Right Ventricular Research Articles

Additive Value of Right Ventricular Global Longitudinal Strain to a Conventional Echocardiographic Parameter to Improve Prognostic Value in Intermediate-Risk Pulmonary Embolism.

Right ventricular (RV) dysfunction has been identified as a prognostic marker for adverse events in patients with intermediate-risk pulmonary embolism. We hypothesized that right-sided strain parameters have additive value to conventional echocardiographic parameters to further risk-stratify patients for mortality. This is a retrospective cohort study of patients with intermediate-risk pulmonary embolism between 2010 and 2018. All-cause 30-day mortality was evaluated. Echocardiographic strain parameters and conventional RV measurements were compared between survivors and nonsurvivors. Two hundred fifty-one patients were analyzed. Mortality at 30 days was 12.4%. Image quality was sufficient for RV strain analysis in 230 patients (91.6%). Right to left ventricular end-diastolic diameter ratio (RV/LV ratio) (odds ratio [OR], 1.490 [95% CI, 1.120-1.990]) and RV global longitudinal strain (RVGLS) (OR, 0.742 [95% CI, 0.605-0.910]) were independently associated with 30-day mortality. Using RVGLS and RV/LV ratio in an additive fashion, we found that 99 patients with a high RVGLS (>17.7%) and low RV/LV ratio (<1.03) had a 30-day mortality of 1.0%. Conversely, 39 patients with a low RVGLS (≤17.7%) and high RV/LV ratio (≥1.03) had a 30-day mortality of 46.2%. Kaplan-Meier analysis depicted the significantly different prognosis among the groups (P<0.001). The combined evaluation of RVGLS and RV/LV ratio is a practical method of evaluating RV dysfunction. Using both parameters in patients with intermediate-risk pulmonary embolism identifies those at highest and lowest risk of short-term mortality. This approach offers promise for improved risk stratification and guidance of treatment pathways.

The impact of additional right ventricular branch grafting on electrocardiographic and echocardiographic parameters

Aims: This study aimed to evaluate the impact of additional coronary artery bypass grafting (CABG) to right ventricular (RV) branches on echocardiographic and electrocardiographic parameters, with a focus on RV function and electrical stability. Methods: A retrospective review was conducted on patients who underwent CABG with significant right coronary artery (RCA) disease between January 2017 and December 2022. Patients were included and divided into two groups: Group 1 (n = 34) received grafts only to the distal RCA branches (posterior descending artery or posterolateral branch); Group 2 (n = 34) underwent grafting to both the distal RCA and the RV branch. Preoperative and discharge periods, echocardiographic and electrocardiographic parameters were compared between groups. Results: Both groups had comparable baseline characteristics, including echocardiographic and electrocardiographic parameters. At discharge, tricuspid annular plane systolic excursion (TAPSE) was lower in Group 1 compared to Group 2 (11.7 ± 2.7 mm vs. 15.1 ± 2.3 mm; p &lt; 0.001). The ratio of diastolic dysfunction was higher in Group 1 compared to Group 2 (91.2% vs. 61.8%; p &lt; 0.001). The mean QT dispersion (54.6 ± 15.4 ms vs. 63.7 ± 18.5 ms; p = 0.031) and mean P wave dispersion (22.5 ± 5.3 ms vs. 26.2 ± 8.8 ms; p = 0.048) levels were lower in Group 2 compared to Group 1. Conclusion: Additional bypass grafting of the RV branch in patients with significant RCA disease was associated with improved RV function and more favorable electrocardiographic parameters.

Enhancing rapid diagnosis of pulmonary embolism in the emergency department: the critical role of point-of-care ultrasound (POCUS)—a systematic review and meta-analysis

BackgroundPoint-of-care ultrasound (POCUS), performed at the patient’s bedside, has been widely used to diagnose several medical conditions. However, its accuracy in diagnosing pulmonary embolism (PE) in the emergency department (ED) is not fully established. Therefore, the current meta-analysis examined the accuracy of POCUS in diagnosing PE in the ED.ResultsA total of fourteen studies involving 1835 patients suspected of PE were included. The pooled results showed that lung ultrasound has a sensitivity and specificity of 47% and 88%, respectively. The most frequently used clinical sign for diagnosing PE using lung ultrasound was the presence of at least one hypoechoic pleural-based lesion. The pooled results also showed that deep venous ultrasound, which mostly used the bilateral compression of the femoral and popliteal veins, yielded a sensitivity of 56% and a specificity of 96% for PE. In addition, cardiac ultrasound yielded a sensitivity of 39% and specificity of 94% for PE, with the most frequently used clinical sign being right ventricular (RV) dilation. On the other hand, multiorgan POCUS displayed a sensitivity of 79% and specificity of 79%.ConclusionCardiac, lung, and deep venous ultrasounds have consistently shown high specificity, making them valuable diagnostic tools for ruling in PE at the patient’s bedside. On the other hand, multiorgan POCUS displayed high diagnostic accuracy, making it a valuable tool for confirming or dismissing PE in ED.

The Effect of Prone Position on Right Ventricular Functions in CARDS: Is Survival Predictable when Evaluated Through Transesophageal Echocardiography?

To evaluate the cardiopulmonary effect during prone position (PP) on right ventricular (RV) recovery in coronavirus disease-2019 related acute respiratory distress syndrome (C-ARDS) through transesophageal echocardiography (TEE). This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with PP in the first 48 h of invasive mechanical ventilation support. It was evaluated with TEE three times: before PP (T0f), the first hour of PP (T1), and the first hour of returning to the supine position (T0 + 24 h) (T2) after 23 hours of PP treatment. RV end-diastolic area/left ventricular (LV) end-diastolic area (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE) and LV end-systolic eccentricity index were preferred RV evaluations as primary outcomes. Pulmonary effects of PP were evaluated as a secondary outcome, including PaO2/FiO2, driving pressure (dP), static compliance (Cstat), mechanical ventilation parameters, and their association with 28-day survival. Tissue DO2 was examined as a secondary outcome, and it was calculated using the measured cardiac output through TEE. With the cardiopulmonary effect of PP, the decrease in RVEDA/LVEDA, the increase in TAPSE, PaO2/FiO2, and Cstat, and the decrease in dP were statistically significant (P < 0.05). The Cstat value associated with 28-day survival showed decreased mortality for each unit increase. The Cstat cut-off value, which was statistically significant for survival, was 37. PP can improve RV recovery and oxygenation, but it isn't always accompanied by increased survival. An increase in the Cstat may improve survival without the development of RV dysfunction while maintaining heart-lung interaction.

Three-dimensional regional evaluation of right ventricular myocardial work from cine computed tomography: A pilot study.

Evaluating regional variations in right ventricular (RV) performance can be challenging, particularly in patients with significant impairments due to the need for 3D spatial coverage with high spatial resolution. ECG-gated cineCT can fully visualize the RV and be used to quantify regional strain with high spatial resolution. However, strain is influenced by loading conditions. Myocardial work (MW)-measured clinically as the ventricular pressure-strain loop area-is considered a more comprehensive metric due to its independence of preload and afterload. In this study, we sought to develop regional RV MW assessments in 3D with high spatial resolution by combining cineCT-derived regional strain with RV pressure waveforms from right heart catheterization (RHC). Regional MW is not measured in the right ventricle (RV) due to a lack of high spatial resolution regional strain (RS) estimates throughout the ventricle. We present a cineCT-based approach to evaluate regional RV performance and demonstrate its ability to phenotype three complex populations: end-stage LV failure (HF), chronic thromboembolic pulmonary hypertension (CTEPH), and repaired tetralogy of Fallot (rTOF). Forty-nine patients (19 HF, 11 CTEPH, 19 rTOF) underwent cineCT and RHC. RS was estimated as the regional change in the endocardial surface from full-cycle ECG-gated cineCT and combined with RHC pressure waveforms to create regional pressure-strain loops; endocardial MW was measured as the loop area. Detailed, 3D mapping of RS and MW enabled spatial visualization of strain and work strength, and phenotyping of patients. HF patients demonstrated more overall impaired strain and work compared to the CTEPH and rTOF cohorts. For example, the HF patients had more akinetic areas (median: 9%) than CTEPH (median:<1%, p=0.02) and rTOF (median: 1%, p<0.01) and performed more low work (median: 69%) than the rTOF cohort (median: 38%, p<0.01). The CTEPH cohort had more impairment in the septal wall;<1% of the free wall and 16% of the septal wall performed negative work. The rTOF cohort demonstrated a wide distribution of strain and work, ranging from hypokinetic to hyperkinetic strain and low to medium-high work. Impaired strain (-0.15≤RS) and negative work were strongly-to-very strongly correlated with RVEF (R=-0.89, p<0.01; R=-0.70, p<0.01, respectively), while impaired work (MW≤5mmHg) was moderately correlated with RVEF (R=-0.53, p<0.01). Regional RV MW maps can be derived from clinical CT and RHC studies and can provide patient-specific phenotyping of RV function in complex heart disease patients.

Comparison of mechanical resuscitation by an LV Impella device to extracorporeal resuscitation using VAECMO in a large animal model

Extracorporeal cardiopulmonary resuscitation (ECPR) is an effective treatment for cardiac arrest (CA). Percutaneous left ventricular (LV) assist devices such as the Impella ECP (intravascular CPR [ICPR]) have been proposed as a less invasive alternative. The aim of this study was to explore the haemodynamic differences between ECPR and ICPR using a large animal model of electrically induced CA. Fourteen juvenile female German landrace pigs (72.4 ± 9.8 kg) were subjected to electrically induced CA for 5 mins followed by either ECPR (veno-arterial extracorporeal membrane oxygenation [VA-ECMO]) or ICPR (Impella ECP). Haemodynamic parameters and echocardiographic ventricular function indicators were monitored. Mechanical circulatory support (MCS) was continued until five hours after the return of spontaneous circulation (ROSC), when the devices were removed. Resuscitation outcomes and the haemodynamic effects of ECPR and ICPR were compared. The cannulation time for ECMO (469 ± 129 s) was significantly longer than the time for Impella device implantation (153 ± 64 s, p < 0.001). ECPR facilitated ROSC in 6/6 animals, whereas ICPR facilitated ROSC in 6/8 animals (p = 0.19). Echocardiography revealed no difference in LV or right ventricular (RV) dysfunction between the ECPR- and ICPR-treated animals after resuscitation (LV-global longitudinal strain [GLS] 3 h post-ROSC: ICPR: − 16.5 ± 5.6% vs. ECPR: − 13.7 ± 5.9%, p = 0.99; RV-GLS 3 h post-ROSC: ICPR: − 15.9 ± 3.3% vs. ECPR: − 17.3 ± 10.6%, p = 0.99). MCS using VA-ECMO and the Impella device both provided effective haemodynamic support during CA and post-ROSC in this large animal model. Despite LV unloading conferring a hypothetical advantage for ICPR, no significant differences in myocardial recovery were observed.

Assessing Right Ventricular Performance During Prone Ventilation in ARDS Patients Using Speckle Tracking Echocardiography.

Acute respiratory distress syndrome (ARDS) frequently results in right ventricular (RV) dysfunction due to increased afterload and pulmonary vascular resistance. Among the standardized therapeutic strategies for ARDS management, protective ventilation and prone positioning in cases of severe oxygenation deterioration have proven effective, with prone positioning offering additional benefits, including improved RV function, enhanced physiological outcomes such as oxygenation and lung mechanics. This study aims to evaluate the impact of prone positioning on RV performance in ARDS patients using speckle tracking echocardiography (STE). This observational, retrospective, single-center study aimed to evaluate the effects of prone positioning on RV function in patients with ARDS requiring mechanical ventilation. The study included patients with ARDS of varying severities who were passively ventilated. Transthoracic echocardiography was performed to assess RV function, with a specific focus on RV global longitudinal strain (GLS) and RV free wall strain (RVFWS) in both supine and prone positions using STE. Between August 2021 and April 2024, a total of 16 mechanically ventilated patients were included in the study. Regarding mechanical ventilation parameters, after applying the Bonferroni correction, there was a statistically significant increase in the PaO2/FiO2 ratio during the prone position (p = 0.004). Concerning echocardiographic variables, no statistically significant differences were found in left ventricular ejection fraction, basal RV diameter, RV/left ventricular end-diastolic area ratio, or the values of tricuspid annular tissue S' wave, TAPSE, and RV fractional area change. However, during the prone position, there was a significant decrease in RV GLS (p = 0.009) and RVFWS (p = 0.003). This study provides preliminary insights into the impact of the prone position maneuver on RV systolic function in patients with ARDS, suggesting that strain measured by STE could serve as a sensitive marker for detecting subclinical RV dysfunction. Further research with larger sample sizes and prospective designs is needed to confirm and build upon these findings.

An unusual thrombus in a patient with arrhythmogenic cardiomyopathy

Herein we present a case of a right ventricular (RV) thrombus in a patient with arrhythmogenic cardiomyopathy (ACM). The 24-year old female patient was diagnosed with ACM after echocardiography, genetic test and cardiac magnetic resonance imaging. Interestingly, at echocardiography, an unusal thrombus formation was detected at RV lateral wall. Also, CMR confirmed the thrombus and oral anticoagulant therapy was started. During the patient’s follow-ups, it was observed that the imaging consistent with the reported thrombus disappeared after effective anticoagulant treatment. After the diagnosis was confirmed with genetic tests, an implantable cardioverter-defibrillator (ICD) was implanted in the patient with a high sudden cardiac death (SCD) risk score. Even in arrhythmogenic right ventricular cardiomyopathy patients thrombi are rarely reported. However, the development of imaging techniques may enable more frequent detection and effective treatment of thrombi in these patients.

The Role of Neutrophil-to-Lymphocyte Ratio and Right Ventricular Dysfunction in Indonesian Patients with COVID-19: A Retrospective Cohort Study.

Background/Objectives: The clinical impact of neutrophil-to-lymphocyte ratio (NLR) and right ventricular (RV) dysfunction on clinical outcomes in COVID-19 remains understudied in the Indonesian population. This study aims to investigate their prognostic value in hospitalized Indonesian adults with COVID-19. Methods: A retrospective cohort study was conducted at a COVID-19 referral hospital in Indonesia. We included all consecutive adults hospitalized between April 2020 and April 2021 who underwent transthoracic echocardiography (TTE) during admission. Clinical information was extracted from electronic medical records. TTE variables were defined according to the American Society of Echocardiography criteria. Statistical analyses were performed using SPSS. Ethical approval was obtained from the Institutional Review Board of Universitas Indonesia (#2022-01-135). Results: A total of 488 patients were included in this study-29 with and 459 without RV dysfunction. The mean age of the population was 54.8, with 42% being female. An NLR >4.793 was considered elevated. Elevated NLR was independently associated with RV dysfunction (OR: 3.38, p = 0.02). Older age (HR: 1.02, p = 0.01), obesity (HR: 1.85, p < 0.01), chronic kidney disease (HR: 1.69, p = 0.01), high NLR (HR: 2.75, p < 0.001), and RV dysfunction (HR: 2.07, p = 0.02) independently increased the risk of 30-day mortality by multivariate Cox regression analysis. Conclusions: In adult Indonesian patients hospitalized with COVID-19, an elevated NLR was associated with RV dysfunction, and both of these parameters increased the risk of 30-day mortality. This retrospective cohort study highlights the prognostic importance of NLR and RV dysfunction in hospitalized COVID-19 patients, providing physicians with tools to identify high-risk patients.

Cardiac biomarkers predict low right ventricle performance in neonatal encephalopathy.

Study the association between cardiac biomarkers and echocardiography parameters of ventricular performance in neonates with neonatal encephalopathy (NE). Prospective observational study (2016-2021) of neonates undergoing therapeutic hypothermia (TH). Neonates with brain injury had repeated echocardiography and biomarkers measurements on day of life (DOL) 2, 3, 4, and 10. Pearson correlation and generalized linear mixed effect models were used to account for repeated measurements. Receiver operating characteristic curves were constructed to assess sensitivity/specificity. 56 neonates had 128 measurements. Creatine Kinase (CK) and cardiac troponin-I (CTn-I) were associated with right ventricular (RV) function. A CK of 1961 U/L and a CTn-I of 91 ng/L identified low Tricuspid Annular Plane Systolic Excursion (<7 mm) with sensitivities of 93% and 79%, and specificities of 55% and 74%, respectively. Elevated CK and CTn-I were associated with decreased RV performance. Trending these markers can be used to suspect altered RV function and may flag optimal timing for evaluation(s) by echocardiography during TH.

Machine learning prediction of right ventricular volume and ejection fraction from two-dimensional echocardiography in patients with pulmonary regurgitation.

Right ventricular (RV) end-diastolic volume (RVEDV) and ejection fraction (RVEF) by cardiac MRI (cMRI) guide management in chronic pulmonary regurgitation (PR). Two-dimensional echocardiography suboptimally correlate with RV volumes. This study tested whether combination of guideline-directed RV measures in a machine learning (ML) framework improves quantitative assessment of RVEDV and RVEF. RV measurements were obtained on subjects with > mild PR who had cMRI and echocardiogram within 90 days. A gradient-boosted trees algorithm predicted cMRI RV dilation (RVEDV > 160 ml/m2) and RV dysfunction (RVEF<47%), first with "guideline-only" measures, and then with "expanded-features" to include 44 total echocardiographic, clinical, and demographic variables. Model performance was compared to clinician visual assessment. Of 232 studies (56% tetralogy of Fallot, 20% pulmonary stenosis), the median age was 21.5 years, 21 (9%) had RV dilation, and 42 (18%) had RV dysfunction. For RV dilation prediction, the guideline-only model area under the receiver operating characteristic (AUROC)=0.68, and expanded-features model AUROC=0.85. At 90% sensitivity, the expanded-features model had 73% specificity, 25% positive predictive value (PPV), and 99% negative predictive value (NPV) This was similar to clinician performance (sensitivity 81%, specificity 81%, PPV 29%, NPV 98%). For prediction of RV dysfunction, the guideline-only AUROC= 0.71, additional features did not improve the model, and clinicians outperformed the model. In patients with PR, a ML model combining guidelines for RV assessment with demographic and additional echocardiographic parameters may effectively rule-out those with significant RV dilation at clinical thresholds for intervention, and performs similarly to expert clinicians.

Tricuspid Regurgitation in Tuberculous Constrictive Pericarditis Underwent Pericardiectomy.

The presence of constrictive pericarditis (CP) in conjunction with tricuspid regurgitation (TR) and the worsening of TR following pericardiectomy are associated with a reduction in patient survival. The purpose of this study was to investigate the prevalence of tuberculous CP in conjunction with TR, the incidence of worsening regurgitation following pericardiectomy, and the analysis of associated factors. Seventy-five consecutive patients who underwent pericardiectomy for tuberculous CP at the institution between January 2021 and December 2023 were retrospectively analyzed. Their clinical, imaging, and hemodynamic characteristics were analyzed. Among the 75 patients with tuberculous CP, 29 patients (38.7%) had mild or greater TR preoperatively and 27 patients (36%) had worsening TR after pericardiectomy. In patients with worsening TR, the pericardial thickness of the right ventricular (RV) lateral wall was significantly thickened preoperatively, and there was a reduction in the tricuspid annular plane systolic excursion (TAPSE), right ventricle S' tissue Doppler velocity (S'), and right ventricle fractional area change (FAC) postoperatively. The preoperative inferior vena cava diameter and the postoperative right atrial and RV basal diameters were significantly larger in patients with worsening TR compared with patients with non-worsening TR, whereas the TAPSE, S', and FAC were significantly lower before and after the surgery (P < .05). The FAC [OR = 0.354; 95% CI (0.165-0.761), P = .008] and pericardial thickness of the RV lateral wall [OR = 1.887; 95% CI (1.206-2.953), P = .005] were independently associated with worsening TR. Patients with tuberculous CP often have coexisting TR, and pericardiectomy can lead to worsening TR. The pericardial thickness of the RV lateral wall and FAC are independently associated with worsening TR following pericardiectomy.

Hemodynamics of Veno-Pulmonary Extracorporeal Membrane Oxygenation With Varying Right Ventricular Function in a Mock Circulatory Loop.

Veno-pulmonary extracorporeal membrane oxygenation (VP ECMO) is an emerging mechanical support therapy for patients with right ventricular (RV) injury. This study aimed to assess the hemodynamic impact of VP ECMO using a mock circulatory loop (MCL) to simulate patients with varying levels of RV injury and pulmonary vascular resistance (PVR). Right ventricular injury was simulated by changing the end-systolic pressure-volume relationship (47.5-100% of healthy RV), in combination with different PVR states (100-600 dyne·s·cm-5). Veno-pulmonary extracorporeal membrane oxygenation was introduced into the MCL circuit from 0 to 5 L/min at 1 L/min intervals. We demonstrated that the effect of VP ECMO support on pulmonary and systemic hemodynamics may vary significantly depending on RV function and RV afterload. A common observation across all cases was that high ECMO flow rates increased mean pulmonary arterial and left atrial pressure and reduced pulmonary artery pulsatility significantly. The absolute value of these parameters depended highly on RV function and corresponding PVR state. The study highlights the importance of considering RV injury severity and corresponding afterload when using VP ECMO to maintain cardiorespiratory stability and prevent pulmonary vasculature damage or hemorrhage. Further research is needed to establish the safe and effective use of VP ECMO in managing cardiac or respiratory failure.

Acute Right Ventricular (RV) Failure Presenting As Isolated Right-Sided Colitis

Acute Right Ventricular (RV) Failure Presenting As Isolated Right-Sided Colitis

Long-Term Evolution of Post-COVID-19 Echocardiographic Parameters in Patients with Chronic Kidney Disease: A Prospective Comparative Observational Study.

Background/Objectives: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused post-acute sequelae, especially for people with pre-existing conditions, including chronic kidney disease (CKD), which may impact the cardiovascular system. Yet, despite the preliminary description of the general population's long-COVID-19 consequences, data on CKD patients is scarce. The aim of this study was to investigate the longitudinal effects of COVID-19 on echocardiographic parameters of cardiac function and on cardiac biomarkers in patients with CKD. Methods: A total of 163 patients were included in this observational prospective trial (listed under NCT05125913 code): 88 in the COVID-19 group and 75 in the control group. The serial echocardiographic characteristics in patients who survived beyond one year, focused on left and right ventricular systolic function, together with cardiac biomarkers evolution, were compared between the two groups. Results: At baseline, there were no significant differences in left ventricular (LV) function parameters, except for a higher Tei Index in the COVID-19 group (p < 0.01). Right ventricular (RV) systolic dysfunction was more frequent in the COVID-19 group, with worse fractional area change (FAC) (p = 0.01), RV free wall longitudinal strain (RVFWLS) (p = 0.01), and RV Tei Index (p = 0.01). Over time, the control group showed a decline in LV ejection fraction (EF), while the COVID-19 group slightly improved. RV global systolic function was better preserved in the COVID-19 group. To the best of our knowledge, this is the first study that demonstrates a statistically significant increase in LAVi in patients with COVID-19. Conclusions: Prior COVID-19 infection influenced the trajectory of LV and RV function in CKD patients over 12 months, suggesting potential transient myocardial adaptations. While overall cardiac function did not differ significantly between groups, COVID-19 survivors exhibited better preservation of some ventricular function parameters.

Assessment of the right ventricular strain, left ventricular strain and left atrial strain using speckle tracking echocardiography in patients with chronic obstructive pulmonary disease

ObjectivesCardiovascular disease is a prevalent comorbidity and leading cause of mortality in chronic obstructive pulmonary disease (COPD) patients. Early identification of cardiac abnormalities in COPD patients is crucial. Speckle tracking...

Echocardiographic Measure of Right Ventricular-pulmonary Arterial Coupling Predicts Survival in Lung Cancer.

Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer. We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling. This prospective observational study included 220 outpatients with non-small cell lung cancer (NSCLC) examined by Doppler, strain, and 3-dimensional echocardiography before starting therapy. Of the included patients, 41% were female and the median age was 68 years [61, 74]. Prediction of one-year overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses. Median sPAP was within the limits of normal (31 mmHg [26, 36]); 30% of the patients had sPAP ≥ 35 mmHg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (hazard ratio [HR]: 8.76 [95% confidence interval (CI): 1.24-61.82], P = 0.03), forced expiratory volume in 1 second (HR: 0.98 [95% CI: 0.96-1.00], P = 0.03) and Eastern Cooperative Oncology Group performance status < 2 (HR: 0.34 [95% CI: 0.17-0.68], P = 0.003) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was -0.54%/mmHg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP > -0.54%/mmHg) had worse survival than those with maintained RV-arterial coupling (HR: 2.89 [95% CI: 1.55-5.42], P < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.65 [95% CI: 0.35-1.20], P = 0.17). RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.

Biventricular vs. right ventricular pacing devices in patients anticipated to require frequent ventricular pacing (BioPace).

Right ventricular (RV) pacing may promote left ventricular (LV) dysfunction. Particularly in patients with preserved LV ejection fraction (LVEF), narrow QRS, and anticipated high ventricular pacing burden (HVPB), evidence is missing that biventricular (BiV) pacing can improve clinical outcome. We therefore evaluated whether implantation of a BiV pacing device (BiVPD) compared with a RV pacing device (RVPD) may improve clinical outcome in predominantly this kind of patients. In the Biventricular Pacing for atrioventricular Block to Prevent Cardiac Desynchronization (BioPace) trial [multicentre, single-blinded (patients), randomized, parallel group], patients were equally allocated to either receive a BiVPD or a RVPD. Co-primary endpoints were (i) the composite of time to death or first heart failure hospitalization and (ii) survival time. We analysed 1810 randomized patients (median age: 73.5 years; female sex: 31.7%; mean LVEF 55.4%; mean QRS 118.4 ms), 902 to BiV and 908 to RV pacing. During mean follow-up of 68.8 months, the difference in the primary composite endpoint between both groups [346 vs. 363 events, hazard ratio (HR) 0.878; 95% confidence interval (CI) 0.756-1.020; P = 0.0882) or in mortality (305 vs. 307 deaths, HR 0.926; 95% CI 0.789-1.088; P = 0.3492) was smaller than 20%. In patients, predominantly with preserved LVEF, narrow QRS, and HVPB, superiority of implanting BiVPDs compared with RVPDs could not be proven. Right ventricular pacing may be less harmful for this kind of patients than often suggested and primary BiV pacing does not clearly improve their clinical outcome. Registered in ClinicalTrials.gov, number NCT00187278 (https://clinicaltrials.gov/ct2/show/study/NCT00187278).

Morphological, functional and biochemical differences in cardiac adaptation to endurance exercise among male and female amateur marathon runners.

Sport is known to have beneficial influence on cardiovascular system. However, activities of high intensity such as marathon running may adversely affect cardiac morphology and function, especially in the heterogenous group of amateur athletes. As males and females exhibit discrepancies in cardiac response to training, we aimed to compare exercise-induced myocardial alterations between sexes among 61 amateur marathon runners, with the use of evolving echocardiographic techniques and cardiac biomarkers. The study followed three stages: 2-3 weeks prior the marathon (Stage 1), at the finish line (Stage 2) and 2 weeks after the run (Stage 3). Echocardiographic examination along with blood analyses for biomarkers of cardiac injury and overload [creatine kinase, high sensitivity cardiac troponin I, heart-type fatty acid binding protein, B-type natriuretic peptide, galectin-3 (Gal-3), endothelin-1 (ET-1), interleukin-6 and neopterin] were performed at each stage. After the marathon there was a transient increase in right ventricular (RV) size and concomitant decrease in left ventricular (LV) volumes, leading to a significant increase of RV end-diastolic volume (RVEDV)/LVEDV ratio (0.91 ± 0.21 vs. 1.10 ± 0.22, p < 0.001 in males; 0.73 ± 0.17 vs. 1.02 ± 0.22, p < 0.001 in females). Although at Stage 2 RV contractility decreased, while LV ejection fraction (LVEF) remained at the same level in both sexes, men had greater tendency for LVEF reduction (p < 0.05 for the interaction sex and stage). The concentrations of biomarkers were higher after the run in both study groups, except for ET-1 and neopterin, which increased post-race only in males. The larger training-related rise in Gal-3 level correlated with the greater drop in LVEF at Stage 2 (r = -0.42; p < 0.05). Less-trained marathoners with lower VO2max values after the race showed higher levels of Gal-3 post-run (r = -0.29; p < 0.05). Marathon running induces transient cardiac remodelling, more pronounced in male than female athletes. Structural and functional changes assessed by echocardiography correspond with biochemical alterations. Galectin-3 was the best biomarker to reflect overload changes. Cardiovascular screening in amateur runners should be implemented to identify subjects requiring further evaluation.

Sex-dependent Pathophysiology and Therapeutic Considerations in Right Heart Disease.

Sex-dependent Pathophysiology and Therapeutic Considerations in Right Heart Disease.