Right Ventricle Parameters Research Articles

Artificial intelligence-driven echocardiographic classification identifies Brugada Syndrome patients at higher arrhythmic risk

Abstract Background Mounting evidence exists to support the hypothesis that patients with Brugada Syndrome (BrS) present morphological and structural anomalies localized to the right ventricle (RV), but this has not been investigated in a large cohort and the association with clinical outcomes are unknown. Purpose To investigate the role of echocardiography-derived RV parameters in a large, single-center cohort of patients with BrS. Methods We prospectively enrolled n=492 consecutive patients (379 males, 77%; age 46±14 years) with confirmed BrS who underwent an echocardiogram during their last visit at the outpatient clinic for inherited arrhythmogenic disorders. Comprehensive 2D and color Doppler echocardiographic evaluation was performed using the standard clinical protocol. Unsupervised clustering analysis using cluster package sorted body surface area-corrected morphological (RVOT linear dimensions and RV diastolic area) and functional measurements of RV (fractional area shortening [FAC], tricuspid annular plane systolic excursion [TAPSE]), blinded to other variables. We performed clustering with a hierarchical cluster algorithm (h-cluster) and the optimal number of clusters (k=2) was determined using fviz_nbclust-derived plots. Results All n=492 patients were classified into 2 stable clusters () with the best robustness. The Cluster 1 echocardiograms exhibited normal RV morphological and functional parameters. The Cluster 2 echocardiograms showed a dilatation of the RVOT (PLAX 17.2±2.1 vs. 15.6±2.1, p<0.001; PSAX 18.3±2.2 vs. 16.9±2.2, p<0.001) compared to Cluster 1, while the RV diastolic area was not different (9.9±1.5 vs. 9.9±1.6, p=0.801). Importantly, RV function as assessed by TAPSE was not different between the two groups, but Cluster 2 patients showed a significantly impaired radial contraction (RV FAC 40.1±3.4% vs. 48.6±3.8%, p<0.001). We then investigated the clinical characteristics of patients based on clusters. Patients in Cluster 1 were younger (43.2±12.8 years vs. 47.5±14.0 years, p<0.001) and had significantly less arrhythmic symptoms such as syncope (13% vs. 20%, p=0.046) and life-threatening arrhythmic events (2% vs. 7%, p=0.017). Importantly, no significant differences in terms of gender (77% males in both groups, p=1.000), pattern type (43% with spontaneous type 1 pattern in Cluster 1 vs. 47%, p=0.494) nor genetic status were observed. Multivariate logistic regression confirmed that at parity of age and arrhythmic syncope, Cluster 2 was independently associated with an increased incidence of life-threatening arrhythmic events (odds ratio 3.71, 95% confidence interval 1.31-10.53, p=0.039). Conclusions We constructed a novel, echocardiography-guided classification of patients with BrS using unsupervised clustering analysis. Our data suggest that RV structural abnormalities are associated with a higher incidence of life-threatening arrhythmic events in patients with BrS, independently of arrhythmic syncope or age.

Characteristics of the right ventricle in left ventricular noncompaction with reduced ejection fraction in the light of dilated cardiomyopathy.

Reports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N). Forty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was divided into two subgroups by the amount of RV trabeculation. There was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. The hypertrabeculated RV subgroups showed significantly higher RV volumes and lower RV-EF only in the decreased-LV-function groups. The correlation of LV and RV trabeculation was observed only in the LVNC-N group, while LV trabeculation correlated with RV volumes in both noncompacted groups. Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group. The presence and characteristics of RV hypertrabeculation and the correlations between LV trabeculation and RV parameters raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the early detection of RV function deterioration.

Chemotherapy induced right ventricular cardiomyopathy; a systematic review and meta-analysis.

Left ventricular dysfunction and cardiomyopathy are well documented adverse effects associated with chemotherapy agents. Limited information exists regarding the impact of chemotherapeutic agents on the integrity and function of the right ventricle (RV). The current metanalysis compared pre- chemotherapy versus post- chemotherapy RV parameters measured on 2D echocardiography in patients receiving anthracycline and/or trastuzumab across all breast cancer patients. A systematic search across PubMed, EMBASE and Cochrane databases were performed from inception of the databases until November 2021 for relevant studies. We used the inverse variance method with a random effect model and DerSimonian and Laird method of Tau2 generation to calculate mean difference [MD] with 95% confidence interval [CI]. The analysis was carried out using RevMan Version 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Fifteen studies, constituting total of 644 patients, met the inclusion criteria, with most studies having a follow up period of less than 12 months from initiation of chemotherapy. Anthracycline and/or Trastuzumab chemotherapy resulted in a statistically significant reduction in right ventricular ejection fraction (RVEF) at follow-up [MD: 2.70, 95% CI: 0.27 to 5.13, P-value- 0.03, I2- 71%, χ2 P-value < 0.05]. Treatment with Anthracycline and/or Trastuzumab chemotherapy resulted in a significant reduction in RV fractional area change (RVFAC) at follow-up [MD: 3.74, 95% CI: 1.33 to 6.15, P-value < 0.01, I2- 68%, χ2 P-value < 0.05]. RV free wall longitudinal strain (RVFWLS) was lower at baseline, while LVEF was significantly reduced at follow-up [MD: -1.00, 95% CI: -1.86 to -0.15, P-value < 0.05, I2- 0%, χ2 P-value-0.40], [MD: 4.04, 95% CI: 2.08 to 6.01, P-value < 0.01, I2- 91%, χ2 P-value < 0.05], respectively. However, treatment with Anthracycline and/or Trastuzumab chemotherapy had no statistically significant effect on Tricuspid annular plane systolic excursion (TAPSE) at follow-up [MD: 0.53, 95% CI: -0.11 to 1.17, P-value-0.11, I2- 98%, χ2 P-value < 0.05]. Chemotherapy with anthracyclines and trastuzumab negatively affects right ventricular function leading to decline in RVEF, RVFAC, RVFWLS and LVEF.

Correlation between echocardiographic and primary percutaneous coronary intervention for proximal right coronary artery in inferior-wall myocardial infarction

Abstract Background Diagnosing myocardial infarction (MI) of the right ventricle (RV) is difficult. ECG remains the main tool for diagnosis of acute RVMI. For accurate diagnosis of RVMI, angiography can be done to enforce RVMI diagnosis. The physiology of the RV makes it less likely to suffer muscle infarction, but this can happen in cases of acute severe right coronary-artery (RCA) occlusion. Echocardiographic parameters have proven their efficacy in predicting proximal RCA infarction, including annular velocity and tricuspid annular-plane systolic excursion. Aim Assessment of the value of RV echocardiographic parameters in the diagnosis of early acute inferior RVMI in relation to coronary angiogram of proximal RCA. Patients and methods This prospective study was conducted on 125 patients diagnosed with inferior MI. ECG, echocardiographic RV parameters, and primary percutaneous coronary-intervention technique for proximal RCA were performed for all included patients at the Cardiovascular Medicine Department Tanta University Hospitals from June 2019 to December 2019. Results RV infarction occurred mostly in cases of proximal RCA occlusion and few cases with mid-segment of RCA lesion. This was reported by echocardiography using tricuspid annular-plane systolic excursion and S-wave tissue Doppler. Few cases showed impairment in RV function in left circumflex-artery occlusion as culprit vessel reported by echocardiography and the impairment occurred only with S wave. RV function was not affected with left circumflex-artery occlusion as culprit lesion. Conclusion Echocardiographic parameters of RV are useful in predicting RVMI due to proximal RCA occlusion.

Impact of Right Ventricular Surface Area-to-Volume Ratio on Ventricular Remodeling After Pulmonary Valve Replacement.

Optimal reverse remodeling of the right ventricle (RV), a sentinel goal of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot, is not fully predicted by volume-based pre-PVR parameters. Our objectives were to characterize novel geometric RV parameters in patients receiving PVR and in controls, and to identify associations between these parameters and chamber remodeling post-PVR. Secondary analysis was performed on cardiac magnetic resonance (CMR) data from 60 patients enrolled in a randomized trial of PVR with and without surgical RV remodeling. 20 healthy age-matched subjects served as controls. The primary outcome was optimal post-PVR RV remodeling (end-diastolic volume index (EDVi) ≤ 114 ml/m2 and ejection fraction (EF) ≥ 48%) vs. suboptimal remodeling (EDVi ≥ 120 ml/m2 and EF ≤ 45%). RV geometry was markedly different at baseline in PVR patients compared with controls, with lower systolic surface area-to-volume ratio (SAVR) (1.16 ± 0.26 vs.1.44 ± 0.21 cm2/mL, p < 0.001) and lower systolic circumferential curvature (0.87 ± 0.27 vs. 1.07 ± 0.30cm- 1, p = 0.007) but similar longitudinal curvature. In the PVR cohort, higher systolic SAVR was associated with higher RVEF both pre- and post-PVR (p < 0.001). Among PVR patients, 15 had optimal and 19 had suboptimal remodeling post-PVR. Multivariable modeling showed that among the geometric parameters, higher systolic SAVR (OR 1.68 per 0.1 cm2/mL increase; p = 0.049) and shorter systolic RV long-axis length (OR 0.92 per 0.1cm increase; p = 0.035) were independently associated with optimal remodeling. Compared with controls, PVR patients have lower SAVR and lower circumferential but not longitudinal curvature. Higher pre-PVR systolic SAVR is associated with optimal remodeling post-PVR.

Prognostic Value of Right Ventricular Dysfunction in Patients With Decompensated Chronic Heart Failure

Aim To determine the incidence rate and the practical significance of right ventricular dysfunction (RVD) in the development of cardiovascular complications in patients with decompensated chronic heart failure (DCHF).Material and methods This prospective, single-site observational study included 171 patients older than 18 years with NYHA functional class (FC) II-IV chronic heart failure (CHF) who were hospitalized for DCHF. Standard and extended 2D and 3D echocardiography (EchoCG) was performed for all patients on admission. Additionally, functional characteristics of the right ventricle (RV) were evaluated in the 3D mode followed by autonomic 3D processing with a EchoPac station (USA). RVD was taken as a disorder of two or more RV functional parameters according to results of 2D EchoCG, or a reduced RV free wall strain according to results of 2D speckle-tracking EchoCG, or a reduced RV ejection fraction (EF) according to results of 3D EchoCG. Statistical analysis was performed with a SPSS Statistics v. 26.0 software.Results The incidence rate of RVD in general population of patients with DCHF was 75.4 % (n=129). A higher prevalence of RVD was observed in patients with CHF with a low left ventricular (LV) EF (90.1 %). Patients with RVD had a more severe clinical status (significantly higher FC and higher Clinical Condition Scale (CCS) scores), more frequent atrial fibrillation (AF), and higher concentrations of uric acid and total bilirubin. RVD significantly correlated with male sex (odds ratio (OR), 2.05; 95 % confidence interval (CI), 1.01–4.19; р=0.046) and AF (OR, 3.52; 95 % CI, 1.71–7.26; р&lt;0.001). Patients with RVD had lower values of both LV and RV function. Lower LV EF and AF increased the probability of RVD by 1.06 times (95 % CI, 0.90–0.98; р=0.001) and by 2.63 times (95 % CI, 1.08–6.40; р=0.001), respectively. Evaluation of the predictive significance of RV parameters measured by 2D and 3D EchoCG showed only effects of RV EF (2D) and RV global longitudinal strain (GLS) (3D) on all-cause hospitalization. RVD as evaluated by accepted criteria did not influence adverse outcomes.Conclusion The determined incidence, correlations, and the predictive value of RVD in patients with DCHF indicated the appropriateness of assessing the RV function to optimize the management of patients regardless of the CHF phenotype.

Normative ranges of biventricular volumes and function in healthy term newborns

BackgroundCardiovascular magnetic resonance (CMR) is increasingly used in newborns with congenital heart disease. However, reporting on ventricular volumes and mass is hindered by an absence of normative data in this population. Design/methodsHealthy term (37–41 weeks gestation) newborns underwent non-sedated, free-breathing CMR within the first week of life using the ‘feed and wrap’ technique. End-diastolic volume (EDV), end-systolic volume (ESV) stroke volume (SV) and ejection fraction (EF) were calculated for both left ventricle (LV) and right ventricle (RV). Papillary muscles were separately contoured and included in the myocardial volume. Myocardial mass was calculated by multiplying myocardial volume by 1.05 g/ml. All data were indexed to weight and body surface area (BSA). Inter-observer variability (IOV) was performed on data from 10 randomly chosen infants. ResultsTwenty healthy newborns (65% male) with a mean (SD) birth weight of 3.54 (0.46) kg and BSA of 0.23 (0.02) m2 were included. Normative LV parameters were indexed EDV 39.0 (4.1) ml/m2, ESV 14.5 (2.5) ml/m2 and ejection fraction (EF) 63.2 (3.4)%. Normative RV indexed EDV, ESV and EF were 47.4 (4.5) ml/m2, 22.6 (2.9) ml/m2 and 52.5 (3.3)% respectively. Mean LV and RV indexed mass were 26.4 (2.8) g/m2 and 12.5 (2.0) g/m2, respectively. There was no difference in ventricular volumes by gender. IOV was excellent with an intra-class coefficient > 0.95 except for RV mass (0.94). ConclusionThis study provides normative data on LV and RV parameters in healthy newborns, providing a novel resource for comparison with newborns with structural and functional heart disease.

Impact of Pulmonary Arterial Elastance on Right Ventricular Mechanics and Exercise Capacity in Repaired Tetralogy of Fallot.

Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO2] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO2 was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.

797 ENDOTHELIAL FUNCTION AND RIGHT VENTRICLE DIMENSION AND FUNCTION IN PATIENTS WITH SYSTEMIC SCLEROSIS

Abstract Background Systemic sclerosis (SSc) is a connective tissue disease characterized by the fibrosis of skin and internal organs, frequent immunity abnormalities and alterations in microvasculature. Among SSc complications, Pulmonary Hypertension (PH) is a frequent and severe one. Many echocardiographic parameters are used to assess pulmonary pressure and Right Ventricle (RV) dimension and function in these patients, from classical echocardiographic indexes to the most recent Speckle-Tracking Echocardiography (STE), while flow-mediated vasodilation (FMD) is the most common method to assess vascular reactivity. Aim of the study To evaluate any possible relations between endothelial function and RV dimension and function in patients with SSc. Method 48 sclerodermic patients underwent to echocardiographic examination and FMD, searching for relations between RV dimension and function and endothelial function indexes. For the RV we considered: 1) the eccentricity index (EI), 2) the fractional area change (FAC), 3) the ratio TAPSE/PAPs, 4) the RV basal diameter, 5) the RV free-wall strain and 6) the tricuspid regurgitation velocity; for the endothelium we evaluated the absolute difference between the radial artery diameters before and after 5 minutes of ischemia. We used a t-Student test (t-test) for unpaired samples with similar variances to verify the hypothesis that patients with altered RV parameters show a lower value in the absolute difference between radial diameters. Results Only EI and endothelial function showed a significant relation. In fact, with a level of confidence of the 95% we can say that patients with an EI&amp;gt;=1,1 report a minor increase in radial artery diameter than patients with EI&amp;lt;1,1. Conclusions In patients affected by SSc, the endothelial function is related to eccentricity index. Multicenter studies are needed in order to confirm the results of our study

Abstract 10124: Characteristics of the Right Ventricle in Left Ventricular Noncompaction With Reduced Ejection Fraction

Introduction: Reports of left ventricular noncompaction (LVNC) rarely include descriptions of the right ventricle (RV). Hypothesis: This study aimed to describe the characteristics of the RV in LVNC patients with reduced LV function (LVNC-R) compared with patients with dilated cardiomyopathy (DCM) and subjects with LVNC with normal left ventricular ejection fraction (LV-EF) (LVNC-N). Methods: Forty-four LVNC-R patients, 44 LVNC-N participants, and 31 DCM patients were included in this retrospective study (LV-EF: LVNC-R: 33.4±10.2%; LVNC-N: 65.0±5.9%; DCM: 34.6±7.9%). Each group was further divided into two subgroups by the amount of RV trabeculation. Results: There was no difference in the RV-EF between the groups, and the RV trabecular mass correlated positively with the RV volume and negatively with the RV-EF in all the groups. All the measured parameters were comparable between the groups with decreased LV function. Subgroups with RV hypertrabeculation showed significantly higher RV volumes and lower RV-EF in the decreased-LV-function groups than patients with normal RV trabeculation. LV trabeculation correlated with RV volumes in both noncompacted groups, while the correlation with RV trabeculation was observed only in the LVNC-N group (r=0.469, p=0.001). Both decreased-LV-function groups had worse RV strain values than the LVNC-N group; however, RV strain values correlated with RV trabeculation predominantly in the LVNC-R group. Conclusions: Correlations between LV trabeculation and RV parameters and the presence and characteristics of RV hypertrabeculation raise the possibility of RV involvement in noncompaction; moreover, RV strain values might be helpful in the detection of early subclinical changes of the RV.

The effect of the location of arteriovenous fistula on the right ventricle in end stage renal disease patients indicated for hemodialysis

Abstract Background End-stage renal disease (ESRD) has significantly increased in developing countries such as Egypt [1]. There are many sites for arteriovenous fistula (AVF) creation. The most common sites for AVF are radio-cephalic AVF (RC-AVF) followed by brachio-cephalic AVF (BC-AVF) [2]. To date, there are no significant studies discussing the possible correlation between the AVF location and abnormalities in the right ventricle (RV) in hemodialysis (HD) patients. Objective To determine the best location for AVF in order to ensure the least possible hazardous side effects of the AVF on the RV. Methods Our study, designed as an interventional study, included 50 ESRD patients referred for primary AVF construction to start HD for the first time. Patients were divided into two groups, 25 patients each. one group underwent a RC-AVF construction and the other had a BC-AVF. We assessed the RV by two dimensional transthoracic echocardiography (2D TTE) twice for each patient, firstly just before the AVF surgery and secondly three months after AVF construction. Results There was a statistically significant difference in between study groups regarding change in RV Tei index (p=0.001) with a decrease in the radial group (Mean ± SD = −0.19±0.2) and an increase in the brachial group (Mean ± SD = 0.02±0.12), and regarding the right ventricular outflow tract proximal diameter (p&amp;lt;0.001) with a decrease in the radial group (Mean ± SD = −2.32±5.49) and a larger increase in the brachial group (Mean ± SD = 2.94±3.14). Changes in the other RV dimensions and functional parameters did not show statistically significant difference. Conclusion After three months follow up, despite the fact that all the RV parameters remained within the normal range, the RV indices with the RC-AVF were associated with either improvement or less decline than with the BC-AVF. Funding Acknowledgement Type of funding sources: None.

Right Ventricular Dysfunction Is Associated With Increased Mortality in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Issues With the Method.

To the Editor: We read with interest the article published by Maharaj et al.1 The authors’ aim was to investigate the correlation between echocardiographic parameters and survival in patients supported by venovenous extracorporeal membrane oxygenation (VV-ECMO). The authors retrospectively collected clinical and echocardiographic data from 17 patients over 1 year period. The echocardiograms were a mixture of transthoracic (TTE) and transesophageal (TEE) scans. Visual assessment and right ventricle (RV) fractional area change (FAC) were used as the parameters for RV systolic function as measured by two independent blinded experts, and an average was used for statistical analysis. In patients who did not survive, significant RV dysfunction by visual assessment was more prevalent in nonsurvivors. In addition, median value for FAC in nonsurvivors was significantly lower (11.3% [10.3–15] vs. 30.1% [27.6–31.4], respectively). RV FAC is performed by tracing the endocardial border area of the RV in end systole (ESA) and end diastole (EDA), and it is calculated as EDA − ESA/EDA.2 This method renders FAC open to intra- and interobserver variabilities. A previous study demonstrated FAC to exhibit limited and nonstatistically significant intraobserver (r, 0.56; p = 0.06) and interobserver (r, 0.46; p = 0.16) agreements.2 In addition, mean intra- and interobserver differences were high (mean, 1.86%; 95% CI, −9.25% to −12.96%; and mean, 4.00%; 95% CI, −7.72% to −15.72%, respectively). FAC variability was worst compared with other RV systolic function parameters (e.g., Tricuspid annular plane systolic excursion and velocity). Where FAC is used for RV systolic function assessment, intra- and interobserver variabilities should be assessed and cited providing a guide to results reliability. The authors used a mixture of TEE and TTE to obtain FAC. The two modalities were considered comparable, and thus, values from both modalities were incorporated in the FAC comparison. A recent study compared TTE and TEE in the assessment of RV function using the same parameters in 100 patients undergoing cardiac surgery.3 The TTE and TEE were performed in close temporal proximity under the same loading conditions. The study demonstrated that RV parameters had fair agreement between modalities but not identical. FAC comparison demonstrated correlation concordance coefficient between TTE and TEE of 0.31 (95% CI, 0.12–0.48), suggesting limited agreement and that FAC results are not interchangeable between the two modalities. This result casts a shadow on the feasibility of incorporating FAC from TTE and TEE in the same statistical comparison. Association between a continuous independent parameter (e.g., RV FAC) and categorical dependent parameter (e.g., mortality) requires in-depth statistical analysis. Logistic regression is the most commonly statistical method used to investigate such association.4 A multivariate model is constructed to incorporate all likely and significantly different independent parameters to investigate which parameters predict outcome. Furthermore, receiver operator curve (ROC) analysis is usually performed to establish sensitivity and specificity of the independent parameter in predicting the dependent parameter.5 Without such analysis, association between FAC and mortality could not be convincingly established. Fractional area change is a method of RV systolic function assessment with high observer variability. FAC is not interchangeable between TTE and TEE. Further statistical analysis is required to establish association between RV FAC and outcome.

Platelet sTWEAK and plasma IL-6 are associated with 18F-fluorodeoxyglucose uptake in right ventricles of patients with pulmonary arterial hypertension: A pilot study.

Cytokines soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and interleukin 6 (IL-6) are involved in immune response, proliferation, apoptosis, and cardiovascular pathologies. We have previously confirmed that changes of their platelet or plasma contents are associated with pulmonary arterial hypertension (PAH). The positron emission tomography/magnetic resonance imaging (PET/MRI) hybrid imaging provides detailed insight into right ventricle (RV) hemodynamic and metabolic function. To evaluate the relationship between RV parameters obtained using PET/MRI and concentrations of plasma and platelet sTWEAK and IL-6 in stable PAH patients. Eighteen stable PAH patients (48.44 ±16.7 years) had simultaneous PET/MRI scans with 18F-fluorodeoxyglucose (18F-FDG) performed. Its uptake was presented as a standardized uptake value (SUV) for RV and left ventricle (LV). Cytokines concentrations were measured in platelet-poor plasma and platelet lysate. Follow-up time of this study was 58 months; the combined endpoint (CEP) was defined as death or clinical deterioration. We observed significant correlations between platelet sTWEAK levels, plasma IL-6 and PET parameter SUVRV/LV (r = -0.57, p = 0.011; r = 0.50, p = 0.032, respectively). In logistic regression, platelet sTWEAK and IL-6 were both prognostic factors for unfavorable ratio of SUVRV/LV higher than 1 (hazard ratio (HR) = 0.44, 95% confidence interval (95% CI): [0.23; 0.84], p = 0.017; and HR = 3.62, 95% CI: [1.21; 10.17], p = 0.011, respectively). Furthermore, their concentrations were related with prognostically important higher late gadolinium enhancement mass index (LGEMI) and RV global longitudinal strain/systolic pulmonary artery pressure (RV GLS/sPAP) values. Patients who had CEP in follow-up (n = 13) had significantly lower platelet sTWEAK content and higher plasma IL-6 at baseline than stable patients. Lower platelet sTWEAK was related to a worse prognosis in log-rank test (p = 0.006). Platelet sTWEAK and plasma IL-6 together with RV GLS/sPAP, RV ejection fraction (RVEF), mean pulmonary arterial pressure (mPAP), and SUVRV/LV were significantly associated with time to CEP in univariate Cox analysis. The sTWEAK and IL-6 concentrations in PAH patients are linked with metabolic and functional changes of RV visualized in PET/MRI, and both sTWEAK and IL-6 predict clinical deterioration.

Prevalence and haemodynamic profiles of pulmonary hypertension in cardiac amyloidosis

ObjectivesWhile cardiac amyloidosis (CA) classically involves the left ventricle (LV), less is known about its impact on the right ventricle (RV) and pulmonary vasculature. We performed a retrospective analysis to identify the prevalence and types of pulmonary hypertension (PH) profiles in CA and to determine haemodynamic and cardiovascular magnetic resonance (CMR) predictors of major adverse cardiovascular events (MACE).MethodsPatients with CA who underwent CMR and right heart catheterisation (RHC) within 1 year between 2010 and 2019 were included. Patients were assigned the following haemodynamic profiles based on RHC: no PH, precapillary PH, isolated postcapillary PH (IPCPH), or combined precapillary and postcapillary PH (CPCPH). The relationship between PH profile and MACE (death, heart failure hospitalisation) was assessed using survival analysis. CMR and RV parameters were correlated with MACE using Cox-regression analysis.ResultsA total of 52 patients were included (age 69±9 years, 85% men). RHC was performed during biopsy in 44 (85%) and for clinical indications in 8 (15%) patients. Rates of no PH, precapillary PH, IPCPH and CPCPH were 5 (10%), 3 (6%), 29 (55%) and 15 (29%), respectively. Haemodynamic PH profile did not correlate with risk of death (p=0.98) or MACE (p=0.67). Transpulmonary gradient (TPG) (HR 0.88, CI 0.80 to 0.97), RV, (HR 0.95, CI 0.92 to 0.98) and LV ejection fraction (HR 0.95, CI 0.92 to 0.98) were significantly associated with MACE.ConclusionsPH is highly prevalent in CA, even at the time of diagnosis. While IPCPH was most common, CPCPH is not infrequent. TPG and RV ejection fraction (RVEF) are prognostic markers in this population.

Right ventricular function declines prior to left ventricular ejection fraction in hypertrophic cardiomyopathy

BackgroundThe right ventricle (RV) in hypertrophic cardiomyopathy (HCM) tends to be neglected, as previous efforts have predominantly focused on examining the prognostic value of left ventricular (LV) abnormalities. The objectives of this study were to assess RV function in HCM, changes over time, and association with clinical outcomes.MethodsTwo hundred and ninety HCM patients with preserved LV ejection fraction (LVEF ≥ 55%) and 30 age- and sex-matched controls underwent cardiovascular magnetic resonance (CMR). All patients were followed up for clinical events for a median duration of 4.4 years. Sixty-three patients had a follow-up CMR undertaken at a median interval of 5.4 years. Main study measures and outcomes were RV function (RV ejection fraction (RVEF) and RV strain) at baseline, temporal changes in RV function over time and prognostic value of RV dysfunction for predicting cardiovascular outcomes in HCM.ResultsWhen compared to controls, HCM patients exhibited lower RV and LV peak global longitudinal systolic strains on feature-tracking analysis of cine images, while RVEF and LVEF were within the normal range. On follow-up CMR, both RV and LV strain parameters decreased over time. RVEF decreased at follow-up (65 ± 7% to 62 ± 7%, P < 0.001) but the change in LVEF was not significant (68 ± 10% to 66 ± 8%, P = 0.30). On clinical follow up, reduced RVEF was an independent predictor of non-sustained ventricular tachycardia (NSVT) [HR 1.10 (95% CI 1.06–1.15), P < 0.001] and composite cardiovascular events (NSVT, stroke, heart failure hospitalisation and cardiovascular death) [HR 1.07 (95% CI 1.03–1.10), P < 0.001]. RV longitudinal strain was an independent predictor of NSVT [HR 1.05 (95% CI 1.01–1.09), P = 0.029]. Patients with RVEF < 55% showed an increased risk of NSVT and composite cardiovascular events. In contrast, LVEF and LV global longitudinal strain were not predictive of such events on multivariable analysis.ConclusionsIn HCM, RV function, including RV strain, and LV strain decrease over time despite preserved LVEF. Reduction in RV but not LV function is associated with adverse cardiovascular outcomes. Assessing RV function in early HCM disease might have a role in risk stratification to prevent future cardiovascular events.

Right ventricular function during trastuzumab therapy for breast cancer.

Cardiotoxicity (CDT) is the main adverse effect related to trastuzumab (TTZ). The role of the right ventricle (RV) in this context is not clear. We aimed to evaluate the longitudinal changes in RV function during TTZ therapy and to determine RV function changes associated with subclinical CDT. Breast cancer patientsunderwent echocardiograms at the beginning of TTZ treatment (Exam 1) and every 3months during the first year (Exams 2, 3, and 4). Subclinical CDT was defined as ≥ 12% relative reduction of left ventricle global longitudinal strain (LV GLS). Twenty-five women (52.1 ± 13.1 y-o) were included. We found a decrease in LV ejection fraction between the first and fourth exams (Ex1: 64.1% ± 4.9 vs Ex4: 60.9% ± 4.9, p = 0.003) and the LV GLS gradually decreased during follow-up (Ex1: -20.6% ± 2.0; Ex2: -19.4% ± 2.1; Ex3: -19.2% ± 1.8; Ex4: -19.0% ± 2.1, all p < 0.05). RV GLS changed from baseline to 3month and to 6month (Ex1: -23.9% ± 1.6; Ex2: -22.5% ± 2.1; Ex3: -22.5% ± 2.3, all p < 0.05), and the RV Fractional Area Change was lower in the third exam (Ex1: 44.3% ± 6.6 vs Ex3: 39.9% ± 6.0, p = 0.004). We found subclinical CDT in 13 patients (52%); worsening in RV parameters did not differ between those with and without subclinical CDT. In this sample, the RV function decreased during TTZ therapy and the decrease was not associated to the observed LV cardiotoxicity.

Abstract 11006: Prevalence and Hemodynamic Profiles of Pulmonary Hypertension in Cardiac Amyloidosis

Background: While cardiac amyloidosis (CA) classically involves the left ventricle (LV), less is known about its impact on the right ventricle (RV) and pulmonary vasculature. Objectives: We aimed to determine the prevalence and types of PH profiles in CA, and to determine hemodynamic and cardiovascular magnetic resonance (CMR) predictors of major adverse cardiovascular events (MACE). Methods: CA patients who underwent CMR and right heart catheterization (RHC) from 2010-2019 were included. Patients were assigned the following hemodynamic profiles: no PH, pre-capillary PH, isolated post-capillary PH (IPCPH), or combined pre- and post-capillary PH (CPCPH). Transpulmonary gradient (TPG)—the difference between mean pulmonary artery and wedge pressures, was calculated. The relationship between PH profile and MACE (death, heart failure hospitalization) was assessed using survival analysis. CMR and RV parameters were correlated with MACE using Cox-Regression analysis. To evaluate the importance of parameters for predicting MACE, Random Forest algorithm for survival analysis were applied. Results: A total of 52 patients were included (age 69±9 years, 85% male, 60% transthyretin, and 40% light chain CA). PH was present in 50 (96%) patients. RHC was performed during biopsy in 44(85%) and for clinical indications in 8(15%) patients. Rates of no PH, pre-capillary PH, IPC-PH, and CPCPH were 5(10%), 3(6%), 29(55%) and 15(29%) respectively (Panel A). Hemodynamic PH profile did not correlate with death (p=0.98) or MACE (p=0.67) (Panel B). TPG (HR 0.88, CI 0.80-0.97), RV, (HR 0.95, CI 0.92-0.98), and LV ejection fraction (HR 0.95, CI 0.92-0.98) were significantly associated with MACE. In Random Forest analysis, LVEF, RVEF, and TPG were the most important predictors of MACE (Panel C). Conclusions: PH is highly prevalent in CA, even at the time of diagnosis. While IPC-PH was most common, CPCPH is not infrequent. TPG and RVEF are prognostic markers in this population.

Right ventricle strain changes in patients with breast cancer during anthracycline therapy

Abstract Background Cardiotoxicity has become a significant adverse effect of cancer therapy, with Anthracyclines (ANT) in particular. There is a crucial need for the early subclinical detection of cardiotoxic effect. We aimed to evaluate Right ventricle (RV) two-dimensional speckle tracking echocardiography (2D-STE) changes during ANT therapy and to assess the correlation between RV 2D-STE and the routine echocardiographic RV parameters. Methods Data were prospectively collected as part of the Israel Cardio-Oncology Registry (ICOR). All female patients with breast cancer, planned for ANT therapy were included. All patients underwent serial echocardiography exams including baseline RV 2D-STE (before chemotherapy, T1) and shortly after the completion of ANT therapy (T3). RV 2D-STE was evaluated using the apical 4 chamber (4C) RV-focused view, assessing both the combined RV free wall and inter-ventricular septum (RV GLS) and solely the RV free wall strain (RV FWLS). Significant reduction in both RV GLS and RV FWLS was determined by either a relative reduction of &amp;gt;10% or an absolute value of &amp;gt;−25% for RV GLS and &amp;gt;−29% for RV FWLS. Results From September 2016 to June 2019, 40 patients were evaluated with a mean Doxorubicin (type of ANT) dose of 238.5±9.4 mg/m2. RV FWLS showed significant correlation to Tricuspid annular plane systolic excursion. At T3, significant reduction in both RV GLS and RV FWLS was observed among 77% and 62% of the patients with a mean RV GLS and RV FWLS reduction from −26.8 (±4.7) % to −21.5 (±4.4) % and −28.9 (±5.1) % to −25.6 (±5.9) % (p&amp;lt;0.001, p=0.002), respectively. Left ventricle (LV) ejection fraction and LV GLS were within the normal range. Conclusions RV GLS and RV FWLS reduction are frequent and occur early in the course of ANT therapy, preceding LV dysfunction, which may imply for the role of RV 2D-STE in the detection of early cardiotoxicity. Funding Acknowledgement Type of funding sources: None.

Age- and Sex-Specific Changes in CMR Feature Tracking-Based Right Atrial and Ventricular Functional Parameters in Healthy Asians.

Cardiovascular magnetic resonance (CMR) is the reference standard for non-invasive assessment of right-sided heart function. Recent advances in CMR post-processing facilitate quantification of tricuspid annular (TA) dynamics and longitudinal strains of the right ventricle (RV) and right atrium (RA). We aimed to determine age- and sex-specific changes in CMR-derived TA dynamics, and RV and RA functional parameters in healthy Asian adults. We studied 360 healthy subjects aged 21–79 years, with 30 men and 30 women in each of the six age groups. Functional parameters of RV and RA were measured on standard four-chamber cine CMR using fast feature tracking: (1) TA peak velocities (systolic velocity S′, early diastolic velocity E′, late diastolic velocity A′) and TA plane systolic excursion (TAPSE); (2) RV global longitudinal strain (GLS) and strain rates; and (3) RA phasic longitudinal strains and strain rates. S′ and TAPSE exhibited negative correlations with age. RV GLS was significantly higher in females than in males but not associated with age in both sexes. Females had similar E′, lower A′, and higher E′/A′ ratios compared to males. Positive associations of E′ and E′/A′, and negative association of A′ with age were observed in both sexes. Females had higher RA reservoir and conduit strains compared to males. There were significantly negative and positive associations between RA conduit and booster strains, respectively, with age. Age- and sex-specific reference ranges were established, and associations revealed, for fast CMR feature tracking parameters of right heart function in a large normal Asian population.

Dynamics of right ventricle contractility after cardiac surgery of tricuspid valve

Abstract Funding Acknowledgements Type of funding sources: None. Background The function of right ventricle (RV) is an independent prognostic factor for patients with valvular heart disease. However, changes in RV function parameters in patients with and without tricuspid valve operations after cardiac surgery are lack known. The aim of the study was to define changes in RV parameters after cardiac surgery in patients with left-sided valve diseases. Methods Fifty-five consecutive patients (33 men, 61 ± 10 years old), who were referred for the repair and/or replacement of left-sided valves, were included in the study. A transthoracic echocardiography assessment before and an average of 109 days (91-114) following the operation was performed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change RV (FAC), strain of the RV free wall (SRV), and right atrial volume were assessed in groups of patients with and without tricuspid valve repair. Results Valve repair for secondary tricuspid regurgitation was performed in nineteen patients undergoing left-sided valve surgery. Thirty-six patients had repair and/or replacement of left-sided valves without a tricuspid valve operation. There was a strong correlation between TAPSE, FAC, and RV strain before the operation (R = 0.62-0.77, p &amp;lt; 0.000002). However, there was no correlation between TAPSE and FAC; TAPSE and RV strain after the operation. TAPSE and RV strain significantly decreased after the operations and were below the normal range in both the groups of patients with and without tricuspid valve repair. TAPSE was 21 ± 5mm before the operation vs. 14 ± 4 mm after operation, p &amp;lt; 0.0000001 for all patients (20 ± 5mm vs. 13 ± 3 mm, p &amp;lt; 0.0003 for the group which underwent tricuspid valve repair; 22 ± 4mm vs. 14 ± 4 mm, p &amp;lt; 0.000001 for tricuspid valves which were not operated on). RV strain was -19 ± 6 mm before operating vs. -16 ± 5mm after operating, p &amp;lt; 0.0004 for all patients (-20 ± 6mm vs. -15 ± 5mm, p &amp;lt; 0.006 for tricuspid valve repair; -19 ± 6mm vs. -16 ± 4 mm, p &amp;lt; 0.02 for the tricuspid valves which were not operated on). There was no difference in TAPSE and SRV among patients with and without tricuspid valve repair. Decreased longitudinal function parameters (TAPSE and SRV) didn’t correlate with patients’ clinical status or with normalized right chambers volumes. FAC was 39 ± 11% before operating vs. 41 ± 9% after the operation, p = 0.45 for all patients (37 ± 13% vs. 40 ± 8%, p = 0.69 for the group which underwent tricuspid valve repair; 40 ± 10% vs. 41 ± 9%, p = 0.52 for the group with tricuspid valves which were not operated on). An increase in FAC correlated with a decrease in right chamber sizes after operations (R=-0.37, p &amp;lt; 0.03). Conclusion Longitudinal right ventricle parameters (TAPSE, SRV) significantly decrease after valve operations in groups with and without tricuspid valve repair. However, there is no correlation with the clinical status of patients. Global function parameters (FAC) correlates with the normalization of right chamber size after cardiac operation.