Right Ventricular Strain In Patients Research Articles

Early deterioration of right ventricular strain in patients undergoing transcatheter tricuspid valve intervention

Abstract Background Severe tricuspid regurgitation (TR) leads to volume overload and increased wall stress causing detrimental right ventricular (RV) remodelling and dysfunction and is associated with excess mortality. Transcatheter tricuspid valve interventions (TTVI) emerged to treat patients with severe TR and high surgical risk, but predictors of outcome remain largely unknown. RV free wall longitudinal strain (RVFWLS) is a sensitive parameter for RV dysfunction and has shown prognostic value in patients with functional TR treated conservatively. Periinterventional changes in RVFWLS and right atrial (RA) strain have not been evaluated in patients undergoing TTVI. Purpose To analyse the effect of transcatheter tricuspid valve annuloplasty (TTVA) and transcatheter edge-to-edge repair (TEER) on RVFWLS and RA strain, assessed by speckle tracking echocardiography, and their association with outcome. Methods We retrospectively analysed consecutive patients with severe TR that underwent TTVI at our centre between 2020 and 2022. 126 patients were included (n=48 underwent TTVA with the Cardioband system, n=78 underwent TEER with the PASCAL system). Established parameters for RV function (TAPSE, FAC) as well as RVFWLS and RA reservoir strain (RASR) were analysed at baseline and one month after TTVI. Results All patients (median age 80 years, 69% female, 79% in NYHA III/IV functional class) were at prohibitive surgical risk. RV function at baseline was slightly reduced according to FAC (34% [29-39]) and preserved according to TAPSE (18mm [15-20]), whereas RVFWLS (-18.6±5.7%) and RASR (10.0% [7.0-14.0]) were severely reduced in markedly dilated right heart chambers (RV basal 45mm [41-49], RA area 34 cm2 [28-41]). TR reduction following TTVI to TR grade ≤ 2 was achieved in 77%. Right heart chamber size significantly decreased after one month (RV basal 41mm [38-45], RA area 29cm2 [25-38], P<0.001), with no improvement of FAC (37% [30-40], P=0.668) or RASR (10% [7-13], P=0.143) but deterioration of RV longitudinal function (TAPSE 17mm [13-20], P=0.002; RFWLS -16.1±5.7%, P=0.001) compared to baseline. RVFWLS reduction occurred irrespective of the procedure performed (TEER [-9.2±41.4] vs. TTVA [-7.0±31.3], P=0.783). RVFWLS deterioration occurred in 63%, whereas it improved in 37% of patients. Symptomatic and clinical outcome did not differ in patients with deteriorated vs. improved RVFWLS (improvement of at least one NYHA class 61.9% vs. 58.3%, P=0.569, one-year mortality 13.7% vs. 12.3%, P=0.940, one-year heart failure rehospitalization 10.8% vs. 17.1%, P=0.701). Conclusion Deterioration of RVFWLS after TTVI possibly reflects the decreased wall stress due to TR and consecutive preload reduction. However, symptomatic and clinical outcomes did not differ in patients with deteriorated RVFWLS vs. patients with improved RVFWLS. Reduction of RA size after TTVI did not translate into improvement of RASR, indicating an already advanced pre-existing RA dysfunction.

OC 01.1 Discordance between Computed Tomography Pulmonary Angiography (CTPA) and Transthoracic Echocardiography (TTE) in Identification of Right Ventricular Strain in Patients with Acute Pulmonary Embolism

OC 01.1 Discordance between Computed Tomography Pulmonary Angiography (CTPA) and Transthoracic Echocardiography (TTE) in Identification of Right Ventricular Strain in Patients with Acute Pulmonary Embolism

Evaluation of right ventricular myocardial strain in pulmonary arterial hypertension associated with atrial septal defect by cardiac magnetic resonance feature tracking.

We aimed to research the role of right ventricular strain parameters (RVSP) quantified by cardiac magnetic resonance feature tracking (CMR-FT) in the early assessment of right ventricular (RV) function in patients with pulmonary arterial hypertension associated with atrial septal defect (PAH-ASD). From September 2017 to May 2021, we retrospectively enrolled 41 patients with PAH-ASD and 20 healthy controls. All subjects underwent CMR-FT, and right heart catheterization was conducted in patients with PAH-ASD. The relationship between RVSP and RV functional parameters was subjected to correlation analysis, and intragroup correlation coefficient (ICC) and Bland-Altman plots were used to assess the consistency. The subjects were divided into three groups: Group A (controls; n = 20), Group B (PAH-ASD, RVEF ≥ 45%; n = 14), and Group C (PAH-ASD, RVEF < 45%; n = 27). Compared with healthy controls, the RV global longitudinal strain (GLS) in Group B was significantly decreased (-19.68 ± 2.72% vs. -25.21 ± 3.6%, P < 0.05). In RVEF-preserved PAH-ASD patients (Group B), compared with patients with GLS ≤ -20%, patients with GLS > -20% also had significantly elevated right ventricular end-diastolic pressure (RVEDP) [8 (6.5-8.25) mmHg vs. 4.5 ± 1.64mmHg, P < 0.05]. RV GLS had a moderate to strong correlation with RVEF, RVESVi, RVEDVi, RVEDP, and NT-proBNP (P < 0.05). ICC and Bland-Altman plots showed good intragroup and intergroup consistency in radial, circumferential and longitudinal strains of RV. In conclusion, it is feasible to quantify RV strain in patients with PAH-ASD by CMR-FT, and GLS is valuable for the early assessment of RV dysfunction in patients with PAH-ASD.

Value of 3D right ventricular function over 2D assessment in acute pulmonary embolism.

Pulmonary embolism (PE) is a common life-threatening disease, with mortality related to right ventricular (RV) dysfunction. To investigate the value of 3D global and regional RV strain in patients with acute PE and at 1month, as compared to a control population. We conducted a longitudinal case-control prospective study, including 24 consecutive intermediate-risk PE patients. All patients underwent 2D and 3D transthoracic echocardiography within 12hours of PE diagnosis and 1 month after hospital discharge. A control group was recruited, consisting of healthy volunteers matched on age and sex with PE patients. 3D RV echocardiographic sequences were analyzed by commercial RV-specific software and output meshes were post-processed to extract regional deformation. 3D echocardiographic 1-month follow-up was available in 18 patients. During acute PE, area strain was substantially altered in the RV free wall and within the trabecular septum. PE patients initially had RV dysfunction as assessed by 2D and 3D parameters. At follow-up, 2D parameters were restored compared to the control group, contrary to 3D RV area and circumferential strains. The McConnell's sign was identified in 83% of patients and was associated with reduced apical and global RV area strain. Our 3D RV strain study demonstrates an incomplete recovery of 3D strain parameters 1month after an episode of intermediate-risk acute PE despite restored 2D parameters. Further studies are required to assess the prognostic role and implications of this residual RV strain impairment after PE.

Heterogeneous pattern of improvement in right ventricular mechanics following hematopoietic stem cell transplant in patients with systemic sclerosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systemic sclerosis (SSc) is an autoimmune disorder that causes fibrosis in the skin and internal organs, including the heart. Patients with SSc can have right ventricular (RV) systolic dysfunction in the absence of pulmonary hypertension. Studies have shown a predilection for impairment of the mid and apical segments of the RV free wall compared to controls. The effect of hematopoietic stem cell transplant (HSCT) – a disease modifying treatment for SSc – on RV mechanics is not known. Aim To study the effect of HSCT on RV mechanics using speckle-tracking echocardiography. Methods Patients with SSc who underwent comprehensive 2D echocardiographic evaluation pre- and post-HSCT were identified. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). RV strain was measured from the RV focused apical 4-chamber view. Paired student’s t-test and linear regression analysis were used in data analysis. Results Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary arterial pressure measured by right heart catheterization prior to HSCT was 18.5 ± 4.5 mmHg. There was a significant improvement in RV global longitudinal strain (GLS) and free wall strain (FWS) following HSCT. The improvement in strain was significant in the mid and apical segments of the RV free wall, but not so in the basal segment. The change in RV strain was linearly related to pre-HSCT strain. The lower the RV GLS and FWS, the greater the improvement in strain after HSCT. Conclusions There was a significant improvement in RV strain in patients undergoing HSCT, specifically within the mid and apical segments of the RV free wall. The improvement in strain after HSCT was directly related to the baseline strain. This suggests that HSCT may directly improve RV mechanics with the preferential enhancement of the less robust mid and apical RV free wall segments. Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) &amp;lt;0.01 RV GLS (%) -18.13 ± 3.88 -20.06 ± 4.51 &amp;lt;0.01 RV FWS (%) -20.79 ± 5.30 -23.21 ± 5.61 &amp;lt;0.01 RV basal free wall (%) -27.97 ± 9.33 -27.84 ± 7.94 0.93 RV mid free wall (%) -20.68 ± 9.61 -23.75 ± 7.91 0.05 RV apical free wall (%) -15.26 ± 8.57 -20.84 ± 8.92 &amp;lt;0.01 All values are presented as mean ± SD unless indicated otherwise. Abstract Figure. Pre-HSCT RV strain vs change in strain

Effects of normoxic versus hyperoxic hyperventilation followed by apnea on right ventricular strain in patients with multi-vessel coronary artery disease

Introduction Hypocapnia and hyperoxia are coronary vasoconstrictors, whereas hypercapnia acts as a coronary vasodilator. Prior to anaesthetic induction, patients receive a FiO2 of 1.0 and are asked to take deep breaths. Resulting hyperoxic hypocapnia may be aggravated by excessive manual ventilation. Subsequent apnea during intubation increases paCO2. So far it remains unclear whether and how such rapid blood gas alterations impact right ventricular (RV) function, especially so in the presence of coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) imaging is useful to assess subtle changes of myocardial function and constitutes the gold standard for RV imaging. The objective of this CMR study is to compare RV function of healthy persons and patients with CAD during a typical hyperventilation-apnea maneuver. Methods Ten healthy participants and 25 patients with stable, well-defined multi-vessel CAD underwent a CMR study. After baseline imaging at room air, subjects hyperventilated for 60 seconds (HV) and then maintained apnea for 30s. Cine images of two ventricular short axis slices were acquired at baseline and from the end of HV throughout the breath-hold. After reequilibration, participants breathed oxygen (10L/min) for 5 minutes via a non-rebreathing mask and repeated the same respiratory maneuver under oxygen inhalation. CMR cine images were analyzed for RV global peak circumferential strain (RVGCS) for each group and condition. Results Healthy participants showed no significant RVGCS changes within or between normoxic or hyperoxic respiratory maneuvres, although HV enhanced strain numerically. CAD patients showed significant attenuation of RVGCS at the end of the hyperoxic HV-apnea sequence (baseline, -13.5±4.7 % vs. hyperoxic apnea, -11.8±4.9 %; p= 0.047), but not after the respective sequence at room air (-13.8±4.1%, p=0.611). In 20% of the CAD patients the hyperoxic HV-apnea sequence attenuated RVGCS by more than 5% from normoxic baseline. The figure shows RVGCS of both groups during the maneuver (more negative numbers representing better systolic contractile function, i.e., circumferential shortening). Discussion At the conclusion of an induced respiratory maneuver, which resembles a hyperoxic anaesthesia induction sequence, awake CAD patients exhibit significant attenuation of RV peak circumferential strain. This response could be haemodynamically relevant during anaesthesia induction in high-risk CAD patients and needs to be investigated further in a scenario of general anaesthesia.

P1383 The effects of doxorubicin on left and right ventricular strain in patients with lymphoma: insights from a retrospective study

Abstract Funding Acknowledgements South Tees Research and Development Fund (UK) Background Anthracyclines are a cornerstone in the management of lymphoma. However, their use is associated with cardiotoxicity. Speckle tracking echocardiography (STE) has been established as a valid measure of quantifying cardiac function. However, most studies to this date have focused predominantly on left ventricular (LV) global longitudinal strain (GLS) with only a limited number assessing the right ventricle (RV) and other LV strain parameters. Purpose Using 2D STE, we assessed the effects of anthracyclines on LV and RV strain parameters, focusing on LV endocardial (GLS), LV myocardial GLS (myoGLS), LV radial strain (GRS), RV endocardial (RV GLS), myocardial GLS (RV myoGLS), and RV free wall strain (RVFWS). Methods We retrospectively collected data on patients treated for lymphoma between 2015-2018. Two groups (G) were defined: those with a conventional drop in LV ejection fraction (EF), (G1, n = 11) and those without (G2, n = 24). Echocardiograms were performed pre-chemotherapy (T0), mid-treatment (T1), and post-chemotherapy (T2) and were analysed offline using vendor-independent software (TomTec 2D CPA). LV and RV strain analysis was performed in both groups. This study was ethically approved by Health Research Association (REC Reference 18/SS/0139). Results Mean age was 61 ± 16 years (G1) and 65 ± 12 years (G2). 18% (G1) and 17% (G2) of patients had a history of IHD in each group. Mean cumulative dose of doxorubicin was 280 ± 31 mg/m2 (G1) and 280± 48mg/m2 (G2). In both groups, there was no significant change in LV or RV strain parameters from T0 to T1. In G1, between T1 and T2, patients exhibited a significant deterioration in LV GLS (-19.7 ± 2.6% vs.-15.6 ± 2.5% p &amp;lt; 0.0005), and LV myoGLS (-17.3 ± 2.2% vs. -14.1 ± 2.9% p = 0.02). There was also a measurable decline in RV strain parameters between T1 to T2 (RV GLS, -23.1 ± 4.7% vs. -18.8 ± 4.2% p = 0.028) and (RV myoGLS -21.5 ± 5.2% vs -17.3 ± 3.6% p = 0.013). When analysed from T0 to T2, the changes in RV strain were more marked; RV GLS (-25.2 ± 4.9% vs. -18.8 ± 4.2% p = 0.005), RV myoGLS (-22.4 ± 5.2% vs-17.3 ± 3.6% p = 0.005), and RVFWS (-28.8 ± 5.7% vs. -20.9 ± 6.7% p = 0.001). In G2, no change was observed in LV GLS (-20.4 ± 2.3% vs. -19.6 ± 2.8% p = 0.66), LV myoGLS (-18.8 ± 2.5% vs. -17.5 ± 3.1% p = 0.18), RV GLS (-24.2 ± 2.3% vs. -23.1 ± 2.7% p = 0.42), RV myoGLS (-22.4 ± 2.9% vs. -20.6 ± 2.8% p = 0.09), RVFWS (-26.7 ± 4.6% vs. -25.2 ± 3.6% p = 1.0). GRS did not significantly change in either G1 or G2 during treatment. Conclusion In patients with a reduction in LVEF, this analysis demonstrated a significant reduction in LV strain parameters secondary to anthracycline treatment. Novel strain parameters did not change in the normal EF group, or predate EF/GLS decline in those with reduced LVEF. Measurable RV dysfunction was noted in those with LV deterioration, highlighting the global cardiac insult of anthracycline treatment. Preventative and monitoring strategies in cardio-oncology should not overlook RV function.

Right ventricular strain in patients with pulmonary embolism and syncope.

Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully elucidated and data of right ventricular (RV) function in patients has been limited. We retrospectively identified 477 consecutive patients hospitalized with acute PE diagnosed with a computed tomogram (CT) who also had a transthoracic echocardiogram (TTE) 24h prior to or 48h after diagnosis. Parameters of RV strain on CT, TTE, electrocardiogram (ECG), and clinical characteristics and adverse outcomes were collected. Patients with all three studies available for assessment were included (n = 369) and those with syncope (n = 34) were compared to patients without syncope (n = 335). Patients with syncope were more likely to demonstrate RV strain on all three modes of assessment compared to those without syncope [17 (50%) vs. 67 (20%); p = 0.001], and those patients were more likely to receive advanced therapies [9 (53%) vs. 15 (22%); p = 0.02]. PE-related mortality was highest among those presenting with high-risk PE and syncope (36%, OR 20.1, 95% CI 5.3-81.1; p < 0.001) and was low in patients with syncope without criteria for high-risk PE (3%, OR 1.2, 95% CI 0.2-10.0; p < 0.001). In conclusion, acute PE patients with syncope are more likely to demonstrate multimodality evidence of RV strain and to receive advanced therapies. Syncope was only associated with increased PE-related mortality in patients presenting with a high-risk PE. Syncope alone without evidence of RV strain is associated with low short-term adverse events and is similar to those without syncope.

Neurocardiac Injury Assessed by Strain Imaging Is Associated With In-Hospital Mortality in Patients With Subarachnoid Hemorrhage

ObjectivesThis study sought to test the hypothesis that speckle tracking strain echocardiography can quantify neurocardiac injuries in patients with aneurysmal subarachnoid hemorrhage (SAH), which is associated with worse clinical outcome. BackgroundSAH may be a life-threatening disease associated with variable degrees of neurocardiac injury. Strain imaging has the potential to detect subtle myocardial dysfunction which is additive to conventional measurements. MethodsA total of 255 consecutive patients were prospectively enrolled with acute SAH, who were admitted to the intensive care unit with echocardiography studies within 72 h. Left ventricular (LV) and right ventricular (RV) strains were acquired from standard apical views. Abnormal LV global longitudinal strain (GLS) and RV free-wall strain were pre-defined as <17% and <23% (absolute values), respectively. ResultsPerforming LV GLS was feasible in 221 patients (89%) 53 ± 10 years of age, 71% female, after excluding those with previous cardiac disease. Abnormal LV GLS findings were observed in 53 patients (24%) and were associated with worse clinical severity, including a Hunt-Hess grade >3 (34% vs. 15%; p = 0.005) and biomarker evidence of neurocardiac injury and higher troponin values (1.50 [interquartile range (IQR): 0.01 to 3.87] vs. 0.01 [IQR: 0.01 to 0.22] ng/ml; p < 0.001). A reverse Takotsubo pattern of segmental strain was observed in 49% of patients (apical sparing and reduced basal strain). Importantly, LV GLS was more strongly associated with in-hospital mortality than left ventricular ejection fraction (LVEF), even after adjusting for clinical severity (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.12 to 8.63; p = 0.029). RV strain was measured in 159 subjects (72%); abnormal RV strain was added to LV GLS for predicting in-hospital mortality (p = 0.007). ConclusionsNeurocardiac injury can be detected by LV GLS and RV strain in patients with acute SAH. LV GLS was significantly associated with in-hospital mortality. RV strain, when available, added prognostic value to LV GLS. Abnormal myocardial strain is a marker for increased risk of in-hospital mortality in SAH and has clinical prognostic utility.

GW29-e1406 Prognostic Value of Right Ventricular Strain in Patients with Heart Failure and Preserved Ejection Fraction: A Three-Dimensional Speckle Tracking Echocardiography Study

GW29-e1406 Prognostic Value of Right Ventricular Strain in Patients with Heart Failure and Preserved Ejection Fraction: A Three-Dimensional Speckle Tracking Echocardiography Study

Multimodality Assessment of Right Ventricular Strain in Patients With Acute Pulmonary Embolism

Optimal risk stratification is essential in managing patients with an acute pulmonary embolism (PE). There are limited data evaluating the potential additive value of various methods of evaluation of right ventricular (RV) strain in PE. We retrospectively evaluated RV strain by computed tomography (CT), transthoracic echocardiography (TTE), electrocardiography (ECG), and troponin levels in consecutive hospitalized patients with acute PE (May 2007 to December 2014). Four-hundred and seventy-seven patients met inclusion criteria. RV strain on ECG (odds ratio [OR] 1.9, confidence interval [CI] 1.1 to 3.3; p = 0.03), CT (OR 2.7, CI 1.5 to 4.8, p <0.001), TTE (OR 2.8, CI 1.5 to 5.4, p <0.001), or a positive troponin (OR 2.7, CI 2.0 to 6.9, p <0.001) were associated with adverse events. In patients with ECG, CT, and TTE data, increased risk was only elevated with RV strain on all 3 parameters (OR 4.6, CI 1.8 to 11.3, p <0.001). In all patients with troponin measurements, risk was only elevated with RV strain on all 3 parameters plus a positive troponin (OR 8.8, CI 2.8 to 28.1, p <0.001) and was similar in intermediate-risk PE (OR 11.1, CI 1.2 to 103.8, p = 0.04). In conclusion, in patients with an acute PE and evaluation of RV strain by ECG, CT, and TTE, risk of adverse events is only elevated when RV strain is present on all 3 modalities. Troponin further aids in discriminating high-risk patients. Multimodality assessment of RV strain is identified as a superior approach to risk assessment.

Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

Left ventricular structural and functional changes in patients with arterial hypertension are well established. However, the influence of arterial hypertension on right ventricular (RV) remodeling is still being investigated. The introduction of strain analysis provided an insight into RV function and mechanics. Previous research has demonstrated the predictive value of RV longitudinal strain in patients with various cardiovascular conditions, such as pulmonary hypertension, heart failure, congenital heart diseases, and valvular disease. Nowadays, we are aware of the fact that conventional echocardiographic methods usually do not provide necessary information about RV dysfunction in patients with arterial hypertension, which is why the evaluation of new parameters that could detect RV subtle changes in hypertension is essential. The present review article is an overview of the main principles of RV deformation and a summary of the current knowledge and clinical significance of RV strain in patients with arterial hypertension.

Echocardiogram in the Evaluation of Hemodynamically Stable Acute Pulmonary Embolism: National Practices and Clinical Outcomes.

Societal guideline recommendations vary with regard to the role of routine trans-thoracic echocardiography to screen for right ventricular strain in patients with hemodynamically stable acute pulmonary embolism. To characterize national patterns in use of early trans-thoracic echocardiography for the evaluation of patients with hemodynamically stable acute pulmonary embolism and determine associations between trans-thoracic echocardiography use and patient outcomes. Retrospective cohort study using Premier, Inc. database of approximately 20% of patients hospitalized in the United States with hemodynamically stable acute pulmonary embolism between 2008 and 2011. Multivariable, risk-adjusted hierarchical regression models were used to evaluate hospital variation in use of trans-thoracic echocardiography for pulmonary embolism and associations between hospital trans-thoracic echocardiography rates and patient outcomes. Patient-level trans-thoracic echocardiography exposure was used in sensitivity analyses. We identified 64,037 patients (mean age, 61.7 years; 54% women; 68% white) hospitalized at 363 U.S. hospitals. Trans-thoracic echocardiography rates for hemodynamically stable acute pulmonary embolism varied widely among hospitals (median trans-thoracic echocardiography rate, 41.4%; range, 0-89%; interquartile range, 32.7-51.7%). Hospital rates of trans-thoracic echocardiography were not associated with significant differences in risk-adjusted mortality (trans-thoracic echocardiography rate quartile 4 vs. quartile 1: odds ratio, 0.88; 95% confidence interval, 0.69-1.13) or use of thrombolytics (odds ratio, 1.28; 95% confidence interval, 0.84-1.96), but rates of intensive care unit admission (odds ratio, 1.57; 95% confidence interval, 1.18-2.07), hospital length of stay (relative risk, 1.08; 95% confidence interval, 1.03-1.15), and costs (relative risk, 1.15; 95% confidence interval, 1.07-1.23) were significantly higher at hospitals with high trans-thoracic echocardiography rates. Analyses of patient-level trans-thoracic echocardiography exposure produced similar results, except with higher rates of thrombolysis (odds ratio, 5.58; 95% confidence interval, 4.40-7.09) and bleeding (odds ratio, 1.37; 95% confidence interval, 1.24-1.51) among patients receiving trans-thoracic echocardiography. Trans-thoracic echocardiography use in the evaluation of patients with hemodynamically stable acute pulmonary embolism varied widely between hospitals. Hospitals with high rates of pulmonary embolism-associated trans-thoracic echocardiography use did not achieve different patient mortality outcomes but had higher resource use and costs. Our findings support the 2016 American College of Chest Physicians guidelines for management of pulmonary embolism, which recommend selective, rather than routine, use of trans-thoracic echocardiography to risk stratify patients with hemodynamically stable pulmonary embolism.

Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance

Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r=0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤-14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25-17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.

Association of Decreased Right Ventricular Strain with Worse Survival in Non–Acute Coronary Syndrome Angina

Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non-acute coronary syndrome angina. In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81±10.12years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded. During follow-up (23.1±6.6months), 27 patients (12.98%) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using -18% as a cutoff point for RV strain, patients with strain≤-18% had superior outcomes (log-rank χ(2)=9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P=.003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.03-1.72; P=.01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95% CI, 1.08-2.41; P=.01). RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non-acute coronary syndrome angina.

Reference Values for Right Ventricular Strain in Patients without Cardiopulmonary Disease: A Prospective Evaluation and Meta-Analysis.

Myocardial strain imaging is a sensitive echocardiographic technique for identifying ventricular dysfunction. The aim of this study was to describe a reference range for right ventricular (RV) strain in subjects without cardiopulmonary disease and to report these values from a systematic review and meta-analysis of the current literature. Prospective online measurement of RV free wall longitudinal systolic strain using speckle tracking echocardiography (STE) was performed in 116 subjects with normal echocardiograms and without cardiopulmonary disease or risk factors. A systematic search of studies in EMBASE and Medline reporting RV strain values was performed through February 2014. The mean age was 48±16years and 58% were female. Mean RV strain was -26±4%. Ten studies involving a total of 486 patients met our inclusion criteria. The mean age range was 43-57years and 59% were female. All prior studies were performed with offline strain analysis, and 9 used a GE Healthcare strain analysis software system. The weighted estimate of RV free wall strain measured using tissue Doppler imaging (4 studies) was -27±1% (95% confidence interval [CI] -30% to -25%) and with STE (8 studies, including the current study data) -27±2% (95% CI -29% to -24%), respectively. A reference range for RV strain in subjects without cardiopulmonary disease is presented. These data may help facilitate the routine clinical measurement of RV strain in patients referred for right heart echocardiography assessment.

Right ventricular strain in patients with tetralogy of Fallot

Background Left ventricular (LV) circumferential strain shows cardiac dysfunction earlier than ejection fraction. However, measuring right ventricle strain is technically challenging due to the thin RV wall and complex morphology. Also, the predominant RV strain is longitudinal, whereas the predominant LV strain is circumferential. We recently validated a feature tracking algorithm for evaluation of left ventricular strain. Based on that work, we hypothesized that feature tracking would provide accurate and reproducible RV strain metrics for use in longitudinal evaluation of repaired TOF patients. Methods Forty patients and sixteen normal controls were evaluated. All patients had pulmonary regurgitant fraction > 30% with no residual obstruction. We dichotomized the TOF patients by RVEF ( 55%) for analysis. CMR image analysis included routine volumetry. Circumferential LV and longitudinal RV strain were calculated using the previously validated feature tracking algorithm. The average strain at the mid-ventricular level was used for comparison. Means were compared using student’s t-test and variances were compared with the Lev1:med test. Results All images yielded interpretable LV circumferential and RV longitudinal strain curves. All control subjects had normal biventricular ejection fraction. They had mean longitudinal right ventricular strain = -21+/-5%. The mean RV strain of patients with TOF and normal EV was -19 +/- 12%, not statistically different than normal. However, the variance in the strain as group was 2.5x higher than controls (p 55%) have markedly variable strain with increased dispersion in regional strain values. TOF patients with

Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction

BackgroundImprovement of left ventricular ejection fraction (LVEF) after radiofrequency catheter ablation (RFCA) of frequent premature ventricular contractions (PVCs) has been reported. However, most patients with frequent PVCs have a normal...