Right Ventricular Pulmonary Artery Research Articles

Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging

PurposePulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models.MethodsPatients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size.ResultsOf 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030).ConclusionCMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis.Key Points• Pulmonary hypertension is a marker of poor outcome in COPD.• MRI can predict invasively measured mean pulmonary artery pressure.• Cardiac MRI allows for estimation of survival in COPD.• Cardiac MRI may be useful for follow up or future trials.• MRI is potentially useful to assess pulmonary hypertension in patients with COPD.

Pulmonary vascular indices and survival in left heart disease: illusion of conclusion?

Pulmonary vascular indices and survival in left heart disease: illusion of conclusion?

The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution.

BackgroundThe Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution.MethodsBetween June 1995 and January 2016, 16 consecutive patients (mean age, 6.0±5.9 years; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months).ResultsThere were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively.ConclusionPulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center.

The relationship between right ventricular deformation and heart rate variability in asymptomatic diabetic patients

ObjectiveTo investigate heart rate variability (HRV) and right ventricular (RV) remodeling in asymptomatic diabetic patients, as well as the relationship between HRV indices and RV structure, function and deformation. MethodThis cross-sectional study included 59 asymptomatic patients with type 2 diabetes and 45 healthy controls without cardiovascular risk factors. All study subjects underwent 24-h Holter monitoring, laboratory analyses and complete two-dimensional echocardiography examination (2DE). ResultsRV diastolic function and longitudinal deformation were significantly impaired in diabetic individuals comparing with controls. RV global longitudinal strain and layer-specific longitudinal strains were significantly decreased in diabetic group. The same trend of changes in RV deformation was observed for global RV and lateral wall. All parameters of time and frequency domain of HRV were reduced in diabetic subjects. RV endocardial longitudinal strain together with LV mass index, mitral E/e’ ratio and HbA1c correlated with HRV parameters. However, multivariate linear regression analysis showed that only RV endocardial longitudinal strain and LV mass index are associated with HRV parameters independently of age, BMI, HbA1c, RV free wall thickness and pulmonary artery pressure. ConclusionsRV subendocardial strain is independently associated with HRV parameters in the whole study population. This reveals potentially important role of determination of layer-specific RV longitudinal function as important marker of preclinical cardiac damage, but also indirectly show the impairment of cardiac autonomic function in diabetic patients.

Dobutamine stress MRI in pulmonary hypertension: relationships between stress pulmonary artery relative area change, RV performance, and 10-year survival.

In pulmonary hypertension (PH), right ventricular (RV) performance determines survival. Pulmonary artery (PA) stiffening is an important biomechanical event in PH and also predicts survival based on the PA relative area change (RAC) measured at rest using magnetic resonance imaging (MRI). In this exploratory study, we sought to generate novel hypotheses regarding the influence of stress RAC on PH prognosis and the interaction between PA stiffening, RV performance and survival. Fifteen PH patients underwent dobutamine stress-MRI (ds-MRI) and right heart catheterization. RACREST, RACSTRESS, and ΔRAC (RAC STRESS – RAC REST) were correlated against resting invasive hemodynamics and ds-MRI data regarding RV performance and RV-PA coupling efficiency (n’vv [RV stroke volume/RV end-systolic volume]). The impact of RAC, RV data, and n’vv on ten-year survival were determined using Kaplan–Meier analysis. PH patients with a low ΔRAC (<−2.6%) had a worse long-term survival (log-rank P = 0.045, HR for death = 4.46 [95% CI = 1.08–24.5]) than those with ΔRAC ≥ −2.6%. Given the small sample, these data should be interpreted with caution; however, low ΔRAC was associated with an increase in stress diastolic PA area indicating proximal PA stiffening. Associations of borderline significance were observed between low RACSTRESS and low n’vvSTRESS, Δη’VV, and ΔRVEF. Further studies are required to validate the potential prognostic impact of ΔRAC and the biomechanics potentially connecting low ΔRAC to shorter survival. Such studies may facilitate development of novel PH therapies targeted to the proximal PA.

Pulmonary pulse wave transit time is associated with right ventricular-pulmonary artery coupling in pulmonary arterial hypertension.

Pulmonary pulse wave transit time (pPTT), defined as the time for the systolic pressure pulse wave to travel from the pulmonary valve to the pulmonary veins, has been reported to be reduced in pulmonary arterial hypertension (PAH); however, the underlying mechanism of reduced pPTT is unknown. Here, we investigate the hypothesis that abbreviated pPTT in PAH results from impaired right ventricular-pulmonary artery (RV-PA) coupling. We quantified pPTT using pulsed-wave Doppler ultrasound from 10 healthy age- and sex-matched controls and 36 patients with PAH. pPTT was reduced in patients with PAH compared with controls. Univariate analysis revealed the following significant predictors of reduced pPTT: age, right ventricular fractional area change (RV FAC), tricuspid annular plane excursion (TAPSE), pulmonary arterial pressures (PAP), diastolic pulmonary gradient, transpulmonary gradient, pulmonary vascular resistance, and RV-PA coupling (defined as RV FAC/mean PAP or TAPSE/mean PAP). Although the correlations between pPTT and invasive markers of pulmonary vascular disease were modest, RV FAC (r = 0.64, P < 0.0001), TAPSE (r = 0.67, P < 0.0001), and RV-PA coupling (RV FAC/mean PAP: r = 0.72, P < 0.0001; TAPSE/mean PAP: r = 0.74, P < 0.0001) had the strongest relationships with pPTT. On multivariable analysis, only RV FAC, TAPSE, and RV-PA coupling were independent predictors of pPTT. We conclude that shortening of pPTT in patients with PAH results from altered RV-PA coupling, probably occurring as a result of reduced pulmonary arterial compliance. Thus, pPTT allows noninvasive determination of the status of both the pulmonary vasculature and the response of the RV in patients with PAH, thereby allowing monitoring of disease progression and regression.

Long-term Outcomes after Truncus Arteriosus Repair: A Single-center Experience for More than 40 Years.

This study aimed to analyze long-term survival and functional outcomes after truncus arteriosus repair in a single institution with more than 40 years of follow-up. Medical records were analyzed retrospectively in 52 patients who underwent the Rastelli procedure for truncus arteriosus repair between 1974 and 2002. Thirty-five patients survived the initial repair. The median age at the initial operation was 2.8 months (range, 0.1-123 months) and the body weight was 3.9 kg (range, 1.6 to 15.0 kg). The median age at follow-up was 23.6 years (range, 12.4 to 44.5 years). The median follow-up duration was 23.4 years (range, 12.3 to 40.7 years). The actuarial survival rate was 97% at 10 years and 93% at both 20 years and 40 years after the initial operation. At follow-up, most patients were in New York Heart Association (NYHA) functional classes I (73%) and II (24%). Thirty-six percent of patients had full-time jobs, 40% were students, and 21% were unemployed. Most patients (97%) had undergone conduit reoperations. Freedom from reoperation for right ventricular (RV) outflow and pulmonary artery (PA) stenosis was 59% at 5 years, 28% at 10 years, and 3% at 20 years after the initial operation. Freedom from catheter interventions for RV outflow and PA stenosis was 59% at 5 years, 47% at 10 years, and 38% at 20 years after the initial operation. Freedom from truncal valve replacement was 88% at 5 years, 85% at 10 years, and 70% at 20 years after the initial operation. In this single-center retrospective study, with long-term follow-up after repair of truncus arteriosus, long-term survival and functional outcomes were acceptable, despite the requirement for reoperation and multiple catheter interventions for RV outflow and PA stenosis in almost all patients, and the frequent requirement for late truncal valve operations.

Pulmonary Artery Branch Stent Implantation in Congenital Heart Disease: A 10-Year Multicenter Experience

Background: Stent implant is considered the treatment of choice for most cases of congenital or postoperative pulmonary artery branch stenosis in patients with congenital heart defects. However, there are still doubts on the clinical effectiveness and the incidence of complications of this technique that need to be elucidated.Methods: This multicenter study has a descriptive, observational and retrospective design. The procedures were performed between January 2005 and April 2015. Twenty-five patients with pulmonary artery branch stenosis underwent stent implant and were followed-up both clinically and by different imaging tests. Persistent clinical and/or anatomic improvement defined clinical effectiveness.Results: Average age was 9.48 years (2 months-34 years), mean weight was 27.54 kg (3-104 kg) and 44% were women. The most frequent congenital heart defects in the treated cohort were tetralogy of Fallot and its variants, followed by single ventricle heart physiology after bidirectional Glenn shunt and/or Fontan-Kreutzer procedures. Right ventricular systolic and pulmonary artery pressure decreased significantly after the intervention (from 68.35 mmHg to 45.8 mmHg and from 47.4 mm Hg to 32 mm Hg, respectively) (p < 0.0001). The initial minimum diameter of the treated pulmonary artery branch increased significantly after the procedure (from 3.98 mm to 9.82 mm, p < 0.0001). The incidence of complications was 8% (n = 2) and the clinical effectiveness of the procedure was good in 22 patients (88%).Conclusions: Stent implant in pulmonary artery branch stenosis is a safe and feasible though challenging technique, with significant clinical and anatomic improvement. The procedure represents an alternative to surgery and decreases the need for reinterventions in patients with congenital heart defects.

Diagnostic implications of computed tomography pulmonary angiography in patients with pulmonary embolism.

INTRODUCTION:Pulmonary embolism (PE) is a serious cardiovascular and pulmonary complication worldwide. We aimed to assess the implications of different computed tomography pulmonary angiography (CTPA) parameters in patients with acute PE.METHODS:A retrospective observational study to include patients presented with clinical suspicious of PE who underwent CTPA was conducted. Patients' demographics, clinical presentation, risk factors, laboratory investigations, management, and outcome were analyzed. Computed tomography findings included clot burden (Qanadli score [QS]) and right ventricular dysfunction (RVD) parameters.RESULTS:A total of 45 patients with radiologically confirmed diagnosis of PE were included in the study; of these patients, 8 (17.8%) died during the hospital course. Patients who died were 13 years older than those who survived, and the mortality rate was significantly higher in patients with cancer. The two groups were comparable for cardiovascular parameters. The mean clot burden (QS) was 19.5 ± 11.3 points and 53% of patients had QS >18 points. Obesity (52.4% vs. 12.5%; P = 0.01), hypertension (54.4% vs. 23.8%; P = 0.03), and median D-dimer levels (7.8 vs. 3.4; P = 0.03) were significantly higher in patients with QS >18. Among right ventricular (RV) dysfunction parameters, only higher RV/left ventricular (LV) ratio (P = 0.001) and bowing of interventricular septum (P = 0.001) were associated with higher QS. A significant positive correlation was found between RV short axis (r = 0.499, P = 0.001), RV/LV ratio (r = 0.592, P = 0.001), and pulmonary artery (PA) diameter (r = 0.301, P = 0.04) with the PA clot burden. Receiver operating characteristic curve for clot burden showed a cutoff value of 17.5 points to accurately predict RV dysfunction.CONCLUSIONS:Clot burden >18 is associated with RV dysfunction in patients with acute PE. Echocardiography and RVD parameters showed no correlation with in-hospital deaths. CTPA has clinicoradiological implications for risk stratification in PE patients. As the sample size is small, our findings warrant further larger prospective studies.

Altered Right Ventricular Kinetic Energy Work Density and Viscous Energy Dissipation in Patients with Pulmonary Arterial Hypertension: A Pilot Study Using 4D Flow MRI.

IntroductionRight ventricular (RV) function has increasingly being recognized as an important predictor for morbidity and mortality in patients with pulmonary arterial hypertension (PAH). The increased RV after-load increase RV work in PAH. We used time-resolved 3D phase contrast MRI (4D flow MRI) to derive RV kinetic energy (KE) work density and energy loss in the pulmonary artery (PA) to better characterize RV work in PAH patients.Methods4D flow and standard cardiac cine images were obtained in ten functional class I/II patients with PAH and nine healthy subjects. For each individual, we calculated the RV KE work density and the amount of viscous dissipation in the PA.ResultsPAH patients had alterations in flow patterns in both the RV and the PA compared to healthy subjects. PAH subjects had significantly higher RV KE work density than healthy subjects (94.7±33.7 mJ/mL vs. 61.7±14.8 mJ/mL, p = 0.007) as well as a much greater percent PA energy loss (21.1±6.4% vs. 2.2±1.3%, p = 0.0001) throughout the cardiac cycle. RV KE work density and percent PA energy loss had mild and moderate correlations with RV ejection fraction.ConclusionThis study has quantified two kinetic energy metrics to assess RV function using 4D flow. RV KE work density and PA viscous energy loss not only distinguished healthy subjects from patients, but also provided distinction amongst PAH patients. These metrics hold promise as imaging markers for RV function.

Novel assessment of haemodynamic kinetics with acute exercise in a rat model of pulmonary arterial hypertension

What is the central question of this study? The acute effect of exercise at moderately high intensity on already-elevated pulmonary arterial pressures and right ventricular wall stress in a rat model of pulmonary arterial hypertension (PAH) is unknown. What is the main finding and its importance? We show, for the first time, that in a rat model of PAH, exercise induces an acute reduction in pulmonary artery pressure associated with lung endothelial nitric oxide synthase activation, without evidence of acute right ventricular inflammation or myocyte apoptosis. Haemodynamic measures obtained with traditional invasive methodology as well as novel implantable telemetry reveal an exercise-induced 'window' of pulmonary hypertension alleviation, supporting future investigations of individualized exercise as therapy in PAH. Exercise improves outcomes of multiple chronic conditions, but controversial results, including increased pulmonary artery (PA) pressure, have prevented its routine implementation in pulmonary arterial hypertension (PAH), an incurable disease that drastically reduces exercise tolerance. Individualized, optimized exercise prescription for PAH requires a better understanding of disease-specific exercise responses. We investigated the acute impact of exercise on already-elevated PA pressure and right ventricular (RV) wall stress and inflammation in a rat model of PAH (PAH group, n = 12) induced once by monocrotaline (50 mg kg(-1) , i.p.; 2 weeks), compared with healthy control animals (n = 8). Single bouts of exercise consisted of a 45 min treadmill run at 75% of individually determined aerobic capacity (V̇O2max). Immediately after exercise, measurements of RV systolic pressure and systemic pressure were made via jugular and carotid cannulation, and were followed by tissue collection. Monocrotaline induced moderate PAH, evidenced by RV hypertrophy, decreased V̇O2max, PA muscularization, and RV and skeletal muscle cytoplasmic glycolysis detected by increased expression of glucose transporter-1. Acute exercise normalized the monocrotaline-induced elevation in RV systolic pressure and augmented pulmonary endothelial nitric oxide synthase activation, without evidence of increased RV inflammation or apoptosis. Real-time recordings of pulmonary and systemic pressures during and after single bouts of exercise made using novel implantable telemetry in the same animal for up to 11 weeks after monocrotaline (40 mg kg(-1) ) corroborated the finding of acute PA pressure decreases with exercise in PAH. The PA pressure-lowering effects of individualized exercise associated with RV-neutral effects and increases in vasorelaxor signalling encourage further development of optimized exercise regimens as adjunctive PAH therapy.

Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

The aim of the present study was to evaluate of the right and left heart mechanics by two-dimensional (2D) speckle tracking echocardiography (STE) in chronic thromboembolic pulmonary hypertension (CTEPH) patients before and after pulmonary thromboendarterectomy (PTE). A total of 40 consecutive CTEPH patients (mean age 49.3 ± 13.5 years, 27 female) were included. 2D STE was performed in all patients before, and 3 months, after PTE. 12 months of prognostic data were also recorded via the use of telephone calls. Postoperative 6-minute walk test (6MWT) distances were significantly longer than preoperative values (410.5 ± 61.5 vs. 216.6 ± 131.4 m, p < 0.001). Postoperative left ventricular (LV) and right ventricular (RV) systolic functions (LV EF, TAPSE, RVS) were similar compared to preoperative values. While postoperative RV, right atrial (RA) and systolic pulmonary artery pressure measurements were significantly lower, LV and left atrial (LA) measurements were higher than preoperative values. Postoperative LV and RV global longitudinal strain (GLS) measurements were significantly higher than preoperative values. Postoperative LV global radial and circumferential strain measurements were similar to preoperative values. While postoperative RA reservoir and conduit functions were significantly higher, postoperative LA reservoir and conduit functions were similar to preoperative values. Correlation analysis revealed that baseline 6MWT distances were correlated with LV GLS, RV GLS, and RA reservoir and conduit functions in the preoperative and postoperative periods. 2D STE indices may help the clinician in assessing the effect of PTE on cardiac functions and may also be used for follow-up data in CTEPH patients.

Enhanced Pulmonary Vasodilator Reserve and Abnormal Right Ventricular

Background— Pulmonary hypertension and right ventricular (RV) dysfunction are common in patients with advanced heart failure with preserved ejection fraction (HFpEF), yet their underlying mechanisms remain poorly understood. We sought to examine RV–pulmonary artery (PA) functional reserve responses and RV–PA coupling at rest and during β-adrenergic stimulation in subjects with earlier stage HFpEF. Methods and Results— In a prospective trial, subjects with HFpEF (n=39) and controls (n=18) underwent comprehensive invasive and noninvasive hemodynamic assessment using high fidelity micromanometer catheters, echocardiography, and expired gas analysis at rest and during dobutamine infusion. HFpEF subjects displayed similar RV structure but significantly impaired RV systolic (lower RV d P /d t max /IP and s′) and diastolic function (higher RV τ) coupled with more severe pulmonary vascular disease, manifest by higher PA pressures, higher PA resistance, and lower PA compliance compared with controls. Dobutamine infusion caused greater pulmonary vasodilation in HFpEF compared with controls, with enhanced reductions in PA resistance, greater increase in PA compliance, and a more negative slope in the PA pressure–flow relationship when compared with controls (all P &lt;0.001). RV–PA coupling analysis revealed that dobutamine improved RV ejection in HFpEF subjects through afterload reduction alone, rather than through enhanced contractility, indicating RV systolic reserve dysfunction. Conclusions— Pulmonary hypertension in early stage HFpEF is related to partially reversible pulmonary vasoconstriction coupled with RV systolic and diastolic dysfunction, even in the absence of RV structural remodeling. Pulmonary vascular tone is more favorably responsive to β-adrenergic stimulation in HFpEF than controls, suggesting a potential role for β-agonists in the treatment of patients with HFpEF and pulmonary hypertension. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01418248.

Pulmonary artery enlargement is associated with right ventricular dysfunction and loss of blood volume in small pulmonary vessels in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease causes significant morbidity and concomitant pulmonary vascular disease and cardiac dysfunction are associated with poor prognosis. Computed tomography-detected relative pulmonary artery (PA) enlargement defined as a PA to ascending aorta diameter ratio >1 (PA:A>1) is a marker for pulmonary hypertension and predicts chronic obstructive pulmonary disease exacerbations. However, little is known about the relationship between the PA:A ratio, pulmonary blood volume, and cardiac function. A single-center prospective cohort study of patients with chronic obstructive pulmonary disease was conducted. Clinical characteristics and computed tomography metrics, including the PA:A and pulmonary blood vessel volume, were measured. Ventricular functions, volumes, and dimensions were measured by cine cardiac MRI with 3-dimensional analysis. Linear regression examined the relationships between clinical characteristics, computed tomography and cardiac MRI metrics, and 6-minute walk distance. Twenty-four patients were evaluated and those with PA:A>1 had higher right ventricular (RV) end-diastolic and end-systolic volume indices accompanied by lower RV ejection fraction (52±7% versus 60±9%; P=0.04). The PA:A correlated inversely with total intraparenchymal pulmonary blood vessel volume and the volume of distal vessels with a cross-sectional area of <5 mm(2). Lower forced expiratory volume, PA:A>1, and hyperinflation correlated with reduced RV ejection fraction. Both PA diameter and reduced RV ejection fraction were independently associated with reduced 6-minute walk distance. The loss of blood volume in distal pulmonary vessels is associated with PA enlargement on computed tomography. Cardiac MRI detects early RV dysfunction and remodeling in nonsevere chronic obstructive pulmonary disease patients with a PA:A>1. Both RV dysfunction and PA enlargement are independently associated with reduced walk distance. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00608764.

Estradiol improves right ventricular function in rats with severe angioproliferative pulmonary hypertension: effects of endogenous and exogenous sex hormones.

Estrogens are disease modifiers in PAH. Even though female patients exhibit better right ventricular (RV) function than men, estrogen effects on RV function (a major determinant of survival in PAH) are incompletely characterized. We sought to determine whether sex differences exist in RV function in the SuHx model of PAH, whether hormone depletion in females worsens RV function, and whether E2 repletion improves RV adaptation. Furthermore, we studied the contribution of ERs in mediating E2's RV effects. SuHx-induced pulmonary hypertension (SuHx-PH) was induced in male and female Sprague-Dawley rats as well as OVX females with or without concomitant E2 repletion (75 μg·kg(-1)·day(-1)). Female SuHx rats exhibited superior CI than SuHx males. OVX worsened SuHx-induced decreases in CI and SuHx-induced increases in RVH and inflammation (MCP-1 and IL-6). E2 repletion in OVX rats attenuated SuHx-induced increases in RV systolic pressure (RVSP), RVH, and pulmonary artery remodeling and improved CI and exercise capacity (V̇o2max). Furthermore, E2 repletion ameliorated SuHx-induced alterations in RV glutathione activation, proapoptotic signaling, cytoplasmic glycolysis, and proinflammatory cytokine expression. Expression of ERα in RV was decreased in SuHx-OVX but was restored upon E2 repletion. RV ERα expression was inversely correlated with RVSP and RVH and positively correlated with CO and apelin RNA levels. RV-protective E2 effects observed in females were recapitulated in male SuHx rats treated with E2 or with pharmacological ERα or ERβ agonists. Our data suggest significant RV-protective ER-mediated effects of E2 in a model of severe PH.

Сопоставление векторкардиографических параметров со структурно-функциональным состоянием правого желудочка у пациентов с легочной гипертензией

Changes of the vectrocardiographic ventricular gradient (VG) in patients with pulmonary arterial hypertension (PAH) are indicative of right ventricular (RV) overload and may be used to assess its severity. The study aim was to evaluate interrelations between vectrocardiographic VG, spatial QRS-T angle and echocardiographic parameters of structural-functional state of the RV.The following parameters were assessed in 30 PAH patients: RV dimensions; tricuspid annular plane systolic excursion (TAPSE); RV fractional area change (FAC); RV peak systolic annular velocity (TDI-S’), and longitudinal strain (LS). VG and spatial QRS-T angle were calculated using the orthogonal leads derived from standard echocardiography.Spatial component VG-Y had moderate negative correlation with LS (r=-0.62; p <0.005); VG magnitude, VG-X and VG-Y had positive correlations with FAC (r from 0.50 to 0.65; p <0.005); VG magnitude and VG-Y had positive correlations with TDI-S’ (0.58 and 0.53; p <0.005); spatial QRS-T angle had negative correlation with TAPSE (r=-0.59; p <0.005), FAC (r=-0.66; p <0.005) and TDI-S’ (r=-0.67); p <0.005.In patients with severe PAH, VG and spatial QRS-T angle correlate not only with RV dimensions and pulmonary artery pressure, but with parameters of RV systolic function.

Right ventricular outflow tract systolic excursion: a useful method for determining right ventricular systolic function.

Assessment of right ventricular (RV) systolic function is not an easy task. Although RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) are useful in the assessment of RV function, their use can be sometimes limited. Right ventricular outflow tract systolic excursion (RVOT_SE) is a new way to evaluate RV systolic function. The aim of this study was to assess the correlation between RVOT_SE and other RV systolic function assessment methods. RVOT_SE was defined as the systolic excursion of the RV outflow tract anterior wall endocardium. A total of 104 patients with a wide range of RV systolic function, ejection fraction, and pulmonary artery systolic pressure were studied. We also measured another four ways to evaluate RV systolic function, FAC, TAPSE, right ventricular outflow tract fractional shortening (RVOT_FS), and tricuspid annular systolic excursion velocity S' (Tissue S'). There was a strong correlation between RVOT_SE and each one of the four studied ways to evaluate RV systolic function. Multivariate regression analysis showed that the independent variables correlated with RVOT_SE were RVOT_FS (p<0.0001), FAC (p=0.005) and TAPSE (p=0.023). RVOT_SE diagnosed patients with reduced RV systolic function with 98% sensitivity and 96% specificity. There was no correlation between RVOT_SE and ejection fraction, or between RVOT_SE and pulmonary artery systolic pressure in patients with reduced RV systolic function. Intra-observer and inter-observer reproducibility were favorable for RVOT_SE and all four studied ways. RVOT_SE is a simple, accurate, and promising method for evaluating RV systolic function.

Prognostic Value of RV Function Before and After Lung Transplantation

ObjectivesWe investigated the effects of lung transplantation on right ventricular (RV) function as well as the prognostic value of pre- and post-transplantation RV function. BackgroundAlthough lung transplantation success has improved over recent decades, outcomes remain a challenge. Identifying predictors of mortality in lung transplant recipients may lead to improved long-term outcomes after lung transplantation. MethodsEighty-nine (age 60 ± 6 years, 58 men) consecutive patients who underwent single or double lung transplantation and had pre- and post-transplantation echocardiograms between July 2001 and August 2012 were evaluated. Echocardiographic measurements were performed before and after lung transplantation. Left ventricular (LV) and RV longitudinal strains were analyzed using velocity vector imaging. Cox proportional prognostic hazard models predicting all-cause death were built. ResultsThere were 46 all-cause (52%) and 17 cardiac (19%) deaths during 43 ± 33 months of follow-up. After lung transplantation, echocardiography showed improved systolic pulmonary artery pressure (SPAP) (50 ± 19 mm Hg to 40 ± 13 mm Hg) and RV strain (−17 ± 5% to −18 ± 4%). No pre-transplantation RV parameter predicted all-cause mortality. After adjustment for age, sex, surgery type, and etiology of lung disease in a Cox proportional hazards model, both post-transplantation RV strain (hazard ratio: 1.13, 95% confidence interval: 1.04 to 1.23, p = 0.005), and post-transplantation SPAP (hazard ratio: 1.03, 95% confidence interval: 1.01 to 1.05, p = 0.011) were independent predictors of all-cause mortality. When post-transplantation RV strain and post-transplantation SPAP were added the clinical predictive model based on age, sex, surgery type, and etiology, the C-statistic improves from 0.60 to 0.80 (p = 0.002). ConclusionsAlterations of RV function and pulmonary artery pressure normalize, and post-transplantation RV function may provide prognostic data in patients after lung transplantation. Our study is based on a highly and retrospectively selected group. We believe that larger prospective studies are warranted to confirm this result.

Poor Right Ventricular Systolic Function (Lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and All Cause Mortality in Elderly Patients with Heart Failure

Heart failure(HF) related early readmission (<30days) and mortality remains high in elderly patients. Right ventricular (RV) dysfunction is associated with worse prognosis in patients with HF with reduced ejection fraction (HFrEF). We evaluated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolic excursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission and mortality in elderly HF patients.

Abstract 307: Poor Right Ventricular Systolic Function (lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and all Cause Mortality in Elderly Patients with Heart Failure

Background: Heart failure(HF) related early readmission (&lt;30days) and mortality is higher in elderly patients. Right ventricular (RV) dysfunction is associated with worse prognosis in patients with HF with reduced ejection fraction (HFrEF). We evaluated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolic excursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission and mortality in elderly HF patients. Methods: This is single center observational study of elderly (≥65 years )patients with HFrEF. Patients with principal discharge diagnosis of HFrEF are included (n = 278, age 77 ± 9 years, 38% female, LVEF 29% ± 9%). Demographic and echocardiographic data are collected. TAPSE (as a marker of RV systolic dysfunction) and PASP are measured as per ASE guidelines. Prediction models are performed. Results: Among 278 patients, 62 patients ( 22.3%) had HF related early readmission and 123 patients (44%) died at the end of 5 year. On univariate analysis, older age, Hypertension, Diabetes, higher PASP , RV systolic dysfunction (TAPSE &lt;16mm) and BMI&lt; 25 are predictors of early readmission and mortality (P value &lt;0.05). On multivariate logistic regression analysis, early HF readmission was predicted by TAPSE &lt;16 mm (OR=23.6; p &lt; 0.001; CI 10.23-54.60) and PASP &gt;50 mmHg ( OR = 34; p &lt; 0.001; 95 CI 14.08-82.81); five year all cause mortality was predicted by TAPSE &lt; 16mm (OR = 1.85; p 0.023; 95 CI 1.08-3.16) and PASP &gt;50 mmHg (OR = 2.11; p 0.009; 95 CI 1.19-3.72). Conclusion: TAPSE &lt;16 mm and PASP &gt;50 mmHg are strong predictors of early readmission and five year all cause mortality in elderly HF patients. The assessment of RV function through TAPSE and PASP, helps to risk-stratify elderly patients with HFrEF.