Right Ventricular Dysfunction In Patients Research Articles

(816) - Best Practices to Manage Right Ventricular Dysfunction in Patients with Left Ventricular Assist Device Therapy

(816) - Best Practices to Manage Right Ventricular Dysfunction in Patients with Left Ventricular Assist Device Therapy

Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure.

The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. This study comprised 195 patients, aged between 18 and 80years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1year due to non-cardiac causes were excluded. The study participants' mean age was 57.7 ± 10.9years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17mm, RV S' < 9.5cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.

Clot ratio, new clot burden score with deep learning, correlates with the risk stratification of patients with acute pulmonary embolism.

Risk stratification for patients with acute pulmonary embolism (APE) is significantly important for treatment and prognosis evaluation. We aimed to develop a novel clot burden score on computed tomography pulmonary angiography (CTPA) based on deep learning (DL) algorithm for risk stratification of APE. The study retrospectively enrolled patients newly diagnosed with APE in China-Japan Friendship Hospital consecutively. We collected baseline data and CTPA parameters, and calculated four different clot burden scores, including Qanadli score, Mastora score, clot volume and clot ratio. The former two were calculated by two radiologists separately, while clot volume and clot ratio were based on the DL algorithm. The area under the curve (AUC) of four clot burden scores were analyzed. Seventy patients were enrolled, including 17 in high-/intermediate-high risk and 53 in low-/intermediate-low risk. Clot burden was related to the risk stratification of APE. Among four clot burden scores, clot ratio had the highest AUC (0.719, 95% CI: 0.569-0.868) to predict patients with higher risk. In the patients with hemodynamically stable APE, only clot ratio presented statistical difference (P=0.046). Clot ratio is a new imaging marker of clot burden which correlates with the risk stratification of patients with APE. Higher clot ratio may indicate higher risk and acute right ventricular dysfunction in patients with hemodynamically stable status.

Kiosk 7R-FC-03 - Prevalence, Associations, and Prognostic Relevance of Right Ventricular Dysfunction in Patients with Chronic Ischemic Cardiomyopathy Undergoing Cardiovascular Magnetic Resonance Imaging

Kiosk 7R-FC-03 - Prevalence, Associations, and Prognostic Relevance of Right Ventricular Dysfunction in Patients with Chronic Ischemic Cardiomyopathy Undergoing Cardiovascular Magnetic Resonance Imaging

Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism

Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism

Predictors of Right Ventricular Dysfunction in Patients with Atrial Fibrillation and its Clinical Implications: Single Centre Experience

Predictors of Right Ventricular Dysfunction in Patients with Atrial Fibrillation and its Clinical Implications: Single Centre Experience

Assessment of pulmonary vascular resistance via doppler echocardiography in ischemic heart disease with reduced ejection fraction

Objectives: To determine pulmonary vascular resistance (PVR) by echocardiography - Doppler; and evaluate the correlation between pulmonary vascular resistance and some variables such as left ventricular EF, PASP, TAPSE, and tissue S-wave of the tricuspid valve in patients with ischemic heart disease. Method: Observational study on 82 heart failure patients with reduce ejection fraction brought upon by ischemic heart disease, at the Cardiology Department of the University of Medicine and Pharmacy from 04/2016 - 05/2017. Results: The average PVR is 3.91 ± 1.85 WU. There was not significant difference between age and gender groups (p &gt; 0.05), but there was a statistically significant difference of PVR in patients with NYHA III and IV compared to NYHA I, II (p &lt; 0.05). When EF &lt; 30%, the rate of increased PVR is higher than the normal value (35.4 % vs 4.9%). There is a strong correlation between LVEF and PVR (r = - 0.545, p &lt; 0.001), especially when PVR &lt; 8 WU (r = - 0.618, p &lt; 0.001). When the PASP increases, the rate of increased PVR is higher than normal value (54.9% vs. 9.8%, p &lt; 0.001), with an enough correlation coefficient (r = 0.361, p &lt; 0.001). In patients with RV systolic dysfunction evaluated by TAPSE and S’ wave, there was a significant difference in the rate of increased PVR from the normal value (41.5% vs 1.2%; 34.1 vs 8.5%, p 0.001). PVR is closely correlated with TAPSE (r = -0.590; p &lt; 0.001) and is inversely correlated with S’ wave (r = -0.590; p &lt; 0.001). Conclusions: Increased PVR is the primary mechanism for pulmonary hypertension and right ventricular dysfunction in patients with HFrEF brought upon by IHD. The evaluation of PVR in patients with left ventricular dysfunction by echocardiography is important in clinical practice

Aortic stenosis and right ventricular dysfunction

At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn’t any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = − 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.

Qp/Qs in ostium secundum atrial septal defect mitigates right ventricular dysfunction in patients with secondary pulmonary hypertension

Abstract Background Ostium-secundum atrial septal defect (OS-ASD) can potentially lead to pulmonary hypertension (PH) and associated right ventricle (RV) - pulmonary artery (PA) uncoupling. This, in turn, may eventually result in RV systolic dysfunction. Notwithstanding, whether the characteristics of the OS-ASD could mitigate this relationship is unclear. Purpose To evaluate a potential interaction of the OS-ASD shunt (Qp/Qs ratio) on the relationship with RV–PA coupling and RV systolic function in patients with secondary PH. Methods We designed a cross-sectional study of 63 adult patients with OS-ASD in which we performed a conventional transthoracic echocardiogram using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway). We evaluated the OS-ASD shunt and other echocardiographic parameters, including the tricuspid annular plane systolic excursion (TAPSE), the systolic pulmonary artery pressure (sPAP) ratio and the right ventricular free wall longitudinal strain (RVFWLS). Polynomic adjusted correlations were performed to model the relationship between the TAPSE/sPAP ratio and the RVFWLS, then we evaluated an interaction effect of the OS-ASD shunt (Qp/Qs ratio), respectively adjusted for age, sex, body mass index, body surface area and right atrial area. Results In our study, 49 (78%) subjects were male, with a mean age of 41.8 (±15) years; 7.94% (n=5) had mild PH, 42.9% (n=27) had moderate PH and 49.2% (n=31) had severe PH. Mean echocardiographic parameters were: TAPSE 24.5 (±5.1) mm , sPAP of 55.9 (±20.7) mmHg, TAPSE/sPAP 0.49 (±0.2) mm/mmHg, RVFWLS -25.6 (±6.6) % and Qp/Qs 2.9 (±0.9). We observed a quadratic relationship between the TAPSE/sPAP ratio and the RVFWLS (r=0.691, p &amp;lt; 0.001; Figure 1). OS-ASD shunt had a positive interaction effect (β=10.9, 95% CI: 2.09-19.6, p=0.018) on the relationship between TAPSE/sPAP and RVFWLS after adjusting for covariates (Figure 2). Conclusions In conclusion, in patients with OS-ASD, the RV systolic function decreases as the RV-PA uncoupling increases, as reflected in the quadratic regression between the TAPSE/sPAP and the RVFWLS. Moreover, the increase in OS-ASD shunt decreases RVFWLS values in relationship to the TAPSE/sPAP ratio as observed in the interaction model. These results could suggest that the OS-ASD characteristics could potentially mitigate RV dysfunction in patients with secondary PH.Figure 1.Quadratic regressionFigure 2.Interaction model

Echocardiographic assessment of right heart function in the presence of TR: Is right heart strain the answer?

Abstract Background Right heart function is challenging to assess with echocardiography due to the complex anatomy and load dependence. To complicate the assessment, significant tricuspid regurgitation flatters the right ventricle. These complexities have led to the need for other modalities and invasive measures of RV function to complement clinical decision-making and risk profiling. Speckle tracking can assess subtle anomalies and appears to be promising for right heart assessment. We assessed right heart strain against classic echocardiographic measures of RV function (TAPSE, RVS’ and fractional area change (FAC)) and invasive measures of RV function (right ventricular stroke work index (RVSWI) and Pulmonary Artery Pulsatility index (PAPi)), in patients with severe TR and without, to see strain reclassifies the assessment of RV function from "normal" to impaired and to assess the prognostic value of right heart strain. Methods A single-centre retrospective analysis of data from 262 consecutive patients (age 74 ±11.2 years old; male 53%) with both right heart catheterization (RHC) and TTE. Clinical data was gathered from patient files, and outcomes of heart failure hospitalisation or death were recorded. Echocardiographic evaluation was completed on commercially available GE ultrasounds and data was stored on a dedicated workstation for offline analysis (EchoPAC version 112.99). Statistical analysis was performed using SAS 15.1. Results Over a median follow up of 34 ±15 months 99 events occurred. 53% of patients had severe TR. RV free wall strain reclassified RV function as impaired in 73% of patients with "normal" RV function as determined by FAC (p value 0.005), and in 71% of patients with normal RVS’ (p value 0.03) with severe TR. Using invasive measures, RVSWI reclassified RV function as abnormal when compared to TAPSE in 53% of patients (p value 0.02). PAPi reclassified RV function as impaired compared to TAPSE in 53% of patients (p value of 0.009). In patients with TR 3+, right atrial strain reclassified presence of right heart dysfunction in 91% of patients compared to TAPSE &amp;gt;17 (p value 0.01) and in 95% of patients compared to RVS’ (p value 0.004). In patients with moderate or less TR, RV strain reclassified 66% as having RV dysfunction with normal FAC (p value 0.003) and reclassified 61% of patients with RV dysfunction in patients with a normal RVS (p value 0.03). Invasive measures did not reclassify RV function assessment in patients with moderate or less TR. In patients with and without TR, RV strain and invasive measures were in accordance. Abnormal RV strain (&amp;gt;-23%) was associated with an adverse prognosis HR 3.63 (1.43 – 9.22). Conclusion In the presence of severe TR, right heart strain helps to reclassify RV function, comparable to invasive measures. Abnormal right heart strain is strongly associated with prognosis and its utility should be confirmed in prospective studies.

Abstract 18495: Right and Left Ventricular Starling Function in Heart Failure With Preserved Ejection Fraction

Background: Efficient conversion of cardiac filling pressure to stroke volume (SV) is described by the Frank-Starling mechanism. Our group has previously characterized dynamic Starling mechanisms (DSM) in the frequency domain using respiratory mediated changes in beat-by-beat SV as a function of changes in pulmonary artery diastolic pressures (PAD) and shown this to be impaired in heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is common in HFpEF but efficiency of the RV Starling mechanism is unknown. The goal of this study was to characterize RV and LV DSM in patients with HFpEF. Methods: We studied 16 HFpEF patients (10 females; age: 68 ± 6 years) at seated rest following the placement of a radial arterial and right heart catheter. DSM was quantified by transfer function (input/output frequency) analyses of beat-by-beat changes in PAD (for LV) and A wave right atrial pressures (for RV) as input variables. Output variable was SV (Modelflow from radial arterial line waveform) and normalized for LV DSM using direct-Fick derived SV and for RV DSM using acetylene rebreathing derived SV as a measure of pulmonary blood flow. Results: The power spectral density (PSD) was higher for LV compared to RV filling pressure (521 ± 446 vs 125 ± 111 mmHg 2 , P = 0.001); there was no difference for adjusted SV PSD (819 ± 764 vs 808 ± 765 ml 2 , P = 0.232). DSM gain was higher for LV compared to RV for all but 1 subject (0.58 ± 0.29 vs 0.30 ± 0.16 ml/mmHg, P = 0.002; Figure). Conclusions: RV DSM gain was significantly worse than LV DSM gain suggesting decreased RV contractile and/or compliance reserve in patients with HFpEF. These results highlight the utility of RV DSM gain to characterize RV dysfunction in patients with HFpEF.

The association of hemodynamic markers of right ventricular dysfunction with SII index and clinical outcomes in reduced ejection fraction heart failure.

Heart failure (HF) is a clinical syndrome with various etiologies and presentations. The role of the inflammatory pathway in HF prognosis is not fully understood. We investigated the association between the systemic immune-inflammation index (SII) and HF complicated by right ventricular dysfunction (RVD) and whether the SII is related to compromised hemodynamic volume status. A total of 235 patients with HF with reduced ejection fraction (HFrEF) were enrolled and divided into 2 groups according to the presence of RVD. The relationship between the SII score, hemodynamic parameters, and clinical endpoints was evaluated. Higher SII scores and neutrophil counts (P < .001 and P = .017, respectively) were observed in the RVD group (n = 120). In the high SII score group (≥590.4), hospitalization and the need for positive inotrope treatment were significantly higher (P = .026 and P = .009, respectively), and left ventricular ejection fraction (LVEF) was significantly lower (P = .015). In addition, in the high SII score group, right heart catheterization values, including cardiac output and index, were significantly impaired compared with those in the lower SII score group. There was a significant negative correlation between the SII score and the LVEF, cardiac output, and cardiac index in the correlation analyses. A significant relationship was observed between indirect inflammation and RVD in patients with HFrEF. The hemodynamic volume status and functional capacity were impaired in patients with high SII scores. These results indicated that advanced HF with worse outcomes may be related to the inflammatory process.

Predictive value of reduced pulmonary arterial elasticity in acute pulmonary embolism for right ventricular dysfunction.

Computed tomography pulmonary angiography (CTPA) yields indices, such as the right ventricular/left ventricular (RV/LV) ratio > 1.0, which are commonly used for risk stratification of patients with acute pulmonary embolism (APE). Although pulmonary artery elasticity (PAE) has been previously described, its relationship with right ventricular dysfunction (RVD) has not been explored. Here, we investigated whether PAE, measured using CTPA, is associated with RVD. Patients who underwent retrospective electrocardiogram-gated CTPA and had a definitive diagnosis of APE were included in the study. The subjects were classified into RVD and non-RVD groups according to the RVD on echocardiography. PAE, involving aortic distensibility (AD), aortic compliance (AC), and aortic stiffness (ASI), and right heart function indices were compared between the two groups, and their correlations were examined. Receiver operating characteristic (ROC) curves were generated to evaluate the specificity and sensitivity of the RVD prediction. Thirty-five patients with APE were enrolled in the study (RVD: 18, non-RVD: 17). The groups showed no significant differences in age, sex, number of patients receiving thrombolysis, and number of high-risk conditions (P > 0.05). Regarding PAE parameters, AD was significantly reduced in the RVD group compared to that in the non-RVD group (P < 0.05), whereas AC and ASI were not statistically different (P > 0.05). The ratio of the maximum cross-sectional area of PA and AA (PA/AAmax),the ratio of the minimum cross-sectional area of PA and AA(PA/AAmin), diameter of the coronary sinus, RV/LV diameter, RV/Lvarea, the ratio of the end-diastolic volume of right ventricular and left ventricular (RV/LVDV), the ratio of the end-systolic volume of right ventricular and left ventricular (RV/LVSV) were significantly greater in the RVD group than in the non-RVD group (P < 0.05). Correlation analysis of AD and right heart function parameters showed that AD was negatively correlated with PA/AAmax, PA/AAmin, RV/LV diameter, RV/LVDV, and PAE measured by ultrasound, with correlation coefficients ranging from - 0.336 to - 0.580 (P < 0.05). The ROC curves of AD and RV/LVdiameter to predict RVD had areas under the curve of 0.748 and 0.712, sensitivities of 82.35% and 70.59%, specificities of 66.67% and 72.22%, and cutoff values of 4.9433 and 1.1105, respectively. AD obtained by retrospective ECG-gated CTPA may be helpful in assessing RVD in patients with APE while accurately diagnosing APE. It contributes to timely diagnosis and treatment and improves the prognosis of patients with APE.

Value of Speckle Tracking Echocardiography for Detection of Clinically Silent Left and Right Ventricular Dysfunction in Patients with β-Thalassemia Major

Value of Speckle Tracking Echocardiography for Detection of Clinically Silent Left and Right Ventricular Dysfunction in Patients with β-Thalassemia Major

Evaluation of right ventricular function using two-dimensional speckle tracking echocardiography and analysis of the risk factors for right ventricular dysfunction in patients with silicosis

Objective: To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography (2-D STE) and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis. Methods: All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022. The clinical information of patients such as general data, arterial blood gas analysis and pulmonary function test were collected. The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain (RVFWLS) and conventional echocardiographic-derived parameters, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'), respectively. Based on their RVFWLS, the patients were divided into right ventricular dysfunction group and normal right ventricular function group. Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis. Results: A total of 104 silicosis patients were enrolled, with aneverage age (65.52±11.18) years old, among whom including 57 cases diagnosed with stage Ⅰ/Ⅱ silicosis and 47 cases diagnosed with stage Ⅲ silicosis. 26 (25.00%) patients concurrent right ventricular dysfunction. The abnormal rates of RVFAC, TAPSE and S' in patients were 16.35% (17 cases), 21.15% (22 cases) and 6.73% (7 cases), respectively. The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group, and the incidence of pulmonary arterial systolic pressure ≥36 mmHg was higher than that in normal right ventricular function group (P<0.05). Logistic regression analysis showed that arterial partial pressure of oxygen (OR=0.932, 95%CI: 0.885-0.981, P=0.007) was the protective factor, and the forced expiratory volume in 1 second (FEV(1)) /forced vital capacity (FVC) ratio<70% (OR=5.484, 95%CI: 1.049-28.662, P=0.044) and stage Ⅲ silicosis (OR=6.343, 95%CI: 1.698-23.697, P=0.007) were the risk factors for silicosis patients concurrent right ventricular dysfunction. Conclusion: The incidence of right ventricular dysfunction is higher in patients with stage Ⅲ silicosis than that in patients with stage Ⅰ/Ⅱ silicosis. Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction. Hypoxemia, airflow limitation and the stage Ⅲ silicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.

Risk stratification of pulmonary embolism.

Pulmonary embolism is the third most frequent type of cardiovascular disease behind coronary artery disease and stroke. Patients with acute pulmonary embolism have significant variability in short-term mortality from less than 0.6% in low-risk patients to 19% in high-risk patients. Risk stratification plays an important role in the management of acute pulmonary embolism as it can determine the need for urgent reperfusion therapies versus conservative strategies. The three fundamental steps of risk stratification include the immediate identification of patients that are at high risk for mortality, the identification of patients that are at an increased risk of complications from pulmonary embolism that requires hospital monitoring and potential escalation of therapies, and the identification of patients at a low risk that can be treated as an outpatient. It is vital to immediately identify high-risk patients for mortality so that they can be evaluated for urgent reperfusion therapies to improve outcomes. Risk stratification for intermediate-risk patients is based on right ventricular dysfunction in patients with hemodynamic stability. RV dysfunction can be assessed by clinical signs and symptoms along with ECHO and cardiac biomarkers. Identifying the low-risk population can help reduce the healthcare burden by allowing for early discharge and outpatient management.

Predictors of Pulmonary Hypertension and Right Ventricular Dysfunction in Patients with Hypersensitivity Pneumonitis.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) that occurs in susceptible individuals in response to various inhaled antigens. The fibrotic phenotype of HP is characterized by disease progression and can lead to pulmonary hypertension (PH). The aim of this study was to estimate the prevalence of PH and to identify predictors of PH in patients with chronic HP. We conducted an observational longitudinal study that included 85 patients with an established diagnosis of HP. Clinical examination, quality of life questionnaires, high-resolution computed tomography (HRCT) of the chest, arterial blood gases analyses, six-minute walking test (6-MWT), pulmonary function tests, and echocardiography were performed. Patients were divided into groups with fibrotic (71.8%) and nonfibrotic phenotype (28.2%). PH was detected in 41 (48.2%) patients. Patients with PH had the predominant fibrotic phenotype of HP, were older, more symptomatic, and had a higher FVC/DLco ratio. The most significant predictors of PH were CT signs of fibrosis, finger clubbing, FVC/DLco, decreased distance, and SpO2 at the end of 6-MWT, as well as the presence of cardiovascular diseases. PH is a common condition in patients with chronic HP, especially with the fibrotic phenotype. Early detection of the PH predictors is necessary for the timely diagnosis of this complication of HP.

Apical but not basal RV strain reflects right ventricular dysfunction in patients with dilated cardiomyopathy

BackgroundRV dysfunction is an important predictor of morbidity and mortality in cardiac patients, especially those having dilated cardiomyopathy (DCM). Deformation imaging parameters (strain and strain rate) are established as new echocardiographic measures that allow for both global and regional RV function assessment. Previous studies showed that heterogeneous segmental deformation affects global RV function differently in various disease states. Echo-Doppler parameters of RV and LV function including RV global longitudinal strain, basal & apical RV strain, LV ejection fraction and LV global longitudinal strain were evaluated in 42 DCM patients & 28 normal subjects, aiming to assess the value of apical versus basal RV strain in detection of RV dysfunction in patients with dilated cardiomyopathy.ResultsDCM patients had significantly lower values of both RV global longitudinal strain and apical RV strain compared to normal subjects (p < 0.001). Basal RV strain did not significantly differ in DCM from normal. The apical RV strain correlated significantly with RV global longitudinal strain, LV ejection fraction and LV global longitudinal strain (p < 0.001 for all). Using ROC curve, a cut-off value of apical RV strain ≤ 29.5 distinguished RV dysfunction from normal with 91.2% sensitivity & 100% specificity.ConclusionsRV apical but not basal strain reflects the status of RV function, and it represents a valuable measure to diagnose RV dysfunction in patients with DCM.

Right ventricular dysfunction in patients with acute respiratory distress syndrome receiving venovenous extracorporeal membrane oxygenation.

Acute respiratory distress syndrome is characterized by non-cardiogenic pulmonary edema, decreased pulmonary compliance, and abnormalities in gas exchange, especially hypoxemia. Patients with acute respiratory distress syndrome (ARDS) who receive support with venovenous (V-V) extracorporeal membrane oxygenation (ECMO) usually have severe lung disease. Many patients with ARDS have associated pulmonary vascular injury which can result in elevated pulmonary vascular resistance and right heart dysfunction. Since V-V ECMO relies upon preserved cardiac function, right heart failure has important implications for patient evaluation, management, and outcomes. Worsening right heart function complicates ARDS and disease processes. Given the increasing use of ECMO to support patients with ARDS, an understanding of right ventricular-ECMO and cardiopulmonary interactions is essential for the clinician. A narrative review of the manifestations of right heart dysfunction, as well as diagnosis and management strategies for the patient with ARDS on ECMO, is provided.

Prognostic value of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure

The role of echocardiographic right ventricular (RV) dysfunction in predicting clinical outcome in clinically stable patients with pulmonary embolism (PE) is undefined. In this study, we assessed the prevalence and clinical outcome of normotensive patients with RV dysfunction among a broad spectrum of PE patients. This retrospective clinical outcome study included cohort of 186 consecutive patients (age: 62 ± 15 years) with documented PE. Acute RV dysfunction was diagnosed in the presence of one or more of the following criteria: a quotient of RV septal-lateral diameter/LV septal-lateral diameter > 0.9 in the 4 chamber view in TTE or CT, RV hypokinesis (TAPSE < 15 mm), Doppler evidence of pulmonary hypertension (PASP > 40 mmHg) and/or paradox septal systolic motion. Eighty-eight patients were judged to have RV dysfunction (47.3%). There was no difference in age, gender, prevalence of deep venous thrombosis (DVT), cancer or other risk factors in these two groups. In hospital mortality (21.6% vs. 5.4%; P = 0.001), cardiogenic shock (P = 0.001), and thrombolytic therapy use (P = 0.004) were significantly higher for RV dysfunction patients than for the other group. The multivariate logistic regression models revealed significant associations between RV dysfunction and in-hospital mortality (OR: 3.815, 95% CI: 1.012–10.47, P = 0.001) A significant proportion (47%) of normotensive patients with acute PE presents with RV dysfunction; these patients with latent hemodynamic impairment have more PE-related shock and in-hospital mortality and may require aggressive therapeutic strategies.