Right Ventricular Myocardial Function Research Articles

Correlations among noninvasive right ventricular myocardial work indices and the main parameters of systolic and diastolic functions.

BackgroundRight ventricular (RV) myocardial work (RVMW) is the latest method used to assess RV function. To date, correlations among RVMW indices and RV systolic and diastolic functions have not been studied.MethodsA total of 106 healthy volunteers (median age, 34 years; 46% male) were prospectively enrolled. RVMW indices were measured using the RV pressure–strain loop using specific software. The correlations among RVMW indices and other RV functions were analyzed.ResultsDuring the multivariate analysis, the RV global work index (RVGWI) was significantly correlated with RV global longitudinal strain (RV GLS) (p < .0001), pulmonary systolic artery pressure (PASP) (p < .0001), and tricuspid annular (TA) plane systolic excursion (TAPSE) (p = .036). RV global constructive work (RVGCW) was correlated with RV GLS (p < .0001) and PASP (p < .0001). RV global wasted work (RVGWW) was correlated with RV GLS (p = .008) and TA isovolumetric acceleration (TA IVA) (p = .008). RV global work efficiency (RVGWE) was correlated with RV GLS (p < .0001) and tissue Doppler (TD) RV myocardial performance index (TD RMPI) (p = .043).ConclusionRVMW indices showed good correlations with RV myocardial systolic function.

799 Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis

Abstract Aims The real effects of the chronic consumption of anabolic–androgenic steroids (AAS) on cardiovascular structures are subjects of intense debate. Aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. Methods and results 115 top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. LA volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P &amp;lt; 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P &amp;lt; 0.01), PASP (beta = 0.43, P &amp;lt; 0.001) at peak effort, and number of weeks of AAS use per year (beta = 0.45, P &amp;lt; 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P &amp;lt; 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. Conclusions STE represents a promising technique to assess RV myocardial function in athletes abusing steroids. AAS users showed a more impaired RV deformation, closely associated with reduced functional capacity during physical effort, and—during exercise—more pulmonary congestion.

Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis

The real effects of the chronic consumption of anabolic-androgenic steroids (AASs) on cardiovascular structures are subjects of intense debate. The aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. One hundred and fifteen top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. left atrial volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), pulmonary artery systolic pressure (beta = 0.43, P < 0.001) at peak effort and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. In athletes abusing steroids, STE analysis showed an impaired RV systolic deformation, closely associated with reduced functional capacity during physical effort, and-during exercise-more pulmonary congestion.

Prognostic value of soluble ST2 biomarker in heart failure patients with obstructive sleep apnea syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Objective. To analyze the relationships between soluble ST2 (sST2) levels, apnea/hypopnea index (AHI) and echocardiographic parameters in heart failure patients with preserved ejection fraction (HFpEF) and to evaluate prognostic values of sST2 in the development of adverse cardiac events (ASE) during the 12-month follow-up period. Methods. A total of 86 men, median age of 62.0 (41.0; 78.0) years with obstructive sleep apnea syndrome (OSAS) and HF of NYHA class I-III with baseline LVEF of 60% [52; 65]% were enrolled in the study. The severity of obstructive breathing disorders during sleep was assessed by AHI. Serum levels of NT-proBNP and sST2 were measured using ELISA at baseline. Two-dimensional transthoracic echocardiography with assessment of right ventricular (RV) function and 6-minute walk test (6MWT) were performed at baseline. Results. The values of AHI significantly correlated with body mass index (r = 0.362), left atrial volume (r = 0.570), fractional change in the area of the RV (r=-0.527), RV myocardial function index (r=-0.377), NT-proBNP (r = 0.611), 6MWT (r=-0.511), RV anterior wall thickness (r = 0,472), while the levels of sST2 significantly correlated with LV remodeling parameters: LVEF (r =-0.301), end-systolic volume (r =0.453), end-diastolic volume (r =0.396), end-systolic dimension (r = 0.373), end-diastolic dimension (r =0.288). Based on ROC-analysis, sST2 ≥29.67 ng/mL (sensitivity 63.6%, specificity 73.6%, AUC = 0.645; p &amp;lt; 0.0001) were identified as a cut-off values predicting the development of ACE. At 12 months of follow-up period all patients were divided into 2 groups according to cut-off values of sST2: group 1 (n = 29) comprised patients with sST2 ≥29.67 ng/mL, group 2 (n = 42) comprised patients with sST2 &amp;lt;29.67 ng/mL. The median baseline values of sST2 were 41.39 [33.31; 50.99] ng/mL in group 1, and 22.18 [20.64; 25.5] ng/mL in group 2. The concentrations of NT-proBNP did not differ between the groups. During the 12-month follow-up period in group 1 the rate of ACE was 29.7% cases, and 5.2% in group 2, respectively. According to Kaplan-Meier analysis, a higher sST2 levels was associated with a higher frequency of ACE during 12 months of follow-up (р&amp;lt;0.0001). Univariable and multivariable Cox regression analyses showed sST2 concentrations were significantly associated with ACE (odds ratio 2.25, 95%CI: 2.06 to 3.29, p &amp;lt; 0.001), when adding AHI and LV myocardial mass index improved reclassification of risk stratification (odds ratio 3,28, 95%CI: 3,09 to 4,49, p &amp;lt; 0.001, AUC of 0.945, percent of cases correctly classified of 90.14 %). However, NT-proBNP addition had a limited effect on risk stratification. Conclusion. Our data suggest that sST2 may be used as a diagnostic biomarker for prediction of ACE in patients with HFpEF and OSAS during the 12-month follow-up period. The combined evaluation of sST2, AHI and LV myocardial mass index values demonstrated higher diagnostic sensitivity and specificity for prediction of ACE.

Speckle tracking right ventricular myocardial strain post-percutaneous closure of atrial septal defects in children

Background: Atrial Septal Defects (ASDs) can induce Right Ventricular (RV) volume overload and dysfunction. The RV has complex morphology; thus makes the quantitative assessment of its function challenging. Speckle tracking Global Longitudinal Strain (GLS) could be applied to estimate RV function. This study aimed to evaluate the changes in RV myocardial function by 2D speckle tracking global longitudinal strain in children with secundum ASD pre- and 3-month post-percutaneous device closure. Methods and findings: Thirty-one children who underwent percutaneous ASD closure were prospectively examined. LV Ejection Fraction (EF), Estimated Systolic Pulmonary Artery Pressure (ESPAP), Tricuspid Annulus Plane Systolic Excursion (TAPSE), Fractional Area Change (FAC), and RV-GLS were calculated and analyzed prior- and 3-month after device closure. The mean age of patients was 8.15 ± 3.43 years with a mean weight of 17.31 Kg. ± 6.17 Kg. Sixteen (51.61%) patients were females. The pulmonary to systemic blood flow (QP/QS) ratio was 1.6 ± 0.56. The vertical, horizontal, and oblique diameters of the ASD were 15.06 mm ± 4.95 mm, 12.84 mm ± 3.12 mm, and 16.17 mm ± 4.29 mm respectively, and the device diameter was 16.94 mm ± 4.80 mm. After 3-month, there was a significant decrease in RA diameters, RV diameters, and ESPAP (P<0.001). TAPSE increased significantly from 14.32 mm ± 1.44 mm to 20.32 mm ± 1.57 mm (P<0.001), FAC enhanced significantly from 33.31% ± 11.14% to 39.15% ± 18.17 %, and RVGLS improved significantly from -17.26% ± 2.32% to -24.79% ± 3.41% (P<0.001). There were negative correlations between RV-GLS with RA diameters, RV diameters, and ESPAP (P<0.05), and positive correlations between RV-GLS with TAPSE, and FAC (P<0.05). Conclusion: Speckle tracking-based GLS is a quantitative calculator of the subtle RV function impairment in children with ASDs that showed significant improvement to normal values in mid-term 3-month follow-up post-percutaneous device closure. Such a validated tool can be used in volume overloaded conditions to predict early ventricular dysfunction and to guide the initiation of percutaneous closure management strategy.

Evaluation of Right Ventricular Systolic Function in Patients With Chronic Pulmonary Heart Disease by 2-Dimensional Speckle-Tracking Echocardiography.

To investigate the value of 2-dimensional (2D) speckle-tracking echocardiography for assessing right ventricular (RV) systolic function in patients with chronic pulmonary heart disease (CPHD) and the correlation of its parameters with the right ventricular ejection fraction (RVEF) on cardiac magnetic resonance imaging (MRI). According to pulmonary arterial systolic pressure, 80 patients with CPHD and tricuspid regurgitation were divided into 2 groups: 42 with mild pulmonary hypertension (PH; 30-50 mm Hg) and 38 with moderate or severe PH (≥50 mm Hg); 41 control participants were recruited. All participants underwent 2D speckle-tracking echocardiography and cardiac MRI. The longitudinal peak systolic strain and longitudinal peak systolic strain rate were measured by echocardiography in each segment of the RV free wall and interventricular septum and compared with the RVEF on cardiac MRI. Strain values in all segments of the RV free wall and interventricular septum were lower in the mild PH group than the control group (P < .05). Strain rate values in the apical segment of the RV free wall and basal segment of the interventricular septum were lower in the mild PH group than the control group (P< .05). Strain and strain rate values in all segments of the RV free wall and interventricular septum were lower in the moderate or severe PH group than the control group (P < .05). Strain and strain rate values in all segments of the RV free wall and interventricular septum were lower in the moderate or severe PH group than the mild PH group (P< .05). Strain and strain rate values in all segments of the RV free wall and the interventricular septum correlated with the RVEF (P < .001). The ability of speckle-tracking echocardiography to directly monitor RV myocardial function may allow early sensitive detection of subclinical myocardial dysfunction in patients with CPHD, with better risk stratification and timely institution of therapy.

Utility of speckle tracking echocardiography imaging in patients with asymptomatic and symptomatic arrhythmogenic right ventricular cardiomyopathy.

Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by the progressive replacement of ventricular myocytes with variable amounts of fibrous and adipose tissue. Several studies have suggested that speckle tracking echocardiographic (STE) parameters such as strain (S) and strain rate (SR) may prove useful in the early detection of right ventricular (RV) dysfunction. Therefore, the aim of this study was to evaluate RV myocardial function using the STE method in both asymptomatic and symptomatic patients with ARVD and to assess its potential role in the differential diagnosis of these two presentations. We recruited 34 patients with ARVD. Seventeen patients were symptomatic, and seventeen were asymptomatic. The RV free wall global longitudinal S and SR were significantly lower in symptomatic patients with ARVD than in asymptomatic patients. According to a cutoff value of 1.35 per seconds for RV global SR, the sensitivity and specificity for predicting ARVD were 88% and 77%, respectively. According to a cutoff value of 17.3% for RV S, the sensitivity and specificity for predicting ARVD were 82% and 77%, respectively. In conclusion, we present strong evidence that STE-derived global S and SR in the RV free wall are decreased in symptomatic patients with ARVD compared with asymptomatic patients.

OP.4B.06] THE IMPACT OF UPDATED LEFT VENTRICULAR GEOMETRY CLASSIFICATION ON RIGHT VENTRICULAR REMODELLING IN A HYPERTENSIVE POPULATION

Objective: We aimed to investigate right ventricular (RV) mechanics and function in hypertensive patients with different left ventricular (LV) geometric patterns by using a two-dimensional (2D) strain analysis and three-dimensional echocardiography (3D). Design and method: This cross-sectional study included 232 hypertensive subjects who underwent complete 2D and 3D examination. We applied the updated classification of LV geometry that considers LV mass index (LVMI), LV end-diastolic volume (LVEDV) index and relative wall thickness (RWT). All the subjects were divided into 6 groups: normal LV geometry, concentric remodelling, eccentric LVH, concentric LVH, dilated LVH and concentric-dilated LVH. Results: According to the updated classification, the study sample included 98 subjects with normal LV geometry (42%), 32 patients with LV concentric remodeling (14%), 49 with eccentric LVH (21%), 36 concentric LVH (15%), 11 dilated LVH (5%) and 6 concentric-dilated LVH (3%). 3D RV end-diastolic and end-systolic volume indexes gradually and significantly increased from the subjects with normal LV geometry and LV concentric remodelling, across patients with eccentric and concentric LVH, to participants with dilated and concentric-dilated LVH (61 ± 6 vs. 63 ± 6 vs. 68 ± 8 vs. 67 ± 7 vs. 77 ± 8 vs. 74 ± 8 ml/m2 for RV end-diastolic volume index, p < 0.001), whereas 3D RV ejection fraction gradually decreased in the same direction (59 ± 4 vs. 59 ± 3 vs. 58 ± 3 vs. 57 ± 3 vs. 55 ± 3 vs. 54 ± 3 %, p < 0.001). Global RV longitudinal strain was significantly decreased in patients with concentric and concentric-dilated LVH comparing to subjects with normal LV geometry and concentric LV remodelling (−24.0 ± 3.5 vs. −23.7 ± 3.3 vs. −22.5 ± 3.1 vs. −20.7 ± 2.6 vs. −21.4 ± 2.9 vs. −20.5 ± 2.5 %, p < 0.001). Conclusions: 2D RV myocardial deformation and 3D RV function are significantly impacted by LV geometry in hypertensive patients. Concentric and concentric-dilated LVH patterns have the greatest unfavourable effect on RV mechanics.

Assessment of right ventricular function by feature-tracking echocardiography in conscious healthy dogs

Advanced two-dimensional echocardiographic techniques allow strain (S) analysis of regional function and thus can provide information on regional myocardial deformation. Feature-tracking echocardiography (FTE) is based on a mono-dimensional technology and may offer more detailed information about septal deformation because it can analyse the activity of left- and right-sided septal fibres separately. The present study aimed to quantify global and regional (free wall and septal) right ventricular (RV) longitudinal S and strain rate (SR). We also investigated the relationships of S and SR with age, sex, weight, breed (sighthound breed vs other breeds), and heart rate. Cine loops were acquired from the left apical four-chamber view, optimized for the RV, in 60 dogs. The within-day and between-day intra-observer coefficient of variation for global RV S and SR in normal dogs using FTE was acceptable (<8.5%). Global longitudinal S (GLS) and SR showed a significant correlation with breed. GLS showed a significant weak positive correlation with weight. Global longitudinal SR showed a significant moderate negative correlation with heart rate. No correlation was found between GLS/SR and age. There was no significant difference between male and female dogs. This study shows, for the first time, that a novel FTE algorithm represents a promising and feasible non-invasive technique to assess RV myocardial function (free wall and septal deformation) in dogs. Based on our results, sighthound breeds appear to need specific reference values.

Pre-operative Speckle-tracking Imaging to Predict the Need for Right Ventricular Support in Patients Undergoing Left Ventricular Assist Device Implantation

Background: Right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation significantly complicates post-device management and has been shown to be associated with increased mortality. Pre-operative identification of patients who may develop post-LVAD RV dysfunction is challenging. This study was designed to evaluate pre-operative echocardiographic speckle tracking imaging as a predictor of post operative RV dysfunction. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement in a single center were studied. Pre- and post-operative clinical, hemodynamic, laboratory, and echocardiographic data were prospectively collected as part of an ongoing institutional LVAD database. RV strain parameters were measured retrospectively using off-line speckletracking analysis software. Results: Twenty five of 39 LVAD recipients developed acute RV failure during the early post-operative period. RV function in 14 of these recipients improved with inotropes and judicious adjustment of LVAD parameters. Eleven patients, however, expired despite aggressive medical therapy including 7 patients who underwent placement of an RVAD. These 11 individuals were identified as having significantly lower global RV strain prior to device placement (p Conclusion: Poor intrinsic RV myocardial function is associated with a higher mortality in LVAD patients. Speckle-tracking echocardiography imaging, particularly, peak systolic global RV strain appears to be promising in predicting LVAD patients who require RVAD. Key words: Echocardiography, Heart Failure, Right heart function, Strain, Ventricular assist device.

Right Heart Mechanics in Untreated Normotensive Patients with Prediabetes and Type 2 Diabetes Mellitus: A Two- and Three-Dimensional Echocardiographic Study

The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69±10 vs 63±8 vs 58±8mL/m(2), P<.001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25±4 vs 23±4 vs 22±4mL/m(2), P<.001). However, there was no difference in 3DE RV ejection fraction among the three groups (63±4% vs 62±4% vs 61±5%, P=.063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.

The effect of right ventricular myocardial remodeling on ventricular function as assessed by two-dimensional speckle tracking echocardiography in patients with tetralogy of Fallot: A single center experience from China

BackgroundPublished correlations between histological abnormalities and right ventricular (RV) function, as evaluated by speckle tracking echocardiography (STE), are scarce in patients with tetralogy of Fallot (TOF). The purpose of the study is to assess age-associated differences in the effect of RV myocardial remodeling on ventricular function in patients with TOF. MethodsOperatively resected crista supraventricularis muscle from 30 patients (median age 12months) undergoing intracardiac repair of TOF were studied by light microscopy. The patients were divided into younger (age at surgery ≤12months) and older (age at surgery >12months) subgroups. The RV global longitudinal peak systolic strain (GLS), strain rate (GLSRs) and early diastolic strain rate (GLSRe) were measured by two-dimensional STE before and 6months after repair. ResultsThe histopathological data revealed hypertrophy of the cardiomyocytes, a thickened endocardium, and increased interstitial and perivascular collagen in RV, which were associated with older age at the time of repair. The RV global systolic and diastolic functions in patients with repaired TOF were increased compared with the preoperative values. The RV cardiomyocyte diameter and collagen volume fraction (CVF) correlated with the preoperative GLS, GLSRs and GLSRe, respectively, in the younger patients (r1=−0.566, P1=0.018; r2=−0.493, P2=0.004; r3=−0.504, P3=0.039). The RV cardiomyocyte diameter and CVF correlated with preoperative GLS, GLSRs and GLSRe, respectively, in the older patients (r1=−737, P1=0.004; r2=−0.588, P2=0.035; r3=−0.812, P3=0.001). The correlation of the RV cardiomyocyte diameter with the postoperative GLS and GLSRe (r1=−665, P1=0.036; r2=−0.787, P2=0.007) and the CVF with the postoperative GLSRs and GLSRe (r1=−762, P1=0.002; r2=−0.713, P2=0.004) were identified only in the older patients. Multivariate analysis indicated that the age at repair was an independent predictor of postoperative GLSRs and GLSRe in all of the patients (β=−0.449, P=0.041; β=−0.607, P=0.004). ConclusionsThe effect of RV myocardial remodeling on preoperative RV function was more pronounced in the older patients with TOF than in the younger ones. Preoperative myocardial remodeling affected the postoperative RV function in the older but not in the younger patients. The age at the time of surgical repair was the independent determinant of the postoperative RV myocardial function.

Heart diastolic dysfunction in patients with systemic sclerosis.

IntroductionThere are limited data on left (LV) and right ventricular (RV) diastolic function in systemic sclerosis (SSc) patients especially in relation to biomarkers of matrix remodeling. The aim of the study was to analyze LV and RV myocardial diastolic function in SSc patients at baseline and after at least 1 year of follow-up and its relation to serum tissue inhibitors of metalloproteinase 1 (TIMP-1) level.Material and methodsWe prospectively studied 111 SSc patients (101 female, 10 male, age 54.2 ±13.8 years) and 21 age-matched controls (18 female, 3 male, age 49.3 ±10.5 years). After at least 1 year of observation (3.0 ±1.1 years) we reevaluated 69 of the SSc patients. Transthoracic echocardiography (Philips, iE33) for assessment of LV and RV diastolic function was performed and TIMP-1 serum level was measured.ResultsImpaired LV relaxation was observed in 38 (34%) SSc patients and in 1 (5%) of the controls (p < 0.001). The mean E/A ratio was lower in patients with SSc than in controls (p = 0.002) and significantly decreased after the follow-up period (p = 0.02). Impaired RV relaxation was detected in 25 (22.5%) SSc patients and in 1 (5%) control subject (p < 0.001) but did not deteriorate after follow-up. Mean serum level of TIMP-1 was significantly elevated in the follow-up group compared to baseline examination (p = 0.0001). Serum TIMP-1 level correlated positively with E/E’, both septal and lateral (r = 0.4, p = 0.002 and r = 0.32, p = 0.01).ConclusionsThe LV and RV relaxation is impaired in SSc patients. Moreover, left ventricular diastolic function deteriorated after the follow-up period. The TIMP-1 serum levels correlate with echocardiographic parameters, providing a potent link for LV diastolic function and matrix remodeling in patients with SSc.

Effects of the Metabolic Syndrome on Right Heart Mechanics and Function

BackgroundWe sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). MethodsThis cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ≥ 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. Results2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (−24 ± 5 vs −27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. ConclusionsRV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling.

Pre-Operative Velocity Vector Imaging To Predict the Need for Right Ventricular Support in Patients Undergoing Left Ventricular Assist Device Implantation

<h3>Purpose</h3> The aim of this study was to predict right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implant by preoperative assessment of RV global myocardial systolic strain and strain rate using velocity vector imaging. Novel 2D echo parameters may prove useful in preoperatively identifying patients at high risk for RV dysfunction post LVAD implant. <h3>Methods and Materials</h3> Between Jan 1^st 2010 and Dec 31^st 2011, 39 consecutive patients who received a HeartMate II LVAD underwent a pre-operative 2D ECHO. The RV systolic myocardial longitudinal velocity, strain and strain rate were measured using dynamic 2D vector velocity imaging as markers of RV performance. The primary endpoint was death or implant of a RV assist device (RVAD) due to acute RV failure within 6 months after LVAD implant. <h3>Results</h3> RV failure occurred in 25 of 39 patients (64%) after LVAD placement. Despite inotropic support, inhaled nitric oxide and RVAD support 11 patients of the 25 who developed RV failure expired. A preoperative RV global systolic myocardial strain cut off of -3% had a sensitivity of 73% and a specificity of 86% in predicting post LVAD implant RV failure. RV global strain was an independent predictor of RV failure in a multivariate model (including RV free wall strain, mean PAP, RV EF and Michigan score) (AUC was 0.81). [figure 1] <h3>Conclusions</h3> Poor intrinsic RV myocardial function is associated with a higher mortality in LVAD patients. Dimensionless RV parameters, derived from 2-dimensional speckle tracing echocardiography imaging, particularly, peak systolic global RV strain appears to be promising in predicting LVAD patients who require RVAD.

Abstract 19809: Intrinsic Right Ventricle Dysfunction is a Major Cause of Post LVAD Mortality

Background: Right ventricular (RV) dysfunction after left ventricular assistant device (LVAD) confers significant challenges for post-device managements and increases mortality. The purpose of this study was to test the hypothesis that intrinsic RV myocardial dysfunction measured by 2-D echocardiography speckle tracking imaging prior to LVAD implantation is the most common cause of post-LVAD failure. Methods: Thirty-nine patients who underwent Heartmate II LVAD placement from 2010 to 2011, and 10 age-matched controls were studied. Pre- and post-operative clinical, and echocardiographic data were prospectively collected for LVAD database. RV longitudinal myocardial velocity, strain, and strain rate were measured retrospectively using an off-line speckle-tracking analysis software. Results: Of the 39 LVAD recipients, 24 patients developed acute RV failure immediately post LVAD implantation, among which 13 patients recovered from RV dysfunction after LVAD adjustment and medical management, while 11 patients with intrinsic RV dysfunction as identified by significantly lower global RV peak myocardial velocity, strain, and strain rate prior to LVAD (p&lt;0.05), eventually required RVAD and/or death despite optimal medical therapy. Intrinsic RV myocardial dysfunction often cannot be completely improved by LVAD implantation alone and may be exaggerated by septal shifting caused by emptying or decompressing LV, thus, worsening severe or deteriorating RV dysfunction which eventually requires RVAD or leads to death. Eight of 11 patients including all 7 RVAD patients died within 6 months from LVAD implantation had a peak longitudinal systolic RV global strain of -3% or lower (absolute value). Twenty-four of 27 (88%) patients with the global RV strain higher than -3% (absolute value) survived without RVAD (p&lt;0.05). Conclusions: Poor intrinsic RV myocardial function is often worsened in LVAD patients and is a leading cause for a high LVAD mortality.

Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis

To analyse right ventricular (RV) myocardial deformation in patients with left ventricular (LV) hypertrophy secondary to either hypertrophic cardiomyopathy (HCM) or athlete's competitive endurance training. Standard Doppler echo, exercise stress echo, and 2D speckle-tracking strain echocardiography (2DSE) of RV longitudinal deformation in RV septal and lateral walls were performed in 50 top-level endurance athletes and in 35 patients with HCM, all men, having evidence of LV hypertrophy. Right ventricular global longitudinal strain (GLS) was calculated by averaging local strains along the entire right ventricle. The two groups were comparable for age and blood pressure, whereas athletes showed lower heart rate and increased body surface area than HCM. Interventricular septal thickness was higher in HCM, whereas both LV and RV end-diastolic diameters (LVEDD and RVEDD) and LV stroke volume were increased in athletes. Right ventricular tricuspid annulus systolic excursion was comparable between the two groups. Conversely, RV GLS and regional peaks of RV myocardial strain were significantly impaired in patients with HCM (all P < 0.001). Multiple linear regression models detected an independent association between RV GLS and LVEDD (beta-coefficient = -0.68, P < 0.0001) in athletes, as well as an independent correlation of the same RV GLS with septal thickness (beta = 0.63, P < 0.0001) in HCM. An RV GLS cut-off value of -0.16% differentiated athletes and HCM with an 86% sensitivity and a 92% specificity. Furthermore, in the overall population, RV GLS (beta = 0.51, P < 0.0001) was a powerful independent predictor of maximal workload during exercise stress echo. Right ventricular myocardial systolic deformation is positively influenced by preload increase in athletes and negatively associated with increased septal thickness in HCM. Therefore, 2DSE may represent a useful tool in the differential diagnosis between athlete's heart and HCM, underlining the different involvement of RV myocardial function in either physiological or pathological LV hypertrophy.

Noninvasive Assessment of Right Ventricular Function: Will There Be Resurgence in Radionuclide Imaging Techniques?

Right ventricular (RV) function is increasingly being recognized as an important prognostic marker in multiple cardiopulmonary disease states, including congestive heart failure, pulmonary arterial hypertension, and chronic obstructive pulmonary disease. Accurate and reproducible measures of RV function, although technically challenging, are highly relevant in the clinical setting. Radionuclide techniques (eg, first-pass radionuclide angiography for quantifying RV systolic function) were developed nearly 40 years ago. More recently, MRI and transthoracic echocardiography have become the diagnostic imaging techniques of choice for the noninvasive evaluation of RV function. However, developments in single photon emission computed tomography (SPECT), positron emission tomography (PET), and hybrid SPECT/CT and PET/CT systems have greatly improved the image quality and contrast resolution of radionuclide imaging of the heart, allowing for coregistered physiologic and anatomical information of the right ventricle in three dimensions. These improvements in cardiac imaging provide new opportunities for assessing RV myocardial perfusion, function, and anatomy in the same setting. Such imaging approaches may in the future provide assistance with proactive disease management, including early diagnosis of impending RV dysfunction in high-risk patients and for guiding decisions to initiate and/or modify treatments.

Right Ventricular Myocardial Function in Patients with Either Idiopathic or Ischemic Dilated Cardiomyopathy Without Clinical Sign of Right Heart Failure: Effects of Cardiac Resynchronization Therapy

In dilated cardiomyopathy (DCM), right ventricular (RV) dysfunction has been reported and attributed both to altered loading conditions and to RV involvement in the myopathic process. The aim of the study was to detect RV myocardial function in DCM using two-dimensional (2D) strain echocardiography and to assess the effects of cardiac resynchronization therapy (CRT) on RV myocardial strain during a 6-month follow-up. A total of 110 patients (mean age: 55.4 +/- 11.2 years) with either idiopathic (n = 60) or ischemic (n = 50) DCM, without overt clinical signs of RV failure, underwent standard echo and 2D strain analysis of RV longitudinal strain in RV septal and lateral walls. The two groups were comparable for clinical variables (New York Heart Association class III in 81.8%). Left ventricular volumes, ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar between the two groups. No significant differences were evidenced in Doppler mitral and tricuspid inflow measurements. RV diameters were mildly increased in patients with idiopathic DCM, while RV tricuspid annulus systolic excursion and Tei-index were comparable between the two groups. RV global longitudinal strain and regional peak myocardial strain were significantly impaired in patients with idiopathic DCM compared with those having ischemic DCM (all P < 0.001). Using left ventricular end-systolic volume as marker for response to CRT, 70 patients (63.3%) were long-term responders. Ischemic DCM patient responders to CRT showed a significant improvement in RV peak systolic strain. Conversely, in patients with idiopathic DCM and in ischemic patients nonresponders to CRT, no improvement in RV function was evidenced. By multivariable analysis, in the overall population, ischemic etiology of DCM (P < 0.0001), positive response to CRT (P < 0.001), and longitudinal intraventricular dyssynchrony (P <0.01) emerged as the only independent determinants of RV global longitudinal strain after CRT. Two-dimensional strain represents a promising noninvasive technique to assess RV myocardial function in patients with DCM. RV myocardial deformation at baseline and after CRT are more impaired in idiopathic compared with ischemic DCM patients. Future longitudinal studies are warranted to understand the natural history of RV myocardial function, the extent of reversibility of RV dysfunction with CRT, and the possible prognostic impact of such indexes in patients with congestive heart failure.

The impact of ageing on right ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study

To evaluate the influence of age on pulsed Tissue Doppler-derived measurements of right ventricular (RV) tricuspid annulus in a population of healthy subjects and to propose reference values according to age decades. Two hundred and ninety-eight healthy subjects (M/F = 186/112) underwent Doppler echocardiography and pulsed Tissue Doppler of tricuspid annulus in apical four-chamber view. Tricuspid annular plane systolic excursion (TAPSE), Doppler indexes of RV outflow tract and of tricuspid inflow, right atrial dimension and inferior vena cava size, and collapsibility were measured. Pulsed Tissue Doppler lateral corner of the tricuspid annulus was also recorded and annular systolic (Sa), early diastolic (Ea), and atrial (Aa) peak velocities and Ea/Aa ratio determined. The ratio of tricuspid E peak velocity and Ea (E/Ea ratio) was calculated as an index of right atrial pressure. The population was divided in seven age decades: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and >70 years. TAPSE, Sa, Ea, and Ea/Aa ratio were progressively reduced and both Aa and E/Ea ratio increased with the increasing age groups (all P < 0.0001). E/Ea ratio was 4.1 +/- 0.9 in the age decade 11-20 years and 5.4 +/- 1.5 in subjects >70 years (P < 0.0001). By multi-linear regression analyses, after adjusting for heart rate and body mass index, age was the main independent predictor of average Sa, Ea, and Aa velocities and of E/Ea ratio. Ageing shows an independent impact on pulsed Tissue Doppler-derived indexes of RV myocardial function in healthy subjects. Our data provide reference values of pulsed Tissue Doppler of the right ventricle for age decades.