Right Ventricle Global Strain Research Articles

Three-Dimensional Feature Tracking Study of Healthy Chinese Ventricle by Cardiac Magnetic Resonance.

Myocardial strain, as a crucial quantitative indicator of myocardial deformation, can detect the changes of cardiac function earlier than parameters such as ejection fraction (EF). It has reported that cardiac magnetic resonance(CMR) and post-processing software possess the ability to obtain the stability and repeatability strain values. Recently, the normal strain values range of people are debatable, especially in the Chinese population. Therefore, we aim to explore the ventricular characteristics and the myocardial strain values of the Chinese people by using the cardiac magnetic resonance feature tracking (CMR-FT). Additionally, we attempted to use the myocardial and chordae tendineae contours to calculate the ventricular volumes by the CMR-FT. This study may provide valuable insights into the application of CMR-FT in tracking the ventricular characteristics and myocardial strain for Chinese population, especially in suggesting an referable myocardial strain parameters of the Chinese. A total of 109 healthy Chinese individuals (age range: 18 to 58 years; 52 males and 57 females) underwent 3.0T CMR to acquire the cardiac images. The commercial post-processing software was employed to analyse the image sequence by semi-automatic processing, then the biventricular morphology (End-Diastolic Volume, EDV; EDV/Body Surface Area, EDV/BSA), function(EF; Cardiac Output, CO; Cardiac Index, CI) and strain(Radial Strain, RS; Circumferential Strain, CS; Longitudinal Strain, LS) values were obtained.The biventricular myocardial strain values were stratified according to the age and gender. The Left Ventricular( LV base, mid, apex) and myocardial strain values of three coronary artery areas were calculated based on the the strain value of LV American Heart Association(AHA) 16 segments. It was shown that the females had larger LV globe strain values compared with the males (LVGPRS: 42.0 ± 8.5 versus 33.6 ± 6.2%, P < 0.001; LVGPCS: -21.2 ± 2.1 versus - 19.7 ± 2.3%, P < 0.001; LVGPLS: -16.4 ± 2.6 versus - 14.6 ± 2.2%, P < 0.001;). Moreover, the differences in RS, CS, and LS among the LV myocardium 16 segments were obvious. However, the right ventricle (RV) strain values showed non-normal distribution in the volunteers of this research. Here, we successfully tracked the characteristics of bilateral ventricles in healthy Chinese populations through using the 3.0T CMR. We confirmed that there was a gender difference in LV Globe Strain values. In addition, we obtained strain values for each myocardial segment of the LV and different coronary artery regions based on the AHA 16 segments method, Our results also showed that the RV strain values with a non-normal distribution, and RV global strain values were not related to the gender and age. Furthermore, LVGPRS, LVGPLS, and RVGPRS were significantly correlated with BMI, CO, CI, and EDV in the Chinese population.

Right Ventricular Strain Derived from Cardiac MRI Feature Tracking for the Diagnosis and Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy.

Purpose To demonstrate the myocardial strain characteristics of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), based on revised Task Force Criteria (rTFC), and to explore the prognostic value of strain analysis in ARVC. Materials and Methods This retrospective study included 247 patients (median age, 38 years [IQR, 28-48 years]; 167 male, 80 female) diagnosed with ARVC, based on rTFC, between 2014 and 2018. Patients were divided into "possible" (n =25), "borderline" (n = 40), and "definite" (n = 182) ARVC groups following rTFC. Biventricular global strain parameters were calculated using cardiac MRI feature tracking (FT). The primary outcome was defined as a composite of cardiovascular events, including cardiovascular death, heart transplantation, and appropriate implantable cardioverter defibrillator discharge. Univariable and multivariable cumulative logistic regression and Cox proportional hazards regression analysis were used to evaluate the diagnostic and prognostic value of right ventricle (RV) strain parameters. Results Patients with definite ARVC had significantly reduced RV global strain in all three directions compared with possible or borderline groups (all P < .001). RV global longitudinal strain (GLS) was an independent predictor for disease (odds ratio, 1.09 [95% CI: 1.02, 1.16]; P = .009). During a median follow-up of 3.4 years (IQR, 2.0-4.9 years), 55 patients developed primary end point events. Multivariable analysis showed that RV GLS was independently associated with the occurrence of cardiovascular events (hazard ratio, 1.15 [95% CI: 1.07, 1.24]; P < .001). Kaplan-Meier analysis showed that patients with RV GLS worse than median had a higher risk of combined cardiovascular events (log-rank P < .001). Conclusion RV GLS derived from cardiac MRI FT demonstrated good diagnostic and prognostic value in ARVC. Keywords: MR Imaging, Image Postprocessing, Cardiac, Right Ventricle, Cardiomyopathies, Arrhythmogenic Right Ventricular Cardiomyopathy, Revised Task Force Criteria, Cardiovascular MR, Feature Tracking, Cardiovascular Events Supplemental material is available for this article. © RSNA, 2024.

Static Immersion and Negative Static Lung Load-Induced Right Ventricle Systolic Function Adaptation: A Risk Factor for Immersion Pulmonary Edema

Immersion pulmonary edema (IPE) is a form of hemodynamic edema, likely involves individual susceptibility. Can assessing right ventricular systolic adaptation during immersion be a marker for IPE susceptibility? Twenty-eight experimented divers participated: fifteen study subject with history of IPE ('IPE' group) (40.2 ± 8.2 years old, two females) and thirteen controls subjects ('no-IPE' group) (mean age, 43.1 ± 8.5 years old, two females) underwent three transthoracic echocardiogram under three different conditions: 'dry' (subjects supine on an examination table without immersion), 'surface immersion' (participants floating prone on the water's surface, breathing through a snorkel), and 'immersion & negative static lung load (SLL)' (divers submerged 20 cm below the water's surface in a prone position, using a specific snorkel connected to the surface). Echocardiographic measurements included Tricuspid Annular Plane Systolic Excursion (TAPSE), tissue S' wave, and right ventricle global strain (RVGLS). For all divers, immersion increased right ventricular preload. In the 'no-IPE' group, the increase in right ventricular preload induced by immersion is accompanied by an improvement in the contractility of the right ventricle, as evidenced by increases in TAPSE (17.08 ± 1.15 vs. 20.89 ± 1.32), S' wave (14.58 ± 2.91 vs. 16.26 ± 2.77), and RVGLS (25.37 ± 2.79 vs. 27.09 ± 2.89). Negative SLL amplified these right ventricular adaptations. In contrast, among 'IPE' divers, the increase in right ventricular preload does not coincide with an improvement in right ventricular contractility, indicating altered adaptive responses. In the IPE group, the TAPSE values changed from 17.19 ± 1.28 to 21.69 ± 1.67 and then to 23.55 ± 0.78, respectively, in the 'dry', 'surface immersion', and 'immersion & negative static lung load (SLL)' conditions. The S'wave values changed from 13.42 ± 2.94 to 13.26 ± 2.96 and then to 12.49 ± 0.77, and the RVGLS values changed from -24.09 ± 2.91 to -23.99 ± 3.38 and then to -21.96 ± 0.55. Changes in right ventricular systolic function induced by immersion (especially with the addition of negative SLL) vary among divers based on their history of IPE. Analyzing ventricular contractility during immersion, particularly RVGLS, could help identify individual susceptibility in divers. These findings provide insights for the development of preventive strategies.

Right ventricular pressure-strain-volume loop-derived myocardial work for the noninvasive assessment of volume overload-induced dysfunction in patients with secondary tricuspid regurgitation

Abstract Development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with left-sided cardiac diseases. Severe TR imposes substantial volume overload (VO) on the right ventricle (RV), inducing a vicious circle of progressive RV remodelling and dysfunction. Although previous studies have established the value of speckle tracking echocardiography (STE)-derived strain and pressure-strain loop-derived myocardial work indices, these metrics neglect chamber geometry, limiting their utility in conditions accompanied by VO. Accordingly, we aimed to (1) incorporate instantaneous RV volume into myocardial work calculation to define a method capable of detecting VO-induced RV dysfunction using 3D echocardiography (3DE) and (2) to test its prognostic power in patients with secondary TR. We enrolled 195 patients (age: 64±15 years, 69% male) with left-sided cardiac diseases and followed them for a median of 42 months. The primary endpoint was all-cause mortality. TR severity was graded according to current guidelines and we compared patients with significant (moderate+) TR (sTR, n=85) versus non-significant TR (nsTR, n=110). All patients underwent 3DE to measure left (LV), and RV volumes and ejection fractions (EF). A reference RV pressure curve was constructed using previously acquired right heart catheterization data and was individually adjusted by non-invasively estimated RV pressures. To obtain RV pressure-strain loops and global myocardial work index (GMWI), RV pressure and 3DE-derived RV circumferential strain tracings were concatenated. We further adjusted GMWI to instantaneous RV volumes (GMWIV) and constructed pressure-strain-volume loops (Figure 1). Twenty-three patients (11.8%) died during follow-up (16 out of 85 in the sTR group, and 7 out of 110 in the nsTR group). There were no differences in LV and RV volumes and EFs between the sTR and nsTR groups. Interestingly, patients with sTR had significantly higher values of GMWI (sTR vs. nsTR; 667 [438-879] vs. 567 [414-770] mmHg%, p=0.01), whereas GMWIV (292 [169-467] vs. 282 [170-399] mmHg%/mL, p=0.57) did not show difference. We compared patients with versus without adverse outcomes within the sTR group. Patients with sTR who died, presented with significantly lower volume-adjusted GMWIV values (dead vs. alive; 158 [122-332] vs. 312 [207-502] mmHg%/mL, p=0.02), while GMWI did not differ. By Cox regression analysis, GMWIV (hazard ratio [95% CI]: 0.997 [0.994-1.000], p&amp;lt;0.05) was a significant predictor of all-cause mortality in the entire population, whereas GMWI was not. By integrating RV volume into the pressure-strain relationship, our novel metric could detect the detrimental effects of VO on RV function with prognostic implications in patients with secondary TR. Our approach can be able to capture VO-induced subclinical RV dysfunction that conventional echocardiographic metrics could not unveil.Figure 1

Detection of early signs of right ventricular systolic impairment in unoperated Ebstein's anomaly by cardiac magnetic resonance feature tracking.

Cardiovascular magnetic resonance feature-tracking analysis (CMR-FT) provides a quantitative assessment of myocardial contraction with potential for diagnostic and prognostic ability in a wide spectrum of diseases. Ebstein's anomaly (EA) is a rare congenital heart disease characterized by apical displacement of the tricuspid valve. However, it is also considered a disorder of development affecting the global right ventricular myocardium. Aim of our study is to describe the complex contractile mechanics of the functional right ventricle (RV) in patients affected by EA through CMR-FT. Fifty surgery-free EA patients who had undergone a complete CMR protocol at our institution between January 2017 and December 2020 were selected for the retrospective study. A historical control group of twenty-five healthy subjects was also included. CMR-FT analysis was performed at a dedicated workstation by manually tracing RV endo- end epicardial borders on steady-state-free-precession (SSFP) cine images. Strain values were calculated. Apical displacement of the tricuspid valve (TV) was measured on a 4-chamber cine image from the right atrio-ventricular junction to the functional annulus of the TV. EA patients presented significantly impaired RV global radial strain (GRS) and global circumferential strain (GCS) compared to controls (P<0.0001 and P=0.0008, respectively). In a subgroup analysis, GRS was significantly compromised in patients with a severely displaced TV (>16 mm/m2) compared to milder forms (P=0.03) and to controls (P<0.0001). Among EA patients with a preserved ejection fraction, 12 (48%) vs. 6 (24%) controls had reduced both GRS and GCS. The contractile pattern of the functional RV in EA is characterised by prevalent alterations in the short-axis direction as indicated by reduced GRS and GCS. Strain values might be reduced prior to routine used functional parameters like RV ejection fraction (RVEF) and can possibly serve as an early predictor of myocardial dysfunction in EA patients.

Regional Fat Distributions Are Associated With Subclinical Right Ventricular Dysfunction in Adults With Uncomplicated Obesity.

ObjectiveObesity is a prominent public health problem that has increased cardiovascular mortality risks. However, the specific effects of obesity, independent of comorbidities, on cardiac structure and function have not been well clarified, especially those effects on the right ventricle (RV). Cardiovascular magnetic resonance (CMR) tissue tracking can assess detailed RV mechanical features. This study aimed to evaluate RV strain using CMR in uncomplicated obese adults and assess its association with fat distributions.MethodsA total of 49 obese patients and 30 healthy controls were included. The RV global systolic function and strain parameters based on CMR were assessed. Body fat distributions were measured with dual X-ray absorptiometry. RV function indices of obese patients were compared with those of healthy controls. Correlations among related body fat distribution parameters and RV function indices were conducted with multivariable linear regression.ResultsCompared with healthy controls, the obese group had impaired RV strain with lower global longitudinal peak strain (PS), longitudinal peak systolic strain rate (PSSR), circumferential and longitudinal peak diastolic strain rates (PDSR) (all P < 0.05), while LV and RV ejection fractions were not significantly different between the two groups (P > 0.05). Multivariable linear regression analysis demonstrated that android fat% was independently associated with longitudinal PS (β = −0.468, model R2 = 0.219), longitudinal PDSR (β = −0.487, model R2 = 0.237), and circumferential PSSR (β = −0.293, model R2 = 0.086). Trunk fat% was independently associated with longitudinal PSSR (β = −0.457, model R2 = 0.209). In addition, the strongest correlations of circumferential PDSR were BMI and gynoid fat% (β = −0.278, β = 0.369, model R2 = 0.324).ConclusionsExtensive subclinical RV dysfunction is found in uncomplicated obese adults. BMI, as an index of overall obesity, is independently associated with subclinical RV dysfunction. In addition, central obesity (android fat and trunk fat distributions) has a negative effect on subclinical RV function, while peripheral obesity (gynoid fat distribution) may have a positive effect on it.Clinical Trials RegistrationEffect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).

Assessment of Right Ventricular Function and Structure in Children with Idiopathic Dilated Cardiomyopathy

Background: Dilated cardiomyopathy (DCM) refers to dilating the ventricles and dysfunction of their systolic functions (predominantly the left ventricle) with or without congestive heart failure. In children, it is the most common form of heart muscle disease. We aimed to evaluate the right ventricular functions and structure using speckling tracking echocardiography in children with dilated cardiomyopathy and correlate this parameter with other echocardiographic findings.&#x0D; Methods: This observational Case-Control Study was carried out on 75 subjects. They were subdivided into two groups: Group 1: 50 patients with dilated cardiomyopathy Group 2: 25 healthy children matched for age and sex. Patients were evaluated by M-mode echocardiography, Transthoracic 2DE Examination (TTE), Tissue Doppler Examination (TDE) and Speckling Tracking Technique.&#x0D; Results: Left ventricle (LV) and right ventricle (RV) systolic dysfunction was evidenced by a significant decrease of mitral and tricuspid annular systolic velocities and a significant decrease of LV and RV global systolic strain and a significant decrease of LV and RV Ejection fraction (EF). LV and RV diastolic dysfunction were evidenced by a significant decrease of mitral and tricuspid annular diastolic velocities (E’/A’) and a significant increase of LV and RV Myocardial Perfusion Imaging (MPI). LV and RV global strains were significantly reduced in comparison to controls, suggesting that the dilated cardiomyopathy is a diffuse disease.&#x0D; Conclusion: In DCM patients, RV had significant systolic and diastolic dysfunction mainly elicited by the Tissue Doppler imaging (TDI) beside LV affection secondary to the interventricular interaction. TDI and 2D-STE add value to interpreting the findings and the dependency of RV systolic and diastolic functions on each other in DCM patients.

Correlation between automatic and manual methods of right ventricle and left atrium strain quantification

Abstract Introduction Myocardial strain quantification by speckle-tracking of the right ventricle (RV) and left atrium (LA) can be performed by manual or automatic methods. Purpose The objective of our study is to evaluate the degree of correlation between manual measurement method and automatic software used in our imaging laboratory, in a population of healthy individuals and patients with cardiac transthyretin amyloidosis (ATTR). Methods Fifty-seven individuals were included, 30 patients with ATTR and 27 healthy volunteers, who underwent a transthoracic echocardiogram (TTE) from January to December 2019. Classic echocardiographic parameters and myocardial deformation were obtained according to the ASE/ EACVI guidelines. Global and free wall longitudinal strain of the RV (RVGLS, RVFWLS) and LA global strain (LAGS) analysis were obtained using speckle-tracking with two different software: QLAB Philips 10.7 and AutoSTRAIN Tomtec. Measurements analysis was performed by two experienced echocardiographers. Correlation and reproducibility analysis was performed using Pearson correlation coefficient (PCC) and intraclass correlation coefficient (ICC), respectively. Results Seventy-two percent were male and average age was 63±20 years. Linear correlation of RVGLS, RVFWLS and LAGS measurements with both methods reached statistical significance (table). This correlation was stronger and more reliable in the case of the LAGS. The attached figure shows the correlation between the different software in both groups. Conclusions AutoSTRAIN Tomtec automatic measurement method had higher reliability and correlation comparing to manual measurements performed by QLAB 10.7, especially in LA measurements. The obtained results, the application speed and the less operator's dependence of this automatic software support its routine use for RV and LA strain quantification. Funding Acknowledgement Type of funding sources: None. Correlation and reproducibility resultsLinear regression lines

555 Right ventricular longitudinal strain of patients with pulmonary hypertension

Abstract Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients. Methods We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients referred to an expert tertiary care referral centre from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®. Results Of the 97 included patients, 76% were female. The mean age was 65 ± 15 years. Most patients were in NYHA class II. Median time between TTE and RHC was 70 days [IQR 34 - 184]. Group 2 PH was the most frequent aetiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, Tricuspid S wave, RV diastolic diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time and presence of RV outflow tract notching. Strain parameters were also associated with pulmonary artery pressures and pulmonary vascular resistance (PVR) measured by RHC. Strain parameters did not correlate with PECP (p &amp;gt; 0.05). In multivariate analysis, RV global longitudinal strain predicted invasive mean pulmonary artery pressure and PVR independently of TAPSE and FAC (β=1.38, p &amp;lt; 0.001). RV global strain &amp;gt; -17.1 predicted PVR &amp;gt; 3 wood (OR 3.46, CI 1.50 - 8.02, AUC 0.72) and PMAP &amp;gt; 20 mmHg (OR 4.92, CI 1.67 - 14.51, AUC 0.78). TAPSE &amp;lt; 18 mm predicted PVR &amp;gt; 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures and PVR. Abstract 555 Figure.

P1505 Echocardiographic assessment of different pulmonary hypertension groups

Abstract Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Different etiology groups might have different echocardiographic phenotypes. In this study, we aimed to study echocardiographic characterization of the different PH groups and its ability to predict pulmonary vascular disease severity. Methods We collected echocardiographic and right heart catheterization (RHC) data from 97 (75% female, age 65 ± 15 years) consecutive patients referred to an expert tertiary care referral PH centre from 12/2016 to 11/2018. Echocardiographic analysis was performed using Echo-Pac software from GE Healthcare®. Group 3 and 5 were not included in the group comparison analysis due to few patients included. Results Group 2 PH was the most frequent etiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population as a whole showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. PH group 1 had a significantly lower FAC (26 ± 4%, p = 0.0025), higher eccentricity index (IE) (1.5 ± 0.1, p = 0.01), and more frequently RV outflow tract (RVOT) notching than other groups (62%, p = 0.012). Group 4 presented an intermedium echocardiographic phenotype between group 1 and 2, and showed more abnormal strain values than the other groups. Group 2 had fewer patients in sinus rhythm (atrial fibrillation in 34% of patients, p = 0.02), presented a thicker interventricular septum (11.3 ± 1.8, p = 0.014), a higher FAC (35 ± 3%, p = 0.0025), higher E mitral wave velocity (72 ± 6 cm/s, p &amp;lt; 0.001) and E/E’ ratio (12.7 ± 10.2, p = 0.006), and larger left (45 ± 3 cm3/m3, p &amp;lt; 0.01) and right atria (25 ± 2 cm2, p = 0.03). PH groups 1 and 4 had higher Pulmonary Vascular Resistance (PVR) and Pulmonary Mean Arterial Pressure (PMAP) values than group 2, which significantly correlated with echocardiographic RV function parameters as TAPSE, FAC, RV global strain and IE. In PH group 2, eccentricity index was the only predictor of PVR (β=4.1, p = 0.018). In this population, a left atria volume &amp;lt; 32.7 cm3/m2 (OR 4.25, CI 1.71 - 10.55) and a E/e’ ratio &amp;lt; 12 (OR 4.72, CI 2.05 - 10.87) predicted PECP &amp;lt; 15 mmHg. RV global strain &amp;gt; -17.1 predicted PVR &amp;gt; 3 wood (OR 3.46, CI 1.50 - 8.02) and PMAP &amp;gt; 20 mmHg (OR 4.92, CI 1.67 - 14.51). TAPSE &amp;lt; 18 mm predicted PVR &amp;gt; 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion Different PH groups present mild echocardiographic differences between them. PH group 1 presented with more echocardiographic signs of RV disfunction, and PH group 2 had higher FAC, E/E’ and larger right and left atria. RV function parameters predicted PVR in PH groups 1 and 4, and EI was the only predictor of PVR in PH group 2. Abstract P1505 Figure.

P5288Slice position vulnerability in the basal and apical parts for right ventricular circumferential strain measurement with feature tracking cardiac magnetic resonance

Abstract Background Strain is a more sensitive and precise parameter than ejection fraction (EF) for detection and characterization of subclinical left ventricular (LV) dysfunction and remodeling. Similar relationship is expected for right ventricle (RV); however RV functional parameters are less validated. Feature tracking strain analysis based on standard cardiac magnetic resonance (CMR) cine imaging is available for both ventricles. We experience a large slice-to-slice variation for RV global circumferential strain (GCS), possibly making the parameter vulnerable to minute position changes. Purpose To evaluate slice-to-slice differences in RV GCS for identification of the least variation region in a patient group without regional RV disease, in order to achieve a robust method for measurement. Hypothesis The slice-to-slice difference in peak GCS is lower in the mid-ventricular part of the RV than in the basal and apical parts. Methods 50 patients 6–72 months after pulmonary embolism without other major cardiopulmonary disease were included; mean age 60 years (range: 18–75 years); 68% men. Standard 2D cine CMR was obtained in longitudinal planes and in 10–12 consecutive 10 mm short axis planes for complete coverage of the RV. RV free wall and the inner contour of the septum were manually segmented on every end-diastolic and end-systolic slice from the pulmonary valve to the apex for feature tracking strain analysis. Peak RV GCS for every short axis slice and GCS difference (absolute percentage points) between adjacent slices were calculated. RV EF and peak RV GLS from the 4-chamber image were measured for correlation to RV GCS. Wilcoxon signed rank test and Pearson correlation were performed. Confidence intervals of means are based on 1000 bootstrap samples. Results RV EF was 46.6% (95% CI: 44.3; 48.8), RV peak GLS was −17.6% (95% CI: −18.6; −16.6). RV mid-ventricular GCS was −10.9% (95% CI: −12.0; −9.9). RV peak GCS slice-to-slice difference was 6.8 absolute percentage points (95% CI: 6.0; 7.6) in the basal part, 2.7 (95% CI: 2.4; 3.0) in the mid-ventricular part and 4.6 (95% CI: 3.9; 5.3) apically. Difference was significantly lower in mid-ventricular (p&lt;0.001) compared to both basal and apical. RV EF correlated to RV peak GLS (r: −0.397, p=0.004) and mid-ventricular peak GCS (r: −0.356, p=0.01) but not to basal or apical peak GCS. RV peak GLS correlated to basal and mid-ventricular peak GCS (r: 0.313, p=0.03 and r: 0.301, p=0.03 respectively) but not to apical peak GCS. Figure 1 shows slice-to-slice difference (expressed in absolute percentage points) in right ventricular peak GCS. Conclusion Slice-to-slice difference in RV peak GCS was significantly lower in the mid-ventricular region. Large differences in the basal and apical parts indicate that measurements largely depend on slice positioning.

Inter-individual variability in right ventricle adaptation after an endurance race.

Right ventricle (RV) dysfunction has been described in athletes after endurance races. We aimed to understand and characterize the RV response to endurance exercise, the impact of individual variability and the effects of the amount of exercise. Echocardiography was performed in 55 healthy adults at baseline and after a three-stage trail race: short (14 km; n = 17); medium (35 km; n = 21); and long (56 km; n = 17). Standard and speckle tracking echocardiographic assessment of the RV was performed with global and separate analysis of the RV basal (inflow) and apical regions. Although no change was observed in the short distance runners, the RV systolic deformation decreased significantly (p < 0.05) after both the medium length and long races (Δ% RV global strain -7.6 ± 20.1 and -8.7 ± 21.8, respectively) with significant RV dilatation (Δ% RV volume +10.6 ± 9.9 and +15.3 ± 12.8, respectively). The RV basal segment made a major contribution to stroke volume during exercise, showing larger increases in size and strain compared with the apex. Various patterns of RV adaptation to exercise, ranging from increases in both RV segmental strains and sizes to an insufficient increase in size and a decrease in strain, were identified; this individual variability was not correlated with prior training. An acute RV impairment was demonstrated after a trail-running race and was related to the amount of exercise. A high inter-individual variability was observed. Differences in RV adaptation patterns were independent of prior training, suggesting the influence was due to other individual factors.

Restrictive Right Ventricular Physiology and Right Ventricular Fibrosis as Assessed by Cardiac Magnetic Resonance and Exercise Capacity After Biventricular Repair of Pulmonary Atresia and Intact Ventricular Septum

The hypertrophic myocardium, myocardial fiber disarray, and endocardial fibroelastosis in pulmonary atresia and intact ventricular septum (PAIVS) may provide anatomic substrates for restrictive filling of the right ventricle. Restrictive right ventricle (RV) physiology is related to RV fibrosis and exercise capacity in patients after biventricular repair of PAIVS. A total of 27 patients, age 16.5 +/- 5.6 years, were recruited after biventricular repair of PAIVS. Restrictive RV physiology was defined by the presence of antegrade diastolic pulmonary flow and RV fibrosis assessed by late gadolinium enhancement (LGE) cardiac magnetic resonance. Their RV function was compared with that of 27 healthy controls and related to RV LGE score and exercise capacity. Compared with controls, PAIVS patients had lower tricuspid annular systolic and early diastolic velocities, RV global longitudinal systolic strain, systolic strain rate, and early and late diastolic strain rates (all P < 0.05). A total of 22 (81%, 95% confidence interval: 62%-94%) PAIVS patients demonstrated restrictive RV physiology. Compared to those without restrictive RV physiology (n = 5), these 22 patients had lower RV global systolic strain, lower RV systolic and early diastolic strain rates, higher RV LGE score, and a greater percent of predicted maximum oxygen consumption (all P < 0.05). Restrictive RV physiology reflects RV diastolic dysfunction and is associated with more severe RV fibrosis but better exercise capacity in patients after biventricular repair of PAIVS.