Right Ventricular Remodeling In Patients Research Articles

Suppressing the expression of steroidogenic acute regulatory protein (StAR) in the myocardium by spironolactone contributes to the improvement of right ventricular remodeling in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a progressive condition that frequently leads to right ventricular (RV) remodeling. Aldosterone promotes vascular and RV remodeling. The upregulation of steroidogenic acute regulatory protein (StAR) stimulates aldosterone synthesis. However, the expression of StAR in the myocardium under PAH conditions remains unknown. To investigate the expression of StAR in the myocardium and its association with RV remodeling in PAH, utilizing spironolactone as a treatment. A PAH model was created using male Sprague-Dawley rats, which received a subcutaneous injection of Sugen5416 (20 mg/kg) and were exposed to hypoxia (10% O2) for 2 weeks, followed by 2 weeks of normoxia. The animals were then divided into two groups, with one group receiving spironolactone (25 mg/kg/day) for an additional 4 weeks, while the other group did not. H9c2 cells were cultured under hypoxic conditions (37 °C, 1% O2, 5% CO2) with or without spironolactone treatment. In the model rats, RV systolic pressure and the Fulton index, both of which increased upon exposure to Sugen5416 and hypoxia, significantly decreased with spironolactone treatment. In H9c2 cells, hypoxic exposure elevated aldosterone levels, while spironolactone treatment significantly suppressed aldosterone production. Suppression of StAR expression in the myocardium via spironolactone contributes to the improvement of RV remodeling in PAH. Spironolactone may offer a valuable therapeutic strategy for RV remodeling in patients with PAH.

Kiosk 3R-TA-09 - Serial Changes in Systemic Right Ventricular Remodeling in Patients with Transposition of the Great Vessels as Assessed by Cardiovascular Magnetic Resonance Imaging

Kiosk 3R-TA-09 - Serial Changes in Systemic Right Ventricular Remodeling in Patients with Transposition of the Great Vessels as Assessed by Cardiovascular Magnetic Resonance Imaging

Kiosk 2R-TA-09 - Right Ventricular Remodelling in Patients with Pulmonary Hypertension Is Associated With impaired Left Ventricular Systolic Function

Kiosk 2R-TA-09 - Right Ventricular Remodelling in Patients with Pulmonary Hypertension Is Associated With impaired Left Ventricular Systolic Function

Association of right ventricular mechanics with the severity of tricuspid regurgitation and mortality in patients with left-sided cardiac diseases: a propensity score-matched 3D echocardiography study

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by the ÚNKP-22-3-II New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund. Introduction The development of secondary tricuspid regurgitation (TR) is associated with poor outcomes in patients with left-sided cardiac diseases. Data are scarce concerning the right ventricular (RV) morphological and functional remodeling in patients with left-sided heart diseases in relation to the severity of TR. Purpose Accordingly, we aimed to characterize RV remodeling in patients with left-sided cardiac diseases with and without significant TR using three-dimensional (3D) echocardiography. Methods We retrospectively identified 357 patients with a wide variety of left-sided cardiac diseases and we graded TR severity according to current guidelines. To account for the heterogeneity of our cohort, we performed propensity-score matching using relevant clinical variables (age, sex, etiology of left-sided cardiac disease, left [LV] and right ventricular [RV] ejection fraction [EF]), and then we compared 134 patients with significant TR (sTR) with a matched cohort of 134 patients without significant TR (nsTR) (Figure 1). All patients underwent clinically indicated 3D transthoracic echocardiography, and 3D EFs were measured. To characterize RV mechanical patterns, the ReVISION method was used to quantify the contribution of the longitudinal (LEF), radial (REF), and anteroposterior (AEF) motion components to total RV EF. The primary endpoint was all-cause mortality, and patients were followed up for a median of 39 months. Results During the follow-up period, 48 patients (17.9%) met the primary endpoint. The propensity-matched groups did not differ in terms of LV and RV EFs. In patients with significant TR, values of AEF were significantly lower (sTR vs. nsTR; 17±7 vs.19±7 %, p<0.05), whereas LEF and REF did not show a difference in the two matched groups. Using univariable Cox regression analysis, both AEF (HR, 0.93 [95% CI 0.89–0.97], p = 0.001) and the presence of significant TR (HR, 2.75 [95% CI 1.48–5.14], p = 0.001) were found to be significant predictors of all-cause mortality. By receiver operating characteristics analysis, we defined an optimal cut-off value of 20.9% for AEF, which was then used to dichotomize our patient population (Figure 2A). Patients with AEF values below the 20.9% cut-off had more than a three-fold risk of all-cause mortality (HR, 3.03 [95% CI 1.42–6.47], p = 0.004) compared to patients with AEF values above the cut-off (Figure 2B). Furthermore, we assessed the relationship between regurgitant volume describing the extent of TR, and AEF, which showed a significant inverse correlation (r=-0.37; p<0.001). Conclusions Three-dimensional echocardiography enabled a more precise assessment of RV mechanics. In patients with left-sided heart diseases with TR, the deterioration of the RV anteroposterior motion component was significantly associated with both the severity of TR and all-cause mortality.

Prognostic value of right ventricular remodelling in patients undergoing concomitant aortic and mitral valve surgery.

Long-term risk stratification and surgical timing remain suboptimal in concomitant aortic and mitral (double) valve surgery. This study sought to examine the predictors, changes, and prognostic implications of right ventricular (RV) remodelling in patients undergoing double-valve surgery. In 152 patients undergoing double-valve surgery, four RV remodelling patterns were characterized using transthoracic echocardiography: normal RV size and systolic function (Pattern 1); dilated RV (tricuspid annulus diameter >35 mm) with normal systolic function (Pattern 2); normal RV size with systolic dysfunction (percentage RV fractional area change <35%; Pattern 3); and dilated RV with systolic dysfunction (Pattern 4). The primary endpoint was the composite of heart failure hospitalization and all-cause mortality. Patterns 1, 2, 3, and 4 RV remodelling were present in 41, 20, 23, and 16% of patients, respectively. Patients with Stage 4 RV remodelling had worse renal function, higher EuroSCORE II, and impaired left ventricular ejection fraction. During a 3.7-year median follow up, 45 adverse events occurred. Patterns 3 and 4 RV remodelling were associated with significantly higher adverse event rates compared with Pattern 1 (37 and 75% vs. 11%, P < 0.01) and had incremental prognostic value when added to clinical parameters and EuroSCORE II (χ2 increased from 30 to 66, P < 0.01). At 1 year after surgery (n = 100), Patterns 3 and 4 RV remodelling had a higher risk of adverse events compared with Pattern 1. Right ventricular remodelling was strongly related to adverse outcomes and deserves consideration as part of the risk and decision-making algorithms in double-valve surgery.

Prognostic Relevance of Right Ventricular Remodeling after ST-Segment Elevation Myocardial Infarction in Patients Treated With Primary Percutaneous Coronary Intervention

ST-segment elevation myocardial infarction (STEMI) often leads to changes in right ventricular (RV) function and size over time. The prognostic implications of RV remodeling after STEMI, however, are unknown. RV remodeling in patients who underwent STEMI with primary percutaneous coronary intervention (PCI) was defined by RV end-systolic area (RV ESA) change at 6 months after STEMI compared with baseline. The optimal threshold of RV ESA change (≥40%) to define RV remodeling was derived from spline curve analysis. Long-term outcomes were compared between patients with and without RV remodeling. A total of 2,280 patients were analyzed (mean age 60 ± 11 years, 76% were men). RV remodeling was present in 315 patients (14%). After a median follow-up of 76 months (interquartile range 51 to 106 months), 271 patients (12%) died (primary end point) and the composite end point of all-cause mortality and HF hospitalization (secondary end point) was observed in 292 patients (13%). After adjustment for various risk factors, including tricuspid annular plane systolic excursion (TAPSE), post-STEMI RV remodeling was independently associated with a higher risk of all-cause mortality (hazard ratio [HR]=1.44, 95% confidence interval [CI] 1.02 to 2.02, p=0.038) and the composite of all-cause mortality and HF hospitalization (HR=1.41, 95% CI 1.02 to 1.96, p=0.040). Finally, patients with RV remodeling had a significantly lower survival rate (Log-rank, p=0.006) and event-free survival rate than those without RV remodeling during follow-up (log-rank, p=0.006). RV post-infarct remodeling is associated with mortality and HF hospitalization, independent of RV systolic function.

Right ventricular remodelling in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Inconsistent changes in right ventricular (RV) dimensions and function have been observed after tricuspid valve (TV) surgery and their associations with long-term outcomes have not been explored. Purpose To evaluate RV remodelling and RV function in patients with significant (moderate or severe) tricuspid regurgitation (TR) undergoing TV surgery and their association with outcome. Methods A total of 121 patients (mean age 63 ± 12 years, 47% male) with significant TR treated with TV surgery and who had an echocardiogram between 3 months and 1 year of follow-up, were included for this analysis. Remodelling was assessed by comparing dimensions and function at follow-up to baseline values. The population was stratified by tertiles of percentage reduction of RV end-systolic area (RVESA) and absolute change of RV fractional area change (RVFAC). Five-year mortality rates were compared across the tertiles of RV remodelling and the independent associates of mortality were investigated. Results Reduction in RVESA and improvement in RVFAC were significantly associated with better survival after TV surgery, whereas reduction in RV end-diastolic area was not (Figure 1). One third of the patients presented with a reduction in RVESA of at least 17.2% and improvement in RVFAC of at least 2.3%, constituting the third tertiles for comparison. Kaplan-Meier curves for overall survival according to RVESA- and RVFAC-tertiles are shown in Figure 2. Cumulative survival rates were significantly better in patients in the third tertile of RVESA reduction: 49%, 69%, and 90% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 12.526; p = 0.002); as well as according to RVFAC improvement: 57%, 65%, and 87% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 7.784; p = 0.02). Tertile 3 of RVESA-reduction as well as tertile 3 of RVFAC-change were both independently associated with better survival after TV surgery compared to tertile 1 (hazard ratio: 0.221 [95% CI: 0.074 to 0.658] and 0.327 [95% CI: 0.118 to 0.907], respectively). Conclusion The magnitude of RV reverse remodelling (based on reduction in RVESA) and improvement in RVFAC were associated with better survival at 5 years’ follow-up after TV surgery for significant TR. Abstract Figure 1: Spline curves Abstract Figure 2: KM curves for overal survival

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

Impact of concomitant tricuspid annuloplasty on right ventricular remodeling in patients with rheumatic mitral valve disease

BackgroundStudies on the management of functional tricuspid regurgitation (TR) during mitral valve operations have drawn inconsistent conclusions. This study was designed to compare the treatment strategy of concomitant tricuspid annuloplasty (TAP) against isolated mitral valve replacement (MVR) in rheumatic mitral valve disease patients, and to assess the effect of concomitant TAP on postoperative right ventricular (RV) remodeling and function.MethodsOne hundred-seventy patients with rheumatic mitral valve disease receiving MVR were categorized into TAP group (n = 124) and non-TAP group (n = 46). Clinical and echocardiographic data were collected preoperatively and at 1-year follow-up. Three-dimensional echocardiographic indices of RV geometry and function were analyzed.ResultsAt baseline, concomitant TAP group had larger RV end-diastolic volume, more decreased RV ejection fraction and RV longitudinal strain than non-TAP group (all P < 0.001). At 1-year follow-up, TAP group had improved RV geometry and function. While adverse changes were observed in non-TAP group. In analysis of variance, the above indices demonstrated significant interaction with different treatment group (all P < 0.001). In multivariate regression analysis, independent of age and Maze procedure, concomitant TAP was associated with postoperative RV volume reduction (P < 0.001), improvement of RV ejection fraction (P < 0.001), and relieved postoperative functional TR severity (P = 0.025).ConclusionsOur results suggest that concomitant TAP could improve RV remodeling and function for rheumatic mitral valve disease patients, while those with mild preoperative functional TR who had isolated MVR might experience RV dilation and deterioration of RV function at follow-up. Concomitant surgery for functional TR could be considered for patients undergoing MVR with rheumatic mitral valve disease.

Rivaroxaban Attenuates Right Ventricular Remodeling in Rats with Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a progressive condition that frequently results in right ventricular (RV) remodeling. The objectives of this study are to investigate effects of rivaroxaban on RV remodeling in a rat model of PAH, created with Sugen5416 and chronic hypoxia, and the in vitro effects of rivaroxaban on human cardiac microvascular endothelial cells (HCMECs). To create the PAH model, male Sprague-Dawley rats were subcutaneously injected with Sugen5416 (20 mg/kg) and exposed to 2 weeks of hypoxia (10% O2), followed by 2 weeks of exposure to normoxia. The animals were then divided into 2 groups with or without administration of rivaroxaban (12 mg/kg/d) for a further 4 weeks. HCMECs were cultured under hypoxic conditions (37 °C, 1% O2, 5% CO2) with Sugen5416 and with or without rivaroxaban. In the model rats, RV systolic pressure and Fulton index increased by hypoxia with Sugen5416 were significantly decreased when treated with rivaroxaban. In HCMECs, hypoxia with Sugen5416 increased the expression of protease-activated receptor-2 (PAR-2) and the phosphorylation of extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and nuclear factor-kappa B (NF-κB), while treatment with rivaroxaban significantly suppressed the expression of these proteins. Rivaroxaban attenuated RV remodeling in a rat model of PAH by reducing ERK, JNK and NF-κB activation. Rivaroxaban has the possibility of providing additive effects on RV remodeling in patients with PAH.

The role of epicardial fat thickness and lipid profile in right ventricular remodeling in patients with metabolic syndrome

Background and Aims: Metabolic syndrome represents a cluster of cardiovascular risk factors, which emphasizes the importance of visceral obesity. Right ventricular hypertrophy and dimensions showed particular importance in the evaluation of prognosis in patients with different pathologies. The aim of this study was to evaluate epicardial fat thickness (EFT), as a marker of visceral adiposity, lipid profile and right ventricular morphological parameters in patients with metabolic syndrome.

TRPM4 Modulates Right Ventricular Remodeling Under Pressure Load Accompanied With Decreased Expression Level

Survival of patients with congenital heart defects including increased right ventricular pressure load (ie, tetralogy of Fallot) or pulmonary hypertension is dependent on the function of the right ventricle (RV). RV remodeling has several effects with progressive transition from compensated status to heart failure. Transient receptor potential melastatin 4 (TRPM4) forms cation channels expressed in myocardium, which was shown to modulate cardiac remodeling in the left ventricle of mice. Aim of this study was to identify the role of TRPM4 for contractile function and remodeling of the RV in a rat model of right ventricular pressure load. We performed experiments with untreated rats and under monocrotaline (MCT)-induced pressure load comparing wild-type (Trpm4+/+) and TRPM4-deficient (Trpm4-/-) rats. RV function was characterized by echocardiography and contractility measurements of isolated papillary muscles. RV hypertrophy was investigated by echocardiography and by determination of hypertrophy indices. Pulmonary arterial remodeling was evaluated by echocardiography and histology. TRPM4 protein expression in RV of human, rat and mouse was detected by Western blot and quantified in rat. TRPM4 proteins were detected in RV myocardium of rat and mouse, which were not detectable in TRPM4-deficient animals. Proteins of the same size were found in RV of a pediatric patient with tetralogy of Fallot. In untreated status, Trpm4+/+ and Trpm4-/- rats showed comparable RV contractile function and dimensions. Under pressure load (42 days after MCT injection), RV hypertrophy was significantly increased in Trpm4-/- rats compared with Trpm4+/+ controls, whereas MCT-mediated alterations in cardiac contractility and pulmonary arterial remodeling were not affected by TRPM4 inactivation in rats. Finally, TRPM4 protein expression in RV was drastically reduced in MCT-treated rats, whereas left ventricle of the same animals showed no alteration in TRPM4 expression. Right ventricular pressure load evoked by MCT treatment in rats leads to a prominent downregulation of TRPM4 protein expression in the RV and complete deletion of TRPM4 expression aggravates right ventricular hypertrophy. Thus, therapeutic modulation of TRPM4 expression and activity might represent a novel approach to target right ventricular remodeling in patients with pulmonary hypertension or otherwise loaded RV.

Trends and outcomes of pulmonary valve replacement in tetralogy of Fallot

BackgroundPulmonary valve replacement (PVR) is associated with improvement in symptoms and right ventricular remodeling in patients with tetralogy of Fallot (TOF). There are limited population-based data about outcomes after PVR. We therefore hypothesized a temporal increase in annual volume of PVR and decrease in in-hospital mortality after PVR in the United States. MethodsWe reviewed the National Inpatient Sample (NIS) for PVR performed in adults (>18 years) with TOF, 2000–2014. The primary outcome was trends in admissions for PVR, in-hospital mortality after PVR, and age at time of PVR. In order to assess trends, we divided the study period into tertiles: early era (2000–2004), mid era (2005–2009) and late era (2010–2014). ResultsThere were 18,353 admissions in adults with TOF diagnosis, of which PVR was performed in 1230 (6.7%), and 90 (7.3%) were transcatheter PVRs. The median age at PVR was 34 years and in-hospital mortality was 1.5%. Comparisons by study era showed temporal increase in the proportion of admissions for PVR (3.7% vs 6.3% vs 9.6%, p < 0.001), decrease in in-hospital mortality (4.1% vs 1.2% vs 0.8%, p = 0.002), and a decrease in age at the time of PVR (35.8 vs 33.8 vs 31.0 years, p < 0.001). ConclusionsThe proportion of admissions for PVR increased while in-hospital mortality and age at time of PVR decreased over time. A younger age at the time of PVR highlights important concerns and knowledge gaps about the cumulative lifetime risk of reinterventions and prosthetic valve endocarditis. Further studies are required to address these knowledge gaps.

Prognostic Implications of Right Ventricular Remodeling and Function in Patients With Significant Secondary Tricuspid Regurgitation.

In patients with significant (moderate and severe) tricuspid regurgitation (TR), the decision to intervene is influenced by right ventricular (RV) size and function. RV remodeling in significant secondary TR has been underexplored. The aim of this study was to characterize RV remodeling in patients with significant secondary TR and to investigate its prognostic implications. RV remodeling was characterized by transthoracic echocardiography in 1292 patients with significant secondary TR (median age 71 [62-78]; 50% male). Four patterns of RV remodeling were defined according to the presence of RV dilation (tricuspid annulus≥40 mm) and RV systolic dysfunction (tricuspid annulus systolic excursion plane<17 mm): pattern 1, normal RV size and systolic function; pattern 2, dilated RV with preserved systolic function; pattern 3, normal RV size with systolic dysfunction; and pattern 4, dilated RV systolic dysfunction. The primary end point was all-cause mortality and the event rates were compared across the 4 patterns of RV remodeling. A total of 183 (14%) patients showed pattern 1 RV remodeling; 256 (20%) showed pattern 2; 304 (24%) presented with pattern 3; and 549 (43%) had pattern 4 RV remodeling. Patients with pattern 4 RV remodeling were more frequently male; more often had coronary artery disease, worse renal function, and impaired left ventricular ejection fraction; and were more often symptomatic. Only 98 (8%) patients underwent tricuspid valve annuloplasty during follow-up. During a median follow-up of 34 (interquartile range, 0-60) months, 510 (40%) patients died. The 5-year survival rate was significantly worse in patients presenting with patterns 3 and 4 RV remodeling in comparison with pattern 1 (52% and 49% versus 70%; P=0.002 and P<0.001, respectively), and were independently associated with poor outcome on multivariable analysis. In patients with significant secondary TR, patients with RV systolic dysfunction have worse clinical outcome regardless of the presence of RV dilation.

The obesity paradox: the protective effect of obesity on right ventricular function using echocardiographic strain imaging in patients with pulmonary hypertension

Obesity is associated with right ventricular (RV) dysfunction, but its effect on RV remodeling in patients with pulmonary hypertension (PHTN) has not been studied. We evaluated the effect of obesity, and its interplay with diabetes, in patients with PHTN using RV echocardiographic strain imaging. One hundred eighty-five patients underwent echocardiographic imaging and pulmonary artery pressure was calculated using tricuspid regurgitation jet velocity. From focused RV apical-four-chamber view, global and mid peak systolic RV free wall longitudinal strain (FWLS) was calculated using speckle-tracking software. Global and mid RV FWLS in patients with PHTN (N.=84) was lower (-16.8±7 vs. 18.9±6.3, P=0.035 and -11.2±12.8 vs. -18.9±9.2, P=0.002 respectively) compared with patients without PHTN (N.=101). Among patients without PHTN, obese patients (BMI>30) had lower global and mid RV FWLS (-17.2±6.2 vs. -20.3±5.7, P=0.012 and -17.6±7.2 vs. -21.9±7.3, P=0.004), even after excluding diabetic patients (Mid RV FWLS -18.2±6.8 vs. -22.1±8, P=0.032). Among patients with PHTN, obese patients had similar RV FWLS compared with non-obese patients (P=0.46). However, on excluding diabetic patients from PHTN group, obese patients with PHTN had higher global and mid RV FWLS (-21.7±5.7 vs. -16.1±8, P=0.017 and 23.8±4.8 vs. -17±9.4, P=0.009 respectively) compared to non-obese patients which suggests a protective effect of obesity on RV function in patients with PHTN. Obesity is associated with subclinical RV dysfunction as assessed by RV strain imaging, but paradoxically it may confer a protective effect on RV function once the patient develops PHTN. Future studies should evaluate the clinical impact of this paradox.

Early postoperative remodelling following repair of tetralogy of Fallot utilising unsedated cardiac magnetic resonance: a pilot study.

MRI was completed in 16 subjects at a median age of 77 days (interquartile range 114). There was normal ventricular ejection fraction and indexed right ventricular end-diastolic volume (48±13 cc/m2), but elevated right ventricular mass (z score 6.2±2.4). Subjects requiring a transannular patch or right ventricle to pulmonary artery conduit had moderate pulmonary insufficiency (regurgitant fraction 27±16%).DiscussionEarly right ventricular remodelling after surgical repair for tetralogy of Fallot is characterised by significant pulmonary regurgitation, right ventricular hypertrophy, and lack of dilation. Performing cardiac MRI using the feed and sleep technique is feasible in infants younger than 5 months. These results might open new avenues to study longitudinal right ventricular changes in tetralogy of Fallot and to further explore the utility of unsedated MRI in patients with other types of CHDs.

The Association between Obesity, Blood Pressure Variability, and Right Ventricular Function and Mechanics in Hypertensive Patients

The purpose of this investigation was to evaluate the association between blood pressure (BP) variability and right ventricular (RV) mechanical function in normal-weight, overweight, and obese untreated patients with hypertension. This retrospective cross-sectional study included 127 untreated subjects with hypertension who underwent 24-hour ambulatory BP monitoring and complete two-dimensional and three-dimensional echocardiographic examination. All participants were divided into three groups according to body mass index (BMI): normal-weight patients (BMI<25kg/m(2)), overweight patients (25≤BMI<30kg/m(2)), and obese patients (BMI≥30kg/m(2)). Daytime, nighttime, and 24-hour BP variability parameters were higher in overweight and obese subjectswith hypertension than in lean subjects. Two-dimensional RV longitudinal strain and systolic strain rate were significantly lower in obese patients with hypertension than in normal-weight patients (-24.1±3% vs -23.3±3.2% vs -21.7±3.3%, P=.004). Three-dimensional echocardiographic RV volumes indexed to body surface area were lower in lean and overweight subjects than in obese participants with hypertension(mean RV end-diastolic volume index, 65±6 vs 67±7 vs 71±8mL/m(2), P=.001), while three-dimensional RV ejection fraction decreased in the same direction (60±4% vs 58±3% vs 57±3%, P<.001). Nighttime BP variability indices, more than daytime BP variability parameters, correlated with two-dimensional RV global longitudinal strain and three-dimensional echocardiographic RV volumes. BP variability and RV structure, function, and mechanics are significantly affected by obesity in patients with untreated hypertension. BP variability is significantly associated with RV remodeling in patients with hypertension.

Speckle-tracking imaging in patients with Eisenmenger syndrome

Adults with Eisenmenger syndrome have a survival advantage over those with idiopathic pulmonary arterial hypertension. Improved survival may result from preservation of right ventricular (RV) function. To assess left ventricular (LV) and RV remodelling in patients with Eisenmenger syndrome compared to a control population, using speckle-tracking imaging. Adults with Eisenmenger syndrome and healthy controls were enrolled into this prospective two-centre study. Patients with Eisenmenger syndrome with low acoustic windows, irregular heart rhythm or complex congenital heart disease were excluded. Clinical assessment, B-type natriuretic peptide (BNP), 6-minute walk test and echocardiography (including dedicated views to perform offline two-dimensional-speckle-tracking analysis) were performed on inclusion. Our patient population (n=37; mean age 42.3 ± 17 years) was mostly composed of patients with ventricular septal defect (37.8%) or atrial septal defect (35.1%). Compared with the control population (n=30), patients with Eisenmenger syndrome had reduced global LV longitudinal strain (-17.4 ± 3.5 vs. -22.4 ± 2.3; P<0.001), RV free-wall longitudinal strain (-15.0 ± 4.7 vs. -29.9 ± 6.8; P<0.001) and RV transverse strain (25.8 ± 25.0 vs. 44.5 ± 15.1; P<0.001). Patients with Eisenmenger syndrome also more frequently presented a predominant apical longitudinal and transverse strain profile. Among patients with Eisenmenger syndrome, those with a post-tricuspid shunt presented with reduced global LV longitudinal strain but increased RV transverse strain, compared to patients with pre-tricuspid shunt. Patients with Eisenmenger syndrome had impaired longitudinal RV and LV strain, but present a relatively important apical deformation. RV and LV remodelling, as assessed by speckle-tracking imaging, differ between patients with pre- and post-tricuspid shunt.

Moderated Posters session: pulmonary hypertension and other conditionsP516Echocardiographic findings predicting mortality in pulmonary arterial hypertension: a systematic review and meta-analysisP517Impairment of endothelial-mediated coronary flow reserve in patients with Anderson Fabry diseaseP518Comparative evaluation of various echocardiography-based methods for the estimation of pulmonary vascular resistance in pulmonary hypertensionP519Detection of early radiotherapy-induced changes in myocardial cyclic variation in breast cancer patients - an

Purpose: Pulmonary hypertension (PH) is a rare and severe disease for which right ventricular (RV) remodelling and function are associated with survival. The unique anatomy and structure of the RV limit 2D analysis, and its regional function has not been studied yet. We show the contribution of regional 3D deformation analysis for the study of RV remodelling in patients with PH, as compared to healthy controls. Methods: 3D RV echocardiographic sequences were prospectively obtained from 32 patients with PH (57±21y, 15 male) and 10 healthy controls (38±13y, 6 male). Myocardial tracking was performed by semi-automatic Tomtec 4D RV-Function 2.0 software. Volumes and EF were directly obtained from the software. Output RV meshes were post-processed to extract local deformation (area strain) and radial/circumferential/longitudinal displacement. Data were temporally realigned to allow inter-subject pattern comparison. Spatial correspondences were obtained from the software, and allowed statistical computation in 8 standard zones of the RV. Results: 19 patients (59%) were NYHA class III-IV at baseline. Over a mean FU of 49±41days, 5 patients died from cardiopulmonary causes. The highest contraction was at the RV lateral and inferior levels. Regional motion and deformation and global volume patterns for patients was significantly affected at the RV anterior, lateral, inferior, and trabecular and inlet septum. The first 4 segments were significantly associated with NYHA class and survival. Global area strain >-15% was a significant predictor of death (HR 411e12 [140 – 1.2e27]). Conclusion: Our study confirms that the segments into which RV contraction predominates are also the determinants of symptoms and survival in PH patients. This is of high relevance to establish the prognosis of such patients.

Determinants of Right Ventricular Remodeling Following ST-Segment Elevation Myocardial Infarction

Right ventricular (RV) function after ST-segment elevation myocardial infarction (STEMI) has important prognostic implications. However, the changes in RV function over time after STEMI and the incidence of RV remodeling remain unknown. The present study evaluated changes in RV dimensions and function in contemporary patients with first STEMI and assessed the independent determinants of RV dysfunction at follow-up. Patients with first STEMI (n = 940, 60 ± 11 years, 77% men) treated with primary percutaneous coronary intervention underwent echocardiography at baseline and 6- and 12-month follow-up. The prevalence of RV dysfunction (tricuspid annular plane systolic excursion [TAPSE] ≤15 mm) decreased significantly at 6 months follow-up (from 15% to 8%, p <0.001) and the incidence of RV remodeling (increase in RV end-diastolic area [RVEDA] ≥20%) was observed in 200 patients (25%). Absolute changes in RVEDA were independently associated with absolute changes in wall motion score index and left ventricular (LV) remodeling (p <0.001 for both parameters), whereas absolute changes in TAPSE were independently related with absolute changes in wall motion score index and mitral regurgitation grade (p <0.001 for both parameters). Independent correlates of RV dysfunction at 6 months follow-up were multivessel coronary disease (odds ratio [OR] 2.13), peak cardiac troponin T (OR 1.05), angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers use (OR 0.27), baseline LV ejection fraction (OR 0.96) and baseline TAPSE (OR 0.88). In conclusion, despite the non-negligible incidence of RV remodeling in patients with first STEMI, RV function improves early after STEMI. Multivessel coronary disease, infarct size, baseline LV ejection fraction and TAPSE and the nonuse of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers are independent determinants of RV dysfunction.