Right Ventricular Systolic Function Research Articles

Long-Term Outcomes of Percutaneous Trans-catheter Device Closure of Atrial Septal Defects During Teenage Life versus Adulthood

Abstract Aim and Objectives To evaluate the long-term follow up outcome of patients who underwent percutaneous trans-catheter closure of atrial septal defects during teenage life versus adulthood. Patients and Methods The study included 100 patients with secundum type ASD were treated by transcatheter closure of their defects. Two year after the procedure patients included in the study were subjected to thorough history taking, physical examination,12 leads surface electrocardiogram and Holter. Full 2D and Doppler echocardiographic study was performed in addition to Tissue Doppler Assessment of left ventricular function. Results At the 2 years follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P = 0.000). By comparing 2D echocardiographic parameters between teenagers and adults there was a highly significant difference in RV basal diameter (P = 0.004), RV systolic function (P = 0.000), RA area (P = 0.030). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P = 0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P = 0.000). There was statistically significant difference regarding defect size (P = 0.037), device size (P = 0.038) and Holter findings (P = 0.042) while there was no statistically significant difference between both groups regarding mPAP, device type and ECG. Defect size was larger in adult group ranged from 9 to 33 mm with mean ± SD 15.57 ± 6.57 mm than teenagers ranged from 6 to 22 mm with mean ± SD 13.06 ± 5.18 mm. Also, incidence of arrhythmia in adults was higher than teenagers as follows: PACs was in 7 patients (14 %) in adult group while 3 patients (6 %) had PACs in teenagers group and paroxsymal AF was found in 4 patients (8 %) in adult group while no patients in teenagers develop AF. All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 2-year follow up. Regarding Doppler parameters, mitral E/A ratio (P = 0.000) and lateral E/e' ratio (P = 0.041) had significant difference between adults and teenagers as shown in table (8) mostly related to age. Mitral E/A ratio in adults ranged from 0.7 to 1.5 with mean ± SD 1.06 ± 0.20 while in teenagers ranged from 1.1 to 1.8 with mean ± SD 1.45 ± 0.17. Lateral E/e’ ratio in adults ranged from 3 to 7.9 with mean ± SD 5.43 ± 1.24 while in teenagers ranged from 3 to 7 with mean ± SD 4.94 ± 1.13. Conclusion Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume. Key words: Atrial septal defect, arrhythmia, transcatheter closure, adults, teenagers. Abbreviations and Acronyms 2D: Two-Dimensional 3D:Three-dimensional ASD(s): Atrial septal defect(s) BSA: Body surface area CHDs: Congenital heart defects ECG: Electrocardiogram EF: Ejection fraction FAC: Fractional Area Change LA: Left Atrium mPAP: mean Pulmonary Artery Pressure RA: Right Atrium RAA: Right atrial area RBBB: Right Bundle Branch Block RV : Right Ventricle TEE : TransEsophgyeal Echocardiography TTE : TransThoracic Echocardiography

Assessment of right ventricular function in healthy Great Danes and in Great Danes with dilated cardiomyopathy

IntroductionRight ventricular (RV) dysfunction is a significant negative prognostic indicator in human dilated cardiomyopathy (DCM). Many RV indices are weight-dependent, and there is a lack of reference values for the right heart in giant breed dogs (over 50 kg), including Great Danes (GDs). This study aimed to compare indices of RV function in echocardiographically normal GDs, those with preclinical DCM (PC-DCM), and those with DCM and congestive heart failure (DCM-CHF). AnimalsA total of 116 client-owned adult GDs: 74 normal, 31 with PC-DCM, and 11 with DCM-CHF. MethodsA retrospective, single-center cohort study assessed RV function using free-wall RV longitudinal strain (RVLS), strain rate, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and pulsed-wave tissue Doppler imaging-derived systolic myocardial velocity of the lateral tricuspid annulus (TDI S’). Relationships between DCM status and RV function indices were analyzed. ResultsRV function, measured by TAPSE (P=0.001), FAC (P<0.001), and TDI S’ (P<0.001), decreased in dogs with PC-DCM and DCM-CHF compared to healthy dogs, with FAC being lower in DCM-CHF compared to PC-DCM (P=0.048). RVLS impairment was more significant in the DCM-CHF group than in the PC-DCM group (P=0.048). RVLS had the highest area under the curve (0.899) for differentiating between normal and DCM-CHF dogs. ConclusionAs DCM progresses, echocardiographic variables of RV function, including TAPSE, FAC, TDI S’, RVLS, and strain rate, worsen, indicating impaired RV systolic function in GDs affected by DCM.

Speckle-Tracking Echocardiography in Right Ventricular Function of Clinically Well Patients with Heart Transplantation.

Heart transplantation (HT) is the mainstream therapy for end-stage heart disease. However, the cardiac graft function can be affected by several factors. It is important to monitor HT patients for signs of graft dysfunction. Transthoracic echocardiography is a simple, first-line, and non-invasive method for the assessment of cardiac function. The emerging speckle-tracking echocardiography (STE) could quickly and easily provide additive information over traditional echocardiography. STE longitudinal deformation parameters are markers of early impairment of ventricular function. Although once called the "forgotten ventricle", right ventricular (RV) assessment has gained attention in recent years. This review highlights the potentially favorable role of STE in assessing RV systolic function in clinically well HT patients.

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.

Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study.

Prognosis and management of patients with intermediate-risk pulmonary embolism (PE) is challenging. We investigated whether stroke volume may be used to identify the subset of this population at increased risk of clinical deterioration or PE-related death. Our secondary objective was to compare echocardiographic measurements of patients who received escalated interventions vs anticoagulation monotherapy. We selected patients with intermediate-risk PE, who had comprehensive echocardiography within 18 hours of PE diagnosis and before any escalated interventions, from a PE registry populated by 11 emergency departments. Echocardiographers measured right ventricle (RV) size, tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) using velocity time integral (VTI) by left ventricular (LV) outflow tract Doppler or two-dimensional method of discs (MOD). The primary outcome was a composite of PE-related death, cardiac arrest, catecholamine administration for sustained hypotension, or emergency respiratory intervention during the index hospitalization. Secondary outcome was escalated intervention with reperfusion or extracorporeal membrane oxygenation therapy. Of 370 intermediate-risk PE patients (mean age 64.0 ± 15.5years, 38.1% male), 39 (10.5%) had the primary outcome. These 39 patients had lower mean SV regardless of measurement method than those without the primary outcome: SV MOD 36.2 vs 49.9 milliliters (mL), P < 0.001; SV Doppler 41.7 vs 57.2mL, P = 0.003; VTI 13.6 vs 17.9 centimeters [cm], P = 0.003. Patients with primary outcome also had lower mean TAPSE than those without (1.54 vs 1.81cm, P = 0.003). Multivariable models, selecting SV as predictor, had area under the receiver operating curve of 0.8 and Brier score 0.08. The best echocardiographic predictor of our primary outcome was SV MOD (odds ratio 0.72 [0.53, 0.94], P = 0.02). Patients who received escalated interventions had significantly lower SV or surrogate measurements, greater RV dilatation, and lower RV systolic function than patients who received anticoagulation monotherapy. Low stroke volume was a predictor of clinical deterioration and PE-related death. Low SV may be used to identify a subset of intermediate-risk PE patients, who are higher risk (intermediate-high risk), and for whom escalated interventions should be considered.

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.

Does Cell-Type-Specific Silencing of Monoamine Oxidase B Interfere with the Development of Right Ventricle (RV) Hypertrophy or Right Ventricle Failure in Pulmonary Hypertension?

Increased mitochondrial reactive oxygen species (ROS) formation is important for the development of right ventricular (RV) hypertrophy (RVH) and failure (RVF) during pulmonary hypertension (PH). ROS molecules are produced in different compartments within the cell, with mitochondria known to produce the strongest ROS signal. Among ROS-forming mitochondrial proteins, outer-mitochondrial-membrane-located monoamine oxidases (MAOs, type A or B) are capable of degrading neurotransmitters, thereby producing large amounts of ROS. In mice, MAO-B is the dominant isoform, which is present in almost all cell types within the heart. We analyzed the effect of an inducible cardiomyocyte-specific knockout of MAO-B (cmMAO-B KO) for the development of RVH and RVF in mice. Right ventricular hypertrophy was induced by pulmonary artery banding (PAB). RV dimensions and function were measured through echocardiography. ROS production (dihydroethidium staining), protein kinase activity (PamStation device), and systemic hemodynamics (in vivo catheterization) were assessed. A significant decrease in ROS formation was measured in cmMAO-B KO mice during PAB compared to Cre-negative littermates, which was associated with reduced activity of protein kinases involved in hypertrophic growth. In contrast to littermates in which the RV was dilated and hypertrophied following PAB, RV dimensions were unaffected in response to PAB in cmMAO-B KO mice, and no decline in RV systolic function otherwise seen in littermates during PAB was measured in cmMAO-B KO mice. In conclusion, cmMAO-B KO mice are protected against RV dilatation, hypertrophy, and dysfunction following RV pressure overload compared to littermates. These results support the hypothesis that cmMAO-B is a key player in causing RV hypertrophy and failure during PH.

Biventricular function after Ebstein anomaly repair from a single-center echocardiography study

ObjectiveWe aimed to examine biventricular remodeling and function after Ebstein anomaly (EbA) surgical correction using echocardiographic techniques, particularly, the relations between the biventricular changes and the EbA types. MethodsFrom April 2015 to August 2022, 110 patients with EbA were included in this retrospective study based on the Carpentier classification. Echocardiography assessments during the preoperative, early, and mid-term postoperative periods were performed. ResultsThe 54 patients with types A and B EbA were included in group 1, whereas the 56 patients with types C and D were in group 2. Seventy-eight patients underwent surgical correction of EbA. The median age at operation was 8.8 years. During the mid-term follow-up, only 9.1% of the patients had moderate or severe tricuspid regurgitation. Right ventricular (RV) systolic function worsened in group 2 at discharge (fractional area change: 27.6 ± 11.2 vs. 35.4 ± 11.5 [baseline], P < 0.05; global longitudinal strain: −10.8 ± 4.4 vs. −17.9 ± 4.7 [baseline], P = 0.0001). RV function slowly recovered at a mean of 12 months of follow-up. Regarding left ventricular (LV) and RV systolic function, no statistical difference was found between before and after surgery in group 1. ConclusionA high success rate of surgical correction of EbA, with an encouraging durability of the valve, was noted. Biventricular systolic function was maintained fairly in most patients with types A and B postoperatively. A late increase in RV systolic function after an initial reduction and unchanged LV systolic function were observed in the patients with types C and D postoperatively.

Physiological mechanisms behind respiratory variations in right atrial pressure in pulmonary hypertension

Impaired respiratory variation of right atrial pressure (RAP) in severe pulmonary hypertension (PH) suggests difficulty tolerating increased preload during inspiration. Our study explores whether this impairment links to specific factors: right ventricular (RV) diastolic function, elevated RV afterload, systolic RV function, or RV-pulmonary arterial (PA) coupling. We retrospectively evaluated respiratory RAP variation in all participants enrolled in the EXERTION study. Impaired respiratory variation was defined as end-expiratory RAP − end-inspiratory RAP ≤ 2 mm Hg. RV function and afterload were evaluated using conductance catheterization. Impaired diastolic RV function was defined as end-diastolic elastance (Eed) ≥ median (0.19 mm Hg/mL). Seventy-five patients were included; PH was diagnosed in 57 patients and invasively excluded in 18 patients. Of the 75 patients, 31 (41%) had impaired RAP variation, which was linked with impaired RV systolic function and RV-PA coupling and increased tricuspid regurgitation and Eed as compared to patients with preserved RAP variation. In backward regression, RAP variation associated only with Eed. RAP variation but not simple RAP identified impaired diastolic RV function (area under the receiver operating characteristic curve [95% confidence interval]: 0.712 [0.592, 0.832] and 0.496 [0.358, 0.634], respectively). During exercise, patients with impaired RAP variation experienced greater RV dilatation and reduced diastolic reserve and cardiac output/index compared with patients with preserved RAP variation. Preserved RAP variation was associated with a better prognosis than impaired RAP variation based on the 2022 European Society of Cardiology/European Respiratory Society risk score (chi-square P = 0.025) and survival free from clinical worsening (91% vs 71% at 1 year and 79% vs 50% at 2 years [log-rank P = 0.020]; hazard ratio: 0.397 [95% confidence interval: 0.178, 0.884]). Subgroup analyses in patients with group 1 and group 4 PH demonstrated consistent findings with those observed in the overall study cohort. Respiratory RAP variations reflect RV diastolic function, are independent of RV-PA coupling or tricuspid regurgitation, are associated with exercise-induced haemodynamic changes, and are prognostic in PH.Trial registration. NCT04663217.

Effect of Radiotherapy on the Right Ventricular Function in Lung Cancer Patients.

Anticancer treatment is associated with many side effects, including those involving the cardiovascular system. While many studies are available on the effects of radiotherapy (RT) on the left ventricle (LV), studies are lacking on the early effects of RT on the structure and function of the right ventricle (RV). Our study aims to assess, using modern echocardiographic techniques, the effect of irradiation on RV systolic function in the mid-term follow-up of patients undergoing RT for lung cancer (LC). This single-center, prospective study included consecutive patients with LC who were referred for treatment with definite radiotherapy and chemotherapy (study group) or chemotherapy only (control group). The study included 43 patients with a mean age of 64.9 ± 8.1 years. Cancer treatment-related RV toxicity (CTR-RVT) was found in 17 patients (40%). Early reductions in TAPSE values were observed among patients in the study group (20.3 mm vs. 22.1 mm, p = 0.021). Compared to baseline, there was a significant reduction in RV global longitudinal strain (RV GLS) in the study group immediately after the treatment (-21.1% vs. -18.4%, p = 0.02) and also at 3 months after RT (-21.1% vs. -19.1%, p = 0.021). A significant reduction in the RV FWLS value was also observed at 3 months after the end of the treatment (-23.8% vs. -21.8, p = 0.046). There were no significant changes in the three-dimensional right ventricular ejection fraction (3DRVEF) during the follow-up. We found a correlation (p = 0.003) between the mean dose of radiation to the RV and 3DRVEF when assessed immediately after RT. The mean dose of radiation to the heart correlated with RV free-wall longitudinal strain (RV FWLS) immediately after RT (p = 0.03). RV cardiotoxicity occurs in nearly half of patients treated for lung cancer. TAPSE is an important marker of deterioration of RV function under LC treatment. Compared to 3DRVEF, speckle tracking echocardiography is more useful in revealing deterioration of RV systolic function after radiotherapy.

Cardiac Dysfunction and Exercise Tolerance in Patients after Complex Treatment for Cranial and Craniospinal Tumors in Childhood.

State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors by up to 74%. The urgency of dealing effectively with late treatment-associated cardiovascular complications is rising. Objective: We aimed to assess echocardiographic parameters and exercise performance in subjects with a history of complex treatment for cranial and craniospinal tumors in childhood. Methods: the study of 48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood and 20 healthy age- and sex-matched volunteers was conducted. The examination included hormone studies, cardiopulmonary exercise testing, and, in the main group, echocardiography (ECHO). Results: In five (10.4%) patients, ECHO changes were detected after complex anti-cancer treatment: thickening and calcification of the aortic valve leaflets (2%), and reduction in the systolic LV and RV function (8% and 6%, respectively). Irradiation of various areas was a significant predictor for reduced exercise tolerance, hyperventilation at rest and upon exertion, and an increased ventilatory equivalent for carbon dioxide. Low exercise tolerance was associated with a younger age at the time of treatment initiation. Significant differences were noted between the control group and the childhood cancer survivors with endocrine disorders. Conclusions: The obtained data confirm the importance of regular cardiovascular and endocrine monitoring of this group of cancer survivors.

Correlation between Electrocardiogram Changes and Right Ventricular Systolic Function in Patients with Chronic Atrial Fibrillation

Background: Chronic atrial fibrillation (CAF) induces various electric disturbances, and a single mutation can cause multifarious phenotypes or combinations. Identifying the correlation of electrocardiogram changes corresponding to the disorders of electrical activity with right ventricular systolic function (RVSF) is important for the treatment and prognosis of CAF. Therefore, this study explored the correlation of electrocardiogram changes and RVSF in patients with CAF. Methods: From March 2022, to March 2023, 97 patients with CAF admitted to the Department of Cardiology of our hospital (study group) and 100 normal people who received health examination (control group) were subjected to echocardiogram and electrocardiogram to record relevant parameters for correlation analysis. Results: Significant differences were found in the electrocardiogram indices and right heart function parameters between the two groups. The study group had significantly higher heart rate, QTc interval, QT interval and T wave time than the control group (p &lt; 0.05). The study group showed significantly higher right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV), and lower right ventricular stroke volume (RVSV) and right ventricular ejection fraction (RVEF) than the control group (p &lt; 0.05). Pearson correlation analysis showed that QTc interval, QT interval, and T wave time were positively correlated with RVESV (p &lt; 0.05); QTc interval, QT interval, and T wave time were negatively correlated with RVSV (p &lt; 0.05); and QTc interval was negatively correlated with RVEF (p &lt; 0.05). Conclusion: A correlation exists between electrocardiogram changes and RVSF in patients with CAF.

Prognostic value of the echocardiographic ratio tricuspid annular plane systolic excursion / pulmonary arterial systolic pressure in acute pulmonary embolism.

The occurrence of death from acute pulmonary embolism (PE) is often linked to right ventricular (RV) failure, arising from an imbalance between RV systolic function and heightened RV afterload. In our study, we posited that an echocardiographic ratio derived from this disparity [RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] could offer superior predictive value for adverse outcomes compared to individual measurements of TAPSE and PASP alone. We conducted a retrospective analysis using data from a University Hospital Centre spanning from 2017 to 2023. All individuals with confirmed PE and a formal transthoracic echocardiogram within 7 days of diagnosis were included. The primary endpoint was a composite outcome of death, hemodynamic deterioration needing introduction of inotropes or thrombolysis within 30 days. Secondary endpoints included 6 months all-cause mortality and onset of right-sided heart failure. Thirty-eight patients were included. Mean age was 58 ±15 years old. A male predominance was noted: 23 male patients (60.5%) and 15 female patients (39.5%). Eight patients met the primary composite endpoint while nine patients met the secondary composite endpoint. In multivariate analysis, the TAPSE/PASP ratio was independently associated with the primary outcome (OR=2.77, 95% CI 1.101-10.23, P=0.042). A TAPSE/PASP ratio <0.3 was independently associated with the secondary outcome (OR=3.07, 95% CI 1.185-10.18, P=0.034). This study suggests that a combined echocardiographic ratio of RV function to afterload is effective in predicting adverse outcomes in acute PE.

Low circulating lysophosphatidylcholine and phosphatidylcholine are linked to pulmonary hypertension severity

Background: Pulmonary hypertension (PH) is a progressive pulmonary vascular disease. Given the mechanistic role of lipids in peripheral vascular diseases, we hypothesized that PH is also associated with pathologic circulating lipid metabolites. To test this, lipid metabolites of patients with PH were evaluated in association with clinical severity, including right ventricle systolic pressure (RVSP), pulmonary vascular resistance (PVR), right ventricular size and function, and plasma endothelin-1. Methods and Results: Participants were recruited as a part of a small site clinical trial (Clinicaltrials.gov, # NCT01586156). Comprehensive lipidomes were determined using unbiased nontargeted lipidomics (Metabolon Inc., Durham, NC) in 30 PH patients and 12 healthy controls. RVSP, right ventricular end diastolic (RVED) and end systolic (RVES) area were measured by echocardiogram and PVR was calculated. Plasma endothelin-1 was measured by Elisa. Nontargeted analysis detected 1099 lipid-related metabolites of which 83 and 60 metabolites were upregulated and downregulated in PH ( p&lt;0.05), respectively. Pathway enrichment analysis identified abnormalities of lipid metabolic pathways including choline-related, acylcarnitine, and sphingolipid metabolism. Targeted measures of lysophosphatidylcholine (lysoPC) and phosphatidylcholine (PC) confirmed these findings. Total circulating lysoPC and PC were downregulated [Healthy vs. PH, mean ± SD, mM; LysoPC, 786±102 vs. 586±139, p&lt;0.01; PC, 1855±389 vs. 1495±282, p&lt;0.01]. Sixteen out of the 25 lysoPC detected, and 25 out of 39 PC detected, were lower in PH, including the most abundant lysoPC-16:0 [226±31 vs. 186±39, p&lt;0.01] and PC-34:2 [436±91 vs. 360±75, p&lt;0.01]. RVSP, PVR, RVED area, RVES area and endothelin-1 were all higher in PH (all, p&lt;0.01). Lipid metabolites were inversely related to clinical measures of PH severity. For example, lysoPC-20:3 was related to RVSP [ r=−0.63, p&lt;0.01], PVR [ r=−0.50, p&lt;0.01], and endothelin-1 [ r=−0.51, p&lt;0.01], and PC-36:5 was inversely related to RVSP [ r=−0.36, p=0.02], PVR [ r=−0.43, p&lt;0.01], and endothelin-1 [ r=−0.50, p&lt;0.01]. Additionally, both lysoPC-20:3 and PC36:5 metabolites were inversely associated with right ventricular size, measured as RVED area [lysoPC-20:3, r=−0.62, p&lt;0.01; PC-36:5, r=−0.69, p&lt;0.01], RVES area [lysoPC-20:3, r=−0.66, p&lt;0.01; PC-36:5, r=−0.71, p&lt;0.01] and related with RV systolic function, measured as RV fractional area change [lysoPC-20:3, r=0.57, p&lt;0.01; PC-36:5, r=0.50, p&lt;0.01). Conclusion: Plasma phosphatidylcholine is low in PH and is associated with disease severity, suggesting disturbances in PC metabolism are important in pulmonary vascular disease. NIH NHLBI R37HL60917, R01HL115008 CTSA UL1TR000439; UL1TR002548. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Impact of modulating pulmonary artery pressure on resting right ventricular function in endurance-trained and untrained individuals

Prolonged endurance training is associated with critical adaptations to right ventricular (RV) structure and function that facilitate the achievement of higher exercise capacity, peak cardiac output, and RV stroke volume in the face of large increases in pulmonary artery pressures (afterload) and RV wall stress. Compared to the left ventricle, the RV is more sensitive to increases in afterload during exercise. However, the independent effect of increased afterload on RV function in endurance trained (Trained) vs untrained individuals remain unknown. Trained were considered those with a maximal oxygen consumption ( V̇O2max) &gt;60ml/kg/min (male) or &gt;55ml/kg/min (female) while untrained were defined as V̇O2max &lt;45ml/kg/min. Using echocardiography, this retrospective study sought to evaluate RV systolic function (RV global longitudinal strain [GLS]) and ventriculo-arterial coupling (ratio of RV GLS to pulmonary artery systolic pressure [PASP]) in Trained and untrained individuals while manipulating PASP. Ten participants (5 Trained and 5 Untrained) underwent resting echocardiography while breathing moderate (pressure of inspired oxygen; PiO2=89 mmHg) and severe hypoxia (PiO2=79 mmHg; order randomized) to increase PASP. Separately, eight participants (4 Trained and 4 untrained) inhaled nitric oxide (iNO; 40ppm) during echocardiography to lower PASP. Moderate and severe hypoxia increased PASP by 2.3 ± 1.3mmHg and 3.5 ± 1.8mmHg, respectively, while iNO decreased PASP by 2.6 ± 2.4mmHg, with no between group differences observed. Cardiac output was not different between any condition. A fitness-by-hypoxia interaction was observed in RV GLS in moderate hypoxia suggesting Trained had lower RV function during moderate hypoxia as compared to untrained (Untrained: -23.1 ± 4.4% vs. Trained: -20.2 ± 2.7%; p&lt;0.01). No differences in RV GLS were observed with iNO (p=0.98). The ratio of RV GLS to PASP was significantly different between groups at moderate hypoxia (Untrained: -1.06 ± 0.09%/mmHg vs. Trained: -0.85 ± 0.12%/mmHg; p=0.04) but not severe hypoxia (p=0.78). These findings suggest reducing PASP did not alter RV function or ventriculo-arterial coupling, however, Trained individuals experienced differential RV function responses when PASP is experimentally increased with hypoxia. Natural Sciences and Engineering Research Council of Canada. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Incomplete reverse remodeling in aged mice exposed to pulmonary hypertension-induced right ventricular failure

Right ventricle (RV) function is the strongest predictor of survival in pulmonary hypertension (PH) and age-related HF; however no therapies exist to improve RV function. Understanding mechanisms by which the RV undoes pathological remodeling (reverse remodeling) might aid in identifying therapies for this unmet need. Our objective was to determine whether the aged RV can undergo reverse remodeling following pathological afterload (PH). We hypothesized that return to normoxia after hypoxia-induced PH would result in attenuation of RV mass and improved RV function. We exposed male and female aged (~18 months) C57Bl6 mice to hypobaric hypoxia (HH) for 4 weeks before returning them to normoxia for 3 (WK3RR) or 6 (WK6RR) weeks. HH induced RV hypertrophy by RV myocyte area which was attenuated at Wk3RR and WK6RR in both male (Con: 425 μm2 ± 104, HH: 740 μm2 ± 125, WK3RR: 447 μm2 ± 129, WK6RR: 530 μm2 ± 187) and female mice (Con: 340 μm2 ± 116, HH: 770 μm2 ± 35, WK3RR: 516 μm2 ± 186, WK6RR: 655 μm2 ± 224). HH stimulated fibrosis by collagen deposition that was also reversed during normoxia re-exposure in male mice only (Con: 4.1% ± 1.0, HH: 10.8% ± 0.8, WK3RR: 4.2% ± 0.8, WK6RR: 2.5% ± 0.7). However, HH decreased RV systolic function by fractional area change (FAC) that was also not rescued by normoxia re-exposure. The aged RV can undergo morphological reverse remodeling in response to HH; however RV function does not improve with resolution of afterload. Further investigation into the mechanisms of reverse remodeling may identify potential drug therapies for maladaptive RV remodeling. AHA-Predoctoral Fellowship 897622 (BDM). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes

Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17mm, FAC <35%, FWLS >-20%) considered. Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P<.005). Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.

Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Although the results of A Study to Evaluate the Corvia Medical Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF II) trial were neutral overall, atrial shunt therapy demonstrated potential efficacy in responders (no latent pulmonary vascular disease and no cardiac rhythm management device). Post hoc analyses were conducted to evaluate the effect of shunt vs sham stratified by responder status. To evaluate the effect of atrial shunt vs sham control on cardiac structure/function in the overall study and stratified by responder status. This was a sham-controlled randomized clinical trial of an atrial shunt device in heart failure with preserved ejection fraction (HFpEF)/HF with mildly reduced EF (HFmrEF). Trial participants with evaluable echocardiography scans were recruited from 89 international medical centers. Data were analyzed from April 2023 to January 2024. Atrial shunt device or sham control. Changes in echocardiographic measures from baseline to 1, 6, 12, and 24 months after index procedure. The modified intention-to-treat analysis of the REDUCE LAP-HF II trial included 621 randomized patients (median [IQR] age, 72.0 [66.0-77.0] years; 382 female [61.5%]; shunt arm, 309 [49.8%]; sham control arm, 312 [50.2%]). Through 24 months, 212 of 217 patients (98%) in the shunt arm with evaluable echocardiograms had patent shunts. In the overall trial population, the shunt reduced left ventricular (LV) end-diastolic volume (mean difference, -5.65 mL; P <.001), left atrial (LA) minimal volume (mean difference, -2.8 mL; P =.01), and improved LV systolic tissue Doppler velocity (mean difference, 0.69 cm/s; P <.001) and LA emptying fraction (mean difference, 1.88 percentage units; P =.02) compared with sham. Shunt treatment also increased right ventricular (RV; mean difference, 9.58 mL; P <.001) and right atrial (RA; mean difference, 9.71 mL; P <.001) volumes but had no effect on RV systolic function, pulmonary artery pressure, or RA pressure compared with sham. In the shunt arm, responders had smaller increases in RV end-diastolic volume (mean difference, 5.71 mL vs 15.18 mL; interaction P =.01), RV end-systolic volume (mean difference, 1.58 mL vs 7.89 mL; interaction P =.002), and RV/LV ratio (mean difference, 0.07 vs 0.20; interaction P <.001) and larger increases in transmitral A wave velocity (mean difference, 5.08 cm/s vs -1.97 cm/s; interaction P =.02) compared with nonresponders randomized to the shunt, suggesting greater ability to accommodate shunted blood through the pulmonary circulation enabling LA unloading. In this post hoc analysis of the REDUCE LAP-HF II trial, over 2 years of follow-up, atrial shunting led to reverse remodeling of left-sided chambers and increases in volume of right-sided chambers consistent with the shunt flow but no change in RV systolic function compared with sham. Changes in cardiac structure/function were more favorable in responders compared with nonresponders treated with the shunt, supporting the previously identified responder group hypothesis and mechanism, although further evaluation with longer follow-up is needed. ClinicalTrials.gov Identifier: NCT03088033.

Echocardiographic parameters as adjuncts to the Pulmonary Embolism Severity Index in predicting 30-day mortality in acute pulmonary embolism patients.

The Pulmonary Embolism Severity Index (PESI) is a validated tool to predict 30-day all-cause mortality in patients with acute pulmonary embolism (PE) but includes only clinical variables. We aimed to determine the effectiveness of PESI extended with an echocardiographic parameter. This cross-sectional observational study included consecutive patients with acute PE diagnosed with computed tomography pulmonary angiography. Of 117 subjects (57 men, 48.7%), at a median age of 69 (59-80) years, 16 patients died during the 30-day follow-up. Six modified models of PESI with an additional single echocardiographic parameter were created, which increased the predictive value of PESI (area under the curve [AUC] 0.8608): tricuspid annular plane systolic excursion (TAPSE) <18 mm, right ventricular (RV) free wall longitudinal strain (RVFWLS) >-23%, 60/60 sign, RV global longitudinal strain (RVGLS) >-16%, pulmonary ejection acceleration time (AcT) <67 ms, and thrombus in right heart cavities (AUC 0.8657 to 0.8976, respectively, all markers P <0.001). TAPSE, AcT, RVFWLS, and RVGLS showed significant correlations with the PESI score, but not a thrombus in the right heart cavity or the 60/60 sign. As PESI adjuncts, they independently predicted fatal outcomes: thrombus with hazard ratio (HR) 10.04 (95% confidence interval [CI], 2.81-37.12; P <0.001) and the 60/60 sign with HR 4.07 (95% CI, 1.27-12.81; P <0.001). The quantitative echocardiographic parameters of RV systolic function and pulmonary artery blood flow are associated with the PESI score and thus increase its predictive value to a limited extent. PE- specific findings: a thrombus in the right heart cavity and the 60/60 sign are effective adjuncts to the PESI score.

Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

BackgroundSepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes. MethodThis retrospective study included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset. The patients were divided into two groups: non-MDR-SCM group and MDR-SCM group. The cardiac function was compared between the two groups. ResultA total of 62 patients were included in the study. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction, 35.8% ±4.9% vs. 45.6%±2.4%, P=0.049; LV outflow tract velocity time integral, [10.1±1.4] cm vs. [15.3±0.74] cm, P=0.001; LV-Strain, –9.02%±0.9% vs. –14.02%±0.7%, P=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area/left ventricular end-diastolic area, 0.81±0.03 vs. 0.7±0.05, P=0.042) and worse RV systolic function (RVFAC, 32.3%±1.9% vs. 39.6%±2.7%, P=0.035; tricuspid annular plane systolic excursion, [15.9±0.9] mm vs. [18.1±0.9] mm, P=0.165; systolic tissue Doppler velocity measured at the lateral tricuspid annulus, [9.9±0.5] cm/s vs. [13.1±0.8] cm/s, P=0.002; RV-strain, –11.1%±0.7% vs. –15.1%±0.9%, P=0.002). ConclusionSCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.