Right Ventricular End-diastolic Volume Research Articles

Echocardiographic determination of right ventricular volumes and ejection fraction: Validation of a truncated cone and rhomboid pyramid formula.

Echocardiographic assessment of right ventricular (RV) measurements may be challenging. The aim of this study was to develop a formula for calculation of RV volumes and function based on measurements of linear dimensions by 2-dimensional (2D) transthoracic echocardiography (TTE) in comparison to cardiovascular magnetic resonance (CMR). 129 consecutive patients with standard TTE and RV analysis by CMR were included. A formula based on the geometric assumptions of a truncated cone minus a truncated rhomboid pyramid was developed for calculations of RV end-diastolic volume (EDV) and RV end-systolic volume (ESV) by using the basal diameter of the RV (Dd and Ds) and the baso-apical length (Ld and Ls) in apical 4-chamber TTE views: RV EDV = 1.21 * Dd2 * Ld, and RV ESV = 1.21 * Ds2 * Ls. Calculations of RV EDV (ΔRV EDV = 10.2±26.4 ml to CMR, r = 0.889), RV ESV (ΔRV ESV = 4.5±18.4 ml to CMR, r = 0.921) and RV EF (ΔRV EF = 0.5±4.0% to CMR, r = 0.905) with the cone-pyramid formula (CPF) highly agreed with CMR. Impaired RV function on CMR (n = 52) was identified with a trend to higher accuracy by CPF than by conventional echocardiographic parameters (tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC)). Calculations of RV volumes and RV function by 2D TTE with the newly developed CPF were in high concordance to measurements by CMR. Accuracy for detection of patients with reduced RV function were higher by the proposed 2D TTE CPF method than by conventional echocardiographic parameters of TAPSE and RV FAC.

Restoration of right ventricular function in the treatment of pulmonary arterial hypertension

ObjectiveA 45% threshold of right ventricular ejection fraction (RVEF) is proposed clinically relevant in patients with pulmonary arterial hypertension (PAH). We aim to determine treatment response, long-term right ventricular (RV)...

Right Atrial Adaptation to Precapillary Pulmonary Hypertension: Pressure-Volume, Cardiomyocyte, and Histological Analysis

BackgroundPrecapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness. ObjectivesThis study aimed to investigate RA function using pressure-volume (PV) loops, isolated cardiomyocyte, and histological analyses. MethodsRA PV loops were constructed in control subjects (n = 9) and precPH patients (n = 27) using magnetic resonance and catheterization data. RA stiffness (pressure rise during atrial filling) and right atrioventricular coupling index (RA minimal volume / RV end-diastolic volume) were compared in a larger cohort of patients with moderate (n = 39) or severe (n = 41) RV diastolic stiffness. Cardiomyocytes were isolated from RA tissue collected from control subjects (n = 6) and precPH patients (n = 9) undergoing surgery. Autopsy material was collected from control subjects (n = 6) and precPH patients (n = 4) to study RA hypertrophy, capillarization, and fibrosis. ResultsRA PV loops showed 3 RA cardiac phases (reservoir, passive emptying, and contraction) with dilatation and elevated pressure in precPH. PrecPH patients with severe RV diastolic stiffness had increased RA stiffness and worse right atrioventricular coupling index. Cardiomyocyte cross-sectional area was increased 2- to 3-fold in precPH, but active tension generated by the sarcomeres was unaltered. There was no increase in passive tension of the cardiomyocytes, but end-stage precPH showed reduced number of capillaries per mm2 accompanied by interstitial and perivascular fibrosis. ConclusionsRA PV loops show increased RA stiffness and suggest atrioventricular uncoupling in patients with severe RV diastolic stiffness. Isolated RA cardiomyocytes of precPH patients are hypertrophied, without intrinsic sarcomeric changes. In end-stage precPH, reduced capillary density is accompanied by interstitial and perivascular fibrosis.

Comparison and Validity of Fragmented QRS (fQRS) Against Cardiac Magnetic Resonance (CMR) in Predicting Right Heart Function in Tetralogy of Fallot Patients After Reconstructive Surgery

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Patients with repaired TOF (rTOF) expose to moderate to severe pulmonary regurgitation (PR), right ventricular (RV) dysfunction, and RV failure. Although cardiac magnetic resonance (CMR) provides details of RV function and structure, an electrocardiogram (ECG) is accessible and inexpensive. Objectives: We aimed to assess the correlation between clinical symptoms and ECG parameters with CMR findings. Methods: This cross-sectional study assessed the patients with rTOF who underwent CMR between May 2020 and September 2022 in Imam Reza Hospital. The signs and symptoms of rTOF were assessed, and a pediatric cardiologist interpreted ECG parameters. We considered CMR findings, clinical symptoms, and ECG parameters with CMR findings in rTOF. In addition, fragmented QRS (fQRS), the additional spikes within the QRS complex, was used to indicate conduction disturbance due to myocardial scar or fibrosis. Data were analyzed by SPSS version 18. Results: Among 42 patients with rTOF, 20 patients were male. Although the QT correction (QTc) had a significant correlation with CMR parameters, fQRS showed a positive correlation with right ventricular ejection fraction (RVEF) less than 47% (OR 2.06, 95% CI 1.45 - 2.93; P-value = 0.005), right ventricular end-diastolic volume (RVEDV) more than 150 mL/m2 (OR 4.4, 95% CI 2.03 - 9.5; P-value = 0), and right ventricular end-systolic volume (RVESV) more than 80 mL/m2 (OR 2.83, 95% CI 1.59 - 5.04; P-value = 0). We found a murmur in the clinical examination of 64.3% of patients. Our results showed that tachycardia and tachypnea were the most common signs in these patients. Surgery at a young age was significantly correlated to lower ascending aortic volume, right pulmonary artery size, left pulmonary artery size, right atrium and left atrium volume, and main pulmonary artery flow. Conclusions: Compared to other ECG parameters, fQRS could strongly predict RVESV, RVEDV, and RVEF as the right heart indexes. Besides, repair surgery at a younger age reduces the possibility of needing pulmonary valve replacement surgery at older ages. Therefore, clinicians should consider these issues in patients.

Neuroticism personality traits are linked to adverse cardiovascular phenotypes in the UK Biobank.

To evaluate the relationship between neuroticism personality traits and cardiovascular magnetic resonance (CMR) measures of cardiac morphology and function, considering potential differential associations in men and women. The analysis includes 36 309 UK Biobank participants (average age = 63.9 ± 7.7 years; 47.8% men) with CMR available and neuroticism score assessed by the 12-item Eysenck Personality Questionnaire-Revised Short Form. CMR scans were performed on 1.5 Tesla scanners (MAGNETOM Aera, Siemens Healthcare, Erlangen, Germany) according to pre-defined protocols and analysed using automated pipelines. We considered measures of left ventricular (LV) and right ventricular (RV) structure and function, and indicators of arterial compliance. Multivariable linear regression was used to estimate association of neuroticism score with individual CMR metrics, with adjustment for age, sex, obesity, deprivation, smoking, diabetes, hypertension, hypercholesterolaemia, alcohol use, exercise, and education. Higher neuroticism scores were associated with smaller LV and RV end-diastolic volumes, lower LV mass, greater concentricity (higher LV mass to volume ratio), and higher native T1. Greater neuroticism was also linked to poorer LV and RV function (lower stroke volumes) and greater arterial stiffness. In sex-stratified analyses, the relationships between neuroticism and LV stroke volume, concentricity, and arterial stiffness were attenuated in women. In men, association (with exception of native T1) remained robust. Greater tendency towards neuroticism personality traits is linked to smaller, poorer functioning ventricles with lower LV mass, higher myocardial fibrosis, and higher arterial stiffness. These relationships are independent of traditional vascular risk factors and are more robust in men than women.

Establishing minimally important differences for cardiac MRI end-points in pulmonary arterial hypertension.

Cardiac magnetic resonance (CMR) is the gold standard technique to assess biventricular volumes and function, and is increasingly being considered as an end-point in clinical studies. Currently, with the exception of right ventricular (RV) stroke volume and RV end-diastolic volume, there is only limited data on minimally important differences (MIDs) reported for CMR metrics. Our study aimed to identify MIDs for CMR metrics based on US Food and Drug Administration recommendations for a clinical outcome measure that should reflect how a patient "feels, functions or survives". Consecutive treatment-naïve patients with pulmonary arterial hypertension (PAH) between 2010 and 2022 who had two CMR scans (at baseline prior to treatment and 12 months following treatment) were identified from the ASPIRE registry. All patients were followed up for 1 additional year after the second scan. For both scans, cardiac measurements were obtained from a validated fully automated segmentation tool. The MID in CMR metrics was determined using two distribution-based (0.5sd and minimal detectable change) and two anchor-based (change difference and generalised linear model regression) methods benchmarked to how a patient "feels" (emPHasis-10 quality of life questionnaire), "functions" (incremental shuttle walk test) or "survives" for 1-year mortality to changes in CMR measurements. 254 patients with PAH were included (mean±sd age 53±16 years, 79% female and 66% categorised as intermediate risk based on the 2022 European Society of Cardiology/European Respiratory Society risk score). We identified a 5% absolute increase in RV ejection fraction and a 17 mL decrease in RV end-diastolic or end-systolic volumes as the MIDs for improvement. Conversely, a 5% decrease in RV ejection fraction and a 10 mL increase in RV volumes were associated with worsening. This study establishes clinically relevant CMR MIDs for how a patient "feels, functions or survives" in response to PAH treatment. These findings provide further support for the use of CMR as a clinically relevant clinical outcome measure and will aid trial size calculations for studies using CMR.

Comprehensive echocardiographic assessment of right ventricular function, pulmonary arterial elastic properties and ventricular-vascular coupling in adult patients with repaired tetralogy of fallot: clinical significance of 3D derived indices.

We aimed to comprehensively analyze by three-dimensional speckle-tracking echocardiography (3DSTE) and Doppler echocardiography right ventricular (RV) performance, pulmonary arterial (PA) elastic properties and right ventricular-pulmonary artery coupling (RVPAC) in patients with repaired tetralogy of Fallot (rTOF) and assess the feasibility and clinical utility of related echocardiographic indices. Twenty-four adult patients with rTOF and twenty-four controls were studied. RV end-diastolic volume(3D-RVEDV), RV end-systolic volume(3D-RVESV), RV ejection fraction(3D-RVEF), RV longitudinal strain(3D-RVLS) and RV area strain(3D-RVAS) were calculated by 3DSTE. RV end-systolic area (RVESA) was obtained by planimetry. Pulmonary regurgitation (PR) was assessed as trivial/mild or significant by cardiac magnetic resonance (CMR) and color-Doppler. Pulmonary artery (PA) elastic properties were determined using two-dimensional/Doppler echocardiography. RV systolic pressure (RVSP) was measured using standard Doppler methods. RVPAC was assessed using various 3DSTE-derived parameters (3DRVAS/RVSP, 3DRVLS/RVESA, 3DRVAS/RVESV). Overall, 3DRVEF and 3DRVAS were impaired in rTOF patients compared with controls. PA pulsatility and capacitance were reduced (p = 0.003) and PA elastance was higher (p = 0.0007) compared to controls. PA elastance had a positive correlation with 3DRVEDV (r = 0.64, p = 0.002) and 3DRVAS (r = 0.51, p = 0.02). By ROC (receiver operating characteristics) analysis, 3DRVAS/RVESV, 3DRVAS/RVSP and 3DRVLS/RVESA cutoff values of 0.31%/mmHg, 0.57%/mmHg and 0.86%/mmHg, respectively, had 91%, 88% and 88% sensitivity and 81%, 81% and 79% specificity in identifying exercise capacity impairment. In rTOF patients increased 3DSTE-derived RV volumes and impaired RV ejection fraction and strain are associated with reduced PA pulsatility and capacitance and increased PA elastance. 3DSTE-derived RVPAC parameters using different afterload-markers are accurate indices of exercise capacity.

Clinical Value of a Novel Three-Dimensional Echocardiography–Derived Index of Right Ventricle–Pulmonary Artery Coupling in Tricuspid Regurgitation

Echocardiographic surrogates of right ventricle-to-pulmonary artery (RV-PA) coupling have been reported to be associated with outcomes in patients with secondary tricuspid regurgitation (STR). However, pulmonary artery systolic pressure (PASP) is difficult to estimate using echocardiography in patients with severe STR. The aim of the present study was to evaluate the predictive power of a surrogate of RV-PA coupling obtained using right ventricular (RV) volumes measured on three-dimensional echocardiography. One hundred eight patients (mean age, 73±13years; 61% women) with moderate or severe STR were included. At a median follow-up of 24months (interquartile range, 2-48months), 72 patients (40%) had reached the composite end point of death of any cause and heart failure hospitalization. RV-PA coupling was computed as the ratio between RV forward stroke volume (SV) (i.e., RV SV-regurgitant volume) and RV end-systolic volume (ESV). RV forward SV/ESV was significantly more related to the composite end point than RV ejection fraction (area under the curve, 0.85 [95% CI, 0.78-0.93] vs 0.73 [95% CI, 0.64-0.83], respectively; P=.03). A value of 0.40 was found to best correlate with outcome. On multivariate Cox regression, RV forward SV/ESV, tricuspid annular plane systolic excursion/PASP, and RV free wall longitudinal strain/PASP were all independently associated with the occurrence of the composite end point when added to a group of parameters including STR severity (severe vs moderate), atrial fibrillation, pulmonary arterial hypertension, right atrial volume, RV end-diastolic volume, and RV free wall longitudinal strain. RV forward SV/ESV<0.40 (HR, 3.36; 95% CI, 1.49-7.56; P<.01) carried higher related risk than RV free wall longitudinal strain/PASP<-0.42%/mm Hg (HR, 3.1; 95% CI, 1.26-7.84; P=.01) and tricuspid annular plane systolic excursion/PASP<0.36mm/mm Hg (HR, 2.69; 95% CI, 1.29-5.58; P=.01). RV ejection fraction did not correlate independently with prognosis when added to the same group of variables. RV forward SV/ESV is associated with the risk for death and heart failure hospitalization in patients with STR.

Long-Term Outcomes of Unrepaired Isolated Partial Anomalous Pulmonary Venous Connection With an Intact Atrial Septum

The natural history of an unrepaired isolated partial anomalous pulmonary venous connection(s) (PAPVC) and the absence of other congenital anomalies remains unclear. This study aimed to expand the understanding of the clinical outcomes in this population. Isolated PAPVC with an intact atrial septum is a relatively uncommon condition. There is the perception that patients with isolated PAPVC are usually asymptomatic, that the lesion generally has a limited hemodynamic impact, and that surgical repair is rarely justified. For this retrospective study, we reviewed our institutional database to identify patients with either 1 or 2 anomalous pulmonary veins that drain a portion of but not the complete ipsilateral lung. Patients with previous surgical cardiac repair, coexistence of other congenital cardiac anomalies that would result in either pretricuspid or post-tricuspid loading of the right ventricle (RV), or scimitar syndrome were excluded. We reviewed their clinical course over the follow-up period. We identified 53 patients; 41 with a single and 12 with 2 anomalous PAPVC. A total of 30 patients (57%) were men, with a mean age at the latest clinic visit of 47 ± 19years (18 to 84 years). Turner syndrome (6 of 53, 11.3%), bicuspid aortic valve (6 of 53, 11.3%), and coarctation of the aorta (5 of 53, 9.4%) were commonly associated anomalies. A single anomalous left upper lobe vein was the most commonly identified variation. More than half of the patients were asymptomatic. Cardiopulmonary exercise test demonstrated a maximal oxygen consumption of 73 ± 20% expected (36 to 120). Transthoracic echocardiography demonstrated a mean RV basal diameter of 4.4 ± 0.8cm, RV systolic pressure of 38 ± 13 (16 to 84) mm Hg. A total of 8 patients (14.8%) had ≥moderate tricuspid regurgitation. Cardiac magnetic resonance in 42 patients demonstrated a mean RV end-diastolic volume index of 122 ±3 0ml/m2 (66 to 188ml/m2), of which in 8 (14.8%), it was >150ml/m2. Magnetic resonance imaging-based Qp:Qs was 1.6 ± 0.3. A total of 5 patients (9.3%) had established pulmonary hypertension (mean pulmonary artery pressure ≥25mm Hg). In conclusion, isolated single or dual anomalous pulmonary venous connection is not necessarily a benign congenital anomaly because a proportion of patients develop pulmonary hypertension and/or RV dilation. Regular follow-up and on-going patient surveillance with cardiac imaging is advised.

Electromechanical Dyssynchrony Is Associated With Right Ventricular Remodeling and Dysfunction Independently of Pulmonary Regurgitation Late After Tetralogy of Fallot Repair

The aim of this study was to investigate the relationship among right ventricular (RV) dilatation, dysfunction, and electromechanical dyssynchrony (EMD) in patients with repaired tetralogy of Fallot (rTOF). Data from a prospective rTOF registry of subjects with moderate or greater pulmonary regurgitation (PR) and contemporary imaging were analyzed. Electrocardiograms and echocardiograms were analyzed for EMD (prolonged QRS duration [QRSd], echocardiographic septal flash, and mechanical delay) and mechanical dispersion. The relationship among these, RV measurements on cardiac magnetic resonance, exercise capacity, and incident arrhythmia or death was analyzed with adjustment for PR. In total, 271 patients with rTOF (42% women; median age, 32years; interquartile range [IQR], 23-34 years) were included. Patients had moderate to severe PR (median PR fraction, 38%; IQR, 30%-47%), moderate to severe RV enlargement (median RV end-diastolic volume index, 161 mL/m2; IQR, 138-186 mL/m2) and mild RV systolic dysfunction (median RV ejection fraction [RVEF], 44%; IQR, 38%-48%). Eleven patients (4%) experienced ventricular arrhythmia or death. Presence of EMD was associated with larger RV size (RV end-diastolic volume index and RV end-systolic volume index, P=.006 and P<.001, respectively) and lower RVEF (P<.001). A sharp inflection in the relation among QRSd, RV size, and RVEF was observed when QRSd exceeded 150msec (3.1% decrease in RVEF for every 20-msec increase in QRSd between 160 and 200msec). Similar inflection points were observed for the mechanical delay between the RV basal-lateral and midseptal segments. The mechanical delay was higher in patients with vs without incident atrial arrhythmia (371 vs 276msec, P=.014). In adults with rTOF, EMD is independently associated with larger RV size, lower RVEF, and incident atrial arrhythmias.

Increased hepatic T1 values are correlated with right ventricular involvement and congestion after ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background ST-segment elevation myocardial infarction (STEMI) may have a multiorgan impact. Due to its proximity to the heart, a large portion of the liver is imaged during T1 mapping in Cardiovascular Magnetic Resonance (CMR) and recently higher T1 have been found associated with signs of right heart failure (RHF) in patients with non-ischemic cardiomyopathy, but no data are available in STEMI population. Purpose To evaluate the role of early hepatic native T1 in detecting the presence of right ventricle (RV) involvement after STEMI. Methods 133 patients with STEMI who underwent early CMR after primary angioplasty (PPCI) were enrolled. Patients with known hepatic disease were excluded from the study. Hepatic T1 was evaluated considering the mean value obtained from three regions of interest, free from fat and blood vessels. RV involvement was diagnosed in the presence of RV ejection fraction (EF) reduction according to current guidelines, RV wall motion abnormalities and the presence of necrosis in late gadolinium enhancement (LGE) sequences. Results Overall, the mean age was 59.72 ± 13.32 years and 28.2% were female. Fifty-two (39.1%) patients had an anterior myocardial infarction. The median time from PPCI to CMR was 3 [IQR 2.00–5.00] days. T1 mapping was available in all patients and mean hepatic T1 value of the population was 622.91 ± 100.14 ms. According to the Youden index the optimal hepatic T1 cut-off value to predict RV involvement was 605 ms. A total of 72 (54.1%) patients presented high hepatic T1 values (&amp;gt;605 ms). No significant correlations were found between high hepatic T1 values and left ventricle EF, infarct size, area at risk and the presence of microvascular obstruction. High hepatic T1 values were correlated with larger RV end-diastolic volume index (RVEDVi) (median 83.03 ml/m2 vs 53.16 ml/m2, p&amp;lt;0.001), lower RVEF (median 39.4% vs 57.62%, p&amp;lt;0.001) and presence of LGE in RV (26.5% vs 9.8%, p = 0.015). White blood cells (WBC), C-reactive protein and hs-Tn T peak values did not differ in the two study groups but NT-proBNP values were significantly higher in patients with high hepatic T1 (median 3531.22 vs 111.25 pg/mL, p&amp;lt;0.001). A strong positive correlation was found between hepatic T1 and NTproBNP (r = 0.754, p&amp;lt;0.001, Figure 1). At the univariable analysis, RV EF (OR 0.848, 95%CI 0.806–0.893, p&amp;lt;0.001), RVEDVi (OR 1.026, 95%CI 1.013–1.038, p&amp;lt;0.001) and the presence of RV infarct at the CMR evaluation (OR 3.286, 95%CI 1.218–8.865, p = 0.019) were found predictors of high hepatic T1 values. On multivariable logistic regression, RVEDVi (OR 1.022, 95%CI 1.006–1.038, p = 0.008) and RV-EF (OR 0.854, 95%CI 0.809–0.902, p&amp;lt;0.001) resulted as independent predictors of increased hepatic T1 values. Conclusions RV involvement after STEMI may lead to hepatic congestion and high hepatic T1 values are associated with early RV dysfunction parameters (RVEDVi, RV-EF and LGE) at CMR and higher levels of NT-proBNP.

Mechanical adaptation of the right ventricle to increased volume overload associated with secondary tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular (RV) function is strongly associated with the prognosis of patients with secondary tricuspid regurgitation (STR). However, the mechanical adaptations (contraction pattern) of the RV to volume overload associated with STR remain to be clarified. Purpose To investigate the changes in RV contraction pattern associated with the increase in severity of STR and to analyse whether the assessment of each RV motion component of RV ejection fraction (RVEF) (longitudinal, radial, and anteroposterior) adds prognostic value in patients with STR. Methods Consecutive patients with STR who underwent clinically indicated transthoracic echocardiography were enrolled in a multi-center prospective observational study. The primary outcome was defined as heart failure hospitalization or cardiac death. 3-dimensional echocardiography studies were performed at baseline and the ReVISION software package (Argus Cognitive, Inc, Lebanon, NH) was used to quantify the contribution of the longitudinal, radial, and anteroposterior motion components to total RVEF (Figure). Results We enrolled 172 patients (43% men, age: 75±15 years), followed for a median of 9 months. The patients were divided in two groups by STR severity (non-severe n=125, severe n=47). The characteristics of patients with massive/torrential STR (n=12) vs. "only" severe STR (n=35) were also assessed. RV end-diastolic volume index (r=0.33, p&amp;lt;0.001) and the longitudinal component of RVEF demonstrated significant correlation with STR severity (r=-0.22, p&amp;lt;0.01), while total RVEF did not (r=0.14; p = NS). The anteroposterior component of RVEF was the only parameter showing relatively strong correlation with left ventricular ejection fraction (r=0.39; p&amp;lt;0.001). RVEF was comparable between non-severe and severe patients (49±10 vs. 49±11%, p = NS). In patients with severe STR, the radial and also anteroposterior component of RVEF were comparable to non-severe STR patients, while the longitudinal component was significantly lower in severe STR (19±6 vs.17±7%, p&amp;lt;0.05; shown on Figure). Notably, in patients with massive/torrential STR, the radial contribution markedly decreased (27±8 vs. 20±9%, p&amp;lt;0.05), with consequently reduced global RVEF (52±9 vs. 41±12%, p&amp;lt;0.01) (Figure). In a multivariable Cox regression, using parameters proved to be significant in the univariable analysis, longitudinal component of total RVEF was a significant and independent predictor of outcome (hazard ratio, 0.947 [CI, 0.903–0.992], P= 0.022). Conclusions Patients with severe STR demonstrate significant morphological and functional RV remodeling with chamber enlargement and maintained RVEF, but a significant decrease in the longitudinal component of RVEF. In patients with massive/torrential STR, the radial mechanism markedly deteriorates, leading to decreased global RVEF. The longitudinal component of RV motion demonstrated independent prognostic value in patients with STR.

Right Ventricular Strain Analysis By Tissue Tracking Cardiac Magnetic Resonance Imaging In Pediatric Patients With End-Stage Renal Disease.

To investigate right ventricular (RV) volume and mass by cardiac magnetic resonance (CMR) and the added value of tissue tracking strain analysis as markers of RV dysfunction in pediatric patients with end-stage renal disease (ESRD) and preserved RV ejection fraction. Twenty-five children with ESRD and preserved RVEF (>50%) and 10 healthy control children were enrolled. Tissue tracking CMR was used to assess Global Longitudinal, circumferential (GCS), and radial short and long axes (GRS SAX and GRS LAX) RV strains in the patients group compared with controls. Correlations between strain parameters and other CMR parameters and clinical biomarkers were assessed. Binary logistic regression was used to test the independence of cofounders and detect their significance. RV end-diastolic volume and mass (RVMi) were significantly higher in patients (97.2±19.3 mL/m2 and 26.6±7gr/m2) than control (71±7.8 mL/m2 and 11.9±2 gr/m2, P values 0.000). All RV global strain parameters were significantly impaired in patients compared with control (all P values <0.05). RV Global Longitudinal was significantly correlated to LVEF (r=-0.416, P=0.039), LVEDVi (r=0.481, P=0.015), LVMi (r=0.562, P=0.004), and systolic blood pressure index (r=0.586, P=0.002). RV GRS (LAX) was significantly correlated to LV GCS (r=-0.462, P=0.020) and LV GRS (SAX) (r=0.454, P=0.023). GRS (SAX) and GCS demonstrated the highest diagnostic accuracy (area under curve: 0.82 and 0.81) to detect strain impairment. Univariate binary logistic regression with patients versus control as dependent variables identified LVMi, RV end-diastolic volume, RVMi, weight, body surface area, RV GCS, RV GRS (LAX), RV GRS (SAX), LV GCS, and LV GRS (SAX) as significantly correlated to patients with ESRD. When adjusted to other cofounders in the multivariable model, only RVMi remained as an independent significant cofounder (Odds ratio:0.395, P=0.046). RV global strain, volume, and mass by CMR are markers of RV dysfunction in ESRD pediatric patients with preserved RVEF.

Exercise-induced cardiovascular remodelling in a large cohort of female, elite athletes: towards sex-specific CMR reference ranges

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Amsterdam Movement Sciences (AMS); Dutch National Olympic Committee &amp; National Sports Federation (NOC*NSF); Heart To Handle. Background Differentiating between exercise-induced cardiac remodelling (EICR) and pathology constitutes a central challenge in sports cardiology. To facilitate this differentiation, reference ranges for cardiovascular magnetic resonance imaging (CMR) are needed. However, female athletes, and especially, female elite athletes with potentially the most outspoken adaptation, are severely underrepresented. Moreover, no large studies including CMR data in female, elite athletes are currently available. Purpose To quantify EICR on CMR in a large cohort of female, elite athletes, compared with currently available reference values of the general female, and female athlete population. Methods We performed a cross-sectional CMR analysis in female elite athletes aged ≥16 years, included in the ELITE cohort. We excluded athletes with known cardiovascular disease. The primary outcome was EICR quantification as BSA indexed RV and LV end-diastolic volume (EDVi), LV wall mass (LVMi), LV remodelling index (LVMi/LVEDVi), and LV/RV ratio (LVEDi/RVEDVi). Second, we compared our parameters with reference ranges (1,2). CMR was performed according to a uniform protocol, and included cine-imaging and delayed hyperenhancement, preferentially on 1.5T. A dedicated core-lab analysed all CMRs in Circle Cardiovascular Imaging. Results We included 102 female elite athletes, 97% caucasian, mean age of 26.3 ±5.0, BSA 1.79 ±0.14 m2, and mean professional athlete years of 10.3 ±5. Main athlete disciplines (≥10 hours/week) were field hockey (15%), rowing (13%), road cycling (12%), and European style football (10%). Female elite athletes had marked EICR as compared with general population reference values, with higher LVEDVi (108 ±13.9 vs 69 ±12 ml/m2, p&amp;lt;0.05), RVEDVi (110 ±15.3 vs 76 ±14 ml/m2, p&amp;lt;0.05), and LVMi (49.9 ±11.2 vs 45 ±7 g/m2, p&amp;lt;0.05) (Figure 1). Compared with current female elite athlete references (n=33), our female elite athlete population demonstrated a markedly lower RVEDVi (118 ±17 vs 110 ±15 ml/m2), and a higher upper-limit (95th percentile) of LVMi (66 vs 72.3 g/m2) with comparable LVEDVi. LV remodelling showed a lower LVM/LVEDV ratio (0.46 ±0.08 vs 0.7 ±0.1 ml) compared to the general population, with balanced dilatation (LVEDV/RVEDV=0.98 ±0.05). In general, we observed EICR as increased cardiac volumes in 67% (n=68), increased cardiac volumes and mass in 21% (n=21) lone increase in cardiac mass in 1% (n=1), with 11% (n=11) demonstrating normal geometry (Figure 2). Conclusion EICR on CMR in female, elite athletes is mainly characterised by isolated increased volumes, with a considerable proportion (11%) demonstrating no EICR. Compared with the general population, female athletes have larger cardiac ventricular volumes and wall mass; compared with available elite athlete reference ranges comparable ventricular volumes, but a larger spread in cardiac wall mass. Our results constitute a first step towards sex-specific CMR reference ranges for female athletes.

Effect of pulmonary regurgitation on cardiac functions based on a human bi-ventricle model

Background and objective: Assessing the severity of pulmonary regurgitation (PR) and identifying optimal clinically relevant indicators for its treatment is crucial, yet standards for quantifying PR remain unclear in clinical practice. Computational modelling of the heart is in the process of providing valuable insights and information for cardiovascular physiology research. However, the advancements of finite element computational models have not been widely applied to simulate cardiac outputs in patients with PR. Furthermore, a computational model that incorporates both the left ventricle (LV) and right ventricle (RV) can be valuable in assessing the relationship between left and right ventricular morphometry and septal motion in PR patients. To enhance our understanding of the effect of PR on cardiac functions and mechanical behaviour, we developed a human bi-ventricle model to simulate five cases with varying degrees of PR severity. Methods: This bi-ventricle model was built using a patient-specific geometry and a widely used myofibre architecture. The myocardial material properties were described by a hyperelastic passive constitutive law and a modified time-varying elastance active tension model. To simulate realistic cardiac functions and the dysfunction of the pulmonary valve in PR disease cases, open-loop lumped parameter models representing systemic and pulmonary circulatory systems were designed. Results: In the baseline case, pressures in the aorta and main pulmonary artery and ejection fractions of both the LV and RV were within normal physiological ranges reported in the literature. The end-diastolic volume (EDV) of the RV under varying degrees of PR was comparable to the reported cardiac magnetic resonance imaging data. Moreover, RV dilation and interventricular septum motion from the baseline to the PR cases were clearly observed through the long-axis and short-axis views of the bi-ventricle geometry. The RV EDV in the severe PR case increased by 50.3% compared to the baseline case, while the LV EDV decreased by 18.1%. The motion of the interventricular septum was consistent with the literature. Furthermore, ejection fractions of both the LV and RV decreased as PR became severe, with LV ejection fraction decreasing from 60.5% at baseline to 56.3% in the severe case and RV ejection fraction decreasing from 51.8% to 46.8%. Additionally, the average myofibre stress of the RV wall at end-diastole significantly increased due to PR, from 2.7±12.1 kPa at baseline to 10.9±26.5 kPa in the severe case. The average myofibre stress of the LV wall at end-diastole increased from 3.7±18.1 kPa to 4.3±20.3 kPa. Conclusions: This study established a foundation for the computational modelling of PR. The simulated results showed that severe PR leads to reduced cardiac outputs in both the LV and RV, clearly observable septum motion, and a significant increase in the average myofibre stress in the RV wall. These findings demonstrate the potential of the model for further exploration of PR.

Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography.

Prolonged high-intensity endurance exercise has been reported to have adverse effects on the heart, which are further correlated with exercise dose. However, its effect on the right ventricle (RV) of amateur runners is unknown. This study aimed was to evaluate the early right ventricular structure and systolic function of amateur marathon runners by three-dimensional speckle tracking echocardiography (3D-STE), and to further analyze the correlation between relevant parameters and the amount of training. A total of 30 amateur marathon runners (marathon group) and 27 healthy volunteers (control group) were enrolled. Conventional echocardiography combined with 3D-STE was performed in all subjects, and the marathon group was screened by echocardiography a week before a marathon (V1), within 1h post-marathon (V2), and 4days post-marathon (V3). RV global longitudinal strain (GLS) and RV end-diastolic volume (EDV) increased significantly in the marathon group compared to the control group (P < 0.05). RV GLS was significantly decreased in the marathon group within 1h post-marathon (V1: -26.2 ± 2.5% vs V2: -23.0 ± 1.6% vs V3: -25.6 ± 2.6%, P < 0.001). However, there was no significant difference in RV ejection fraction (RVEF) (P > 0.05). The results of the correlation analysis showed that RV EDV and RV end-systolic volume (ESV) were positively correlated with the average training volume (P < 0.001). Multivariate linear regression analysis showed that average training volume was an independent predictor of RV EDV in amateur marathoners (β = 0.642, P < 0.001). The systolic function of the RV was enhanced in amateur marathon runners in the early stage, manifested by an increase in RV EDV. After a long period of high-intensity endurance exercise, RV systolic function will temporarily be reduced. 3D-STE can identify this subclinical change with high sensitivity and provide valuable information to assess the structure and function of RV in amateur marathon runners.

Cardiac remodeling after tricuspid transcatheter edge-to-edge repair: From the right to the left ventricle

The management of isolated functional tricuspid regurgitation (TR) is under ongoing investigations as recent interventional breakthrough, such as transcatheter edge-to-edge repair (TEER). We aimed to assess whether and how such device would affect right and left reverse remodeling over time. This is a monocentric, prospective cohort of 10 consecutive patients treated by TEER between 2019 and 2022 who underwent successive cardiac magnetic resonance. Clinical and echocardiographic follow-up was performed up to 12 months after intervention. Overall patients were 81 [IQR: 77.5; 84.0] years old and 6 (60%) were women. TTE derived TR was reduced to stage moderate or less in 80% patients (n = 8) at discharge (P < 0.001) and in 77% (n = 7) at 1 year (P < 0.001) compared with 0% at baseline. CMR-derived Left ventricular ejection fraction (LVEF) and left cardiac output improved from 45 [IQR: 40; 56]% to 57 [IQR: 47; 57]% (P = 0.019) and from 2.6 [IQR: 2.1; 2.9] L/min/m2 to 3.1 [IQR: 2.6; 3.7] L/min/m2 (P = 0.020). The interobserver reliability of LVEF before and after TEER was r2 = 0.95 (P < 0.001) versus 0.95 (P < 0.001). Right ventricle end-diastolic volume (RVEDV) decreased from 107 mL/m2 [IQR: 75; 138] to 87 [IQR: 67; 115.0] mL/m2 (P = 0.039). There was no change in native T1 mapping. We found no non-ischemic late gadolinium enhancement. At 12 months, 67% of CMR patients presented with NYHA class I/II and KCCQ overall summery score increased from baseline 46 [IQR: 30.0; 49.1] to 66 [IQR: 57.4; 73.9] (P = 0.001). TR TEER led to encouraging reverse remodeling of the left ventricle, combining a large increase in LVEF, cardiac output and LV stroke volumes. As we found no changes in myocardial fibrosis, our results suggest a tight interdependence between both ventricles and question the role played by the RV on left ventricular efficiency. Outcomes were consistent with clinical amelioration.

A comparison between the apical and subcostal view for three-dimensional echocardiographic assessment of right ventricular volumes in pediatric patients.

Accurate measurement of ventricular volumes is an important clinical imaging goal. Three-dimensional echocardiography (3DEcho) is used increasingly as it is more available and less costly than cardiac magnetic resonance (CMR). For the right ventricle (RV), the current practice is to acquire 3DEcho volumes from the apical view. However, in some patients the RV may be better seen from the subcostal view. Therefore, this study compared RV volume measurements from the apical vs. the subcostal view, using CMR as a reference standard. Patients <18 years old undergoing a clinical CMR examination were prospectively enrolled. 3DEcho was performed on the day of the CMR. 3DEcho images were acquired with Philips Epic 7 ultrasound system from apical and subcostal views. Offline analysis was performed with TomTec 4DRV Function for 3DEcho images and cvi42 for CMR ones. RV end-diastolic volume and end-systolic volume were collected. Agreement between 3DEcho and CMR was assessed with Bland-Altman analysis and the intraclass correlation coefficient (ICC). Percentage (%) error was calculated using CMR as the reference standard. Forty-seven patients were included in the analysis (age range 10 months to 16 years). The ICC was moderate to excellent for all volume comparisons to CMR (subcostal vs. CMR: end-diastolic volume 0.93, end-systolic volume 0.81; apical vs. CMR: end-diastolic volume 0.94, end-systolic volume 0.74).The 3DEcho mean % error vs. CMR for end-systolic volume was 25% for subcostal and 31% for apical; for end-diastolic volume it was 15% for subcostal and 16% for apical. The % error was not significantly different between apical vs. subcostal views for end-systolic and end-diastolic volume measurements. For apical and subcostal views, 3DEcho-derived ventricular volumes agree well with CMR. Neither echo view has a consistently smaller error when compared to CMR volumes. Accordingly, the subcostal view can be used as an alternative to the apical view when acquiring 3DEcho volumes in pediatric patients, particularly when the image quality from this window is superior.

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.

Identification of rapid progression of right ventricular functional measures using three-dimensional cardiac computed tomography after total surgical correction of tetralogy of Fallot

ObjectiveTo identify subsets of patients with tetralogy of Fallot (TOF) after total surgical correction demonstrating the rapid progression of right ventricle (RV) functional measures using cardiac computed tomography (CT) ventricular volumetry. MethodsRapid or slow progression of RV functional measures was determined in 109 patients with TOF who underwent cardiac CT ventricular volumetry more than twice after total surgical correction. Patient age, body surface area, postoperative days, the time interval between the first and last cardiac CT examinations, and CT-based functional measures were evaluated using binary logistic regression to determine the predictors of the rapid progression. Receiver operating characteristic curve analysis was performed to evaluate diagnostic performance of the potential predictors. ResultsThe rapid progression of indexed RV end-systolic volume (ESV) (≥2.7 mL/m2/year) and indexed RV end-diastolic volume (≥0.9 mL/m2/year) could be predicted by RV ejection fraction (EF) at the last cardiac CT with an odds ratio of 1.340 (95 % confidence interval [CI], 1.122–1.600; p = 0.001) and age at the last cardiac CT with an odds ratio of 8.255 (95 % CI, 1.531–44.513; p = 0.014), respectively. RV EF at the last cardiac CT showed the highest diagnostic performance (area under the curve = 0.799; p < 0.002) for the rapid progression of indexed RV ESV. ConclusionCardiac CT ventricular volumetry can be used to identify patients demonstrating the rapid progression of RV functional measures after total surgical correction of TOF and follow-up imaging protocols can be individually optimized based on initial progression rate.