Prevalence Of Right Ventricular Dysfunction Research Articles

Echocardiographic haemodynamic monitoring in the context of HeartMate 3™ therapy: a systematic review.

While echocardiography remains essential within haemodynamic monitoring of durable mechanical circulatory support, previous echocardiographic guidelines are missing scientific evidence for the novel HeartMate 3™ (HM3) system. Accordingly, this review aims to summarize available echocardiographic evidence including HM3. This systematic review adhered to the PRISMA 2020 guidelines. Searches were conducted during August 2023 across PubMed, Embase, and Google Scholar using specific echocardiographic terms combined with system identifiers. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and Critical Appraisal Instrument (PCAI) for cross-sectional studies. Nine studies met the inclusion criteria, of which eight cohort studies and one cross-sectional study. Aortic regurgitation (AR) prevalence at approximately 12months of support exhibited heterogenicity (33.5% (Δ 33%)) in a limited number of studies (n=3). Several studies (n=5) demonstrated an increasing prevalence and severity of AR during HM3 support, generating moderate to high level of evidence. One AR study showed a higher cumulative incidence of death and heart failure (HF) readmission compared with those without significant AR, hazard ratio 3.42 (95% CI 1.48-8.76). A second study showed that a worsening AR group had significantly lower survival-free from HF readmission (59% vs. 89%, P=0.023) with a hazard ratio of 5.18 (95% CI 1.07-25.0), while a third study did not reveal any differences in cardiac-related hospitalizations in the 12months follow-up or non-cardiac-related hospitalization. Mitral regurgitation (MR) prevalence at approximately 12months of support exhibited good consistency 15.0% (Δ 0.8%) in both included studies, which did not reveal any significant pattern of changing prevalence over time. Tricuspid regurgitation (TR) prevalence at approximately 12months of support exhibited fair consistency 28.5% (Δ 8.3%) in a limited number of studies (n=2); both studies showed a statistically un-confirmed trend of increased TR prevalence over time. The evidence of general prevalence of right ventricular dysfunction (RVD) was insufficient due to lack of studies. There are few methodologically consistent studies with focus on long-term haemodynamic effects. Aortic regurgitation still seems to be a prevalent and potentially significant finding. The available evidence concerning right heart function is limited despite clinical relevance and potential prognostic value. Potential interventricular and haemodynamic interplay are identified as a white field for future research.

Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Embolism in SARS-CoV-2

Introduction: Chronic thromboembolic pulmonary disease (CTEPD) consists of persistent pulmonary vascular obstruction on imaging and involves long-term functional limitations, with or without chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to evaluate the incidence and risk factors of both persistent pulmonary vascular defects and CTEPH after hospitalization in patients with COVID-19 and PE during a 2-year follow-up. Methods: A prospective observational study was carried out in a tertiary hospital center. Patients were hospitalized between March 2020 and December 2021 with a diagnosis of PE during SARS-CoV-2 infection. Patients received anticoagulant treatment for at least 3 months and were followed up for 2 years. Between the third and fourth months after discharge, all patients were evaluated for the presence of residual thrombotic defects by CTPA and/or perfusion pulmonary scintigraphy. Clinical findings, lung function tests with DLCO, exercise capacity, and echocardiograms were also assessed. Results: Of the 133 patients included, 18% had persistent thrombotic defects on lung imaging at follow-up. The incidence of CTEPD was 0.75% at 2 years of follow-up. Patients with persistent defects were significantly older, had a higher prevalence of systemic arterial hypertension, higher D-dimer and NT-proBNP levels, and more severe PE at diagnosis. Furthermore, there was a higher prevalence of right ventricular dysfunction on echocardiogram at diagnosis of PE (25.0% vs. 2.7%, p = 0.006). This was the only variable independently related to persistent defects in multivariate analyses (OR: 8.13 [95% CI: 1.82–36.32], p = 0.006). Conclusion: The persistence of thrombotic defects after PE is a common finding after SARS-CoV-2 infection, affecting 18% of the population. However, the incidence of CTEPH appears to be lower (0.75%) in COVID-19-related PE compared to that previously observed in PE unrelated to COVID-19.

Prevalence of long-term right ventricular dysfunction after acute pulmonary embolism: a systematic review and meta-analysis

Right ventricular dysfunction (RVD) is associated with adverse outcomes of acute pulmonary embolism (PE). However, there are no studies describing the long-term, full-spectrum right ventricular parameters on morphology, pressure and function at certain follow-up time points after PE onset. More exploration of right ventricular function would provide useful clues for long-term management of patients with PE. For this systematic review and meta-analysis, we completed a literature search in Pubmed, EMBASE and WebofScience (from Jan 1st, 1998 to April 20th, 2023). Studies of patients with acute PE followed-up longer than 3 months with right ventricle assessment and written in English-language were included. Right ventricular function was assessed by either echocardiography or computed tomographic pulmonary angiography (CTPA). The primary outcome was structural and functional parameters of the right ventricle, and the secondary outcomes were functional assessments [New York Heart Association (NYHA) functional classification and 6-min walk test distance (6MWD)], at each follow-up time points. Random effect meta-analyses were performed using R software (PROSPERO: CRD42023433332). A total of 33 studies (3920 patients) were included in the final analysis. The 3-month, 6-month and 1-year prevalence of right ventricular dysfunction (RVD) was 0.34 [95% confidence interval (CI) 0.21-0.48, I2=96%], 0.26 (95% CI 0.17-0.36, I2=93%) and 0.34 (95% CI 0.19-0.48, I2=94%), respectively. Pooled tricuspid annulus plane systolic excursion (TAPSE), right ventricular to left ventricular diameter (RV/LV) ratio and pulmonary artery systolic pressure (PASP) at 1-year was 21.80mm (95% CI 20.08-23.52, I2=93%), 0.64 (95% CI 0.48-0.81, I2=92%) and 27.33mmHg (95% CI 18.88-35.78) (I2=96%), respectively. The proportion of NYHA III-IV was 0.06 (95% CI 0.0-0.12) and the pooled 6MWD was 462.98m (95% CI 447.55-478.41) over 1 year. Patients treated with thrombolysis had lower prevalence of RVD (1-year 0.17 and 0.07 in systemic thrombolysis and catheter-directed thrombolysis, respectively) than those treated with anticoagulation therapy alone (1-year 0.24) but the pooled risk ratio (RR) was not statistically significant. Although the conclusion of this study may be limited by its high heterogeneity from varied study designs, inclusion criteria and definition of RVD of each study, our findings suggested that persistent RVD and functional impairment were of considerable high prevalence during long-term follow-up after acute PE. Treatment strategy may influence the prevalence of long-term RVD. This study is supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1-061). The National Key Research and Development Program of China (2016YFC0905600). National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-02-03). CAMS Institute of Respiratory Medicine Grant for Young Scholars (2023-ZF-8).

Pulmonary hypertension and right-sided heart failure in hemodialysis patients

Background & Objectives: Cardiovascular complications are associated with poor outcomes in patients with End stage renal disease. This study is aimed to evaluate the prevalence of pulmonary hypertension and right side heart failure in hemodialysis patients, trying to decrease these complications by referring them to the cardiologist in order to manage them either by medical or interventional methods. Methods: A cross-sectional study for evaluation the prevalence of pulmonary hypertension and right sided heart failure in hemodialysis patients was carried out in Duhok kidney center in Kurdistan region-Iraq through a duration period of one year from first of February, 2020 to 31st of January, 2021 for 101 patients. Data were collected which included Age, gender, BMI, causes of renal failure and vascular access, and echocardiography was conducted by a cardiologist, he evaluated them by using tricuspid regurgitation jet peak gradient for pulmonary hypertension, and by using tricuspid annulus plane systolic excursion method for evaluation of right ventricular function. Results: In the current study 51 females with melasma. Their ages ranged between (19-46) years, with (59.9%) between (28-38) years. The duration of melasma was from 6 months to 9 years. Thirty-eight of them were married and had pregnancy. Thyroid stimulating hormone levels were high in 22 of them (43.1%), 20 out of 22 cases that was had high levels of thyroid stimulating hormone had dermal type of melasma by Wood’s lamp examination and their p-value was significant (0.001). Conclusion: The prevalence of pulmonary hypertension among patients on hemodialysis in Kurdistan region-Iraq is within the Iraqi and international range studies with low prevalence of right ventricular dysfunction.

Right ventricle-specific therapies in acute respiratory distress syndrome: a scoping review

ObjectiveTo summarize knowledge and identify gaps in evidence regarding treatment of right ventricular dysfunction (RVD) in acute respiratory distress syndrome (ARDS).Data sourcesWe conducted a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials.Study selectionStudies were included if they reported effects of treatments on right ventricular function, whether or not the intent was to modify right ventricular function.Data extractionData extraction was performed independently and in duplicate by two authors. Data items included the study design, patient population, type of intervention, comparison group, and RV-specific outcomes.Data synthesisOf 1,430 studies screened, 51 studies reporting on 1,526 patients were included. By frequency, the included studies examined the following interventions: ventilator settings (29.4%), inhaled medications (33.3%), extracorporeal life support (13.7%), intravenous or oral medications (13.7%), and prone positioning (9.8%). The majority of the studies were non-randomized experimental studies (53%), with the next most common being case reports (16%). Only 5.9% of studies were RCTs. In total, 27% of studies were conducted with the goal of modifying RV function.ConclusionsGiven the prevalence of RVD in ARDS and its association with mortality, the dearth of research on this topic is concerning. This review highlights the need for prospective trials aimed at treating RV dysfunction in ARDS.

Prevalence of RV dysfunction in patients under cardiotoxic chemoterapy: a preliminary analysis

Abstract Background Chemotherapy-induced cardiotoxicity is a serious complication often leading to heart failure. While the left ventricle (LV) has been thoroughly implicated in this process, data is scarce on right ventricular (RV) function following cardiotoxic chemotherapies. Our goal was to determine the prevalence and clinical significance of RV dysfunction in a cohort of patients who had received these drugs. Methodology Single-center retrospective study of cancer patients performing 2D transthoracic echocardiogram between January 2020 and December 2021. Those previously exposed to anthracyclines and/or anti-HER2 agents (≥6 months prior to echocardiogram) were included. Patients with known coronary artery disease or cardiomyopathy were excluded. LV function was assessed through LV ejection fraction (LVEF) and global longitudinal strain (GLS). LV cardiotoxicity was defined as per 2020 ESMO guidelines. RV function was considered abnormal if the following criteria were met: tricuspid annular plane systolic excursion (TAPSE) <17 mm, peak systolic velocity of the tricuspid annulus by pulsed wave TDI (S'VD) <12 cm/s, fraction area change (FAC) <35% and mean free wall longitudinal strain (FWLS) >−20%. Results Forty patients were included (58±13 years; 95% female; 93% with breast cancer; 30%, 20% and 50% previously treated with anthracyclines, anti-HER2 or both, respectively). Mean LVEF and GLS were 56±7% and −17±3%. Overall, 13 patients had current LV cardiotoxicity. RV dysfunction was documented in 15 (38%) patients (7 [18%] with isolated RV dysfunction), most often detected through FWLS (14 [35%], 7 [18%], 6 [15%] and 5 [13%] patients with abnormal FWLS, TAPSE, FAC and S'VD, respectively) – Figure 1. Seven patients (18%) and one patient (3%) had ≥2 and ≥3 abnormal RV parameters. Those with RV dysfunction were more often symptomatic (NYHA class ≥2: 53% vs. 16%; p=0.013), had higher NT-proBNP levels (516 [204–2400] vs. 66 [46–191] pg/mL; p=0.003) and most often had LV cardiotoxicity (62% vs. 26%, p=0.029); pulmonary artery systolic pressures were similar between both groups. Conclusion In our cohort of patients treated with cardiotoxic anti-neoplastic drugs, RV dysfunction was observed in two out of every five patients, most often detected by RV 2D strain and associated with worse symptoms and higher NT-proBNP levels. This data suggests that RV cardiotoxicity may be common and clinically impactful in those under cardiotoxic chemotherapies. Funding Acknowledgement Type of funding sources: None.

Right ventricular peak systolic free wall longitudinal strain as a practical tool to detect right ventricular dysfunction in acute myocarditis.

Acute myocarditis is one of the etiologies of acute heart failure, chronic dilated cardiomyopathy, and cardiac mortality. The extent of right ventricular (RV) involvement and its impact on the course of the disease have been scarcely studied. This study aimed to evaluate both the prevalence of RV dysfunction in acute myocarditis and echocardiographic measures as a diagnostic tool for RV dysfunction compared with cardiac magnetic resonance imaging (CMR) findings. This retrospective study enrolled patients with a definite or probable acute myocarditis diagnosis based on the Lake Louise criteria in CMR and evaluated the diagnostic accuracy of echocardiographic measures in predicting RV dysfunction in CMR. The study population consisted of 71 patients, including 54 men (76%), at a median (Q1-Q3) age of 33 (26-46) years. CMR detected RV dysfunction in 53.5% of the patients. The RV free wall peak systolic longitudinal strain showed the highest correlation (r=-.786, p<.001) and area under the curve (.919) with the RV ejection fraction in CMR, followed by the RV global peak systolic longitudinal strain and the RV fractional area change. The RV-free wall peak systolic longitudinal strain had a sensitivity of 92% and a specificity of 73% for the diagnosis of RV dysfunction in myocarditis. A cutoff value of -17.9% was 100% specific for RV systolic dysfunction. Echocardiography, as a readily available tool, was predictive of and had acceptable accuracy for RV dysfunction in acute myocarditis compared with CMR.

Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: amulticentre prospective cohort study.

SummaryCardiovascular complications due to COVID‐19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID‐19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high‐sensitivity troponin and N‐terminal pro B‐type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3–13%). Thirty‐day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N‐terminal pro B‐type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.

P262 ULTRASOUND–ASSISTED THROMBOLYSIS OF HIGH RISK AND INTERMEDIATE–HIGH RISK PULMONARY EMBOLISM: A MULTICENTRE REAL WORLD EXPERIENCE IN LOMBARDY REGION

Abstract Introduction Acute pulmonary embolism (PE) is associated with high morbidity and mortality rate. Catheter–directed treatments (CDTs) seem a therapeutical option in case of sistemic thrombolysis (ST) contraindication or failure. Ultrasound–assisted thrombolysis (USAT) allows low–dose thrombolytic loco–regional infusion facilitated by ultrasounds. Methods and Results A multicentre retrospective observational cohort study was conducted among 4 Cardiovascular Interventional Centres in Lombardy Region to evaluate safety and efficacy of USAT in high risk and intermediate–high risk PE patients presenting with contraindications to ST. Patients at high risk were included in case of USAT because of ST contraindications. Patients at intermediate–high risk were included in case of rescue USAT. Loco–regional thrombolysis was performed using rTPA. Procedural success was defined as successful catheters‘ deployment in pulmonary arteries and patient survival during the procedure. Bleeding were defined according to BARC criteria. Echocardiographic evaluation to determine the prevalence of right ventricular (RV) dysfunction and pulmonary hypertension was performed at presentation, discharge and follow–up. Between 2011 and 2021, 109 patients were included. 21.1% presented with high risk PE, the remaining 78.9% with intermediate–high risk. Procedural success was obtained in 99.1% of the cases; major bleedings occurred in 9.2%, minor bleedings in 11.9% and vascular complications in 7.3% of the patients. 91.7% of patients were alive at discharge. In–hospital all–cause mortality was higher in high risk patients (26.1% vs 3.5%; p = 0.003) that showed a steep decline in survival as compared to intermediate–high risk patients that constantly maintained a high survival rate throughout the observation period. At six–months follow–up 3 patients in intermediate–high risk group died so that the overall mortality remains higher in high risk patients (26.1% vs 7%; p = 0.018). No re–hospitalization for recurrent PE at six–months occurred. Prevalence of RV dysfunction and pulmonary hypertension significantly decreased from hospital admission to discharge and to six–months follow–up (p–value &amp;lt;0.0001 for all comparisons). Conclusions Our experience shows good short and mid–term outcomes in USAT in high risk and intermediate–high risk PE patients with contraindications to ST, suggesting that it might be considered in a neglected subset of patients with no alternative therapeutical options.

CE-522-03 LONGITUDINAL PREDICTION OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY

The arrhythmogenic right ventricular cardiomyopathy (ARVC) risk calculator (https://www.arvcrisk.com) stratifies risk for ventricular arrhythmia (VA) at the time of ARVC diagnosis. However, the risk factors included in the ARVC calculator change with time, and how well it performs at follow up evaluations is unknown. To identify the temporal trends of VA risk factors and test the longitudinal performance of the ARVC calculator. This was a retrospective analysis of ARVC patients without prior VA (sustained ventricular tachycardia (VT), appropriate ICD therapy, sudden cardiac death/arrest) enrolled in the Johns Hopkins Hospital ARVC registry and Netherlands ACM registry. Risk factors for VA (age, sex, history of cardiac syncope, burden of PVC on 24-hour heart monitor, history of non-sustained VT, number of T-wave inversions on ECG, and right ventricular ejection fraction) were assessed at the time of ARVC diagnosis and upon repeat evaluations. The 5-year risk of VA was predicted longitudinally using 1) the ARVC calculator (baseline risk factors), 2) the ARVC calculator (updated risk factors), 3) time varying Cox regression. 408 patients (37±15 years old, 40% male) were followed for a median of 5.2 [2.8, 9.6] years, during which time 132 experienced a first VA (4.0% events/year). Comparison of risk factors at baseline versus at >5 years of follow up revealed decreases in 24-hour PVC Burden (3,560 vs 2,510) and prevalence of non-sustained VT on the most recent Holter (53% vs 27%), and an increase in number of T-wave inversions (3.4 vs 3.9 leads). Prevalence of right ventricular dysfunction was unchanged. When calculated using baseline risk factors, the ARVC calculator’s ability to predict 5-year VA risk worsened after 3 years of follow up (from ROC-AUC 0.82 at baseline to 0.69 by 5 years). When calculated using updated risk factors, the ARVC calculator (ROC-AUC 0.77) performed as well as time varying Cox regression (ROC-AUC 0.77) after 5 years of follow up (Figure). Risk factors for VA in ARVC change over time. Up-to-date assessment of these risk factors is warranted for VA risk stratification at evaluations beyond 3 years from the time of initial ARVC diagnosis.

Right Ventricular and Pulmonary Computed Tomography Assessments in Paradoxical Low-Flow Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

BackgroundPatients with paradoxical low-flow low-gradient aortic stenosis (pLFLG AS) have high mortality and a high degree of transcatheter aortic valve replacement (TAVR) futility. Computed tomography (CT) enables accurate simultaneous right ventricular (RV) and parenchymal lung disease evaluation, which may provide useful objective markers of AS severity, concomitant pulmonary comorbidities, and TAVR improvement. However, the prevalence of RV dysfunction and its association with pulmonary disease in pLFLG AS are unknown. The study objective was to test the hypothesis that pLFLG AS patients undergoing TAVR have decreased RV function without a significant parenchymal lung disease. MethodsBetween August 2016 and March 2020, 194 consecutive AS patients completed high-resolution CT imaging for TAVR evaluation. Subjects were stratified based on echocardiographic criteria as the study group, pLFLG (n = 27), and 2 consecutive control groups: classic severe, normal-flow, high-gradient (n = 27) and normal-flow, low-gradient (NFLG) (n = 27) AS. Blinded biventricular function and lung parenchymal disease assessments were obtained by high-resolution CT imaging. ResultsPatient demographics were similar between groups. pLFLG AS had a lower RV ejection fraction (49 ± 10%) than both classic severe (58 ± 7%, p < 0.001) and NFLG AS (55 ± 65%, p = 0.02). There were no significant differences on lung emphysema (p = 0.19), air fraction (p = 0.58), or pulmonary disease presence (p = 0.94) and severity (p = 0.67) between groups. ConclusionspLFLG AS patients have lower RV ejection fraction than classic severe and NFLG AS patients in the absence of significant parenchymal lung disease on CT imaging. These findings support the direct importance of RV function in the pathophysiology of aortic valve disease.

Influence of Shunt Type on Survival and Right Heart Function after the Norwood Procedure for Aortic Atresia

The study objective was to compare the results after Norwood procedure between modified Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery conduit (RVPAC) according to Sano in patients with hypoplastic left heart syndrome (HLHS) and aortic atresia (AA). A total of 146 neonates with HLHS and AA who underwent the Norwood procedure at our institution between 2001 and 2020 were divided into 2 groups according to shunt type (MBTS or RVPAC). Survival after the Norwood procedure was compared between the groups. Longitudinal right ventricular and tricuspid valve function in each group were evaluated using cubic splines method. RVPAC was performed in 103 patients and MBTS in 43 according to surgeon preference. There were no differences in the 30-day mortality rates (16.5% vs 16.3%, P =0.973). Survival at 0.5, 1 and 3 years was 79.6%, 74.6%, and 68.9% in RVPAC and 66.8%, 64.3%, and 58.5% in MBTS (P = 0.293). Among 23 patients undergoing tricuspid valve procedure, different mechanisms of tricuspid regurgitation were observed between the groups. Longitudinal analysis revealed greater prevalence of late right ventricular dysfunction in RVPAC patients. In 77 patients who completed Fontan procedure, the postoperative N-terminal pro B-type natriuretic peptide value was significantly higher in RVPAC vs MBTS (554 vs 276 ng/L, P = 0.007). No survival advantage of RVPAC over MBTS was observed in neonates with HLHS and AA undergoing the Norwood procedure. Longitudinal analysis demonstrated a greater prevalence of right ventricular dysfunction and higher N-terminal pro B-type natriuretic peptide values during late follow-up in patients with RVPAC.

Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis

The Coronavirus Disease (COVID-19) pandemic imposed a high burden of morbidity and mortality. In COVID-19, direct lung parenchymal involvement and pulmonary microcirculation dysfunction may entail pulmonary hypertension (PH). PH and direct cardiac injury beget right ventricular dysfunction (RVD) occurrence, which has been frequently reported in COVID-19 patients; however, the prevalence of RVD and its impact on outcomes during COVID-19 are still unclear. This study aims to evaluate the prevalence of RVD and associated outcomes in patients with COVID-19, through a Systematic Review and Meta-Analysis. MEDLINE and EMBASE were systematically searched from inception to 15th July 2021. All studies reporting either the prevalence of RVD in COVID-19 patients or all-cause death according to RVD status were included. The pooled prevalence of RVD and Odds Ratio (OR) for all-cause death according to RVD status were computed and reported. Subgroup analysis and meta-regression were also performed. Among 29 studies (3813 patients) included, pooled prevalence of RVD was 20.4% (95% CI 17.1–24.3%; 95% PI 7.8–43.9%), with a high grade of heterogeneity. No significant differences were found across geographical locations, or according to the risk of bias. Severity of COVID-19 was associated with increased prevalence of RVD at meta-regression. The presence of RVD was found associated with an increased likelihood of all-cause death (OR 3.32, 95% CI 1.94–5.70). RVD was found in 1 out of 5 COVID-19 patients, and was associated with all-cause mortality. RVD may represent one crucial marker for prognostic stratification in COVID-19; further prospective and larger are needed to investigate specific management and therapeutic approach for these patients.

Prevalence of Right Ventricular Dysfunction &amp; Pulmonary Hypertension and their Relationship to the Number of Hemodialysis Sessions in Patients of End-Stage Renal Disease (ESRD)

Introduction: Chronic hemodialysis (HD) ends up with right ventricular (RV) dysfunction and increased pulmonary hypertension (PHTN). Left to right shunt in dialysis patients due to arterio-venous fistula (AVF) causes chronic volume overload, independent of rise in body water leading to worsening RV overload and RV dysfunction (RVD).&#x0D; Aims &amp; Objectives: To determine the prevalence of RV dysfunction &amp; pulmonary hypertension and its relationship to the number of dialysis sessions in patients of ESRD.&#x0D; Place and duration of study: Department of Cardiology &amp; Nephrology, Sheikh Zayed Hospital, Lahore for one year from March 2016 - March 2017.&#x0D; Material &amp; Methods: This cross-sectional analytical hospital based study enrolled 145 Patients of End-Stage Renal Disease (ESRD) on regular 4-hours HD sessions at two or more times per week for at least 3 months. Echocardiography&#x0D; (Echo) with 2-D, M (Motion) Mode &amp; Doppler studies were done. RV dysfunction by TAPSE value less than 15mm &amp; PHTN by Systolic pulmonary artery pressure &gt;35 mm Hg or tricuspid regurgitation velocity (VTR) ?2m/s at rest were noted. Data was analyzed on SPSS version 20.&#x0D; Results: RV dysfunction was seen in 40.7% (59) of patients and the frequency rose across the 4 dialysis session groups (13.8%, 37.3%, 51.7% &amp; 100%, p&lt;0.001). PHTN was observed in 44.1% of the patients and the prevalence progressively increased across the groups (17.2%, 45.1%, 53.3% &amp; 80.01%, p&lt;0.003). There was significant association between RVD and PHTN (p=0.011).&#x0D; Conclusion: We observed positive correlation between RV dysfunction and PHTN with total number of hemodialysis sessions. Early detection of sub-clinical RV dysfunction may improve mortality and morbidity by optimizing treatment options.

Abstract 16056: The Prevalence, Risk Factors and Outcome of Cardiac Dysfunction in Hospitalized Patients With Covid-19

Objectives: We aimed to investigate the prevalence, risk factors and outcome of cardiac dysfunction, and explore the potential value of echocardiographic parameters in hospitalized patients with coronavirus disease 2019 (COVID-19). Background: Cardiac involvement is a prominent features in COVID-19. However, the prevalence and clinical significance of cardiac dysfunction in COVID-19 patients have not yet been well described. Methods: We studied 157 consecutive hospitalized COVID-19 patients, whose Left ventricular (LV) and right ventricular (RV) structure and function were evaluated by echocardiography. Results: RV dysfunction was found in 40 (25.5%) patients, and LV dysfunction in 28 (17.8%) patients consisting of 24 (15.3%) with heart failure with preserved ejection fraction and 4 (2.5%) with heart failure with reduced ejection fraction. Hypertension, acute respiratory distress syndrome (ARDS), high-sensitivity troponin I (hs-TNI) level and mechanical ventilation therapy was associated with cardiac dysfunction, which contributed to higher mortality (LV dysfunction: 28.6% vs 11.6%, P = 0.022; RV dysfunction: 37.5% vs 6.8%, P &lt; 0.001, respectively). Moreover, LV and RV dysfunction were more frequent in patients with elevated hs-TNI than those without (37.5% vs 12.5 %, P = 0.001; 40.0 % vs 22.9%, P = 0.043, respectively). During hospitalization, 23 patients died. The mortality was 3.0% for patients without cardiac dysfunction and normal hs-TNI levels, 6.7% for those with cardiac dysfunction and normal hs-TNI levels, 13.3% for those without cardiac dysfunction but elevated hs-TNI levels, and 64.0% for those with cardiac dysfunction and elevated hs-TNI. In Cox analysis, RV dysfunction was independently predictor of higher mortality (hazard ratio=2.79; 95% CI: 1.10 to 7.06; P=0.031). HF, especially HFpEF, was not predictive of increased mortality. Conclusions: The prevalence of RV dysfunction was higher than that of HF. Moreover, HFpEF was more common than HFrEF. RV dysfunction is an independent predictor of higher mortality. Additionally, patients with cardiac dysfunction and elevated hs-TNI had the highest mortality, which may prompt physicians to pay attention not only to the hs-TNI level but also the cardiac dysfunction.

Detection of Right Ventricular Dysfunction in Acute Pulmonary Embolism By CT Scan: A Systematic Review and Meta-Analysis

Background: Right ventricular (RV) dysfunction is associated with higher mortality in patients with acute pulmonary embolism (PE). While precise definitions of RV dysfunction vary, up to 40% of patients with acute PE have evidence of RV dysfunction on echocardiography. The incremental utility of echocardiography for identifying RV dysfunction in acute PE is uncertain particularly when evidence of RV dysfunction is present on computed tomography (CT) pulmonary angiogram. However, the diagnostic utility of CT for detecting RV dysfunction is not well established; if CT is shown to have good diagnostic utility, it may reduce the need for routine urgent echocardiography and associated healthcare costs and resource use. We conducted a systematic review and meta-analysis to assess the diagnostic utility of CT scan findings for detecting RV dysfunction compared to echocardiography. Methods: Using a pre-specified protocol (Prospero ID: CRD42020187812) we systematically searched the MEDLINE and EMBASE databases from inception to April 2020. Studies of any design were included so long as they (i) included patients with acute PE diagnosed by CT scan and received an echocardiographic study within a reasonable timeframe and (ii) reported on test characteristics such that a 2x2 table could be constructed to compare the two diagnostic modalities with echocardiography considered the reference standard. Results were analyzed with the bivariate mixed-effects regression framework. Study quality was assessed with the QUADAS-2 risk of bias tool. Results: A total of 631 unique studies were identified by the search. After screening titles and abstracts and reviewing full texts in duplicate, 26 studies (n=3,404 patients) were eligible for inclusion. In individual studies, the average age (mean or median) of patients ranged from 41 to 70 years and 20% to 64.3% were female. The prevalence of RV dysfunction on echocardiography ranged studies from 22.6% to 85.7% and was 63.7% overall. The most common measurements on CT scan were increased RV/LV ratio (21 studies), pulmonary artery measurements (6 studies), RV dilatation or increased size (5 studies), measurements of vena cava size (3 studies), and coronary sinus size (2 studies). Other parameters included reflux of contrast into the inferior vena cava (IVC reflux, 4 studies) and interventricular septal deviation (5 studies). Different combinations of measurements were evaluated in 5 studies. Pooled analysis was performed for septal deviation, IVC reflux, and RV/LV ratio. In pooled analysis septal deviation had a sensitivity of 0.31 (95% CI=0.25- 0.38; I2= 51.6%) and a specificity of 0.98 (95% CI=0.90 - 1.00; I2= 46.9%). IVC reflux had a sensitivity of 0.75 (95% CI = 0.40 - 0.93; I2=95.9%) and specificity 0.75 (95% CI=0.47 - 0.93; I2= 91.1%). Where multiple RV/LV ratios were reported, we utilized the one with the highest sensitivity. The pooled sensitivity of increased RV/LV ratio was 0.83 (95% CI=0.78 - 0.87; I2= 82.9) while the pooled specificity was 0.75 (95% CI=0.66- 0.82; I2= 94.6) (Figure 1). Considering all RV/LV ratio studies, the summary receiver operating characteristic (SROC) curve had an area under the curve (AUC) of 0.86 (0.83-0.89) for identifying the presence of RV dysfunction present on echocardiography. Overall, most studies were considered at high risk of bias. Subgroup analyses demonstrated that sensitivity was significantly affected by the risk of bias for RV/LV ratio for all QUADAS-2 domains. Specificity was not affected by the risk of bias for any of the QUADAS-2 domains. Conclusions: Our results suggest CT imaging findings appear to have moderate to good diagnostic utility for detecting the presence of RV dysfunction in acute PE. With the exception of septal deviation there was significant heterogeneity amount included studies. Overall, increased RV/LV ratio had the best test characteristics (sensitivity 0.83, specificity 0.75 and AUC 0.86). However, the veracity of these findings is limited by the high risk of bias among included studies. Further analyses regarding the diagnostic utility of combinations of multiple CT findings are warranted. Figure 1 Disclosures Crowther: Pfizer: Speakers Bureau; Alnylam: Divested equity in a private or publicly-traded company in the past 24 months; CSL Behring: Speakers Bureau; Servier Canada: Membership on an entity's Board of Directors or advisory committees; Diagnostica Stago: Speakers Bureau; Asahi Kasei: Membership on an entity's Board of Directors or advisory committees; Precision Biologicals: Membership on an entity's Board of Directors or advisory committees; Hemostais Reference Laboratories: Honoraria. Siegal:BMS Pfizer: Honoraria; Bayer: Honoraria; Novartis: Honoraria; Leo Pharma: Honoraria; Portola: Honoraria.

Prevalence of right ventricular dysfunction and prognostic significance in heart failure with preserved ejection fraction

There is a paucity of data characterizing right ventricular performance in heart failure with preserved ejection fraction (HFpEF) using the gold standard of cardiovascular magnetic resonance imaging (CMR). We aimed to assess the proportion of right ventricular systolic dysfunction (RVD) in HFpEF and the relation to clinical outcomes. As part of a single-centre, prospective, observational study, 183 subjects (135 HFpEF, and 48 age- and sex-matched controls) underwent extensive characterization with CMR. transthoracic echocardiography, blood sampling and six-minute walk testing. Patients were followed for the composite endpoint of death or HF hospitalization. RVD (defined as right ventricular ejection fraction < 47%) controls was present in 19% of HFpEF. Patients with RVD presented more frequently with lower systolic blood pressure, atrial fibrillation, radiographic evidence of pulmonary congestion and raised cardiothoracic ratio and larger right ventricular volumes. During median follow-up of 1429 days, 47% (n = 64) of HFpEF subjects experienced the composite endpoint of death (n = 22) or HF hospitalization (n = 42). RVD was associated with an increased risk of composite events (Log-Rank p = 0.001). In multivariable Cox regression analysis, RVD was an independent predictor of adverse outcomes (adjusted Hazard Ratio [HR] 3.946, 95% CI 1.878–8.290, p = 0.0001) along with indexed extracellular volume (HR 1.742, CI 1.176–2.579, p = 0.006) and E/E’ (HR 1.745, CI 1.230–2.477, p = 0.002). RVD as assessed by CMR is prevalent in nearly one-fifth of HFpEF patients and is independently associated with death and/or hospitalization with HF.The trial was registered retrospectively on ClinicalTrials.gov (Identifier: NCT03050593). The date of registration was February 06, 2017.

Effect of improving dialysis adequacy on the right ventricular functions

Background Right ventricular dysfunction (RVD) is a common finding in hemodialysis (HD) patients especially those who are inadequately dialyzed. The aim of this study is to evaluate the effect of improving dialysis adequacy, anemia, and hypertension treatment on the RV function in a cohort of HD patients. Patients and methods The study included 60 HD patients admitted in Mansoura University Hospital, Nephrology Unit. Assessment of patients included complete clinical evaluation, estimation of Kt/V, urea reduction rate, and RV function assessed by echocardiography; all were done at the beginning of the study and 6 months after initiation of protocols of therapy needed for improvement of dialysis adequacy, anemia, and hypertension. Tissue Doppler imaging-derived myocardial performance index was used as the main index of RVD. Results The study results revealed an increased prevalence of RVD in maintenance HD patients. Moreover, this study showed a significant improvement of the mean tissue Doppler-derived myocardial performance index in the studied patients at the end of the study (after improvement of Kt/V, anemia, and hypertension), compared with initial values at the start of the study, from 0.54±0.03 to 0.48±0.02, respectively, with significant P value of 0.001. Conclusion RVD is common among HD patients, but improving dialysis adequacy together with proper management of hypertension and anemia plays an essential role in the improvement of RVD.

Prevalence and Prognostic Implications of Right Ventricular Dysfunction in Patients With Hypertrophic Cardiomyopathy

Right ventricular (RV) dysfunction is a well-known prognostic factor in several cardiac diseases. However, the prevalence of RV dysfunction in hypertrophic cardiomyopathy (HC) is unclear and its prognostic value is unknown. This study aims at addressing these issues assessing RV function with speckle tracking echocardiography. In 267 HC patients (52 ± 15 years, 68% male), standard and advanced echocardiographic measurements of RV function were performed including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall longitudinal strain (RVFWLS). The primary end point was all-cause mortality and heart failure development. RV dysfunction was observed in 9% of patients based on tricuspid annular plane systolic excursion (≤17 mm), 5% based on fractional area change (<35%), 23% based on RVFWLS ≥-19%, 39% based on RVFWLS ≥-23%, and 55% based on RV4CLS ≥-20%. In total 59 (22%) patients reached the primary end point during a median follow-up of 6.7 (interquartile range 4.2 to 9.8) years. Kaplan-Meier survival curve showed a significant worse survival free of the end point for patients with impaired RV4CLS ≥-20% versus patients with preserved RV4CLS <-20% (log-rank 7.0, p = 0.008) and for patients with impaired RVFWLS ≥-19% versus patients with preserved RVFWLS <-19% (log-rank 4.4, p = 0.037). Multivariable Cox regression analysis showed that E/E' (hazards ratio [HR] 2.26 [1.30 to 3.92], p = 0.004), left ventricular global longitudinal strain LV GLS (HR 1.08 (1.01 to 1.17), p = 0.034) and RV4CLS (HR 1.08 (1.02 to 1.15), p = 0.007) were independently associated with the primary end point. In conclusion, RV dysfunction as measured by longitudinal strain is relatively frequent in HC patients. Impaired RV4CLS is - together with LV GLS and E/E' - associated with adverse outcome, which may indicate a more severe form of HC.

Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome.

The prevalence and importance of early right ventricular dysfunction and pulmonary hypertension in pediatric acute respiratory distress syndrome are unknown. We aimed to describe the prevalence of right ventricular dysfunction and pulmonary hypertension within 24 hours of pediatric acute respiratory distress syndrome diagnosis and their associations with outcomes. Retrospective, single-center cohort study. Tertiary care, university-affiliated PICU. Children who had echocardiograms performed within 24 hours of pediatric acute respiratory distress syndrome diagnosis. None. Between July 1, 2012, and June 30, 2016, 103 children met inclusion criteria. Echocardiograms were analyzed using established indices of right ventricular and left ventricular systolic function and for evidence of pulmonary hypertension. Echocardiographic abnormalities were common: 26% had low right ventricular fractional area change, 65% had low tricuspid annular plane systolic excursion, 30% had low left ventricular fractional shortening, and 21% had evidence of pulmonary hypertension. Abnormal right ventricular global longitudinal strain and abnormal right ventricular free wall strain were present in 35% and 40% of patients, respectively. No echocardiographic variables differed between or across pediatric acute respiratory distress syndrome severity. In multivariable analyses, right ventricular global longitudinal strain was independently associated with PICU mortality (odds ratio, 3.57 [1.33-9.60]; p = 0.01), whereas right ventricular global longitudinal strain, right ventricular free wall strain, and the presence of pulmonary hypertension were independently associated with lower probability of extubation (subdistribution hazard ratio, 0.46 [0.26-0.83], p = 0.01; subdistribution hazard ratio, 0.58 [0.35-0.98], p = 0.04; and subdistribution hazard ratio, 0.49 [0.26-0.92], p = 0.03, respectively). Early ventricular dysfunction and pulmonary hypertension were detectable, prevalent, and independent of lung injury severity in children with pediatric acute respiratory distress syndrome. Right ventricular dysfunction was associated with PICU mortality, whereas right ventricular dysfunction and pulmonary hypertension were associated with lower probability of extubation.