Right Ventricular Systolic Dysfunction Research Articles

Residual pulmonary stenosis and right ventricular contractility in repaired tetralogy of fallot.

The impact of residual pulmonary stenosis (rPS) or right ventricular (RV) outflow tract obstruction on prognosis after surgical pulmonary valve insertion (SPVI) in repaired tetralogy of Fallot (TOF) patients with pulmonary regurgitation (PR) remains controversial. rPS assessment is partially dependent on RV contractility. We investigated the impact of rPS according to RV ejection fraction (RVEF). In this multicentre, retrospective study, 117 repaired TOF patients who underwent SPVI for more than moderate PR between 2003-2021 were examined. Regarding rPS, the threshold for PR with rPS (PSR) and PR was 25 mmHg. For RVEF, the threshold for preserved RVEF (pEF) and reduced RVEF (rEF) was 40%. The patients were divided into four groups: patients with PR and pEF (PR-pEF) (n = 48), those with PR and rEF (PR-rEF) (n = 44), those with PSR and pEF (PSR-pEF) (n = 16), and those with PSR and rEF (PSR-rEF) (n = 9). Clinical parameters, postoperative adverse event rates, and their associations were studied. The 5-year freedom from adverse cardiovascular events was the highest in the PSR-pEF and the lowest in the PSR-rEF groups. The PSR-rEF group had the highest RV end-diastolic pressure (RVEDP) (12 ± 2.2 mmHg) (p = 0.006). From multivariable analysis, RVEDP was associated with postoperative adverse events (p = 0.016). RVEDP > 8mmHg was associated with a lower freedom from adverse events. The freedom from adverse events was the lowest in the PSR-rEF group, with the highest RVEDP, suggesting RV systolic and diastolic dysfunction. Reduced RVEF may mask the intrinsic degree of residual stenosis, delay SPVI timing, and increase adverse events.

Systolic and global right ventricular functions of children with bronchial asthma as compared with those of healthy controls using echocardiography: a single-centre cross-sectional observational study from Nigeria

BackgroundAsthma is the most prevalent chronic airway condition in children. It is characterised by hyperresponsiveness of the small airways leading to airway narrowing, which is usually reversible, with or without treatment. Asthma is known to cause right ventricular dysfunction, but not much is known of this effect among children with highest burden of asthma. The aim of this study is to compare the right ventricular functions of children with asthma, aged 6– ≤ 13 years, with those of their age and sex-matched apparently healthy control using transthoracic echocardiography. The systolic and global right ventricular functions were assessed using Tricuspid Annular Plane Systolic Function (TAPSE) and Tei index, respectively.ResultsSeventy cases and 68 controls were included in the final analysis of the results. The male-to-female ratios are 1.9:1 and 2:1 for the cases and controls, respectively, and their mean age were 8.82 (± 2.28) and 9.05 (2.50) years. There was no statistically significant difference between their sex (X2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${X}^{2}$$\\end{document}/P = 0.810/0.85) and their mean age (P = 0.554). The mean TAPSE of the cases (20.16 ± 2.15 mm) and the controls (20.28 ± 2.71 mm) did not differ significantly (P = 0.74), but the mean Tei index of the cases (0.56 ± 0.16) was significantly higher than that of the control (0.50 ± 0.10) (P = 0.007). Among the asthmatics, 17.1% (12/70) and 2.9% (2/70) had global and systolic RV dysfunctions, respectively; 2.9% (2/70) of the controls had RV global dysfunctions, but none had RV systolic dysfunction. The global dysfunction among the asthmatics was significantly associated with their age range and frequency of hospitalisation (X2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${X}^{2}$$\\end{document} /p of 6.051/0.014 and 7.209/0.021, respectively), and significantly correlates with their Body Mass Index, and peripheral oxygen saturation (r/P of −0.236/0.049 and − 2.490/0.038, respectively). None of the participants had right ventricular systolic dysfunction.ConclusionThis study shows that asthmatic patients have global RV dysfunction, and it is suggested that better control of asthma would preserve cardiac function.

Assessment of right ventricular ejection fraction cut-point for predicting mortality and heart failure hospitalization in asian patients with heart failure and reduced ejection fraction (HFrEF)

Abstract Background Left ventricular ejection fraction (LVEF) has been well established as a predictor of morbidity and mortality in heart failure patients (HF). Meta-analyses have confirmed that right ventricular systolic dysfunction (RVSD) identified by cardiac MR predicts adverse outcomes in HF patients. However, the cut-point and predictive value of right ventricular ejection fraction (RVEF) in Asian patients remain unknown. Objectives To evaluate the RVEF cut-point for RVSD and demonstrate the association between RVSD by cardiac MR and a composite endpoint consisting of HF hospitalisation and/or all-cause mortality in HFrEF patients (LVEF ≤40%). Materials & Methods A retrospective chart review of 370 consecutive HFrEF patients who underwent cardiac MR between 01 June 2009 and 31 December 2013 was done. The primary outcome was defined as all-cause mortality and/or HF hospitalisation. Receiver Operating Characteristic (ROC) analysis was done to explore the most accurate RVEF as a cut-point for RVSD. Multivariate Cox regression analysis was calculated. Results Patients were followed for a total of 1,989 patient-years with an average of 5.4 ± 2.9 years. The primary outcome occurred in 112 patients (30.3%). ROC analysis demonstrated that RVEF <48% provided the most accurate prognostic value (specificity 52%, sensitivity 70%) with an area under the curve of 0.62 (95% CI 0.55 – 0.69). Multivariate Cox analysis showed that RVSD was a significant independent risk factor (hazard ratio 1.71; 95% CI 1.10 – 2.66; p=0.018) for the primary outcome, in addition to age (p<0.001), New York Heart Association functional class (p<0.001), and diabetes mellitus (p=0.014), regardless of LVEF. Conclusions In Asian HFrEF patients, RVSD defined by RVEF <48% by cardiac MR can predict adverse events and provide a prognostic parameter for risk stratification.

A new right-heart failure staging system in patients with severe tricuspid regurgitation. Prognostic implications

Abstract Objective Our aim was to describe a new right-heart failure (RHF) staging system in patients with severe tricuspid regurgitation (TR). Methods Multicenter, observational, and prospective registry in which all patients with severe TR have been consecutively collected within a 6-month period, classified according to their clinical condition and right ventricular status, and followed up for one year. Results A total of 1247 patients with severe TR [mean age: 76.7±10.5 years, 876 women (70.2%)] were included: 810 (64.9%) met criteria for severe TR, 301 (24.1%) massive TR, and 136 (11%) torrential TR. A new RHF staging was proposed depending on clinical condition, RV dilation and RV systolic dysfunction (Table). The largest group of patients had a normal right ventricle with signs/symptoms of RHF (41%). Death due to refractory HF occurred in 9,2% of patients, hospitalization for HF in 20,8%, and 12,3% underwent TR interventions. In the multivariate analysis the predictors of CV mortality were age, impaired renal function, previous HF admission, massive and torrential TR and Stages III and IV of the new right-heart failure staging system (figure). Conclusion The new RHF staging system accurately stratifies patients with severe TR into prognostic categories.

CILP1 and NTproBNP in pulmonary hypertension and right ventricular pressure overload: a translational experimental study

Abstract Introduction Cartilage intermediate layer protein 1 (CILP1) has emerged as a novel marker of right ventricular (RV) dysfunction in pulmonary hypertension (PH), although there is still little evidence on its role in different scenarios of RV pressure overload. The aim of our study was to analyze CILP1 as a biomarker of RV remodeling and PH severity, and compare it with N-terminal pro-brain natriuretic peptide (NTproBNP), in different experimental models of RV pressure overload. Methods Three different experimental models of RV pressure overload compared to a sham procedure were evaluated in 24 Yucatan pigs: chronic postcapillary PH by pulmonary vein banding (M1, n=6); chronic PH by aorto-pulmonary shunting (M2, n=6); RV pressure overload by PA banding (thus without PH) (M3, n=6); and sham procedure (M0, n=6). Animals were evaluated at 8 months after surgery by right heart catheterization, cardiac magnetic resonance (CMR), and blood/histological sampling. Levels of CILP1 and NTproBNP at the RV myocardium and blood were determined with dedicated ELISA and compared among groups by Wilcoxon test with Bonferroni correction. Associations between biomarkers and RV performance indices and pulmonary arterial pressure (PAP) were assessed with Spearman correlation test. Results M1 animals developed chronic postcapillary PH with normal left ventricular (LV) performance and RV maladaptive hypertrophy (RV fibrosis and systolic dysfunction). M2 animals developed chronic precapillary PH associated with LV dilatation and RV maladaptive hypertrophy. On contrast, M3-animals developed severe RV pressure overload (without PH) and hypertrophy but maintained normal RV systolic function. CILP1 and NTproBNP levels were moderately correlated (R=0.56, p=0.002). CILP1 levels in RV myocardium and plasma were significantly higher in M1, whereas NTproBNP plasma levels were significantly higher in M2 (Figure 1). CILP1 in plasma and RV myocardium significantly correlated with PAP, while myocardial CILP1 levels also correlated with RV extracellular volume (RV-ECV) by CMR (Figure 2). NTproBNP myocardial levels correlated with RV ejection fraction and RV-ECV and plasmatic levels correlated with PAP (Figure 2). Conclusions CILP1 levels were increased in the presence of PH and isolated RV dysfunction, whereas NTproBNP levels were increased in the model of PH, RV dysfunction and LV remodeling. Myocardial levels of both peptides correlated with diffuse fibrosis, estimated by CMR, whereas plasmatic levels of both biomarkers correlated with PAP. This suggests that CILP1 may be a more specific marker of RV dysfunction in PH, being less dependent of LV parameters.CILP1 and NTproBNP levels among modelsCorrelation with PAP & RV remodeling

Association of pulsatile venous waveform pattern in the venous studies of lower extremities to 2d-echocardiographic parameters for right heart function and right atrial pressure

Abstract Introduction To date, the detection of pulsatile venous waveform (PVW) pattern in venous duplex scans are read as suggestive of increased central venous pressure (CVP) and/or right-sided heart failure. In the advent of point of care ultrasound, non-invasive measures can be used to determine systemic hemodynamics in emergent clinical settings. Purpose This study aims to determine the association of PVW pattern to echocardiographic parameters of right ventricular (RV) function and right atrial pressure (RAP). Methods A single center retrospective study of adult patients with venous studies of the lower extremities and 2d-echocardiogram done from January 2019 to October 2023. Logistic regression analyses were performed to determine the association of PVW pattern with RV dysfunction based on TAPSE, S’ and FAC, as well as with increased RAP. Results A total of 2086 adult patients were included with median for age of 67 years of which 1141 (55%) were females, and 728 (35%) were hypertensive. PVW pattern was noted from 163 participants (7.8%) of which a higher proportion had heart failure, kidney disease, COVID-19, pneumonia and valvular heart disease. Patients with PVW pattern had a significantly lower median TAPSE [18 (IQR 15-20) vs 20 (IQR 18-22)] and median S’ [11.1 (IQR 8.6-13.20) vs 12.3 (IQR 10.6-14.40)] with FAC 27.1 + 11.9%. Increased RAP was noted in 7% of the study population. Patients with PVW pattern had a higher median inferior vena cava (IVC) diameter [1.9 ( IQR 1.5-2.3) vs 1.5 (IQR 1.3-1.8)] and lower median IVC collapsibility [39.9 (IQR 23.5-51.4) vs 50 (IQR 38.9-58.80]. PVW pattern is significantly associated with TAPSE (crude OR 3.89; CI 2.67-5.66, p<0.0001), S’ (crude OR 3.26, CI 2.30-4.62, p<0.0001) and increased RAP (adjusted OR 6.06, CI 4.02-9.14, p<0.0001). Conclusion Patients with PVW pattern had about 4 times and 3 times higher odds of developing RV systolic dysfunction based on TAPSE and S’, respectively. Its presence confers about 6 times higher odds of developing increased RAP. These parameters can direct further diagnostic work-up and guide assessment of response to decongestive therapy in critical units and other areas where 2d-echocardiogram is not readily accessible.

Tissue Doppler Right Ventricle Myocardial Performance Index (TDI RV-MPI) Versus Tricuspid Annular Plane Systolic Excursion (TAPSE) in Evaluation of RV dysfunction in Patients with or without LV dysfunction

Introduction: Cardiovascular disease remains a leading cause of death. Right ventricular (RV) function is a strong predictor of outcome in many cardiovascular diseases, but its significance is often neglected. It has often been coined “the forgotten chamber. RV dysfunction may be secondary to left ventricle (LV) dysfunction as a consequence of “Ventricular Interdependence”. As RV dysfunction is associated with high in-hospital morbidity and mortality, early reorganization of RV dysfunction is warranted; but until today it remains a challenging task because of complex structure and asymmetric shape of RV. Objective: Our objective was to compare the efficacy of Tissue Doppler Right Ventricle Myocardial Performance Index (TDI RV-MPI) with Tricuspid Annular Plane Systolic Excursion (TAPSE), as a predictor of RV Systolic dysfunction. Methods: This was a cross-sectional study in patients undergoing comprehensive Transthoracic Echocardiography for any indication. Our aim was to compare Tissue Doppler Right ventricle Myocardial Performance Index (TDI RV-MPI) with TAPSE to predict RV function in patients with or without LV dysfunction .The current study recruited 100 patients who presented to the Cardiology Clinic of Lab Aid Cardiac Hospital. In addition to calculation of conventional, quantitative LVEF done in 2D guided M-mode in Para-sternal long-axis view, RV function was assessed in all subjects by measurement of Tricuspid Annular Plane Systolic Excursion (TAPSE) & Tissue Doppler RV Myocardial Performance Index (TDI RV-MPI). Both were compared in prediction of RV dysfunction in patients with or without LV systolic dysfunction Results: RV dysfunction was found in subjects with LV dysfunction by both TAPSE & TDI RV -MPI. RV dysfunction increased with reducing left ventricular ejection fraction. Normal TAPSE (~24 mm) was evidence of normal TDI RV-MPI (0.2594±0.03269, P<.001), consistent with normal RV function. Of note, reduced TAPSE (~12 mm) was at the same time was evidence of increased TDI RV-MPI (0.7550±0.06351, P<.001), suggestive of RV dysfunction. Simultaneously normal LVEF (~ 55%) was evidence of normal TAPSE (22±1.582 mm, P<.001) & normal TDI RV-MPI (0.25±.0509, P<.001). Reduced LVEF (~25%) was at the same time, evidence of reduced TAPSE (15.50±3.317 mm, P<.001) & increased TDI RV-MPI (0.66±.1150, P<.001). A statistically significant negative correlation of TDI RV-MPI (r=-0.927) was observed with TAPSE (p<0.001). Also statistically significant negative correlation of TDI RV-MPI (r=-0.798) and significant positive correlation of TAPSE (r=0.813) were observed with LVEF (p<0.001). In the analysis TDI RV-MPI maintained significant correlation with both LVEF & TAPSE. In linear regression analysis TAPSE & LVEF were significant independent predictor of TDI RV-MPI. Most important determinants of TDI RV-MPI was TAPSE (R=0.927, p<0.001) . Conclusion: This study demonstrated that in patients with LV dysfunction there was RV dysfunction due to ‘ventricular interdependence’ as detected by both TAPSE & TDI RV-MPI. TDI RV-MPI is a simple, sensitive, reproducible, noninvasive, non-geometirc echocadiographic parameter to provide global assessment of systolic and diastolic function of RV. It has the ability to detect RV dysfunction at an early stage, so as to reduce morbidity and mortality in these patients. It is evident that TDI RV-MPI can be a surrogate of TAPSE even with superior efficacy in RV functional assessment maintaining close relation with LVEF. These observations could guide decision making in daily clinical practice. Bangladesh Crit Care J September 2024; 12 (2): 105-112

Monocrotaline-induced pulmonary arterial hypertension: the benefic effects of magnesium sulfate, Rosuvastatin and Sildenafil.

Pulmonary arterial hypertension (PAH) is characterized by several maladaptive mechanisms: endothelial dysfunction, oxidative stress, inflammation, pathological remodeling of the pulmonary arterioles, and cellular hypoxia. These mechanisms all favor progressive pulmonary vasculopathy and progressive right ventricle (RV) dysfunction. This study aims to characterize the experimental model of monocrotaline-induced PAH in rats. Subsequently, by administering Sildenafil, Rosuvastatin, and Magnesium sulfate, we assessed the animals via ultrasonography and assayed biochemical parameters to evaluate the efficacy of the treatment. 42 male Wistar rats were randomly allocated into six equal groups (n=7) and received a single subcutaneous MCT injection (60 mg/kg dose). Drug therapy with Sildenafil, Rosuvastatin, and Magnesium sulfate in different combinations was initiated 14 days after MCT injection. Fulton Index, RV anterior wall thickness, RV internal diameter, and pulmonary arterial acceleration time/ejection time (PAAT/PAET) were measured. The following biochemical parameters were also measured: endothelin 1(ET1), brain natriuretic peptide (BNP), nitric oxide (NO) metabolites, vascular endothelial growth factor (VEGF), and inducible nitric oxide synthase (iNOS). MCT-PAH was a successful experimental model that has fulfilled anatomical, pressure, and biochemical characteristics supporting this fact. Sildenafil monotherapy does not provide any substantial benefit in reducing MCT-PAH. The additive effects of Rosuvastatin + Sildenafil or Sildenafil + Magnesium sulfate significantly reduced the degree of RV hypertrophy and improved RV systolic pressures. However, there were also modest decreases in biochemical parameters compared to Sildenafil alone. The triple drug combination Sildenafil + Rosuvastatin + Magnesium sulfate shows significant results (p<0,001) compared to the previously described drug combinations. The lowest biochemical parameters were recorded: RV anterior wall thickness, RV internal diameter values, and a significant PAAT/PAET ratio improvement. Thanks to their benefits on vascular pathological remodeling, triple drug combinations implicitly reduce ET1, VEGF, NO metabolites, and iNOS values with statistical significance. The beneficial pleiotropic effects of Rosuvastatin combined with Magnesium sulfate (thanks to its potent vasodilator and antioxidant effects) demonstrated its efficacy in this study by improving RV systolic pressures, RV hypertrophy, oxidative stress, and myocardial dysfunction biomarkers.

Características de la insuficiencia tricúspide grave inducida por dispositivos de estimulación intracardiacos

Introduction and aimsTricuspid regurgitation (TR) induced by the implantation of cardiac implantable electronic devices (CIED) is an increasingly common cause of severe TR. Our aim was to describe the echocardiographic phenotypic characteristics of CIED-induced severe TR. MethodsRetrospective cohort study that included patients with severe TR related to CIED diagnosed in the cardiac imaging unit of a Spanish tertiary hospital. Results37 patients with severe TR induced by lead/electrode interference formed our study group. TR was predominantly severe (68%), followed by massive (21%) and torrential (11%). The leaflet most affected by the interference was the septal. 58% of the sample presented severe dilatation of the right atrium (RA) (mean RA area 28cm2). Mean tricuspid annulus measurement was 42mm. The usual parameters for quantifying RV systolic function were on average within the normal range (TAPSE mean 19mm, S’ wave 10mm, FAC 41%), while global RV strain (RVGLS -15%) and free wall strain (RVFWLS -19%) were found reduced. An incipient degree of ventricular/pulmonary arterial uncoupling was evident (mean TAPSE/PSAP 0.34, SGLVD/PSAP 0.27%/mmHg). ConclusionsOur patients with CIED-induced severe TR are characterized by a heterogeneous phenotype with a high prevalence of severe RA and tricuspid annulus dilatation. RVGLS, RVFWLS, and arterial ventricular coupling were the most sensitive parameters for early assessment of RV systolic dysfunction.

Abnormal spirometry is a predictor of exercise capacity in patients with tetralogy of Fallot

&lt;p&gt;We investigated the association between cardiac factors, spirometry, and exercise testing in patients with tetralogy of Fallot (TOF). Clinical data from patients with TOF performing a cardiopulmonary exercise test (CPET) was collected retrospectively over a 10-year period. 122 patients with TOF were identified, 52 excluded for incomplete exercise, spirometry, or cardiac data for 70 total patients included in the study. There was a male predominance 39 (56%), a mean age of 25 ± 12 years, with 28 (40%) &amp;lt; 18 years of age. The mean number of cardiac surgeries was 2.1 ± 1.2. Most, 46 (69%) had moderate to severe pulmonary valve insufficiency (PI) and 34 (51%) had moderate to severe right ventricular (RV) dilation. Mean forced vital capacity (FVC) was low at 81.8% predicted, and 32 (46%) with low FVC (&amp;lt; 80% predicted). Overall peak VO&lt;sub&gt;2&lt;/sub&gt;/kg was low with a mean of 58.2 ± 13.2 % predicted. Using multiple regression analysis, a higher number of cardiac surgeries was an independent predictor of lower FVC (&lt;em&gt;p&lt;/em&gt; = 0.01). Lower FVC was itself an independent predictor of lower peak VO&lt;sub&gt;2&lt;/sub&gt;/kg and O&lt;sub&gt;2&lt;/sub&gt; pulse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Moderate or severe RV systolic dysfunction was an independent predictor of stroke volume response (&lt;em&gt;p&lt;/em&gt; = 0.03).&lt;strong&gt; &lt;/strong&gt;Higher body mass index (BMI) was an independent predictor of all exercise measures being worse (&lt;em&gt;p&lt;/em&gt; &amp;lt; 0.05). Low FVC and reduced exercise capacity were common in our population of TOF patients. Low FVC was predictive of low exercise capacity while, of the cardiac measures only RV systolic dysfunction was significant and predictive of stroke volume response. Spirometry may be a valuable screening tool in evaluation of TOF patients.&lt;/p&gt;

The role of Cardiotrophin-1 and echocardiography in early detection of subclinical diabetic cardiomyopathy in children and adolescents with type 1 diabetes mellitus.

To assess the role of Cardiotrophin-1 (CT-1) and echocardiography in early detection of subclinical Diabetic Cardiomyopathy (DCM) in children with type 1 Diabetes Mellitus (T1D). This case-control study included two groups of children and adolescents aged between 7 and 18. Group (1) included forty patients with T1D (duration > 5 years) regularly followed at the children's hospital of Cairo University, and Group (2) included forty age and sex-matched healthy subjects as a control group. The serum level of CT-1 was measured, and conventional echocardiography, tissue Doppler imaging (TDI), and 2D speckle tracking echocardiography were performed. The level of CT-1 in the cases ranged from 11 to 1039.4 pg/ml with a median (IQR) of 19.4 (16.60-25.7) pg/ml, while its level in the control group ranged from 10.8 to 162.6 pg/ml with a median (IQR) of 20.2 (16.2-24.8) pg/ml. CT-1 levels showed no statistically significant difference between cases and controls. Patients had significantly higher mean left ventricle E/E' ratio (p<0.001), lower mean 2D global longitudinal strain (GLS) of the left ventricle (LV) (p<0.001), and lower mean GLS of the right ventricle (RV) (p<0.001) compared to controls. Ofpatients with diabetes, 75 % had LV diastolic dysfunction, 85 % had RV diastolic dysfunction, 97.5 % had LV systolic dysfunction, and 100 % had RV systolic dysfunction. Non-conventional echocardiography is important for early perception of subclinical DCM in patients with T1D. CT-1 was not specific for early detection of DCM.

The Significance of Right-Sided Precordial ECG Leads (V3R and V4R) in Assessing Right Ventricular Dysfunction: ASingle Center Cross-Sectional Study.

Right ventricular systolic dysfunction is associated with poor prognosis and increased mortality rates. Our objective was to investigate ECG changes in patients with this condition, focusing on the right-sided precordial leads. In this cross-sectional study, 60 patients with right ventricular dysfunction were included from April 2020 to April 2021. Cardiac structure and function were assessed using 2D transthoracic echocardiography. Standard 12-lead electrocardiograms and right-sided precordial ECGs (V3R-V4R) were obtained and analyzed for QRS complex configuration, ST-segment elevation, and T-wave morphology. In our study, the majority were male (70.0%) with a mean age of 58.76 years. The most common initial diagnoses were pulmonary thromboembolism (43.3%), chronic obstructive pulmonary disease (26.7%), and pulmonary hypertension (25.0%). The predominant ECG finding in the right-sided precordial leads (V3R, V4R) was a deep negative T wave (90.0%). Patients with severe right ventricular systolic dysfunction often exhibited a qR pattern (41.2%), whereas those with nonsevere dysfunction showed rS and QS patterns (55.8%). Approximately 41.0% of severe RV dysfunction cases had ST segment depression in the right-sided precordial leads, and 28.0% of patients displayed signs of right atrial abnormality. The study found that qR, rS, and QS patterns were more prevalent in V3R and V4R leads among patients with severe and nonsevere right ventricular systolic dysfunction. The most common ECG feature observed was deep T-wave inversion in these leads. The study recommends using right-sided precordial leads in all patients with RV systolic dysfunction for early detection and risk stratification.

Predictors and outcomes associated with right ventricular function in patients with acute respiratory distress syndrome treated with Veno-venous extracorporeal membrane oxygenation.

Right ventricular dysfunction is associated with mortality in patients with acute respiratory distress syndrome (ARDS) but information in veno-venous extracorporeal membrane oxygenation (ECMO) settings is limited. Study objectives were to examine factors associated with right ventricular (RV) systolic dysfunction (RVSD) and RV dilation in ECMO patients with ARDS, to compare outcomes in those with and without RVSD and RV dilation defined by qualitative and quantitative parameters, and to describe RVSD evolution during ECMO. Retrospective observational study of adult ARDS patients supported with ECMO at a tertiary care hospital. Of a total of 62 patients, 56% had RVSD and 61% had RV dilation by qualitative assessment. Male gender, COVID-19, hypercarbia, and pneumothorax were associated with RVSD and RV dilation. In-hospital mortality was significantly higher in patients with RV dilation vs. no dilation (42% vs. 17%, p = .05) but comparisons for patients with and without RVSD (37% vs. 26%, respectively) did not reach statistical significance. Findings were similar when RV size and function were quantified by right to left ventricle end-diastolic area ratio and fractional area change (39% vs. 21% and 36% vs. 20% respectively; p = NS). Of 39 patients with multiple echocardiograms, 9 of 18 with initially normal RV function developed RVSD while RV function normalized in 10 of 21 patients who began ECMO with RVSD. Study results suggest an association of RV dilation and RVSD with worse outcomes and a dynamic nature of RV function necessitating close monitoring during the ECMO course.

Assessment of right ventricular systolic function using speckle tracking strain imaging in patients with severe tricuspid regurgitation: a validation study with cardiac magnetic resonance

BackgroundRight ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tricuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR.MethodsWe included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%.ResultsA total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = –0.37, P < 0.001), followed by RVGLS (r = –0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better discrimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696–0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500–0.859).ConclusionsIn patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and displayed superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.

Sex Differences in Outcomes of Adults with Repaired Coarctation of Aorta and Concomitant Aortic Valve Disease

BackgroundAortic valve disease is common in adults with coarctation of aorta. However, no systematic comparative analyses have been performed of the clinical course of aortic valve disease for male vs female patients in this population. The purpose of this study was to compare cardiac remodelling, onset of symptoms, and incidence of aortic valve replacement (AVR) for male vs female patients. MethodsA retrospective study was conducted of adults with repaired coarctation of aorta and ≥ moderate aortic stenosis and/or aortic regurgitation. Cardiac remodelling (left ventricular [LV], left atrial, right ventricular [RV], and right atrial structure and function) and symptomatic and/or functional class were determined at the baseline encounter. Development of new-onset symptoms and the incidence of AVR were ascertained for the period from baseline to last encounter. ResultsWe identified 214 patients (121 male [57%], 93 female [43%]). Although both groups had a similar aortic valve gradient, aortic valve area indexed to body surface area, aortic regurgitation severity, and functional status at baseline, female patients had more LV concentric hypertrophy and remodelling, left atrial hypertension and dysfunction, elevated RV systolic pressure, and RV systolic dysfunction. Of 151 patients without symptoms at baseline,102 (72%) developed symptoms. Female sex was independently associated with new-onset symptoms (adjusted hazard ratio 1.14, [95% confidence interval 1.05-1.23]). Of 214 patients, 191 (89%) underwent AVR. Female sex was not associated with AVR upon multivariable analysis. However, LV concentric hypertrophy and remodelling (both of which were more common in female patients) were associated with new-onset symptoms and AVR. ConclusionsFemale patients, compared to male patients, had more-advanced cardiac remodelling, and more-rapid onset of symptoms, but a similar risk of AVR.

Prognostic value of right ventricular involvement in hypertrophic cardiomyopathy: A systematic review and meta-analysis

BackgroundRight ventricular (RV) involvement has been reported in one out of three patients with hypertrophic cardiomyopathy (HCM), however its prognostic significance remains unknown. We aimed to assess the prognostic value of RV involvement in patients with HCM through a systematic review and meta-analysis. MethodsA literature search was performed on PubMed, ClinicalTrials.gov and Cochrane Library databases from inception through November 15, 2023. Original articles enrolling HCM patients >18 years old and evaluating the association of RV parameters routinely assessed in clinical practice through trans-thoracic echocardiography or cardiac magnetic resonance (i.e., RV hypertrophy, volumes, systolic function, and late gadolinium enhancement) and the risk of a pre-defined composite endpoint including i) all cause death; ii) cardiac death; iii) heart transplantation; iv) heart failure-related hospitalization; v) atrial fibrillation; vi) ventricular tachycardia; and vii) stroke were retrieved. We pooled the effect of RV imaging variables on the combined clinical endpoint in terms of hazard ratio (HR) with 95% confidence interval (CI). ResultsThe meta-analysis included 12 articles and 4634 patients. The pooled analysis demonstrated that the presence of RV systolic dysfunction conveyed an increased risk of adverse outcomes (HR 2.46; 95% CI 1.80–3.35; P < 0.001), whereas other RV imaging parameters were not significantly associated with patients' prognosis, except for RV-fractional area change analyzed as a continuous variable (HR 0.96 per % increase; 95% CI 0.93–0.995; P = 0.025). ConclusionsOur results pinpoint a prognostic role of RV dysfunction, independent of left ventricular involvement, in patients with HCM, and future longitudinal studies, including multi-parametric RV assessment, are encouraged to provide clinically-relevant data to refine risk stratification in patients with HCM.

Myocardial performance imaging for the early identification of cardiac dysfunction in neonates with sepsis

PurposeThe assessment of cardiac performance in septic new-borns is crucial for detecting hemodynamic instability and predicting outcome. The aim of the study is to assess myocardial performance in neonates with sepsis for the early identification of cardiac dysfunction.Patients and methodsA case control study was carried out from September 2022 to May 2023 at the Neonatal Intensive care unit, Kasturba Medical College, Manipal. A total of 68 neonates were included in the study, with 33 females and 35 males. The study population was further subdivided into 3 groups namely preterm septic neonates (n = 21), term septic neonates (n = 10) and non-septic healthy controls (n = 37). The cardiac structure and function were assessed using conventional method, Tissue Doppler imaging (Sm) and speckle tracking echocardiography (GLS). The study was approved by the Institutional Ethics Committee at Kasturba Medical College, Manipal (approval number IEC: 90/2022). The CTRI registration number for the study is CTRI/2022/09/045437 and was approved on September 12, 2022. Prior to the neonate’s enrolment, informed consent was obtained from their mothers or legal guardians.ResultsOut of the total 68 neonates, 31 were cases and 37 were controls which included 33 females and 35 males. LV systolic function was not statistically significant between cases and controls. E/A ratio of the mitral valve was significantly lower in septic newborns than in healthy neonates. (1.01 ± 0.35 vs 1.18 ± 0.31, p < 0.05) preterm neonates showed significantly lower Lateral E’ and RV E’ velocities than term neonates. TAPSE was significantly lower in septic preterm neonates. (8.61 ± 1.28 vs. 10.7 ± 2.11, p < 0.05) No significant difference was noted in the Myocardial Performance Index between septic neonates and healthy neonates. LV Global Longitudinal Strain was slightly lower in preterm septic neonates than in term neonates with sepsis.ConclusionSeptic newborns are associated with LV diastolic dysfunction, RV systolic dysfunction and substantially higher pulmonary systolic pressures.

New Right Ventricular Dysfunction in Pediatric Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.

The development of new right ventricular (RV) dysfunction after cannulation to venovenous (VV) extracorporeal membrane oxygenation (ECMO) and its association with worse outcomes is increasingly recognized in adult patients, however, no studies have evaluated this phenomenon in pediatric patients. We report results of a single-center retrospective cohort study at a large academic children's hospital. New RV systolic dysfunction was present in 48% (12/25) of pediatric patients on VV ECMO for acute respiratory distress syndrome (ARDS). There was no statistically significant difference in survival, duration of mechanical ventilation, or hospital length of stay between those with and without RV dysfunction. Over half (5/9, 56%) of survivors with RV dysfunction on ECMO had RV dilation or RV hypertrophy on post-ECMO echocardiograms, and in two patients the RV dysfunction persisted for months following decannulation. Cardiac catheterization and autopsy reports suggested that echocardiographic assessment of RV systolic function alone may not be sufficient to diagnose clinically relevant RV injury. This is the first study to report the prevalence of RV dysfunction on VV ECMO for pediatric ARDS. Future multicenter collaboration is needed to create a clinically relevant definition of pediatric "RV injury" and to further evaluate risk factors and outcomes of RV dysfunction.

A STUDY ON ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BY RIGHT VENTRICULAR OUTFLOW TRACT SYSTOLIC EXCURSION IN ADULT POPULATION ATTENDING A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Objectives: The objectives of the study are as follows: (1) to assess the right ventricular function (RVF) by right ventricle outflow tract systolic excursion through M-mode echocardiography and (2) to correlate the right ventricle outflow tract systolic excursion value with other 2D echocardiographic methods of RVF assessment. Methods: The present observational prospective study was conducted in the department of cardiology, Apollo Multispeciality Hospital, Kolkata, among patients visiting the cardiology outpatient department and inpatient department from August 2021 to August 2022 to assess the RVF by right ventricle outflow tract systolic excursion through M-mode echocardiography and correlate the results with other methods (tricuspid annulus plane systolic excursion, tissue Doppler imaging, pulmonary artery pressure, fractional area change [FAC]) of RVF assessment. Results: Majority of the patients in both groups belong to the age group of 51–60 years (45.5%), followed by 61–70 years (29.5%) and 41–50 years (20.5%). Patients with right ventricular (RV) dysfunction were more aged as compared to normal RVF. The mean body mass index (BMI) was significantly higher and mean hemoglobin level was significantly lower in patients with RV dysfunction as compared to the control group (p&lt;0.05). Both systolic and diastolic blood pressures were significantly higher among the patient group than in the control group (p&lt;0.05). We found that right ventricular outflow tract systolic excursion (RVOT-SE), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler myocardial performance index, left ventricular (LV) ejection fraction (%), and FAC were significantly lower among patient group than control group (p&lt;0.01). TAPSE ≤17 mm was the best cutoff value that differentiates patients with RV systolic dysfunction from healthy individuals with normal RV systolic function. There were 67% of patients with ≤17 mm and 33% had &gt;17 mm TAPSE. Conclusion: Our study concludes that RVOT-SE is a highly sensitive and specific method for diagnosing reduced RV systolic function patients. RVOT SE is not accurate as a sole parameter, but its high values can be used as an indicator for normal RV systolic function. It is simple to get, requiring one easy and reproducible M-Mode measurement from the parasternal short-axis view.

Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation.

The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.