Right Ventricle Function In Patients Research Articles

Right ventricular myocardial work by echocardiography: non-invasive assessment of right ventricle function in patients with pulmonary hypertension

Abstract Background Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study and analyze the right ventricular (RV) function non-invasively, using RV pressure-strain loops. The association between these novel indexes of RVMW and invasive hemodynamic parameters has not yet been extensively studied, namely in precapillary pulmonary hypertension (PH) population. In right heart catheterization, stroke volume directly reflects right ventricular function in response to its load, and has prognostic implication in PH. Objectives To evaluate the relationship between RVMW and stroke volume index (SVi) measured invasively by right heart catheterization (RHC), in a cohort of patients with group I and group IV PH. Methods A prospective registry of pre-capillary PH patients evaluated in a single tertiary center was used. Echocardiography and RHC were performed in the same day. Dedicated software for left ventricle myocardial work was used for the RV. RV global myocardial work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW; work contributing to myocardial shortening during systole and lengthening during isovolumic relaxation), RV global wasted work (RVGWW; work contributing to myocardial lengthening during systole and shortening during isovolumic relaxation), and RV global work efficiency (RVGWE; relation between RVGCW and RVGWW) were estimated. Pearson’s correlation was applied to assess correlations between continuous variables. Results 17 pts (80% women, mean age 67 ± 10 years) were included. The average of mean pulmonary arterial pressure (mPAP) was 33 mmHg (± 9,5), of pulmonary vascular resistance (PVR) was 5,7 WU (± 5,1) and of SVi was 40,7 ml/m2 (± 10,8). Conventional echocardiographic parameters for the evaluation of RV systolic function, such as TAPSE, annular tricuspid s’ velocity and fractional area change (FAC), did not correlate with SVi. Moreover, right ventricle-pulmonary artery (RV-PA) coupling and RV GLS also did not correlate with this invasive parameter of right ventricle function. Of the RVMW indexes, RVGWW and RVGWE strongly correlated with SVi: as this invasive parameter decreases, RVGWW (r = -0,560, p = 0,019) increases significantly, whereas RVGWE (r= 0,539, p = 0,026) declines (Fig 1). In our population, RVGWI and RVGCW didn’t correlate significantly with SVi. Conclusions Finding non-invasive methods to evaluate RV function is essential in patients with RV hemodynamic overload, since conventional echocardiographic parameters do not perform well, and RV function is central in prognosis assessment in this population. Novel echocardiographic assessment of RVMW seems to provide a promising index of RV function in PH patients, as demonstrated with its correlation with SVi.Figure 1:Correlation of RVMW with SVi.

Real-time Three-dimensional Echocardiography: A Feasible and Accurate Method for Measuring Right Ventricular Function in Pulmonary Hypertension

Right ventricular function is independently associated with poor clinical outcomes in patients with various cardiovascular diseases including pulmonary hypertension (PH). The complex geometry and mode of contractility means the right ventricle (RV) inlet and outlet are not in line; hence, 2-dimensional echocardiography fails to accurately quantify RV volumes and function in such patients. Three-dimensional echocardiography (3DE) allows for reliable and reproducible quantification of RV volumes and function by overcoming these limitations of conventional echocardiography. This review focuses on the 3DE assessment of RV function in patients with PH and discusses the following points: (1) acquiring an RV data set for 3DE imaging, including details of all available 3DE systems and software utilized in daily practice; (2) the reliability and feasibility of RV remodeling measured with 3DE with different modalities in patients with PH; and (3) the prognostic value of 3DE-derived RV function in such patients.

Evaluating the feasibility of using artificial intelligence for right ventricle function analysis in a routine clinical setting

Abstract Funding Acknowledgements Type of funding sources: None. Background Evaluation of right ventricle (RV) function has clinical value when investigating patients with symptomatic heart failure. However, the assessment of RV function using two-dimensional echocardiography (Echo) is operator-dependent and is time-consuming. Technological advances have enabled the use of artificial intelligence (AI) based algorithms for functional analysis with high reproducibility, facilitated by manufacturer-neutral platform. Purpose We sought to determine the feasibility of using an AI-based application to measure RV function in patients referred for diagnostic evaluation of heart failure, and to compare the results with operator-generated (Human) measurements in order to assess the accuracy and efficiency of the AI. Methods We conducted a study on 190 consecutive patients, comparing the analysis times and accuracies of tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) measurements using both Human and AI-based methods on three consecutive heart beats of the same Echo clip. The participants manually measured TAPSE in M-mode and FAC by tracking the RV endocardium in diastole and systole, while the AI automatically assessed these parameters in a single apical RV-centered 4-chamber view. The results of these measurements were then compared to determine the accuracy and efficiency of the AI. Results The measurement feasibility by the AI was 92% (n=175) on the RV clips. The main reasons for exclusion were poor image quality and insufficient representation of the RV free wall. The analysis time for TAPSE and FAC was significantly shorter for the AI compared to the Human (14±4 seconds vs. 101±21 seconds, p<0.001). Figure 1 shows that there was a significant correlation between TAPSE and FAC measurements made by AI and Human (R=0.66 and 0.64, p<0.001), but there was a mean bias of 3.3 mm (±23.7 mm) for TAPSE and 3.9% (±16.7%) for FAC between the two methods. Conclusions The AI-based application demonstrated good feasibility and significantly reduced analysis time for measuring TAPSE and FAC in patients referred for diagnostic evaluation of heart failure. However, the measurement bias between AI and Human was not negligible, warranting further investigation to determine the cause of this discrepancy and whether this AI-based application is an alternative to the manual method for assessing RV function.

Mysterious right ventricular function detection in isolated left anterior descending disease by speckle tracking imaging

Background and aim Early detection of impaired right ventricle (RV) would give significant data for management strategy and prognosis in patients with history of cardiac disease. Echocardiography machine is still the first and most widely used cardiac imaging modality in diagnosing heart disease and assessing systolic and diastolic function with high accuracy. The study aimed to assess mysterious RV function in significant isolated left anterior descending (LAD) disease by imaging with speckle tracking, strain, and strain rate. Patients and methods The present study was a comparative prospective study included 100 participants, 50 patients with significant LAD disease who were candidates for Percutaneous coronary intervention (PCI) (group I), and 50 persons as a control group (group II). All participants were exposed to full medical history, clinical examination, ECG, conventional echo, tissue Doppler, speckle tracking imaging. Results Global longitudinal free wall strain was statistically lower in patient than control group (−19.21±4.11 in patient group vs. −23.73±1.53 in control group, P<0.001), and RV peak systolic strain rate was reduced in patient group than control group (−1.47±0.55 vs. −1.87±0.42, P<0.001). Conclusion In isolated significant LAD disease RV function should be assessed even after opening of LAD by PCI. New echo modality like strain and strain rate are useful echo methods to detect mysterious RV function in patients with significant LAD disease.

A Comprehensive Assessment of Right Ventricular Function in Chronic Thromboembolic Pulmonary Hypertension.

While chronic thromboembolic pulmonary hypertension (CTEPH) results from macroscopic and microscopic obstruction of the pulmonary vascular bed, the function of the right ventricle (RV) and increased RV afterload are the main determinants of its symptoms and prognosis. In this review, we assess RV function in patients diagnosed with CTEPH with a focus on the contributions of RV afterload and dysfunction to the pathogenesis of this disease. We will also discuss changes in RV function and geometry in response to treatment, including medical therapy, pulmonary endarterectomy, and balloon pulmonary angioplasty.

Correlation between diaphragmatic mobility by transthoracic ultrasound and echocardiography findings in patients with idiopathic pulmonary fibrosis

Background Idiopathic pulmonary fibrosis (IPF) is known as a particular pattern of persistent gradually developing fibrosing interstitial pneumonia of unspecified cause that takes place mainly in elder adults, is restricted to the lungs, and is correlated with the radiological and/or histopathological pattern of usual interstitial pneumonia. Patients with IPF exhibit characteristic features regarding the respiratory and cardiac muscle function. The lack of an association between diaphragmatic mobility and echocardiography findings of right and left ventricle functions in patients with IPF was unexpected as transthoracic ultrasound (US) and echocardiography are feasible, reproducible, noninvasive, and largely adopted in the clinical practice and in clinical trials. Objective To correlate between diaphragmatic mobility using transthoracic US and ventricular functions using echocardiography in patients with IPF. Patients and methods A prospective case–control study was conducted in which 40 patients with IPF and 10 controls underwent transthoracic US assessment of diaphragmatic excursion and echocardiography study, and then the results were correlated. Results There was a statistically significant decrease in deep breathing excursion, right ventricle functional area change, tricuspid annular plane systolic excursion, and ejection fraction in addition to an increase in pulmonary artery systolic pressure among the study group. Both normal breathing excursion and deep breathing excursion have a positive correlation with right ventricle functional area change and tricuspid annular plane systolic excursion, whereas a negative correlation was seen with age and pulmonary artery systolic pressure in both study and control groups. Conclusions Transthoracic US assessment of diaphragmatic mobility can clearly reflect the right ventricle function in patients with IPF.

Serial MRI-based right ventricular mechanical wall stress measurements and their association with right ventricle function in patients with repaired Tetralogy of Fallot

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Stichting Hartekind en Thorax Foundation Background Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Wall stress is considered to be a possible early marker of right ventricular (RV) dysfunction. With patient-specific computational models, wall stress can be determined regionally and with high accuracy, especially in complex shaped ventricles such as in TOF patients. We aimed to 1) develop patient-specific computational models to assess RV diastolic wall stresses and 2) investigate the association of wall stresses and their change over time with functional parameters in TOF patients. Methods Repaired TOF patients with at least moderate pulmonary regurgitation (PR) and prior to PVR were included. MRI-based patient-specific computational ventricular models were created (figure). The ventricular geometry was created by stacking endo- and epicardial contours traced on short axis SSFP cine images. Pressure in the right ventricle was estimated from echocardiography. Mid-diastolic wall stress in the RV free wall was analysed globally and regionally (basal, mid, apical, anterior, lateral and posterior) at two time points. RV ejection fraction (RVEF), NT-proBNP and exercise tests (% maximum predicted workload) were used as outcomes for RV function. Associations between wall stresses and outcomes were investigated using linear mixed models adjusted for follow-up duration. Results Five males and five females were included with an age at baseline of 24 (IQR 16-28) years and RV end-diastolic volume of 140 (IQR 127-144) ml/m2. The period between the two time points was 7.0 (IQR 5.8-7.3) years. Global wall stress of the RV free wall combining both time points was 5.8 kPa (IQR 5.2-7.2). There was no statistical difference between baseline and follow-up global wall stress. The mean wall stresses in the mid region was 1.69 kPa (p < 0.01) higher than in the basal region and was 1.05 kPa (p = 0.03) higher than in the apical region cross-sectionally. The wall stress also increased more in the mid region compared to basal and apical region, corrected for duration of follow-up. Patients with more severe PR at baseline demonstrated a higher increase of global wall stress over time (p = 0.02), especially in lateral free wall. Higher global free wall stresses were cross-sectionally independently associated with lower RVEF, adjusted for LVEF and RVEDV (β=-1.29 % RVEF per kPa increase in wall stress, p = 0.01). This association was most prominent in the anterior, basal and mid part. No statistically significant association was found between wall stress, NT-proBNP, and exercise capacity. Conclusions This study generated a novel MRI-based method to calculate wall stress in geometrically complex ventricles. Wall stress associated negatively with RVEF in patients with TOF and PR. This promising tool for RV wall stress analysis can be used in future larger studies to validate these preliminary findings and to assess the predictive value of wall stress in TOF. Abstract Figure.

LONGITUDINAL EVALUATION OF RIGHT VENTRICLE FUNCTION USING SPECKLE TRACKING ECHOCARDIOGRAPHY IN PATIENTS WITH ACUTE HYPOXEMIC RESPIRATORY FAILURE

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Right ventricle (RV) dysfunction occurs in approximately 22-25% of ARDS patients despite lung protective ventilation and is associated with increased mortality. This mortality increase is thought due to acute cor pulmonale wherein increased pulmonary vascular resistance (PVR) causes RV chamber dilation and systolic dysfunction. Distorted RV geometry compromises cardiac output and can lead to circulatory failure. Determination of PVR directly by pulmonary artery catheter is difficult to apply uniformly at bedside and previous beside echocardiography measurements such as acute cor pulmonale have failed to demonstrate consistent accuracy in predicting mortality. Speckle tracking echocardiography (STE) is a validated technique used to detect subclinical LV dysfunction before global ejection fraction is measurably impaired. STE is easily applied at beside and could prove useful for monitoring RV function in patients with ARDS on positive pressure ventilation. METHODS: We studied 9 patients with acute hypoxemic respiratory failure (PF ratio <300, PEEP >5) admitted to our ICU within 96 hours of intubation. We performed an RV focused echocardiogram with speckle tracking software (ECHOPAC) using GE Vivid 9.5 machines to assess RV function every 2-3 days until the patient was extubated, received tracheostomy or expired. TAPSE, TDI, right atrial pressure (calculated from TR jet maximum velocity and IVC % change), and 2 dimensional EF were also performed on each study. RESULTS: 4/9 patients had new RV dysfunction (RV FWLS >-23%) identified by STE at baseline echocardiogram. 5/9 patients died during the study and those that died had either abnormal RV function at baseline or had worsening function worsened over time despite stable PEEP settings and plateau pressure <30 cm H20. In survivors (4/9), RV function generally improved or remained stable. TDI and TAPSE did not correlate well with predicting mortality. In total, 24 RV echocardiograms were performed; RV dysfunction by strain was identified in 11/24 (44%) compared to TDI 1/24 (4%) and TAPSE 6/24 (25%). CONCLUSIONS: In mechanically ventilated patients with ARDS 5/9 patients died and were found to have either impaired RV function at baseline echocardiogram or had worsening in function overtime. Traditional markers such as TAPSE and TDI, that assess only longitudinal motion of RV performed poorly. CLINICAL IMPLICATIONS: This is the first study to date using speckle tracking echocardiography (STE) to prospectively evaluate RV function over time in patient with acute hypoxemic respiratory failure. STE of RV function correlated better with survivors and non-survivors compared to conventional measurements (TDI and TAPSE). A larger cohort of patients is needed to further characterize the relationship of RV function overtime in ARDS. DISCLOSURES: No relevant relationships by Alice Gallo De Moraes, source=Web Response No relevant relationships by Cameron Long, source=Web Response No relevant relationships by Richard Oeckler, source=Web Response No relevant relationships by Brandon Wiley, source=Web Response

Right Ventricle Mechanics and Function during Stress in Patients with Asymptomatic Primary Moderate to Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction.

Background and objectives. Mitral regurgitation (MR) is usually dynamic and increasing with exertion. Stress may provoke symptoms, cause the progression of pulmonary hypertension (PH) and unmask subclinical changes of the left and right ventricle function. The aim of this study was to evaluate changes of right ventricle (RV) functional parameters during stress and to find out determinants of RV function in patients with MR. Materials and methods. We performed a prospective study that included patients with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) at rest (≥60%). Conventional 2D echocardiography at rest and during stress (bicycle ergometry) and offline speckle tracking analysis were performed. Results. 80 patients were included as MR (50) and control (30) groups. Conventional functional and myocardial deformation parameters of RV were similar in both groups at all stages of exercise (p > 0.05). The grade of MR (p = 0.004) and higher LV global longitudinal strain (p = 0.037) contributed significantly to the changes of tricuspid annular plane systolic excursion (TAPSE) from rest to peak stress. Changes of MR ERA from the rest to peak stress were related to RV free wall longitudinal strain (FWLS) and four chambers longitudinal stain (4CLS) at rest (p = 0.011; r = −0.459 and p = 0.001; r = −0.572, respectively). Significant correlations between LV EF, stroke volume, cardiac output and RV fractional area change, S′, TAPSE, FWLS, 4CLS were obtained. However, systolic pulmonary artery pressure and RV functional, deformation parameters were not related (p > 0.05). Conclusions. Functional parameters of LV during exercise and severity of MR were significant determinants of RV function while PH has no correlation with it in patients with primary asymptomatic moderate to severe MR.

P3527Echocardiographic assessment of the right ventricle in chronic heart failure with focus on patients with atrial fibrillation

Abstract Background Assessment of the right ventricle (RV) in heart failure (HF) is challenging and requires applicable methods and parameters. Atrial fibrillation (AF) is a common and clinically significant arrhythmia in 30–50% of HF patients. Assessment of the RV function in patients with AF is problematic. Still little is known about RV function in HF and AF patients. The aim of the study was to assess RV function in HF with focus on AF patients. Methods Patients with HF of ischemic etiology, NYHA II-III, LVEF ≤40%, with AF and sinus rhythm (SR), underwent two- and three- dimensional echocardiography (2DE and 3DE) for assessment of the RV with use of multiple parameters. The RV was examined for: linear dimensions, end-diastolic and end-systolic areas adjusted to body surface area (RV EDA and RV ESA/BSA) and end-diastolic and end-systolic volumes adjusted to lean body mass (RV EDV and RV ESV/LBM) to reflect volume overload and in terms of right ventricular pressure (RVSP) as an index of pressure overload. RV systolic function was assessed with 2DE: tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RV FAC), tricuspid lateral annular systolic velocity (s') and 3DE parameters: right ventricular ejection fraction (RVEF) and free wall right ventricular longitudinal strain (FW RVLS). Also, TAPSE/RVSP parameter was included. Results The study included 126 patients: 94 with AF and 32 with SR. Within the AF group 28 patients were treated medically, 41 had RV pacing (pacemaker or an implantable cardioverter-defibrillator, ICD) and 25 had cardiac resynchronisation therapy (CRT). In comparison with SR group AF patients had: larger RV inflow tract dimension (4.49±0.85 vs. 3.95±0.72 cm; p=0.0017), RV EDA/BSA (12.7±3.9 vs. 11.1±3.0 cm2/m2; p=0.0358) and RV ESA/BSA (8.0±3.0 vs. 6.7±2.4 cm2/m2; p=0.0226). Similarly, patients with AF had greater RV volumes in 3DE than patients with SR: RV EDV/LBM (1.82±0.60 vs. 1.61±0.38ml/kg, p=0.0267) and RV ESV/LBM (1.11±0.40 ml/kg vs. 0.81±0.28, p&lt;0,0001). Also, in patients with AF right ventricular systolic pressure (RVSP) was higher (40.8±10.2 vs. 34.0±8.1 mmHg, p=0,0010). No differences in TAPSE and RVFAC were found but the relation TAPSE/RVSP was higher in AF than in SR group (0.51±0.21 vs. 0.65±0.24 cm/mmHg; p=0.0046). Also, in AF patients in comparison to SR group some parameters had worse values: s' (9.7±2.31 vs. 12.1±3.83, p=0.014), RVEF (37.2±7.3 vs. 48.2±7.5, p&lt;0.0001 and FW RVLS (−18.3±4.6 vs. −23.9±4.23%, p&lt;0,0001). Within the AF group no significant differences in studied variables depending on RV pacing or CRT were found. Conclusions Larger volumes and higher pressure overload of the RV were observed in patients with AF in comparison to SR. Systolic function of the RV seems to be more depressed in AF compared to SR patients with systolic heart failure. Further research in larger groups is required to identify the most applicable and valuable methods of RV evaluation.

P1493Prognostic significance of right ventricular function during exercise in patients with non-obstructive hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition that may present crucial complication including life-threatening arrhythmia and sudden cardiac death. However, the risk stratification of HCM without left ventricular outflow tract (LVOT) obstruction had not been fully elucidated. Moreover, although recent studies have revealed the right ventricle (RV) involvement of HCM, the prognostic importance of RV function during exercise is unclear. Purpose To investigate the prognostic significance of RV function in patients with non-obstructive HCM using exercise stress echocardiography (ESE). Methods and results This study conducted on 100 HCM patients (age 62.9±13.6 years, 63% men) with preserved left ventricular ejection fraction who underwent ESE using semi-supine bicycle ergometer. Ten patients with significant LVOT obstruction (≥30mmHg) were excluded and 9 were also excluded because of the inadequate imaging quality or insufficiency of data. Among remaining 81 non-obstructive HCM patients, 9 patients suffered from HCM related cardiac events including cardiac death, unexpected hospitalization, life-threatening arrhythmias, and new-onset of syncope during the mean follow up period of 2.6±1.6 years. A multivariate Cox Hazard analysis revealed that low tricuspid annular plane systolic excursion during exercise (Ex-TAPSE, cut-off: 24mm) was an independent predictor of cardiac events. (hazard ratio: 18.66, 95% confidence interval: 3.66–338.46, P&lt;0.001) The estimated cumulative cardiac event free survival using the Kaplan-Meier method was significantly lower in patients with reduced Ex-TAPSE (&lt;24mm) than those with preserved Ex-TAPSE (Log-rank, P&lt;0.01). K-M curve according to Ex-TAPSE Conclusion Ex-TAPSE had a strong predictive value of clinical outcomes in non-obstructive HCM patients. Right ventricular function during exercise may have crucial role in the risk stratification of non-obstructive HCM.

P2595The role of epicardial fat thickness and other parameters of visceral adiposity in right ventricular diastolic function in patients with metabolic syndrome

Abstract Background Abdominal obesity is associated with an increased risk of cardiovascular disease and all-cause mortality especially in patients with metabolic syndrome (MetS). Despite the undeniable importance of right ventricle (RV) function, little is known about RV diastolic function implication in obesity and MetS. Purpose The objective of our study was to evaluate the role of epicardial fat thickness (EFT) and other parameters of visceral obesity in diastolic function of RV in patients with MetS. Methods The study included 70 subjects with MetS (mean age 52.6±9.4 years) and 70 controls without MetS (mean age 53.8±7.5 years). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. We assessed RV diastolic function by pulsed wave and tissue Doppler echocardiography and determined the ratio of early (TV E) and late (TV A) trans-tricuspid valve inflow velocities (TV E/A), early tricuspid valve (TV) annular tissue Doppler velocity (TV e'), the TV E/e' ratio and TV deceleration time (DT). Anthropometric and sonographic parameters of visceral adiposity included: waist circumference (WC), waist-to-hip ratio (WHR), visceral adiposity index (VAI), intraabdominal fat thickness (IFT), abdominal wall fat index (AWFI) and epicardial fat thickness (EFT). Results Mean values of WC (p=0.030), WHR (p=0.008), VAI (p=0.001), IFT (p=0.035), AWFI (p=0.013) and EFT (p=0.012) were significantly higher in the group with MetS vs. controls. RV diastolic function parameters were also significantly changed in the group with MetS vs controls (tab.1). TV E/e' was positively correlated with WC (r=0.297, p&lt;0.01), WHR (r=0.238, p&lt;0.05), VAI (r=0.271, p&lt;0.05), IFT (r=0.556, p&lt;0.01), AWFI (r=0.604, p&lt;0.01) and EFT (r=0.795, p&lt;0.01). Using multivariate regression analysis EFT, WC and plasma glucose level were the most important predictors for RV diastolic dysfunction in subjects with MetS (p&lt;0.05 for all parameters). Table 1. RV diastolic function Variables MetS (n=70) Controls (n=70) p TV E, cm/s 48±11.1 52.1±14 0.025 TV A, cm/s 56.54±11 52.3±11.7 0.034 TV E/A 0.92±0.4 1.07±0.44 0.029 TV e', cm/s 10.6±2.7 10.7±3.5 0.001 TV E/e' 5.84±1.04 4.59±0.82 0.001 DT, ms 227.9±12.4 217±17.8 0.009 Conclusion Our findings support that EFT and WC play an important role in RV diastolic dysfunction in patients with MetS.

P3367Echocardiographic assessment of right ventricle function in patients with severe tricuspid regurgitation and correlates with outcomes

Abstract Background/Introduction Speckle tracking echocardiography has been recently proposed as an accurate and sensitive measure of right ventricle (RV) function that could integrate other more conventional parameters. This tool can be important in the clinical context of severe tricuspid regurgitation (TR), since TAPSE is not fully representative of global RV function and can overestimate this in presence of severe TR. Purpose Evaluate the prognostic relevance of different parameters of RV structure and function derived from 2D and speckle tracking echocardiographic analysis of clinically stable patients with severe TR referred for routine follow up in the context of many etiologies of left side heart disease (secondary TR). Methods The present is a retrospective analysis of prospectively acquired echocardiographic studies including patients with severe secondary TR in the context of left side heart disease. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVLS) and RV free-wall longitudinal strain (RVFWLS) as well as LV function were measured. As suggested in previous studies, we also aimed to explored the use in this population of: i)RVLS/pulmonary systolic arterial pressure (PASP); ii) RVFWLS (average lateral 3 segments strain)/IVSLS (average medial 3 segment strain) as index of RV-LV dependency. The composite end-point of this study included death for any cause and heart failure hospitalization. Results 61 patients (mean age 58±20 years, 65% men), were included. After a mean follow up period of 3,6±2 years 57% of patients reached the combined end-point. At Cox regression univariate analysis a significant correlation with outcomes was found for RVend-diastolic diameter (HR 0,42, p: 0.018), right atrial area (HR: 3, p: 0.02), RVFWLS/IVSLS (HR: 0.5, p: 0.020), RVLS/PASP (HR 0.186, p: 0.039). In multivariable Cox-regression model we found that LVEF, RV dimension and RVFWLS/IVSLS were independently related to outcome; this last one parameter showed the best correlation with outcomes. Conclusions In asymptomatic and clinically stable patients with severe secondary TR longitudinal function of RV free wall is not related to outcomes but RV-arterial coupling and the ratio between deformation of free wall and septal wall of RV are good predictors of clinical deterioration at follow up. The last one conceptually represents the interaction between RV and LV in secondary TR and allows a real “correction” of those effects of severity of TR on the base to apex gradient of lateral wall longitudinal deformation (TR increases movement of basal segments).

Right Ventricle Function in Patients with Acute Coronary Syndrome and Concomitant Undiagnosed Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is frequently undiagnosed in patients with ischemic heart disease. Nowadays, it is still unknown whether undiagnosed concomitant COPD is related to early structural changes of the heart, as detectable by trans-thoracic echocardiography (TTE). Starting from the study population of the Screening for COPD in ACS Patients (SCAP) trial, we sought to investigate potential differences in echocardiographic parameters in patients with acute coronary syndromes (ACS), with or without undiagnosed concomitant COPD. Overall, 137 patients were included. Undiagnosed COPD was detected by spirometry in 39 (29%) patients. TTE was performed at inclusion (before hospital discharge) and after six months. Several echocardiographic parameters including fractional area change (FAC) and RV strain (RVS), were measured. Patients with undiagnosed COPD, as compared to those without COPD, showed lower FAC and reduced RVS both at inclusion (37 ± 6% vs. 44 ± 9%, p < 0.001; −15 ± −4 vs. −20 ± −5, p < 0.001, respectively) and after six months (38 ± 7% vs. 45 ± 9%, p < 0.001; −16 ± −4 vs. −20 ± −5, p < 0.001, respectively). After multivariate analysis undiagnosed COPD was independently associated with lower FAC and reduced RVS at baseline and at TTE after six months. Early impairment of RV function can be detected in ACS patients with concomitant undiagnosed COPD. If these alterations may be changed by an early diagnosis and an early treatment, should be evaluated in future studies. Clinical trial registration: NCT02324660.

Investigation of right ventricle function in patients with tetralogy of Fallot after total correction using cardiac magnetic resonance imaging

Investigation of right ventricle function in patients with tetralogy of Fallot after total correction using cardiac magnetic resonance imaging

GW28-e0486 3D Echocardiographic evaluation of the association between pulmonary hypertension and right ventricle function in patients with severe rheumatic mitral stenosis

GW28-e0486 3D Echocardiographic evaluation of the association between pulmonary hypertension and right ventricle function in patients with severe rheumatic mitral stenosis

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

BackgroundElevated right ventricle (RV) pressure and/or volume can place stress on the right bundle branch block (RBBB) and its associated Purkinje network, which can affect its electrical properties, resulting in conduction delay or block. We hypothesized that prolonged R′ wave duration in lead V1 would extend the later portion of the QRS complex and can act as an indicator of reduced RV function in patients with RBBB. MethodKosin University Gospel Hospital echocardiography and electrocardiography (ECG) database was reviewed to identify patients with complete RBBB between 2013 and 2015. ECGs recorded closest to the time of the echocardiography were carefully reviewed, and QRS and R′ wave duration were measured. RV systolic dysfunction was defined as an RV fractional area change (FAC) less than 35%, as indicated by echocardiography guidelines. ResultsCompared to patients with normal RV function (n=241), patients with RV dysfunction (n=123) showed prolonged QRS duration (145.3±19.3ms vs. 132.2±13.4ms, p<0.001), predominantly due to R′ prolongation (84.8±13.0ms vs. 102.9±12.0ms, p<0.001). R′ duration was significantly associated with RV FAC (r=−0.609, p<0.001), RV systolic pressure (r=0.142, p=0.008), RV dimension (r=0.193, p<0.001), and RV myocardial performance index (r=0.199, p<0.001). On receiving operator characteristic curve analysis, V1 R′ duration ≥93ms was associated with RV dysfunction with 90% sensitivity and 87% specificity (area under the curve: 0.883, 95% confidence interval=0.845–0.914, p<0.001). ConclusionProlonged R′ wave duration in lead V1 is an indicator of RV dysfunction and pressure and/or volume overload in patients with RBBB.

Preoperative Echocardiography Examination of Right Ventricle Function in Patients Scheduled for LVAD Implantation Correlates with Postoperative Hemodynamic Examinations

BACKGROUND Left ventricular assist devices (LVAD) are used to treat heart failure. Preoperative prediction of RV function after LVAD implantation is crucial. Correlations were found between preoperative echo and RV function after LVAD implantation. MATERIAL AND METHODS We retrospectively reviewed 23 male patients (8 ischemic, 15 nonischemic cardiomyopathy) with LVAD implantation (17 HeartWare, 6 HeartMate II) at the Silesian Center for Heart Diseases from 1 January 2013 to 28 October 2014. Preoperative TTE data of RV function included RVFAC (fractional area change), TAPSE (tricuspid annulus plane systolic excursion), RV diameter (RV4), and RV/LV (right/left ventricle) ratio. Postoperative hemodynamic mean pulmonary pressure (mPAP), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI) were measured and recorded every 2 h up to 10 days (1, 2, …120) and correlated. Study endpoints were mortality, discharge from ICU, and RV dysfunction. RESULTS There were no RV dysfunctions. Correlations of CO and CI with RV4 and RV/LV ratio were significantly positive at many time points, with TAPSE and FAC positive or negative. Correlations mPAP with RV4 were significantly positive: 1, 2, 3, 7, 8, 57, 58, 59. With RV/LV ratio positive: 44, 47, with TAPSE in 36. With FAC positive 11, 13-15, 22 and negative 57. Correlations CVP with RV4 were negative, with positive significance in 1, 52. With RV/LV ratio positively 52, 54, 56 and negative 71, 72, 73. With TAPSE were negative significantly: 30, 68. With FAC positive 11, 12, 13, 14 and negative: 68. CONCLUSIONS RV4 and RV/LV ratio before LVAD implantation are more predictive for postoperative RV function than RVFAC and TAPSE, probably because RVFAC and TAPSE are load-dependent.

ESTIMATION OF RIGHT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE IN DIFFERENT AGE GROUPS

Aim. To study the parameters of diastolic function of the right ventricle (RV) in patients with ischemic heart disease (IHD) in different age groups. Material and methods. Patients (n=678) with IHD aged 38 to 85 years were included into the study. They underwent echocardiography with assessment of RV diastolic function. The following parameters were assessed: rate of early and late diastolic RV filling (Et and At), rate of early and late diastolic motion of the ring of the tricuspid valve (e't and a't), the propagation velocity of RV early filling flow (Vpt). All patients were divided into 2 groups: 1st one - patients up to 60 years old (n=282) and the 2nd group - patients 60 years and older (n=396). Results. In IHD patients RV diastolic dysfunction was detected more often in older age group (34.3%) than in group of patients younger than 60 years (22.3%, p=0.008). The next findings were found in the 2nd group: increase in At; reduction in Et/At ratio and e't/a't, as well as higher levels of systolic and mean pulmonary arterial pressure and the greater the thickness of the RV wall. The following parameters of diastolic RV function correlated with age: At (p=0.004); Et/At (p=0.001); Vpt (p=0.002) and e't/a't ratio (p=0.004). Conclusion. The results should be used in assessment of diastolic RV function in patients of different age groups.

Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension.

BackgroundThe convenience and availability of real-time three-dimensional echocardiography (RT3DE) makes it an attractive candidate for assessing right ventricle function. However, the viability of RT3DE is not conclusive.Aim of StudyThis study aims to evaluate RT3DE relative to cardiac magnetic resonance and 2-dimensional echocardiography (2DE) for measuring right ventricular systolic function in patients with pulmonary hypertension.MethodsPatients with pulmonary hypertension (n = 23) underwent cardiac magnetic resonance, 2DE, and RT3DE. Specifically, 2DE was used to measure the right ventricular index of myocardial performance (RIMP), fractional area change, tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler-derived tricuspid annular systolic velocity (S′). Cardiac magnetic resonance and RT3DE were used to measure right ventricular end-diastolic volume (RVEDV) and end-systolic volume (RVESV). The right ventricular ejection fraction (RVEF) was calculated.ResultsRegarding the measurements taken by 2DE, RVEF positively correlated with fractional area change (r = 0.595, P = 0.003) and S′(r = 0.489, P = 0.018), and negatively correlated with RIMP (r = −0.745, P = 0.000). There was no association between RVEF and TAPSE (r = −0.029, P = 0.896). There existed a close correlation between the values of RVEDV, RVESV, and RVEF as measured by RT3DE and CMR respectively (P<0.001); Bland-Altmanan analyses showed good agreement between them.ConclusionRT3DE was a viable method for noninvasive, accurate assessment of right ventricular systolic function in patients with pulmonary hypertension.