Abnormal Right Ventricular Research Articles

Continuous Right Ventricular Pressure Monitoring in Cardiac Surgery

Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. Prospective study. Tertiary care cardiac institute. Cardiac surgical patients. Cardiac surgery. Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them.

Echocardiographic features of right ventricle in septic patients with elevated central venous pressure

BackgroundElevated central venous pressure (CVP) is deemed as a sign of right ventricular (RV) dysfunction. We aimed to characterize the echocardiographic features of RV in septic patients with elevated CVP, and quantify associations between RV function parameters and 30-day mortality.MethodsWe retrospectively reviewed a cohort of septic patients with CVP ≥ 8 mmHg in a tertiary hospital intensive care unit. General characteristics and echocardiographic parameters including tricuspid annular plane systolic excursion (TAPSE), pulmonary vascular resistance (PVR) as well as prognostic data were collected. Associations between RV function parameters and 30-day mortality were assessed using Cox regression models.ResultsEchocardiography was performed in 244 septic patients with CVP ≥ 8 mmHg. Echocardiographic findings revealed that various types of abnormal RV function can occur individually or collectively. Prevalence of RV systolic dysfunction was 46%, prevalence of RV enlargement was 34%, and prevalence of PVR increase was 14%. In addition, we collected haemodynamic consequences and found that prevalence of systemic venous congestion was 16%, prevalence of RV-pulmonary artery decoupling was 34%, and prevalence of low cardiac index (CI) was 23%. The 30-day mortality of the enrolled population was 24.2%. In a Cox regression analysis, TAPSE (HR:0.542, 95% CI:0.302–0.972, p = 0.040) and PVR (HR:1.384, 95% CI:1.007–1.903, p = 0.045) were independently associated with 30-day mortality.ConclusionsEchocardiographic findings demonstrated a high prevalence of RV-related abnormalities (RV enlargement, RV systolic dysfunction and PVR increase) in septic patients with elevated CVP. Among those echocardiographic parameters, TAPSE and PVR were independently associated with 30-day mortality in these patients.

Enhancing Arrhythmogenic Right Ventricular Cardiomyopathy Detection and Risk Stratification: Insights from Advanced Echocardiographic Techniques.

The echocardiographic diagnosis criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly specific but sensitivity is low, especially in the early stages of the disease. The role of echocardiographic strain in ARVC has not been fully elucidated, although prior studies suggest that it can improve the detection of subtle functional abnormalities. The purposes of the study were to determine whether these advanced measures of right ventricular (RV) dysfunction on echocardiogram, including RV strain, increase diagnostic value for ARVC disease detection and to evaluate the association of echocardiographic parameters with arrhythmic outcomes. The study included 28 patients from the Heart Institute of São Paulo ARVC cohort with a definite diagnosis of ARVC established according to the 2010 Task Force Criteria. All patients were submitted to ECHO's advanced techniques including RV strain, and the parameters were compared to prior conventional visual ECHO and CMR. In total, 28 patients were enrolled in order to perform ECHO's advanced techniques. A total of 2/28 (7%) patients died due to a cardiovascular cause, 2/28 (7%) underwent heart transplantation, and 14/28 (50%) patients developed sustained ventricular arrhythmic events. Among ECHO's parameters, RV dilatation, measured by RVDd (p = 0.018) and RVOT PSAX (p = 0.044), was significantly associated with arrhythmic outcomes. RV free wall longitudinal strain < 14.35% in absolute value was associated with arrhythmic outcomes (p = 0.033). Our data suggest that ECHO's advanced techniques improve ARVC detection and that abnormal RV strain can be associated with arrhythmic risk stratification. Further studies are necessary to better demonstrate these findings and contribute to risk stratification in ARVC, in addition to other well-known risk markers.

Electrocardiographic Z-axis QRS-T voltage-time-integral in patients with typical right bundle branch block – Correlation with echocardiographic right ventricular size and function

BackgroundRight bundle branch block (RBBB) can be benign or associated with right ventricular (RV) functional and structural abnormalities. Our aim was to evaluate QRS-T voltage-time-integral (VTI) compared to QRS duration and lead V1 R' as markers for RV abnormalities. MethodsWe included adults with an ECG demonstrating RBBB and echocardiogram obtained within 3 months of each other, between 2010 and 2020. VTIQRS and VTIQRST were obtained for 12 standard ECG leads, reconstructed vectorcardiographic X, Y, Z leads and root-mean-squared (3D) ECG. Age, sex and BSA-adjusted linear regressions were used to assess associations of QRS duration, amplitudes, VTIs and lead V1 R' duration/VTI with echocardiographic tricuspid annular plane systolic excursion (TAPSE), RV tissue Doppler imaging S′, basal and mid diameter, and systolic pressure (RVSP). ResultsAmong 782 patients (33% women, age 71 ± 14 years) with RBBB, R' duration in lead V1 was modestly associated with RV S′, RV diameters and RVSP (all p ≤ 0.03). QRS duration was more strongly associated with RV diameters (both p < 0.0001). AmplitudeQRS-Z was modestly correlated with all 5 RV echocardiographic variables (all p ≤ 0.02). VTIR’-V1 was more strongly associated with TAPSE, RV S′ and RVSP (all p ≤ 0.0003). VTIQRS-Z and VTIQRST-Z were among the strongest correlates of the 5 RV variables (all p < 0.0001). VTIQRST-Z.√BSA cutoff of ≥62 μVsm had sensitivity 62.7% and specificity 65.7% for predicting ≥3 of 5 abnormal RV variables (AUC 0.66; men 0.71, women 0.60). ConclusionIn patients with RBBB, VTIQRST-Z is a stronger predictor of RV dysfunction and adverse remodeling than QRS duration and lead V1 R'.

Normal right ventricular augmentation during stress echocardiography- A comparative study

Abstract Funding Acknowledgements Type of funding sources: None. Background The assessment of right ventricular (RV) contractile reserve (CR) during exercise echocardiography in healthy subjects is not well described. We aimed to describe normal RV CR in healthy cases and to compare CR to patients with defined RV compromise because of previous repair of Tetralogy of Fallot. Methods 40 healthy individuals with satisfactory RV windows were randomly selected and retrospectively analysed from previously published study (marathon study). These cases were compared to 100 adult patients with repaired TOF. We defined RV CR by the change in tricuspid lateral annular systolic velocity (ΔRVS’), change in tricuspid annular plane systolic excursion (ΔTAPSE), and change in fractional area change (ΔFAC). All parameters were evaluated at baseline and at peak stress. Results During exercise, RVS’ was increased by 60±20%, followed by TAPSE 48±15%, and the lowest with FAC by 32±10%. These ranges were significantly higher than in TOF population. RV CR was greater in males than females for all RV functional measures (34±10 vs 28±10, %, p&amp;lt;0.05); (50±10 vs 44±11, %, p&amp;lt;0.05); (61±12 vs 52±11, %, p&amp;lt;0.05), for ΔFAC, ΔTAPSE, and ΔRVS’, respectively. There was no association between RV CR and functional capacity parameters in healthy individuals, whereas in patients with repaired TOF there was a significant association with peak absolute VO2 (ml/min) (r=.36, p&amp;lt;0.001, with ΔFAC). Conclusions We have presented normal values for RV CR parameters in healthy cases during stress echocardiography. RV CR is an important determinant of exercise capacity in patients with abnormal RV function but not in normal subjects.

Right ventricular strain: A powerful prognostic indicator

Right ventricular (RV) characteristics are important for heart failure patients and especially in patients with a tricuspid regurgitation. Right heart catheterisation is advocated by guidelines as an adjunct assessment. Echocardiography alone is challenging due to complexity of the right heart. Speckle tracking allows the detection of subtle changes that may be missed by the naked eye. We sought to assess the utility of RV strain (free wall) to assess prognosis and build a multivariate prediction model based on clinical, echocardiographic and hemodynamic data. A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ± 11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. The echocardiograms were read at the corelab. The association between RV strain (free wall) and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death was recorded. A multivariate predictor model was computed using SAS 15.1. Over a median follow-up of 28 ± 16 months, there were 59 events. Main data are summarized in Table 1. Abnormal RV strain was independently associated with prognosis HR: 3.63 (1.43–9.22). This was the key echo parameter. The other key parameters were: creatinine clearance HR: 0.88 (0.79–0.98), TAPSE HR: 0.73 (0.57–0.93), RA area HR: 1.44 (1.19–1.75), RA pressure HR: 1.65 (1.34–2.04) and mean pulmonary artery pressure HR: 1.39 (1.08–1.78). RV strain is a strong “predictor” and appears to perform better than traditional echocardiographic measurements. Prospective studies would support the utility of RV strain especially in patients with heart failure and tricuspid regurgitation.

PO-02-228 ASSOCIATION BETWEEN SIGNAL-AVERAGED ECG INDICES AND RV STRUCTURAL ABNORMALITIES IN PATIENTS WITH ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY: INSIGHTS FROM NORDIC ARVC REGISTER

The value of signal-averaged ECG (SAECG) derived ventricular late potentials (LP) as a minor depolarization criterion of arrhythmogenic right ventricular cardiomyopathy (ARVC) has been debated. Another criterion from the same category, terminal activation duration (TAD>55 ms), is obtained from standard V1 ECG lead, which makes it easier for use. However little data exist regarding the relationship between structural right ventricular (RV) ARVC substrate, LP and TAD. We aimed to explore the association between structural and functional RV abnormalities assessed using cardiac magnetic resonance (CMR), SAECG parameters, and abnormal TAD. Patients with definite ARVC diagnosis or genotype-positive family members who were recruited in the Nordic ARVC Registry with SAECG and CMR were included (n=268, mean age 42±16 years, female 46%, probands 49%). RV end-diastolic volume index (RVEDVI), RV ejection fraction (RVEF), and late gadolinium enhancement (LGE) presence were assessed. RV was defined as enlarged if RVEDVI > 100 ml/m2 for men and 90 ml/m2 for women. RVEF was considered reduced if lower than 45%. SAECG components were assessed using TFC2010 definitions: filtered QRS duration (fQRSd)>114 ms, duration of terminal low-amplitude QRS signal below 40 μV (LAS40)> 38 ms and root-mean-square voltage of the terminal 40 ms (RMS40)< 20 μV. An abnormal value of any one or more of these indexes was considered as the presence of LP. We assessed sensitivity and specificity of the SAECG indexes and TAD for association with abnormal RVEF, LGE and/or RVEDVI. C-statistics was used to assess the association between each of SAECG parameters as continuous variables and RV abnormalities. All 3 SAECG indexes were significantly associated with RV structural abnormalities using c-statistics (Table), each of them characterized by higher specificity and lower sensitivity than LP. TAD demonstrated high specificity but poor sensitivity in prediction of RV structural abnormalities. LP had lower specificity, but much higher sensitivity for association with RV structural and functional abnormalities than TAD. In a large cohort of patients with definite ARVC or genotype-positive family members SAECG indexes appear to have lower specificity for detection of structural and functional RV abnormalities compared to TAD, however its sensitivity far exceeds the one of the TAD and supports SAECG value as an ECG indicator of RV substrate.

Biventricular Function is Impaired in Right Ventricular Septal Pacing-A Prospective Study Using Myocardial Strain Imaging.

Left ventricular (LV) dysfunction is known to occur after right ventricular (RV) pacing; the effect on RV function is less well studied. The aim of this study was to assess the impact of RV mid-septal pacing upon RV function using the novel parameters of speckle-tracking derived RV global longitudinal strain (RV GLS) and RV free wall strain (RV FWS), as well as the conventional parameters RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular systolic velocity (RV S'). Thirty-two (32) consecutive patients with normal baseline LV and RV function requiring permanent pacemaker insertion were prospectively recruited. Echocardiography was performed prior to implantation, at 1 day, 1 month and 1 year after implantation, with 29 patients completing follow-up. After 1 year, three patients (10%) with otherwise normal RV parameters developed abnormal RV strain patterns. Compared to 1 day after implantation, at 1 year significant reductions were observed in mean RV GLS (-24.8 to -21.8%) RV S' (15.1 to 12.2 cm/s), TAPSE (24.2 to 21.9 mm), RV GLS (-24.8 to -21.8%), left ventricular ejection fraction (LVEF) (66.0 to 57.9%), LV GLS (-19.9 to 17.0), all p<0.01. There was a non-significant reduction for RV FWS (-29.0 to -26.7%, p=0.06) and there was no change in RV FAC (49.1 to 46.9%, p=0.24). We report abnormalities of RV strain developing 1 year after pacemaker insertion. Measurement of myocardial strain is emerging as an additional method to detect patients at risk of RV dysfunction in those who have undergone pacemaker implantation.

Prognostic Impact of Right Ventricular Strain in Isolated Severe Tricuspid Regurgitation

Right ventricular (RV) systolic function is an established marker of outcomes in patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction using conventional two-dimensional echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for the evaluation of RV function, with the capability to detect subclinical RV dysfunction. The aim of this study was to evaluate the prognostic value of RV strain parameters in early stages of severe TR. Consecutive patients with at least severe TR (severe, massive, or torrential) and the absence of a formal indication for tricuspid valve intervention in secondary TR evaluated in the Heart Valve Clinic were prospectively included. RV systolic function was measured using conventional echocardiographic indices (RV fractional area change, tricuspid annular plane systolic excursion, and Doppler tissue imaging S wave [S']) and speckle-tracking echocardiography-derived automatic peak global longitudinal strain and free wall longitudinal strain (FWLS) using an automated two-dimensional strain analytic software. A combined end point of hospital admission due to heart failure or all-cause mortality was defined. A total of 266 patients were enrolled in the study, and 151 were ultimately included. Strain parameters detected a higher percentage of abnormal RV values compared with conventional indices. During a median follow-up period of 26months (interquartile range, 13-42months), 35% of the patients reached the combined end point. Cumulative event-free survival was significantly worse in patients with impaired RV global longitudinal strain and RV FWLS. Conventional indices of RV systolic function were not associated with outcomes (P>.05 for all). On multivariate analysis, RV FWLS was independently associated with mortality and heart failure (adjusted hazard ratio for abnormal RV FWLS, 5.90; 95% CI, 3.17-10.99; P<.001). In early stages of severe TR, RV FWLS is more frequently impaired compared with conventional indices of RV function. Among all parameters, RV FWLS is the strongest predictor of mortality and heart failure, independent of additional prognostic markers.

Abnormal right ventricular echocardiographic findings in recovered patients associated with severe acute respiratory syndrome in COVID-19.

Right ventricular (RV) echocardiographic changes such as dilation or systolic dysfunction, and pulmonary arterial hypertension were observed in patients with COVID-19. The aim of our study was to determine the frequency of RV echocardiographic changes in patients who have recovered from COVID-19 and to verify the association between severe acute respiratory syndrome (SARS) and echocardiographic findings. Patients who had recovered from COVID-19 undergoing outpatient follow-up underwent transthoracic echocardiography, and based on the findings, were divided into two groups: normal and abnormal. It was then verified whether there is an association between SARS and RV echocardiographic abnormalities in recovered patients. The study included 61 patients, with a mean age of 54.2±12.0 years, 57.4% had presented with SARS. The mean period of time between COVID-19 and the echocardiographic examination was 11.9±7.0 months. Patients presented normal left ventricular systolic function. The frequency of RV echocardiographic changes in patients who had recovered from COVID-19 was 44.3%. RV systolic dysfunction was identified in 31.1%, followed by ventricular dilation in 14.7% and pulmonary hypertension in 9.8%. An association was observed between SARS and RV echocardiographic changes in recovered patients during outpatient follow-up (OR: 4.96; 95% CI: 1.37-17.9; p=0.015). An association was also demonstrated between SARS and RV dilation (p=0.007) and between SARS and systolic dysfunction (p=0.028). SARS is a risk factor for abnormal RV echocardiographic findings in patients recovered from COVID-19.

Cardiologic Manifestations in Omicron‐Type Versus Wild‐Type COVID‐19: A Systematic Echocardiographic Study

Background Information about the cardiac manifestations of the Omicron variant of COVID-19 is limited. We performed a systematic prospective echocardiographic evaluation of consecutive patients hospitalized with the Omicron variant of COVID-19 infection and compared them with similarly recruited patients were propensity matched with the wild-type variant. Methods and Results A total of 162 consecutive patients hospitalized with Omicron COVID-19 underwent complete echocardiographic evaluation within 24 hours of admission and were compared with propensity-matched patients with the wild-type variant (148 pairs). Echocardiography included left ventricular (LV) systolic and diastolic, right ventricular (RV), strain, and hemodynamic assessment. Echocardiographic parameters during acute infection were compared with historic exams in 62 patients with the Omicron variant and 19 patients with the wild-type variant who had a previous exam within 1 year. Of the patients, 85 (53%) had a normal echocardiogram. The most common cardiac pathology was RV dilatation and dysfunction (33%), followed by elevated LV filling pressure (E/e' ≥14, 29%) and LV systolic dysfunction (ejection fraction <50%, 10%). Compared with the matched wild-type cohort, patients with Omicron had smaller RV end-systolic areas (9.3±4 versus 12.3±4 cm2; P=0.0003), improved RV function (RV fractional-area change, 53.2%±10% versus 39.7%±13% [P<0.0001]; RV S', 12.0±3 versus 10.7±3 cm/s [P=0.001]), and higher stroke volume index (35.6 versus 32.5 mL/m2; P=0.004), all possibly related to lower mean pulmonary pressure (34.6±12 versus 41.1±14 mm Hg; P=0.0001) and the pulmonary vascular resistance index (P=0.0003). LV systolic or diastolic parameters were mostly similar to the wild-type variant-matched cohort apart from larger LV size. However, in patients who had a previous echocardiographic exam, these LV abnormalities were recorded before acute Omicron infection, but not in the wild-type cohort. Numerous echocardiographic parameters were associated with higher in-hospital mortality (LV ejection fraction, stroke volume index, E/e', RV S'). Conclusions In patients with Omicron, RV function is impaired to a lower extent compared with the wild-type variant, possibly related to the attenuated pulmonary parenchymal and/or vascular disease. LV systolic and diastolic abnormalities are as common as in the wild-type variant but were usually recorded before acute infection and probably reflect background cardiac morbidity. Numerous LV and RV abnormalities are associated with adverse outcome in patients with Omicron.

Evaluation of Right Ventricular Function in Patients with Propionic Acidemia-A Cross-Sectional Study.

(1) Background: In propionic acidemia (PA), myocardial involvement often leads to progressive cardiac dysfunction of the left ventricle (LV). Cardiomyopathy (CM) is an important contributor to mortality. Although known to be of prognostic value in CM, there are no published data on right ventricular (RV) function in PA patients. (2) Methods: In this cross-sectional single-center study, systolic and diastolic RV function of PA patients was assessed by echocardiography, including frequency, onset, and combinations of echocardiographic parameters, as well as correlations to LV size and function. (3) Results: N = 18 patients were enrolled. Tricuspid annulus S' was abnormal in 16.7%, RV-longitudinal strain in 11.1%, tricuspid annular plane systolic excursion (TAPSE) in 11.1%, Tricuspid valve (TV) E/e' in 33.3%, and TV E/A in 16.7%. The most prevalent combinations of pathological parameters were TV E/A + TV E/e' and TAPSE + TV S'. With age, the probability of developing abnormal RV function increases according to age-dependent normative data. There is a significant correlation between TAPSE and mitral annular plane systolic excursion (MAPSE), and RV/LV-longitudinal strain (p ≤ 0.05). N = 5 individuals died 1.94 years (mean) after cardiac evaluation for this study, and all had abnormal RV functional parameters. (4) Conclusions: Signs of diastolic RV dysfunction can be found in up to one third of individuals, and systolic RV dysfunction in 16.7% of individuals in our cohort. RV function is impaired in PA patients with a poor outcome. RV functional parameters should be used to complement clinical and left ventricular echocardiographic findings.

Evaluation of the Effect of Carvedilol in Preventing Right Ventricular Dysfunction in Breast Cancer Patients Receiving Anthracycline.

Today, it has been shown that it is possible for right ventricular (RV) wall motion abnormalities or RV functional disorders to occur during cancer treatment. Now, considering the effect of carvedilol on beta 1, 2, and alpha receptors and its antioxidant properties, it seems that it can prevent RV abnormalities. Therefore, the aim of this study was to investigate the possible protective effects of carvedilol in preventing RV dysfunction in patients with breast cancer treated with anthracyclines. The present single-blind clinical trial study was performed on 23 patients with breast cancer that 12 of them received only the anthracycline antineoplastic doxorubicin (Adriamycin®) chemotherapy (control group) and 11 patients received carvedilol in addition to anthracycline. To evaluate the effect of carvedilol, patients underwent transthoracic echocardiography before intervention and 2 weeks after the end of treatment with anthracyclines. The two parameters of RV ejection fraction and RV fractional area change in the carvedilol group with a mean of 66.41% ± 8.10% and 51.85% ± 6.89% were slightly higher than the control group with a mean of 64.58% ± 6.83% and 50.48 ± 5.79%, respectively, which was not statistically significant (P > 0.05). In contrast, RV S wave tissue Doppler imaging (S-TDI) in the control group with a mean of 0.13 ± 0.02 m/s was significantly lower than the carvedilol group with a mean of 0.14 ± 0.02 m/s (P = 0.022). According to the results of the present study, the effect of using carvedilol as a preservative on improving RV function was seen compared to the control group, although this difference was not statistically significant.

Clinical significance of right ventricular-pulmonary arterial coupling in patients with tricuspid regurgitation before closure of atrial septal defect.

Functional tricuspid regurgitation (TR) usually decreases after atrial septal defect (ASD) closure; however, it may persist and cause heart failure that requires treatment. We aimed to investigate clinical and echocardiographic factors predicting persistent TR after ASD closure. Among 348 adults who underwent isolated ASD closure between January 2010 and September 2020, 91 (26.1%) patients with significant TR (at least moderate degree) before ASD closure were included. Persistent TR was defined as significant TR on echocardiography at 6 months to 1 year after ASD correction. We comprehensively analyzed the echocardiogram before ASD closure, including speckle-tracking imaging. Right ventricular (RV)-pulmonary arterial (PA) (RV-PA) coupling was assessed by the ratio of RV global longitudinal strain (RV GLS) and tricuspid annular S' velocity to PA systolic pressure (PASP). Persistent TR was observed in 22 (24.2%) patients. Patients with persistent TR were significantly older and had larger TR jet areas and lower RV-PA coupling parameters than those without persistent TR. On multivariable regression, persistent TR was independently associated with age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14, p = 0.030) and |RV GLS|/PASP (OR 0.001, 95% CI 0.00-0.017, p = 0.012). ROC curves analysis showed that |RV GLS|/PASP's best cut-off for persistent TR was 0.46 (cut-off 0.46, the area under the curve 0.789, p < 0.001). Persistent TR after ASD closure is not rare. Old age and RV-PA uncoupling could be associated with persistent TR after ASD closure. In older patients with abnormal RV-PA coupling, careful evaluation and concomitant or subsequent TR intervention may be considered.

Abstract 14147: Septal Longitudinal Strain Predicts Long-Term Mortality in Patients With Acute Pulmonary Embolism

Background Acute pulmonary embolism (PE) is associated with an increased risk of short- and long-term mortality. Since interventricular septal systolic function contributes to a third of right ventricular (RV) cardiac output, we sought to investigate the potential value of septal strain in PE. Methods This was a retrospective cohort study of patients admitted with acute pulmonary embolism. Patients underwent echocardiography during admission and included left ventricular (LV) speckle tracking, by which global longitudinal strain (GLS) and regional strain were acquired. Multivariable adjustments were made for age, sex, simplified PE index (sPESI), abnormal cardiac biomarkers (troponin or proBNP) and RV systolic function. The endpoint was all-cause death. Results The cohort consisted of 186 patients (mean age 68 years, 54% men), of whom 49 (26%) died during a median follow up of 3.5 years (IQR: 2.9-6.7 years). All LV systolic measures were univariable predictors of death (LVEF: HR: 1.04 (1.02-1.06), per 1% decrease; GLS: HR: 1.15 (1.07-1.22), per 1% absolute decrease; septal strain: HR: 1.15 (1.08-1.23), per 1% absolute decrease] (figure). RV systolic function was also associated with death [TAPSE: HR: 1.06 (1.01-1.12), per 1mm decrease). After multivariable adjustments, only septal strain remained significantly associated with outcome (HR: 1.09 (1.01-1.19), p=0.029, per 1% absolute decrease). Furthermore, septal strain significantly increased C-statistics when added to a base model of sPESI score, abnormal biomarkers and presence of hypotension (base model C-stat: 0.76; base model and septal strain C-stat: 0.83, p for increment = 0.006). Conclusion Septal strain is associated with death in acute PE and provides prognostic information beyond conventional risk assessment.

Abstract 12518: Echocardiographic Features and Natural History of Right Ventricular Dysfunction in Cardiac Sarcoidosis With or Without Pulmonary Involvement

Introduction: Cardiac sarcoidosis (CS) is a non-ischemic disease which can present with right ventricular (RV) dysfunction, but there is a paucity of research describing RV function and natural history in CS. Methods: We queried a registry of 512 CS patients for those with baseline and follow-up echocardiography (TTE). Demographics, medications, and baseline/follow-up TTE data were collected. RV-pulmonary arterial (RV-PA) coupling was approximated by ratio of tricuspid annular plane systolic excursion to estimated pulmonary artery systolic pressure (TAPSE:ePASP). Results: Our query yielded 343 CS patients with mean age 56y (σ=12y), who were predominantly male (67%) and white (90%) with a median follow-up 4y (interquartile range 4.1y). Most had pulmonary sarcoidosis (68%). Baseline TTE data showed left ventricular ejection fraction 48% (σ=14), abnormal RV function with RV systolic pressure (ePASP) 34 mmHg (σ=11), TAPSE 21mm (σ=5), RV S′ 0.14 m/s (σ=0.07), and RV-PA uncoupling (TAPSE:ePASP 0.69 mm/mm Hg, σ=0.25). Baseline RV function parameters did not differ by pulmonary involvement of sarcoidosis. 92% received immunosuppression and 65% received neurohormonal blockade. In long-term follow-up, the overall cohort demonstrated a trend towards worsening of both RV S’ and RV-PA coupling (P=.02 and P=.003 for linear trend, respectively) but stable ePASP (P=.11). Trends in both non-invasive ePASP and RV-PA coupling were similar in patients with and without pulmonary involvement (P=.48 and P=.79, respectively). Conclusions: In our large CS cohort with extensive follow-up, metrics of RV function and RV-PA coupling are often abnormal at CS diagnosis. Echocardiographic measures of PASP tend to remain stable but markers of RV dysfunction, including RV-PA coupling, tend to worsen throughout the disease course irrespective of pulmonary sarcoidosis. More granular phenotyping of pulmonary hypertension in CS is required to better understand this relationship.

Abstract 13585: In Patients With Right Bundle Branch Block, ECG Z-Axis QRS-T Voltage-Time-Integral Predicts Right Ventricular Structure and Function

Introduction: Right bundle branch block (RBBB) is the most common His-Purkinje conduction abnormality seen on ECG. It is currently unclear if there are any quantitative ECG differences in RBBB without and with structural right ventricular (RV) disease. Our aim was to evaluate quantitative ECG predictors of echocardiographic RV measurements [tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging RV S’, RV basal and mid diameters, RV systolic pressure (RVSP)]. Hypothesis: QRS-T VTI in patients with RBBB is a marker for adverse RV remodeling and dysfunction. Methods: We included adults with ECG demonstrating typical RBBB and echocardiogram performed within 3 months of each other in 2010-2020. Orthogonal X, Y, Z ECG leads were reconstructed using Kors matrix. In addition to overall QRS duration, QRS voltages and QRS/QRS-T VTIs from 12 standard leads, X, Y, Z leads, and 3D (root-mean-square) ECG were evaluated. Age, sex and BSA-adjusted linear regressions were used to assess associations between ECG variables and RV measurements. We separately generated ROC curves for predicting abnormal RV measurements from ECG variables. Results: We included 782 patients (33% women, 71±14 years). Amongst the ECG variables, BSA-indexed Z-axis QRS-T VTI (VTI QRST-Z *√BSA) was the strongest independent predictor of all 5 RV measurements (Table 1a shows a comparison of QRS duration, Z-axis amplitude and VTI). VTI QRST-Z *√BSA cutoff 62 μVsm had a sensitivity 62.7% and specificity 65.7% to distinguish presence of ≥3 abnormal out of the 5 RV measurements (Table 1b). Conclusions: Adverse RV remodeling causes augmentation of the anterior-posteriorly directed QRS-T potential which is seen as a change in Z-axis VTI. VTI QRST-Z *√BSA could be used as a marker for right heart failure in patients with RBBB.

Stress Echocardiographic Prediction of Emerging Pulmonary Vascular Disease in Systemic Sclerosis

Systemic sclerosis (SSc) patients experience disproportionate morbidity and mortality from pulmonary arterial hypertension (PAH) and right ventricular (RV) dysfunction.1 Two-dimensional (2D) speckle-tracking echocardiography (STE) can be used for noninvasive assessment of impaired RV contractile reserve in SSc patients at risk for PAH.2,3 However, there are no established statistical models that are predictive of emerging pulmonary vascular disease (PVD) in SSc. In the present study, we first sought to establish whether abnormal RV contractile reserve is associated with future elevation in pulmonary arterial pressures (PAPs).

Three dimensional speckle tracking echocardiography in breast cancer patients receiving chemotherapy: incidence and clinical outcomes of subclinical right ventricular systolic dysfunction

Abstract Background The data about the influence of chemotherapy on right ventricular (RV) function and mechanics are scarce and conflicting. Due to the special geometric structure and unique wall motion of the RV, routine techniques for echocardiographic assessment of the RV has challenges. However, 3-dimensional echocardiography (3DE) tracks changes in RV volumes in real time, including the inflow and outflow tracts and the apex throughout the cardiac cycle. 3DE evaluation of RV function and morphology has been compared to cardiac magnetic resonance and is accurate, feasible, and reproducible Methods This study conducted was a retrospective cohort study which included 75 breast cancer patients who underwent chemotherapy at a tertiary hospital from January 2019 to May 2021 to determine clinical outcomes of patients among those who developed an abnormal right ventricular longitudinal free wall strain and global longitudinal strain in terms of all-cause mortality, development of overt right ventricular systolic dysfunction, and adverse cardiovascular events. Results There was a striking statistically significant difference in terms of right ventricular ejection fraction among those who developed an abnormal right ventricular global longitudinal strain at 6 and 12 months post-chemotherapy with a p-value of 0.001 and 0.000 respectively. The difference between the 2 groups of patients in terms of right ventricular global longitudinal strain 6 and 12 months after chemotherapy was also statistically significant (p=0.000). As for the left ventricle, the LV ejection fraction and global longitudinal strain were also statistically significantly different at 12 months post-chemotherapy. Among those who developed an abnormal RV global longitudinal strain, the LV global longitudinal strain was also subsequently lower compared to the normal subgroup at 12 months post-treatment. Conclusion Although the sample size was small, the development of abnormal RV GLS post-chemotherapy was generally associated with subsequent development of overt heart failure, increased all-cause mortality, and CV death. The use of echocardiographic RV GLS surveillance to guide chemotherapy is crucial to enhance clinical outcomes and survival. Funding Acknowledgement Type of funding sources: None.

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

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