Right Ventricular Fractional Area Change Research Articles

Right ventricular function during trastuzumab therapy for breast cancer.

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

Abstract 14452: Echocardiographic Evaluation of Donor Cardiac Structure and Function Following Reanimation Using Normothermic Regional Perfusion in Donation After Circulatory Death

Introduction: As heart transplantation from donation after circulatory death (DCD) continues to increase, preliminary results suggest outcomes comparable to donation after brain death. It is unknown if the obligatory period of warm ischemia experienced during DCD withdrawal process causes immediate changes in cardiac allograft function. Methods: We retrospectively reviewed and compared pre-donation with post reanimation echocardiographic findings in all DCD donors at our institution from Jan to March 2021. All DCD donor organs were reanimated with in-situ thoracoabdominal normothermic regional perfusion (NRP) after circulatory death. Echocardiographic assessment included: a) 2-dimensional and speckle-tracking measures of chamber size and function; b) ejection fraction (EF); c) fractional area change (FAC); and d) global longitudinal strain (GLS). Results: Altogether 3 DCD heart donations were performed during the study period. Basic demographics and withdrawal ischemic time periods are depicted in Table 1. There were no changes in LV EF and RV FAC when comparing the pre-donation and the post-reanimation echocardiogram. There was a minimal decrease in LV GLS and RV free-wall systolic strain in 2 of the 3 donors following reanimation (Table 2). Conclusions: DCD cardiac allografts reanimated with NRP demonstrated no change in echocardiographic parameters used for a standard donor heart evaluation and were successfully transplanted. Findings suggest donor cardiac function is not clinically different from the pre-donation in DCD hearts reanimated after a relatively short functional ischemic time and without need for inotropic support.

Abstract 10802: Validation of Artificial Intelligence for Assessing Right Ventricular Function by Transthoracic Echocardiography Compared to Cardiac MRI

Introduction: Cardiac MRI (CMR) is the gold standard for right ventricular function (RVF) because echo assessment is limited. Potential echo parameters to assess RVF include RV fractional area change (FAC), RV free wall strain (FWS), and tricuspid annular plane systolic excursion (TAPSE) on apical 4-chamber (A4C) view. We compared a new Artificial Intelligence method that tracks the RV almost instantaneously in a single 4-chamber view (AI, LVivo RV®, DiA Imaging, Figure) to quantify RVF vs CMR. Methods: We compared AI RVF against CMR in 125 pts. Abnormal LVEF and RVEF were defined as &lt;57% and &lt;49% respectively. Echo closest to CMR date was analyzed with AI RV to obtain FAC, FWS, and TAPSE. We defined abnormal RVF by DiA Imaging’s predetermined thresholds. Sensitivities and specificities for abnormal RVF and chi-square (χ 2 ) tests were calculated for each variable against CMR RVEF. Results: Of the 125 pts, 55 (44%) were female with median age 55 [Q1 44, Q3 67] years. Thirty pts (24%) had abnormal RVEF and 78 (62.4%) had abnormal LVEF by CMR. All pts with abnormal RVEF had abnormal LVEF. Compared to CMR, AI RV sensitivities and specificities for abnormal RVEF were: FAC 87% and 60%, FWS 80% and 61%, TAPSE 77% and 54%, any 2 criteria 83% and 61%, and all 3 criteria 63% and 69%. AI RV χ 2 values were: FAC 19.9 (p&lt;0.001), FWS 15.4 (p&lt;0.001), TAPSE 8.4 (p=0.004), any 2 criteria 18.0 (p&lt;0.001), and all 3 criteria 10.4 (p=0.001). Conclusions: This is the first validation of a novel AI method (LVivo RV®) that can detect RV dysfunction using 3 standard RV measurements from a single A4C view with good sensitivity and specificity compared to volumetric CMR as the gold standard.

Oral N-acetylcysteine as an adjunct to standard medical therapy improved heart function in cases with stable class II and III systolic heart failure.

This research attempted to assess whether N-acetylcysteine (NAC) as adjunctive therapy can be useful in the treatment of patients with heart failure (HF). Fifty-five cases with diagnosed systolic HF and stable symptomatic New York Heart Association (NYHA) functional class II and III and on optimal medical treatment of HF for at least 3months were assigned for receiving oral NAC (600mg twice daily) or placebo for 12weeks. The outcomes were changes in the echocardiographic hemodynamic indices as well as the patients' functional capacity assessed by NYHA classification over a 12-week treatment. Compared to placebo, NAC more significantly improved the systolic left ventricular (LV) function expressed as the ejection fraction and Tei index. These changes are accompanied by more improvement in other LV echocardiographic indices including LV end-diastolic volume index and LV global longitudinal strain in the patients receiving NAC in comparison with those receiving placebo. In parallel with the improvement of LV function, right ventricular (RV) function expressed as RV fractional area change and RV Tei-index also got more improvement in those receiving NAC than those receiving placebo. However, the change in RV global longitudinal strain did not show a significant difference between study groups. Additionally, at week 12, the distribution of the NYHA functional class also shifted toward a better outcome in the NAC group in comparison with the placebo group; however, it was not significant. These preliminary data support experimental findings showing that NAC supplementation is able to improve heart function. The registration of the trial was done at the Iranian Registry of Clinical Trials ( www.irct.ir ). Identifier code: IRCT20120215009014N333. Registration date: 2020-01-11.

Prevalence of cardiac pathology and relation to mortality in a multiethnic population hospitalised with COVID-19

ObjectiveTo determine the prevalence of cardiac abnormalities and their relationship to markers of myocardial injury and mortality in patients admitted to hospital with COVID-19.MethodsA retrospective and prospective observational study of...

Investigation of the influence of manual ventilation-controlled respiration on right ventricular pressure-volume loops and echocardiographic variables in healthy anesthetized dogs.

To evaluate the influence of manual ventilation-controlled respiration on right ventricular (RV) pressure-volume loop-derived and echocardiographic variables in dogs. 8 healthy, anesthetized Beagles. In a prospective experimental study, pressure-volume catheters were percutaneously inserted into the right ventricle of each dog, and manual ventilation was performed; RV pressure-volume loop (hemodynamic) data and conventional echocardiographic variables were assessed. Two-dimensional speckle tracking echocardiography-derived RV strain (RVS) and RV systolic strain rate (RVSR) were obtained with RV free wall-only analysis (free wall) and RV global analysis (RVGA; interventricular septum). Variables were compared between end-inspiratory and end-expiratory phases of respiration by statistical methods. Multiple regression analysis was used to assess associations between selected hemodynamic and echocardiographic variables. The RV pressure significantly increased, and RV volume, stroke volume, tricuspid annular plane systolic excursion, RV fractional area change, peak myocardial systolic velocity of the lateral tricuspid annulus, and RV free wall only-assessed RVS and RVSR significantly decreased in the inspiratory phase, compared with the expiratory phase. There were no significant differences in end-systolic elastance or RVGA-assessed RVS or RVSR between respiratory phases. The RVGA-assessed RVSR was significantly associated with stroke volume and end-systolic elastance. Specific RV echocardiographic variables were significantly affected by respiration. In contrast, RVS and RVSR determined with RVGA were not affected by respiration and were associated with hemodynamic indicators of RV contractility.

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

Right ventricular contractility affects the clinical efficacy of add-on tolvaptan following hospitalization for heart failure in patients with significant tricuspid regurgitation.

Tricuspid regurgitation (TR) is a common condition that is independently associated with high mortality rates in patients with heart failure (HF). Several studies have demonstrated the clinical efficacy of add-on tolvaptan in patients hospitalized for HF. However, the effects of add-on tolvaptan in patients with significant TR are less well understood. Among the patients with moderate-to-severe TR assessed by transthoracic echocardiography during hospitalization for congestive HF, 39 patients who could complete the clinical course after starting add-on tolvaptan were included in the study. Rehospitalization due to HF and cardiac death were defined as adverse cardiac events in this study. We investigated the presence or absence of cardiac events within 2years following the introduction of tolvaptan and evaluated echocardiographic functional parameters associated with cardiac events. The average patient age was 75 ± 14years, and 23 patients (59%) experienced adverse cardiac events within 2years after add-on tolvaptan administration. Serum creatinine (mg/dL) and brain natriuretic peptide (pg/mL) concentrations at discharge were significantly higher in patients with cardiac events than in those without cardiac events {1.48 [1.02-1.58] vs. 1.07 [0.79-1.41], p = 0.03; 526 [414-1044] vs. 185 [104-476], p = 0.01, respectively}. The presence or absence of past hospitalization for HF was also significantly higher in the event-positive group compared to event-free group (78 vs. 44%, p = 0.04). Comparison of echocardiographic parameters revealed that patients with cardiac events had a significantly lower left ventricular ejection fraction (40 ± 16 vs. 49 ± 15%, p = 0.049) and lower right ventricular fractional area change (RVFAC) (35 ± 12 vs. 45 ± 10%, p = 0.008) than those without cardiac events. Multiple logistic regression analysis revealed that RVFAC and past hospitalization for HF were independently associated with cardiac events following the introduction of tolvaptan (odds ratio, 0.934 and 4.992; p = 0.048 and 0.04, respectively). Right ventricular contractility as well as past history of admission for HF, left ventricular ejection fraction, renal function, and brain natriuretic peptide level at discharge may reflect the clinical outcomes after HF hospitalization in patients with significant TR who were treated with tolvaptan.

Sacubitril/Valsartan in the Treatment of Right Ventricular Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction: A Real-world Study.

Objective:There is increasing evidence supporting the efficacy of sacubitril/valsartan for treating left heart failure, but few studies have investigated its effects on right ventricular (RV) dysfunction. This study aimed to explore the effects of sacubitril/valsartan on RV dysfunction among patients with heart failure with reduced ejection fraction (HFrEF).Methods:A total of 93 patients with HFrEF with RV dysfunction who were hospitalized from January 2018 through June 2019 were included in this retrospective observational study. All patients received their first sacubitril/valsartan treatment as in patients during the study period. We excluded 11 patients who were lost to follow-up or had incomplete heart echocardiography data. After 6 months of follow-up, we re-evaluated New York Heart Association Functional Classification and performed echocardiography to identify changes in relevant variables after treatment.Results:At baseline, 24% of the patients had an initial sacubitril/valsartan regimen of 12/13 mg twice daily and 76% of the patients had an initial dose of 24/26 mg twice daily. During follow-up, 27% of patients increased their dosage to 49/50 mg twice daily, 68% of patients were taking 24/26 mg twice daily, and 5% of the patients were still taking 12/13 mg twice daily. We found that sacubitril/valsartan treatment was associated with significant improvements in the following RV function indicators: tricuspid annular plane systolic excursion, tricuspid annular s′ peak velocity (S′), RV fractional area change, and pulmonary artery systolic pressure (PASP). Crude linear regression analysis revealed that a tricuspid annular plane systolic excursion improvement was positively correlated with a change in left ventricular ejection fraction (LVEF) and negatively correlated with a change in left ventricular end-systolic volume (LVESV). However, these correlations were nonexistent after adjusting for multiple echocardiographic variables.Conclusions:In patients with RV dysfunction and HFrEF, sacubitril/valsartan may improve RV remodeling. This influence may be independent of left cardiac remodeling.

Early response of right-ventricular function to percutaneous mitral valve repair

BackgroundThe change in right-ventricular function (RVF) after transcatheter mitral valve repair is still poorly understood. We assessed the early response of RVF to the MitraClip procedure and its clinical relevance.MethodsWe analyzed consecutive patients who underwent a MitraClip procedure to treat MR between August 2010 and March 2019 in the Heart Failure Network Rhineland registry. RVF was assessed before and after the procedure. Impaired RVF was defined as an RV fractional area change (RVFAC) < 35% or tricuspid annular plane systolic excursion (TAPSE) < 16 mm.Results816 eligible patients (77 ± 9 years, 58.5% male) were included in the analysis. Baseline values of RVF were: RVFAC 38.6 (IQR 29.7–46.7) % and TAPSE 17.0 (IQR 14.0–21.0) mm. At a median time of 3 (IQR 2–5) days after the procedure, the RVF remained normal in 34% (n = 274), normalized in 17% (n = 140), deteriorated in 15% (n = 125), and was persistently impaired in 34% (n = 277) of patients. The RVF response was significantly associated with a composite outcome of all-cause mortality and hospitalization due to heart failure within a 2-year follow-up. Compared to stable/normal RVF, the adjusted hazard ratios for the outcome were 1.78 (95% CI 1.10–2.86) for normalized RVF, 1.89 (95% CI 1.34–3.15) for deteriorated RVF, and 2.25 (95% CI 1.47–3.44) for persistently impaired RVF. Changes in TAPSE and RVFAC as continuous variables were significantly correlated with the outcome.ConclusionAn early change in RVF following transcatheter mitral valve repair is predictive of mortality and hospitalization due to heart failure during follow-up.Graphic abstractEarly response of RVF after MitraClip and its clinical significance. An acute, early change in RVF can be observed following the MitraClip procedure, which is associated with the risk of mortality and hospitalization for HF.

Right ventricular ejection fraction as predictor of outcome in acute heart failure using RV ellipsoid model. A retrospective analysis of a prospective cross-sectional study

Abstract Introduction Echocardiography (TTE) is an essential imaging modality for assessment of RV function in acute heart failure. Established parameters are useful and easy to perform but fail to reflect on global volumes due to reliability on one acoustic window. It is therefore attractive to calculate RV volumes and ejection fraction using an ellipsoid model (RVEF/E) which has been validated against MRI in healthy adults but not in the HF patients. Purpose Predictive value of RVEF/E were compared with two established echo parameters of RV function over two-year follow-up period in patients with acute HF. Primary outcome measure was all-cause mortality. Methods Prospective cross-sectional study enrolling 418 consecutive patients with symptoms of acute HF according to a predefined study protocol. All patients underwent TTE assessment of RV function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and RV fractional area change (RVFAC) and RVEF/E. RV Volumes calculated using formula, RVIT is RV inflow tract diameter, RVLAX is RV length and LVD is LV maximal diameter in 2 chamber view. RVV=(3.14/6) x RVIT x RVLAX x LVD Results ROC analyses established an RVEF/E cut-off of 46.8%, TAPSE of 1.6cm and RVFAC of 38.2%. RVEF/E was able to separate patients with higher BNP level (p≤0.0001) and lower systolic BP (p≤0.002). As expected TAPSE and RVFAC were significantly reduced in patients with impaired RVEF. RVEF/E was found equal to TAPSE &amp; RVFAC in predicting outcome (HR 1.48 vs HR 1.48, p≤0.01 vs p≤0.01) and provided benefit of RV volume estimation. Conclusions This is the first study to demonstrate that RVEF/E derived from ellipsoid model is not inferior to well established measures of RV function as a prognostic indicator of medium-term outcome in the acute HF. Funding Acknowledgement Type of funding sources: None. Kaplan Meier survival curvesBaseline characteristics

Tricuspid annular abnormalities in isolated left ventricular noncompaction – a three-dimensional speckle-tracking echocardiographic study

Abstract Introduction Left ventricular (LV) noncompaction (LVNC) is a rare cardiomyopathy due to arrest of the normal maturation process of the myocardium. It is characterized by prominent LV trabecularization with deep intratrabecular recesses. In most of cases LVNC is isolated, but biventricular forms are also known. The tricuspid valve is a complex anatomical structure which incorporates the three-dimensional (3D) saddle-shaped fibrosus annulus (TA). 3D speckle-tracking echocardiography (STE) is a novel non-invasive imaging method with capability of not only measuring volumetric, strain and rotational parameters of heart chambers, but with finding optimal valvular planes in the 3D space evaluation of TA dimensions respecting cardiac cycle is allowed. The present study was designed to assess TA morphological and functional abnormalities by 3DSTE in LVNC patients without right ventricular (RV) involvement. Methods The present study consisted of 15 patients with LVNC (mean age: 52.1±11.4 years, 9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4±3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination with 3DSTE was performed in all LVNC patients and healthy controls. Results Enlarged left atrial and LV dimensions with reduced LV ejection fraction could be seen in LVNC patients. The mean number of noncompacted segments proved to be 6.9±2.0. Grade 1 and 2 mitral regurgitation (MR) could be demonstratred in 5 and 5 LVNC patients, respectively. Higher grade of MR could not be found. Grade 1 and 2 tricuspid regurgitation (TR) could be demonstrated in 4 and 1 LVNC patients, respectively. Only one LVNC patient has grade 4 TR. Tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RV-FAC) proved to be 13.9±3.9 mm and 34.1±2.7%, respectively. LVNC patients showed significantly dilated end-diastolic and end-systolic TA diameter (2.6±0.3 cm vs. 2.2±0.3 cm, p&amp;lt;0.05 and 2.2±0.2 cm vs. 1.8±0.3 cm, p&amp;lt;0.05, respectively), area (8.4±1.7 cm2 vs. 7.0±1.5 cm2, p&amp;lt;0.05 and 6.5±1.7 cm2 vs. 5.3±1.4 cm2, p&amp;lt;0.05, respectively) and tendentiously larger perimeter (11.2±1.4 cm vs. 10.5±1.2 cm, p=ns and 9.8±1.5 cm vs. 8.9±1.0 cm, p=ns, respectively), which was accompanied with tendentiously lower TA functional properties represented by TA fractional area change (TAFAC, 22.2±12.3% vs. 23.7±11.7%, p=ns) and TA fractional shortening (TAFS, 15.9±5.6% vs. 18.8±8.0%, p=ns). TAPSE and RV-FAC showed mild correlations with TAFAC (r=0.39, p=0.05; r=0.36, p=0.05, respectively) and TAFS (r=0.37, p=0.05; r=0.38, p=0.05). Extent of LV noncompaction did not correlate with any echocardiographic parameters. Conclusions TA is dilated in LVNC patients without obvious RV involvement. Longitudinal (TAPSE) and sphincter-like (TAFAC, TAFS) TA motions correlate with each other. Funding Acknowledgement Type of funding sources: None.

Right ventricular myocardial work characterisation in patients with pulmonary hypertension: association with invasive haemodynamic parameters

Abstract Background Non-invasive evaluation of indices of right ventricular (RV) myocardial work derived from RV pressure-strain loops may provide novel insights into RV function in pre-capillary pulmonary hypertension. Purpose This study was designed to evaluate the association between the indices of RV myocardial work and invasive haemodynamic parameters in a patient cohort with pulmonary arterial hypertension (Group I) or chronic thromboembolism pulmonary hypertension (Group IV). Methods The non-invasive analysis of echocardiography-derived RV myocardial work (Figure 1, upper panel) was completed in 51 patients (mean age 58.1±12.7 years, 31% male) with Group I (78%) or Group IV (22%) pulmonary hypertension. Conventional echocardiographic measurements of RV systolic function, RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW) and RV global work efficiency (RV GWE) were compared with parameters derived invasively during right heart catheterisation (RHC). Results The median RV GWI, RV GCW, RV GWW and RV GWE were 620 (443 to 857) mmHg%, 830 (650 to 1206) mmHg%, 105 (54 to 169) mmHg% and 87 (82 to 93)%, respectively. Compared to pulmonary artery systolic pressure and conventional echocardiographic parameters of RV systolic function (RV global longitudinal strain [GLS], tricuspid annular plane systolic excursion and RV fractional area change), RV GCW and RV GWI correlated more closely with invasively-derived RV stroke work index (R=0.63, P&amp;lt;0.001 and R=0.60, P&amp;lt;0.001, respectively) (Figure 1, lower panels). Invasively-derived pulmonary vascular resistance (PVR) correlated with RV GWW (R=0.63, P&amp;lt;0.001), RV GWE (R=0.48, P&amp;lt;0.001) and RV GLS (R=0.58, P&amp;lt;0.001). RV GLS correlated more closely with invasively-derived stroke volume index (R=−0.57, P&amp;lt;0.001) than RV GCW, RV GWI and RV GWE (R=0.34, P=0.016, R=0.48, P&amp;lt;0.001 and R=0.47, P&amp;lt;0.001, respectively). Conclusions In a patient cohort with Group I and Group IV pulmonary hypertension, indices of RV myocardial work were more closely correlated with invasively-derived RV stroke work index and PVR than conventional echocardiographic parameters of RV systolic function. Funding Acknowledgement Type of funding sources: None. Figure 1. Method and correlations

Three-dimensional echocardiography in transcatheter edge-to-edge tricuspid valve repair

Abstract Background Transcatheter tricuspid valve repair (TTVR) is a new treatment option for severe tricuspid regurgitation (TR). First reports have reported conflicting results on development of right ventricular (RV) function after TTVR and questioned the role of conventional echocardiographic parameters to predict outcome. Purpose The aim of this study was to evaluate 3D echocardiography for the comprehensive assessment of RV function and its prognostic value for TTVR-treated patients. Methods We included patients undergoing TTVR from February 2017 to July 2019 who had preprocedural 3D assessment of RV volumes and ejection fraction. At follow-up (FU), 3D echo was performed to evaluate right ventricular reverse remodeling. All-cause mortality was assessed as clinical endpoint. Results 75 patients treated with TTVR for isolated, severe TR had 3D echo assessment. TTVR reduced TR from grade ≥3+ to ≤2+ in 83.1% of patients at discharge. 3D-RV end-diastolic volume (−46.3 ml, p&amp;lt;0.001), end-systolic volume (−22.0 ml, p=0.027) and 3D-RV ejection fraction (−4.7%, p&amp;lt;0.001) decreased at short-term FU at 1-month and remained stable at 6-month FU. An impaired preprocedural 3D-RVEF &amp;lt;44% conferred higher mortality risk (Figure), and was an independent predictor for 1-year mortality (hazard ratio 5.32, p=0.033) in multivariable analysis. Tricuspid annular systolic excursion (TAPSE) and RV fractional area change were not predictive for this endpoint. Importantly, the observed decrease of 3D-RVEF function after TTVR was not associated with outcome (p=0.22 for decrease of 3D-RVEF vs. no decrease of 3D-RVEF in Kaplan-Meier analysis). Instead, left ventricular stroke volume index increased by 9.2% from 26.0 to 28.4 ml/m2 (p&amp;lt;0.01) Conclusion TTVR leads to right ventricular reverse remodeling and decrease of RV systolic function after TTVR. Impaired preprocedural RV systolic function is associated with worse clinical outcome. In contrast, the observed decrease of RV systolic function after TTVR was not associated with outcome. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Klinikum der Universtität München Figure 1

Right ventricular dysfunction but not left ventricular ejection fraction is associated with length of stay in acute heart failure

Abstract Background Acute heart failure (AHF) remains a substantial healthcare burden worldwide. It is therefore important to identify triaging markers which are associated with length of stay (LOS). Attention from an echocardiographic perspective often centres on the left-ventricular ejection fraction (LVEF). The role of right ventricular (RV) function and pulmonary hypertension (PHT) remains less certain. Methods We investigated LOS in 440 consecutive patients presenting in AHF. We also identified those admitted ≥5 days – the cut-off date when reimbursement for AHF-related hospital care is reduced significantly in England. All patients underwent bedside echocardiography within 24 hours of recruitment, prior to intensive diuresis. Patients were followed up for 2 years. We analysed the association between echo parameters with LOS in 414 patients who survived to discharge. We also compared those admitted ≥5 and &amp;lt;5 days. Results The average LOS for survivors was 7.7±5.7 days; 216 (52.2%) stayed ≥5 days, with 198 (47.8%) discharged &amp;lt;5 days. LVEF was not correlated with LOS; Spearman's ρ −0.062 (p=0.207). RV fractional area change (ρ −0.108 [p&amp;lt;0.03]), tricuspid annulus plane systolic plane excursion (ρ −0.166 [p&amp;lt;0.001]) and systolic pulmonary artery pressure (ρ −0.161 [p&amp;lt;0.001]) were all correlated with LOS. In patients with longer LOS, greater BNP, diabetes and chronic kidney disease were more prevalent. 2-year all-cause mortality was 41.0% in those admitted ≥5 days and 27.1% for &amp;lt;5 days (Hazard ratio 1.57; 95% CI 1.13–2.19 [p=0.007]). Discussion RV dysfunction and severe PHT, not LVEF, were correlated with increased LOS in 414 consecutive patients discharged from an admission with AHF. These patients will place a disproportionate cost on health care resources. These hypothesis generating results suggest early echo assessment to quantify RV dysfunction may help to risk stratify patients with AHF and re-design hospital tariffs. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Abbott Laboratories Table and KM curve

Phenotyping the right heart according to left ventricular geometry patterns in severe HFrEF

Abstract Background Right ventricular (RV) failure significantly impact on heart failure with reduced ejection fraction (HFrEF) prognosis. How and whether specific functional and geometrical phenotypes of the RV function adapt and combined with left ventricular (LV) geometry is unknown. Purpose To test the RV function across LV geometrical patterns looking at respective prognostic roles. Methods We retrospectively examined a population of patients homogenously diagnosed with chronic HFrEF (defined as LV ejection fraction (EF) less than 35%) and treated with optimal therapy (OT) and all implanted with ICD for primary prevention of sudden cardiac death. Patients were categorized by echocardiography according to remodeling pattern based on left ventricular mass index and relative wall thickness into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). RV parameters were: tricuspid annulus plane systolic excursion (TAPSE), TAPSE/pulmonary artery pressures (PAPs), RV basal diameter and fractional area change (FAC). Outcome variable was all-cause mortality, assessed with multivariable Cox proportional hazard (PH) models. Results Among 193 patients (age 66±11 years, 81% men, 74% with ischemic etiology of HF and EF 28±5%) 21% had NG, 3% had CR, 8% had CH, and 68% had EH. Distribution of RV echo parameters across LV remodeling groups is shown in table 1. Over a median follow-up time of 4 (1.9 – 6.1) years, 65 deaths occurred. In multivariable Cox PH models adjusted for age, LVEF, ischemic etiology and LV geometry, TAPSE, TAPSE/PAPs, RV basal diameter and FAC strongly and independently predicted the outcome variable [HR 0.92 (95% C.I. 0.86–0.98), HR 0.08 (95% C.I. 0.01–0.57), HR 1.87 (95% C.I. 1.29–2.71), HR 0.97 (95% C.I. 0.95–1.00), respectively all p-value &amp;lt;0.05]. Conclusion In a homogeneously defined population of severe HFrEF outpatients receiving OT, the majority showed EH remodeling pattern, which did not predict the primary outcome. LV geometry did not further stratify patients in this high risk group. Conversely, RV dysfunction proved to be a strong predictor of mortality, independently of age, LV function and etiology of HF, regardless LV morphology. Funding Acknowledgement Type of funding sources: None.

Tricuspid regurgitation in ischemic mitral regurgitation patients – prevalence, predictors for outcome and long-term follow-up

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was five years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N=40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7±9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3±6.45 [%], LA area 46.4±8.06 [mm2], LV internal diastolic diameter (LVIDD) 59.6±3.94 [mm], RV fractional area change (RVFAC) 22.3±4.36 [%], systolic pulmonary artery pressure (SPAP) 48.4±9.45 [mmHg]. Independent variables associated with FTR development were age ≥65y [OR 1.2], failed revascularization, LA area ≥42.5 [mm2] [OR 17.1], LVEF ≤24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p=0.06 and p=0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up. Funding Acknowledgement Type of funding sources: None.

Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (S') and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to right heart failure or cardiovascular mortality was defined. Results A total of 130 patients were included (mean age was 75±17 years, 69% females, 93% in NYHA I/II). According to etiology, 14% were primary TR and 86% were functional (49% due to corrected left valve disease and 37% due to tricuspid annulus dilatation). Mean values of RV function parameters are shown in the table. During a mean follow up of 18±8 months, n=39 patients (30%) reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p&amp;gt;0.05 for all). Conclusion In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients. Funding Acknowledgement Type of funding sources: None. RV parameters

Evaluation of right ventricular function in acute pulmonary embolism by 3D ejection fraction and longitudinal strain echocardiography in acute phase and follow-up

Abstract Background Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to severity stratification. However, there is no reliable information on RV function about the clinical utility of advanced TTE parameters in follow-up. Purpose We aimed to assess the clinical utility of 3D RV ejection fraction (3DEF) and free wall longitudinal strain (FWLS) compared to conventional parameters in evaluating RV function in patients with acute PE at time of diagnosis and after follow-up and the relation with adverse outcomes. Methods We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. Patients underwent TTE during admission and at 6 to 12 months follow-up that included conventional RV parameters (pulsed Doppler S wave (S'), TAPSE, and fractional area change (FAC)). 3DEF and FWLS were obtained as well. Normal values were stablished according to European guidelines. Results Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26,8%. In-hospital mortality was 4,7% (3 patients in the acute phase of PE and 1 due to rePE. The median follow-up was 1.3 years (IQR 1–2.5). 9 patients died (2 due to PE, 3 due to respiratory failure and 5 due to cancer). Patients with adverse events had a greater severity in PESI scale and worse RV function assessed by 3DEF and 3D volumes. There were no significant differences between groups in FAC, S' and TAPSE (Table 1). Baseline echocardiographic parameters were analyzed in the acute phase during admission and at 6–12 month follow-up (Table 2). There was a significant improvement in conventional parameters (TAPSE and FAC) and a reversal of FWLS values (P=0,01) at follow-up. 3DEF improved, but was not statistically significant (p=0,06). There was a greater reversal in end-systolic volume compared to end-diastolic volume. Conclusion Advanced RV function assessment by 3DEF and FWLS is useful in the acute phase and follow-up. FWLS showed and early normalization after PE resolution, whereas 3DEF improved but remained pathological at 6–12 months follow-up. Funding Acknowledgement Type of funding sources: None. Table 1Table 2

Prognostic role of right ventricular geometry and function in patients undergoing double valve surgery

Abstract Introduction Multiple valvular heart disease, a combination of stenotic and regurgitant lesions occurring on two or more valves, is a highly prevalent condition. For these patients, surgical correction is the only definitive treatment to improve prognosis, yet concomitant aortic and mitral (double) valve surgery is associated with poor post-operative outcomes. While current guidelines outline left ventricular dimensions and function as surgical triggers, little is known regarding the importance of right ventricular (RV) remodelling in these patients. Purpose We sought to evaluate the prognostic value of RV remodelling in patients undergoing double valve surgery. Methods RV remodelling was characterised by transthoracic echocardiography in 152 patients undergoing concomitant aortic and mitral valve replacement (n=118) or aortic valve replacement and mitral valve repair (n=34). Four patterns of RV remodelling were defined according to the presence of RV dilation (tricuspid annulus diameter&amp;gt;35mm) and RV systolic dysfunction (percentage RV fractional area change &amp;lt;35%): normal RV size and systolic function (pattern 1); dilated RV with normal systolic function (pattern 2); RV systolic dysfunction with normal RV size (pattern 3); and dilated RV with systolic dysfunction (pattern 4). Adverse events were defined as the composite of all-cause mortality and hospitalisation for heart failure. Results Overall, 62 (41%), 31 (20%), 35 (23%), and 24 (16%) patients were classified as RV remodelling patterns 1, 2, 3, and 4, respectively. Patients with advanced RV remodelling patterns were more frequently male, had worse renal function, and a higher EuroSCORE II. During a median follow-up of 43 months, 41 adverse events (22 heart failure hospitalisation and 19 deaths) occurred. Patients with patterns 3 and 4 RV remodelling had an increased risk of adverse events compared to pattern 1 (log-rank χ2 27.42; p&amp;lt;0.001; Figure 1). After adjustments for EuroSCORE II and significant tricuspid regurgitation, RV remodelling patterns 3 (Hazard Ratio [HR] 3.24, 95% Confidence Interval [CI] 1.27–8.24, p=0.014) and 4 (HR 6.18, 95% CI 2.49–15.32, p&amp;lt;0.001) were independently associated with poor post-operative outcomes. Importantly, RV remodelling patterns provided incremental prognostic value to EuroSCORE II (χ2 increased from 18 to 38, p&amp;lt;0.001). Conclusion In patients with concomitant aortic and mitral valve disease, RV remodelling is frequent and associated with poorer outcomes. Our study highlights the involvement of the RV in left-sided valvular heart disease and underlines the importance of preoperative assessment of RV geometry and function in patients undergoing double valve surgery. Funding Acknowledgement Type of funding sources: None. Figure 1