retrospective and prospective, non-controlled studies.&#x0D; Results: 51 patients (17 men, 34 women, mean age 55.22 ± 9.13) were eligible to participate in the study. The rate of sinus rhythm restoration at the time of discharge - 3 months - 6 months after surgery was 56.9% - 90.2% - 94.1%, respectively. Preoperative echocardiographic parameters have no predictive value in predicting the likelihood of sinus rhythm re-establishment, while postoperative parameters have high prognostic value. Using ROC curve analysis, we provide cut-off thresholds with predictive value: postoperative left atrial diameter &lt; 42.5 mm (AUC = 0.798, sensitivity 75%, specificity) 63.8%, p=0.05), LA diameter at 6 months follow-up &lt; 45.5 mm (AUC = 0.929, sensitivity 75%, specificity 88.6%, p &lt; 0.01), left atrial volume index (LAVi) re-examination at 6 months &lt;62 ml/m2 (AUC = 0.827, sensitivity 75%, specificity 84.6%, p&lt;0.05), LAVi re-examination at 6 months &lt;60.5 ml/m2 (AUC = 0.867, sensitivity 67%, specificity 91.4%, p&lt;0.05) increased the success rate of sinus cardioversion.&#x0D; Conclusion: Maze surgery has a high success rate in patients who are indicated for mitral valve replacement surgery. Using ROC curve analysis, the parameters on echocardiography at 6 months after surgery: LA diameter &lt; 45.5 mm, LAVi &lt; 60.5 ml/m2 are factors that increase the success rate of ablation of atrial fibrillation and sinus cardioversion.

Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation.

We hypothesized that a giant left atrium may oppressthe posterior left ventricle and aggravate diastolic dysfunction and heart failure. We evaluated the effect of left atrial plication (LAP) on atrial functional mitral regurgitation. We retrospectively reviewed patients who underwent LAP for atrial functional mitral regurgitation at our institution between January 2017 and December 2021. Early outcomes, follow-up echocardiography data, and heart failure indicators were compared. Eighteen patients were divided into two groups: LAP + (n = 9) or LAP- (n = 9). There were no significant differences in patient characteristics and preoperative echocardiographic parameters, except for the preoperative New York Heart Association classification. Operative (505.7 [standard deviation: 100.0] minutes vs. 382.9 [standard deviation: 58.1] minutes, P = .0055) and cardiopulmonary bypass times (335.6 [standard deviation: 50.4] minutes vs. 246.9 [standard deviation: 62.7] minutes, P = .0044) were significantly longer in the LAP + group. No in-hospital mortalities were observed in both groups. The postoperative left atrial volume was significantly reduced in the LAP + group, and mitral regurgitation was controlled at less than mild levels in both groups. At follow-up, the left ventricular end-diastolic volume was reduced significantly in the LAP + group. Brain natriuretic peptide, cardiothoracic ratio, and the New York Heart Association classification were improved in the LAP + group. Additional left atrial plication contributes to the control of atrial functional mitral regurgitation and heart failure at a later stage. A careful long-term follow-up is needed as re-expansion of the left atrium is possible. The online version contains supplementary material available at 10.1007/s12055-023-01569-6.

Is epicardial adipose tissue, quantified before cardiac surgery by computed tomography, able to predict postoperative atrial fibrillation?

Abstract Funding Acknowledgements Type of funding sources: None. Background Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery (CS) associated with prolonged hospitalization and increased risk of future adverse events. Epicardial adipose tissue (EAT), defined as adipose tissue between the myocardium and the visceral pericardium, has been recently recognized as a potential contributor to AF pathogenesis. Purpose to evaluate the role of EAT, measured by preoperative CT, in predicting the occurrence of POAF after CS. Methods All patients without prior AT/AF history who underwent CS at our centre were prospectively enrolled and retrospectively analyzed. All the included patients had performed a cardiac CT for the evaluation of the pre-operative coronary arteries. Baseline and surgical characteristics were systematically collected along with pre-operative echocardiographic parameters (LA diameter and area; EF) and CT EAT values. For the evaluation of the EAT we selected the area delimited superiorly from the center of the right pulmonary artery and inferiorly to the end of the pericardial sac. The adipose tissue between the myocardium and the pericardium was manually delimited and the total EAT volume was expressed in mL (total EATV; Fig. 1). Also the thickness (mm) of the EAT at the level of the free wall of the right ventricle (RV EAT) and posterior to the left atrium in a 4-chamber plane (LA EAT) were reported. All the measured EAT were indexed for BSA. Multivariate logistic regression analysis was used to identify independent predictors of the study endpoint: the occurrence POAF during the early postoperative period. Results A total of 117 patients (age 65±15 years old; M= 71%) were enrolled. Soon after surgery, POAF was observed in 55 patients (47%). Patients with POAF were significantly older, with higher comorbidities burden (diabetes; CHA2DS2-VASc score ≥1) than patients without POAF. No other significant differences for clinical features or surgical procedures were observed. Echocardiographic and CT parameters did not significantly differ between the two groups however older patients who developed POAF had elevated levels of indexed total EATV (96.1±46.6 cm3/m2) (Fig.2). At multivariate logistic regression analysis the only indipendent predictor of POAF remained age (OR: 1.053; 95% CI: 1.018-1.089; p=0.003). Conclusions Advanced age is a recognized risk factor for POAF following CS in patients without prior AF history. Older patients who developed POAF had elevated EAT values, however our study did not evidence any link between EAT and POAF.

Proportion of right ventricular failure and echocardiographic predictors in continuous-flow left ventricular assist device: a systematic review and meta-analysis.

Right ventricular failure (RVF) in patients with a continuous-flow left ventricle assist device (CF-LVAD) is associated with higher incidence of mortality. This systematic review aims to assess the overall proportion of RVF and the pre-operative echocardiographic parameters which are best correlating to RVF. A systematic research was conducted between 2008 and 2019 on MEDLINE, EMBASE, PUBMED, UPTODATE, OVID, COCHRANE LIBRARY, and Google Scholar electronic databases by performing a PRISMA flowchart. All observational studies regarding echocardiographic predictors of RVF in patients undergoing CF-LVAD implantation were included. A total number of 19 observational human studies published between 2008 and 2019 were included. We identified 524 RVF patients out of a pooled final population of 1741 patients. The RVF overall proportion was 28.25% with 95% confidence interval (CI) 0.24-0.34. The highest variability of perioperative echocardiographic parameters between the RVF and no right ventricular failure (NO-RVF) groups has been found with tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and right ventricular global longitudinal strain (RVGLS). Their standardized mean deviation (SMD) was - 0.33 (95% CI - 0.54 to - 0.11; p value 0.003), - 0.34 (95% CI - 0.53 to - 0.15; p value 0.0001), and 0.52 (95% CI 0.79 to 0.25; p value 0.0001), respectively. The echocardiographic predictors of RVF after CF-LVAD placement are still uncertain. However, there seems to be a trend of statistical correlation between TAPSE, FAC, and RVGLS with RVF event after CF-LVAD placement. The online version contains supplementary material available at 10.1007/s12055-022-01447-7.

P102 NEW THREE–DIMENSIONAL ECHOCARDIOGRAPHIC PREDICTING PARAMETERS IN TRANS–VENTRICULAR HEART–BEATING MITRAL VALVE REPAIR WITH NEOCHORDAE: A MONOCENTRIC RETROSPECTIVE STUDY

Abstract Background Trans–ventricular off pump mitral valve (MV) repair with neochordae implantation (Neochord procedure) is a minimally invasive surgical technique for correction of degenerative mitral regurgitation (MR) due to prolapse or flail. The aim of this study was to evaluate mid–term results of patients undergoing this procedure and find new three–dimensional pre–operative echocardiographic parameters to predict MR recurrence at follow–up. Methods We performed a retrospective analysis of 72 consecutive patients with severe MR due to prolapse or flail who underwent Neochord procedure at our hospital from March 2015 to February 2021. MV pre–operative anatomical parameters were assessed using 2D TEE, 3D TEE and dedicated three–dimensional (3D) post–processing analysis with dedicated software (QLAB, Philips). TTE follow–up and clinical evaluation were performed at 3 months, 6 months, 1 year and then annually. Results Twenty–seven patients were female (37.5%), mean age was 77±9 years. The average preoperative EuroSCORE II was 2.2%±1.5%. Twenty–three patients (32%) had an history of paroxysmal or persistent atrial fibrillation. Procedural success at discharge was achieved in sixty–eight patients (94.5%). Mean follow–up was 30±16 months. Three years follow–up was completed by fifty patients. At three years thirteen patients (26%) presented with recurrence of severe MR or underwent new surgical operation. Prevalence of mild or trace MR at three years follow–up visit was 70%. End–systolic annulus area (12.5±2.5 cm2 vs 14.1±2.6 cm2; p = 0.038), end–systolic annulus diameter (13.2±1.2 cm vs 14±1.3 cm; p = 0.042) and indexed left atrial volume (59±17 ml/m2 vs 76±37 ml/m2; p = 0.041) were lower in patients with residual MR less than moderate (MR &amp;lt; 3+/4+). Three–dimensional indexes specifically focused on coaptation reserve and annular disfunction were the best predictors of MR &amp;lt; 3+/4+ at follow–up, in particular diastolic sum of the leaflets/end–systolic annulus area ([AUC] 0.74; p = 0.029) and systo–diastolic annulus area fractional change ([AUC] 0.743; p = 0.035). Furthermore, each of these annular parameters, calculated using dedicated 3D software, were predictive of residual MR, whereas annular 2D dimensions were not (p = 0.347). Conclusion In patients with degenerative MR treated with Neochord procedure, 3D analysis focused on annular measures and coaptation indexes, that included 3D annular dimensions, predicts better MR relapse than conventional 2D parameters.

E-41 | Echocardiographic Predictors of Suboptimal Transcatheter Mitral Valve Repair in Patients with Secondary Mitral Regurgitation

BackgroundResidual mitral regurgitation (MR) following mitral valve transcatheter edge-to-edge repair (TEER) is associated with worse outcomes. This study sought to identify echocardiographic predictors of suboptimal MR reduction following TEER in patients with secondary MR.MethodsIn this retrospective single-center study, we identified all patients with secondary MR who underwent TEER between 2016-2021. Pre- and intra-procedural transesophageal echocardiographic (TEE) images were abstracted. The primary outcome was suboptimal MR reduction, defined as ≥ 2+ MR on post-procedural TEE. The association of preoperative echocardiographic parameters with the primary outcome was tested via univariate and multivariate analyses.Results65 patients (69 ± 15 years; 49% female) with secondary MR underwent TEER with MitraClipTM. The average left ventricular ejection fraction and NYHA class were 35% and III, respectively. Technical success (≤ 2+ MR post-TEER) was achieved in 94%. Suboptimal MR reduction was observed in 38% of patients. Independent predictors of suboptimal MR reduction included bicommissural MR [odds ratio (OR): 7.95, 95% confidence interval (CI): 1.50 – 42.3, p = 0.02], 2D-APd [OR: 6.46, CI: 1.85 – 22.51 per cm, p < 0.01], and MVA:LVEDV ratio [OR: 0.69, CI: 0.50 – 0.93 per mm2/mL, p = 0.02] (Table).ConclusionsDisclosuresO. Aksoy: Edwards Lifesciences: Proctor; R. V. Parikh: Abbott: Consulting; M. C. Press: Abbott: Proctor; J. E. Labin Nothing to disclose. D. M. Tehrani Nothing to disclose. P. Lai Nothing to disclose. E. H. Yang Nothing to disclose. G. Lluri Nothing to disclose. A. Nsair Nothing to disclose. BackgroundResidual mitral regurgitation (MR) following mitral valve transcatheter edge-to-edge repair (TEER) is associated with worse outcomes. This study sought to identify echocardiographic predictors of suboptimal MR reduction following TEER in patients with secondary MR. Residual mitral regurgitation (MR) following mitral valve transcatheter edge-to-edge repair (TEER) is associated with worse outcomes. This study sought to identify echocardiographic predictors of suboptimal MR reduction following TEER in patients with secondary MR. MethodsIn this retrospective single-center study, we identified all patients with secondary MR who underwent TEER between 2016-2021. Pre- and intra-procedural transesophageal echocardiographic (TEE) images were abstracted. The primary outcome was suboptimal MR reduction, defined as ≥ 2+ MR on post-procedural TEE. The association of preoperative echocardiographic parameters with the primary outcome was tested via univariate and multivariate analyses. In this retrospective single-center study, we identified all patients with secondary MR who underwent TEER between 2016-2021. Pre- and intra-procedural transesophageal echocardiographic (TEE) images were abstracted. The primary outcome was suboptimal MR reduction, defined as ≥ 2+ MR on post-procedural TEE. The association of preoperative echocardiographic parameters with the primary outcome was tested via univariate and multivariate analyses. Results65 patients (69 ± 15 years; 49% female) with secondary MR underwent TEER with MitraClipTM. The average left ventricular ejection fraction and NYHA class were 35% and III, respectively. Technical success (≤ 2+ MR post-TEER) was achieved in 94%. Suboptimal MR reduction was observed in 38% of patients. Independent predictors of suboptimal MR reduction included bicommissural MR [odds ratio (OR): 7.95, 95% confidence interval (CI): 1.50 – 42.3, p = 0.02], 2D-APd [OR: 6.46, CI: 1.85 – 22.51 per cm, p < 0.01], and MVA:LVEDV ratio [OR: 0.69, CI: 0.50 – 0.93 per mm2/mL, p = 0.02] (Table). 65 patients (69 ± 15 years; 49% female) with secondary MR underwent TEER with MitraClipTM. The average left ventricular ejection fraction and NYHA class were 35% and III, respectively. Technical success (≤ 2+ MR post-TEER) was achieved in 94%. Suboptimal MR reduction was observed in 38% of patients. Independent predictors of suboptimal MR reduction included bicommissural MR [odds ratio (OR): 7.95, 95% confidence interval (CI): 1.50 – 42.3, p = 0.02], 2D-APd [OR: 6.46, CI: 1.85 – 22.51 per cm, p < 0.01], and MVA:LVEDV ratio [OR: 0.69, CI: 0.50 – 0.93 per mm2/mL, p = 0.02] (Table). Conclusions DisclosuresO. Aksoy: Edwards Lifesciences: Proctor; R. V. Parikh: Abbott: Consulting; M. C. Press: Abbott: Proctor; J. E. Labin Nothing to disclose. D. M. Tehrani Nothing to disclose. P. Lai Nothing to disclose. E. H. Yang Nothing to disclose. G. Lluri Nothing to disclose. A. Nsair Nothing to disclose. O. Aksoy: Edwards Lifesciences: Proctor; R. V. Parikh: Abbott: Consulting; M. C. Press: Abbott: Proctor; J. E. Labin Nothing to disclose. D. M. Tehrani Nothing to disclose. P. Lai Nothing to disclose. E. H. Yang Nothing to disclose. G. Lluri Nothing to disclose. A. Nsair Nothing to disclose.

Echocardiographic characteristics of non‐resectional ring‐only valve repair in mitral valve prolapse

AbstractBackgroundSimple mitral valve repair (MVR) using a ring‐only approach (ROA) was recently proposed for some complex forms of bileaflet myxomatous mitral valve prolapse (MVP). Nevertheless, few data are available concerning the characteristics of MVP patients that may benefit from this simple repair technique.MethodsBased on 39 consecutive patients (28 men; mean age 57 ± 15) with severe primary Mitral regurgitation (MR) caused by bileaflet MVP referred for MVR, we sought to identify the preoperative echocardiographic parameters associated with successful ROA repair.ResultsTwenty‐three patients (59%) underwent standard resectional MVR (SMVR) while 16 (41%) underwent ROA. Cardiopulmonary bypass and cross clamp times were lower in ROA than in SMVR (74 ± 27 min vs 99 ± 42 min and 49 ± 19 min vs 70 ± 25 min, respectively, p = 0.03 and p = 0.005). ROA patients were more frequently women (50% vs 13%, p = 0.027). Echocardiographic characteristics of successful ROA were mid‐late systolic MR, a paradoxical systolic papillary muscle displacement, and paradoxical systolic annulus expansion (PAE). A prolapsing depth &lt;10 mm, the absence of flail leaflet and ruptured chordae, the presence of multiple jets, more often in the central part of the valve were also associated with ROA. Non hemodynamic systolic anterior motion and residual trivial MR tended to be more frequent in ROA than in SMVR.ConclusionSimple and fast MVR using a ROA is feasible in 4/10 patients with complex forms of bileaflet MVP. Successful ROA patients were more frequently women, with mid‐late systolic central multiple jet, low prolapse depth, absence of chordal rupture or flail leaflet and PAE.

Changes in echocardiographic parameters of the donor's heart before and after heart transplantation and their relationship with post-transplant survival.

BackgroundHeart transplantation is now widely performed in China, but the current entry criteria for heart transplantation donors are simple and lack reliable standards; there are still no studies on the effect of preoperative echocardiographic parameters of heart transplantation donors on the prognosis of the recipient. Therefore, the aim of this study is twofold: (I) to observe the characteristics of changes in echocardiographic parameters of the donor’s heart before and after heart transplantation and (II) to study the relationship between the changes in echocardiographic parameters of the donor’s heart pre- and post-transplant and transplant recipient survival.MethodsA total of 29 patients who underwent orthotopic heart transplant in our hospital from October 2016 to October 2019 were enrolled in this study. All recipients were followed up until April 2020. Echocardiographic data were collected pre-transplantation (donor) and at 1 week and 1 month post-transplant (recipient).ResultsCompared with the pretransplanted donor’s heart, there was an increase in the interventricular septal diameter, left ventricular posterior wall diameter, right atrium diameter and right ventricular diameter, while a decrease was found in the tricuspid annular systolic displacement and tricuspid annular peak systolic velocity at 1 week post-transplant. The survival curve showed that the postoperative survival time in the right atrium/ventricle ≥32 mm group was better than that in the right atrium/ventricle <32 mm group. The survival curve also showed that the postoperative survival time in the right atrium/ventricle enlargement <2 mm group was better than that in the right atrium/ventricle enlargement ≥2 mm group.ConclusionsIn the early post-transplant period, ventricular myocardial thickening, right heart enlargement and a decrease in right heart function were observed in the post-transplanted heart compared to the pretransplanted donor’s heart. Postoperative survival was higher among heart transplant patients who received a heart with right atrium/ventricle ≥32 mm. Postoperative survival was lower among heart transplant patients whose right atrium/ventricle was dilated ≥2 mm at 1 month postoperatively compared with the pretransplanted donor’s heart.

The value of diastolic speckle-tracking parameters in predicting outcome after surgical ventricular restoration

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): DZHK (German Centre for Cardiovascular Research) BMBF (German Ministry of Education and Research) Background. Parameters of speckle-tracking echocardiography (STE) are incorporated into the integrative assessment of left ventricular (LV) diastolic function 1. In this study we aimed to evaluate both established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm planned for surgical ventricular restoration (SVR). Methods. We retrospectively examined data of 137 patients (60 ± 11 years, 25% women) with anteroapical LV aneurysm who underwent SVR and for whom preoperative echocardiography was available and feasible for STE and for conventional assessment of LV diastolic function by transmitral flow. STE parameters evaluated were: left atrial reservoir strain (LAS), early and late global diastolic strain rate (GLSRe and GLSRa), ratio of early-to-late diastolic strain rate (GLSRe/GLSRa), and ratio of early diastolic transmitral flow velocity (E) to GLSRe and to GLSRa. In 24 patients we evaluated an association of diastolic echocardiographic parameters with mean pulmonary artery pressure (PAPm) and mean pulmonary capillary wedge pressure (PCWPm) obtained invasively within 6 days of echocardiography. Preoperative echocardiographic parameters were assessed in whole cohort of patients for the association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation. Results. During a median follow-up of 4.7 years (IQR: 1.4-8.1 years) events occurred in 59 patients. GLSRa, E/GLSRa and LAS demonstrated significant correlation with PAPm and PCWPm (Table 1). GLSRa with optimal cut-off value of ≤ 0.41 s-1 was able to detect PAPm &amp;gt;30 mmHg with sensitivity of 0.8 and specificity of 0.8 (AUC 0.85; 95% CI 0.68-1.0; p = 0.008). E/GLSRa ≥1.24 m was able to detect PAPm &amp;gt;30 mmHg with sensitivity of 1.0 and specificity of 0.8 (AUC 0.87; 95%CI 0.7-1.0; p = 0.005). There was significant difference in event-free survival between groups stratified by cut-offs for GLSRa (Fig. 1A) and E/GLSRa (Fig. 1B). After adjustment for important clinical (age, sex, plasma creatinine, atrial fibrillation) and echocardiographic parameters (fractional shortening and LV end-systolic volume index) GLSRa and E/GLSRa remained an independent predictors of events (HR 0.16; 95% CI: 0.03-0.86; p = 0.032 and HR 1.22; 95% CI: 1.03-1.43; p = 0.018) and demonstrated higher prognostic value compared to LAS, other STE parameters and conventional parameters of LV diastolic function. Conclusion. Late diastolic longitudinal strain rate and ratio of early diastolic transmitral flow velocity to late diastolic longitudinal strain rate demonstrated association with hemodynamic parameters in patients with LV anteropaical aneurysm and might be used for the evaluation of LV diastolic function. These parameters showed prognostic value for patients underwent SVR and could be implemented for preoperative evaluation of these patients. Abstract Table 1. Correlation data Abstract Figure 1. Survival curves

Relationship between right ventricular geometry and function parameters and tricuspid annuloplasty efficacy

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION The prevalence of untreated moderate and severe functional tricuspid regurgitation (TR) eventually leads to heart failure and is associated with poor prognosis. Therefore, tricuspid annuloplasty (TA) is offered as a first-line treatment for significant functional TR. However, studies to investigate factors leading to recurrent TR after TA are still scarce. AIM The aim is to investigate the relationship between right ventricular (RV) geometry and function parameters and recurrent TR after TA. METHODS Prospective observational cohort study enrolled patients with moderate or severe functional TR caused by left heart valvular disease who underwent surgical tricuspid valve (TV) repair. The dominant pathology was severe mitral regurgitation. Patients with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The current study included 60 patients with full sets of preoperative 2D and 3D echocardiographic parameters. Echocardiographic quantification included the following parameters: the RV and RA geometry, functional (velocity of the tricuspid annular systolic motion [S’] and RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE] and RV ejection fraction (EF)). The severity of TR was measured quantitatively according to the recent ESC guidelines. Patients were divided into two groups according to the outcomes of TA: effective (38 pts.) and ineffective (22 pts.) TV repair. Effective TA was considered if TR 1 year after surgery was mild, while ineffective – TR was moderate or severe (recurrent TR). The statistical analysis was performed using SPSS statistical software, univariate logistic regression was used. RESULTS In 60 patients of current analysis 67% were female, mean age was 67 ± 9 years. The odds ratio for risk of ineffective TA are shown in Table 1. Age, gender, body mass index, left ventricular (LV) functional, as well as left atrial parameters did not differ between effective and ineffective TA groups. When analysing echocardiographic parameters in univariate logistic regression, RV and RA geometry, TV annulus diameter had predictive value for ineffective TA. Preoperative effective regurgitant orifice area (EROA) did not differ significantly between two groups (ineffective TA vs. effective TA; 31 [60] mm2 vs. 24 [17] mm2, p = 0.308 respectively). Meanwhile, none of the RV functional parameters were significant. CONCLUSION Recurrent moderate or severe functional tricuspid regurgitation after tricuspid annuloplasty is associated with preoperative tricuspid annulus size, RA and RV geometry, but not with changes of RV function. Abstract Figure.

Right ventricular longitudinal strain remains unimpaired in severe primary mitral regurgitation and functional tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION The right ventricular global longitudinal strain (RV GLS) increasingly has been used for the prognosis of mortality in the heart failure patients. However, the relationship of RV strains to other RV functional parameters and its dependency of functional tricuspid regurgitation (TR) as a result of left heart valvular disease is not well studied. PURPOSE To investigate the relationship of RV geometry, functional and strain parameters to the predominant left heart aetiology in patients with functional TR as a result of left heart valvular disease. METHODS Prospective observational cohort study enrolled patients with functional TR caused by left heart valvular disease for whom surgical valvular repairment is scheduled. Patients with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The current study included 52 patients with full sets of preoperative echocardiographic parameters. Echocardiographic quantification included the following parameters: the RV geometry (RV diameters, RV area), functional (velocity of the tricuspid annular systolic motion (S’) and RV fractional area change (FAC)) and strain parameters (RV GLS, longitudinal RV free wall strain (RVFWS) and longitudinal strains of each segment of RV free wall). The severity of TR was measured quantitively according the recent ESC guidelines. Patients were divided into groups according to the predominant left heart valvular disease causing moderate or severe functional TR: 1. TR caused by primary severe mitral regurgitation (MR) due to mitral valve (MV) prolapse and MV chordae rupture; 2. TR caused by other left heart valvular pathologies (severe aortic stenosis [16 pts.], severe rheumatic aortic and MV disease [11 pts], severe aortic regurgitation [3 pts]). The statistical analyses were performed using SPSS statistical software. RESULTS In 52 patients of current analysis 64% were female, mean age was 67 ± 9. The distribution of echocardiography parameters in study groups are shown in Table 1. The RV geometry parameters and parameter of TR severity (effective regurgitant orifice area (EROA) did not differ significantly between these two groups. The RV longitudinal function (S’) and RV strain parameters (RV GLS and longitudinal RVFWS) were better in severe MR group. CONCLUSIONS Although the right ventricular geometry and severity of functional tricuspid regurgitation does not depend on different predominant left heart valvular disease causing significant functional tricuspid regurgitation, the right ventricular longitudinal function and longitudinal right ventricular free wall strain are less affected and remains unimpaired in patients with functional tricuspid regurgitation caused by severe primary mitral regurgitation. Abstract Figure.

Development of tricuspid regurgitation and right ventricular performance after implantation of centrifugal left ventricular assist devices.

Tricuspid regurgitation (TR) after left ventricular assist device (LVAD) implantation is associated with a poor prognosis. This study evaluates the development of TR and right ventricular (RV) performance after LVAD implantation. Retrospective analysis of patients who underwent LVAD implantation between March 2018 and June 2019. Patients who underwent concomitant tricuspid valve surgery and patients with congenital heart disease were excluded. A total of 155 patients underwent LVAD implantation. Fourteen patients were excluded. Of the remaining patients, thirty-one died during the first six months, six were lost to follow-up and two underwent transplantation. 102 patients presented at 6.3 months (5.8 to 7.0). Patients were supported with HeartWare HVAD (74%) or HeartMate 3 (26%). 50.4% were rated as INTERMACS profile 1 or 2. At six months, systolic pulmonary artery pressure dropped from 36 to 21 mmHg (P<0.001). Tricuspid annular plane systolic excursion decreased from 17.3 to 14.3 mm (P<0.001), RV fractional area change did not change (P=0.839). Twenty-two patients (22%) presented with moderate-to-severe or severe (ms-s) TR pre-operatively. Of these, eighteen (81%) showed improvement to ≤ moderate TR. At follow-up twelve patients presented with ms-s TR. Of these, only four patients (33%) had been diagnosed with ms-s TR pre-operatively. There were no differences in pre-operative echocardiographic or clinical parameters between the twelve patients with ms-s late TR and the other ninety patients in the cohort. TR can show an impressive improvement with LVAD support. Longitudinal RV function decreases; this appears to be compensated by transverse shortening. Late TR can develop independently from pre-operative parameters including TR.

Risk factors including preoperative echocardiographic parameters for post-induction hypotension in general anesthesia

BackgroundSevere hypotension immediately after induction of general anesthesia (post-induction hypotension) is a common complication and is associated with a poor postoperative outcome. We hypothesized that post-induction hypotension results from cardiac dysfunction which can be assessed by preoperative echocardiography. MethodsWe retrospectively enrolled 200 patients who had undergone elective surgery within 6 months after preoperative transthoracic echocardiography. The incidence of post-induction hypotension identified from anesthesia records was defined as a decrease in mean blood pressure to ≤50 mmHg after injection of induction anesthetics prior to surgery. Logistic regression analysis of patient characteristics and echocardiographic variables was used to identify the independent factors for post-induction hypotension. ResultsPost-induction hypotension was found in 63 of the 200 cases (incidence 32%). Independent risk factors for post-induction hypotension were the presence of a regional wall motion abnormality (RWMA) [odds ratio (OR), 6.65.; 95% confidence interval (CI), 1.76 - 25.10], an elevated E/e’ (OR, 1.13; 95% CI, 1.00 - 1.28), female gender (OR, 3.61; 95% CI, 1.37 - 9.56), and the use of an angiotensin II receptor blocker (OR, 3.17; 95% CI, 1.12 - 8.96). ConclusionsAssessment of RWMA and E/e' with preoperative transthoracic echocardiography might be helpful for stratification of patients at a risk of post-induction hypotension in general anesthesia.

Right atrium to pulmonary capillary wedge pressure ratio is associated with right ventricular failure and mortality after left ventricular assist device surgery

Abstract Introduction Right ventricular failure (RVF) is a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. We investigated the role of right atrium to pulmonary capillary wedge pressure (RA/PCWP) ratio as a preoperative predictor of postoperative RVF after LVAD surgery. Methods A retrospective analysis of all consecutive patients who received continuous-flow LVADs (HeartMate 2, 3, and HVAD) between August 2012 and May 2018 in a single tertiary center. INTERMACS profile 1 patients were excluded. RA/PCWP ratio was calculated for the entire cohort and divided into quartiles (Q). Patients were stratified into high (Q4) vs. low (Q1–3) RA/PCWP ratio. The primary end point was the composite of in hospital mortality and RVF (defined as the need for a right ventricular assist device or inotrope dependence for &amp;gt;7 days). The secondary endpoint was readmission within 14 days after discharge. Results The study cohort consisted of 59 patients (15 patients in the high RA/PCWP group and 44 patients in the low RA/PCWP group) with a median follow-up of 21 months (Interquartile range 14–31). The mean age was 56±11 years and the majority of patients were male (88%). Patients were classified as INTERMACS profile 2 (34%), 3 (19%) or 4 (47%). Preoperative clinical, laboratory, and echocardiographic parameters were similar in both groups except for a larger proportion of patients with a dilated right ventricle and above moderate tricuspid regurgitation in the high compared to the low RA/PCWP group (73% vs. 29%; P=0.006 and 40% vs. 2%; P=0.001, respectively). Overall, 7 patients (12%) developed the primary end-point and 9 patients (15%) developed the secondary end-point. Univariate analysis demonstrated that high RA/PCWP is associated with both primary and secondary end-points (odds ratio [OR], 7.6; 95% confidence interval [CI] 1.2–47.2, P=0.029 and OR, 6.25; 95% CI 1.3–28.5, P=0.018, respectively). On multivariable analysis, the association remained significant after adjustment for INTERMACS score (OR, 10.6; 95% CI 1.4–80.9, P=0.022 and OR, 7.9; 95% CI 1.5–42.2, P=0.015, respectively). Using receiver operating characteristic curve (ROC) derived cut-points, RA/PCWP &amp;gt;0.57 provided 67% sensitivity and 79% specificity (C-statistic = 0.73) for the prediction of in hospital mortality and RVF and 56% sensitivity and 84% specificity (C-statistic = 0.69) for the prediction of readmissions within 14 days after discharge. In comparison, in our cohort using ROC-derived cut points, pulmonary artery pulsatility index, an established RVF predictor, of less than 1.84 provided 40% sensitivity and 20% specificity (C-statistic = 0.3) for the prediction of inhospital death and RVF. Conclusion RA/PCWP ratio may help to identify patients at high risk of developing adverse clinical outcomes, including RVF and mortality, after LVAD surgery. Funding Acknowledgement Type of funding source: None

Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement.

Moderate-to-severe mitral regurgitation is present in 20-35% of patients undergoing transcatheter aortic valve replacement (TAVR) and the current literature lacks simple echocardiographic parameters, which can predict post-TAVR changes in mitral regurgitation. The aim of this study is to investigate the echocardiographic predictors of improvement or worsening of mitral regurgitation in patients undergoing TAVR with moderate-to-severe mitral regurgitation. This retrospective study included 113 patients who underwent TAVR with preoperative mitral regurgitation grade at least 2. Patients with concomitant coronary artery disease requiring treatment were excluded. Mitral regurgitation was related to the annular dilatation or tethering mechanism in all patients. Preoperative and postoperative echocardiographies were compared in terms of mitral regurgitation and other commonly measured parameters. After TAVR, a reduction in mitral regurgitation was observed in 62.8% of cases. On the basis of the difference between postoperative and preoperative echocardiograms, 71 patients had improved mitral regurgitation, whereas 42 patients had stable or worsened mitral regurgitation. After analyzing preoperative echocardiographic parameters with regard to this group difference, left atrial volume index (LAVI) was the only variable that was different between groups (33.4 ± 4.8 ml/m in improved mitral regurgitation vs. 39.8 ± 3.0 ml/m in not improved mitral regurgitation, P < 0.001). In a multivariable logistic regression model, a LAVI increase was associated with lack of an acute reduction in mitral regurgitation (odds ratio = 1.41, P < 0.001) after adjustment for age and preoperative serum creatinine. Higher preoperative LAVI is a determinant predictor of lack of an acute reduction in mitral regurgitation after TAVR, and LAVI could be used as a stratifying tool to tailor the treatment strategy and the timing of the procedures. However, validation of these results and long-term outcomes are warranted to support those conclusions.

Predictors of Late Tricuspid Regurgitation in Patients with Left Ventricular Assist Devices

Moderate and severe tricuspid regurgitation (TR) at the time of LVAD-Implantation is associated with poor survival. Therefore the benefit of Tricuspid repair at the time of LVAD implantation is subject of intensive discussion. The aim of this study was to evaluate predictors of moderate to severe and severe TR (ms-sTR) 6 months after Implantation. All patients that were able to present at our center 6 months after LVAD-Implantation underwent clinical assessment and echocardiography. We divided patients in two groups regarding postoperative TR (no to moderate TR vs. ms-sTR) and retrospectively analyzed preoperative-, operative data and the results of the 6 months follow up. 121 adult patients underwent LVAD-Implantation between 3/2018 and 2/2019. 51% were classified as INTERMACS profile 1 or 2. 31 patients died during first 6 months. Patients who were lost in follow up (n=4), with congenital heart disease (n=2) and patients who underwent Tricuspid repair (n=4) were excluded. Therefore 80 patients presented between 6.24 months (IQR: [5.8, 7.1]) supported with HeartWare HVAD 79 (n=63), HeartMate 3 (n=17). The patients were 56±11 years old, 68 were male, 12 female. 32 had dilative cardiomyopathy, 42 had ischemic cardiomyopathy, 6 other causes. All received optimal medical therapy (27 ACE-Inhibitor or angiogensine II receptor blockers, 51 Sacubitril-Valsartan, 69 aldosterone antagonist, 67 beta blockers). 10 patients showed late ms-sTR while 70 had no to moderate TR. There was no significant difference in preoperative clinical parameters (age, Body mass index, duration of heart failure, INTERMACS level, atrial fibrillation, implantable cardiovascular electric device) between the groups. There was also no significant difference in preoperative echocardiographic parameters (grade of TR, grade of mitral regurgitation, left ventricular enddiastolic diameter, left ventricular ejection fraction, right ventricular diameters, right ventricular ejection fraction, TAPSE, TK annulus diameter, systolic pulmonary artery pressure) between the two groups. 15 patients with preoperative ms-sTR showed spontaneous improvement and 7 patients with preoperative mild or moderate TR developed ms-sTR after six months. Late TR after LVAD-implantation may develop independent from preoperative right ventricular function and preoperative TR.