RV Function In Patients Research Articles

224 RIGHT VENTRICULAR MECHANICS AND THE CLINICAL IMPLICATION OF 2D SPECKLE TRACKING ASSESSMENT IN SEVERE AORTIC STENOSIS

Abstract Introduction The prognostic role of RV function assessment in severe AS has been demonstrated in previous studies. However, the role of 2D speckle tracking RV evaluation in the context of severe AS has not been completely clarified. Methods We retrospectively evaluated consecutive patients with severe AS referred to TAVI at our institution. Exclusion criteria were severe aortic regurgitation, severe mitral stenosis and poor acoustic window for a correct 2D speckle tracking right chamber evaluation. The echocardiographic exams were analyzed off-line with a semi-automatic software (Tomtec Arena, Autostrain ®) to assess RVFW strain and LV GLS. Additionally, a conventional echocardiographic evaluation was made in both right and left chambers (LVEF, FAC, LVEF). Prevalence of conventional RV disfunction was defined as a TAPSE<17 mm or FAC<35%. RVFW impairment cuf-off was defined below 20%. Multivariate regression models were elaborate to assess the major determinants of RV function. Moreover, logistic regression analysis has been made to analyze if RV function could predict high-risk clinical features in the context of severe AS. Results Our cohort was composed of 110 consecutive patients. Mean RVFW was 21±7%, TAPSE 21±4 mm, FAC 44±11% and mean RV area 10±4 cmq/mq. The prevalence of RV disfunction defined by standard echocardiography was 26% (29 patients), instead, RVFW was impaired (below 20%) in 53 patients (40%). At multivariate regression analysis, the main RVFW determinants were MR, AS severity, LVMI, GLS and E/e’ (R2 0.68, p<0.001 including AVA; R2 0.53, p<0.001 including mean gradient). At logistic regression analysis RVFW strain was associated with previous HF hospitalization admission independently from TAPSE (CI 95% 1.03–1.22, p=0.008). Furthermore in a second model, RVFW strain was a significant predictor of advanced NYHA class independently from FAC (CI 95%, 1.01–1.18, p=0.0036). Conclusion The major determinants of RV function in patients with severe AS were MR and LV function. A pressure overload driven by the MR-LV dysfunction combination on right sided heart could impact profoundly negatively on RV function. RVFW strain in this study resulted a more sensitive parameter that conventional RV assessment in highlighting more symptomatic severe-AS patients.

Prognostic impact of right ventricular strain in isolated severe tricuspid regurgitation

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with severe tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is challenging. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detecting subclinical RV dysfunction. Purpose This study was aimed to evaluate the prognostic value of RV strain parameters in consecutive stable patients with severe TR. Methods Consecutive patients in stable clinical status with at least severe TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic following a comprehensive clinical protocol were included. Patients with previous episodes of heart failure or scheduled for TV intervention were excluded. RV systolic function was measured with conventional echocardiographic indices (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE], DTI S wave [`S]) and with Speckle-tracking echocardiography (STE) derived automatic peak global and free wall longitudinal strain (RV-GLS and RV-FWLS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to heart failure (HF) or all-cause mortality was defined. The interobserver variability of RV strain was assessed in 20 randomly selected patients. Results A total of 176 patients were included in this study. Strain parameters detected higher percentage of RV dysfunction compared to conventional indices (figure 1). After a median follow-up of 28 months (IQR: 15–48 months), n=65 patients (37%) reached the combined endpoint. 65 (37%) were admitted for right heart failure and 8% of the population (n=14) died. Cumulative event-free survival was significantly worse in patients with impaired RV-GLS and RV-FWLS. Conventional indices of RV systolic function were not associated with outcomes (p>0.05 for all). In a multivariable analysis (in a model including NYHA class, BNP values, biplane VC, RV end-diastolic area, and RV-FWLS), RV-FWLS was an independent predictors of heart failure and CV mortality (figure 1 and 2; LR χ2: 40.2, p<0.001). Inter-observer agreements for RV strain values were high (intraclass correlation coefficient for RV-GLS and RV-FWLS, r=0.96 and r=0.98 respectively) Conclusion Clinical outcomes demonstrate that RV strain parameters are superior to conventional indices of RV function in patients with isolated ≥ severe TR and absence of previous episodes of heart failure. Among all parameters of RV function, RV-FWLS is the strongest independent predictor of mortality and HF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto Carlos III

Significance of echocardiographic right ventricular predictors of adverse prognosis in right ventricular dysfunction in patients with HFrEF

Abstract Funding Acknowledgements Type of funding sources: None. Background Dysfunction of the RV in patients with HFrEF is a prognostically unfavorable factor, which depends on the etiology, the duration of myocardial damage and the tactics of the treatment (Pharmacotherapy, Heart Surgery, CRTD, Heart Transplantation). RV function in patients with HFrEF realized in the concept of continuous contraction of the muscle tape proposed by Torrent-Guasp, where systolic and diastolic interventricular interactions are carried out through the common IVS and implemented in the degree of dyssynchrony of ventricular contraction. 3DERV and STE (GLSRV, FWLS) may add the prognostic value of the more commonly used RV functional parameters as the sensitive echocardiographic predictors of worse prognosis in patients with HFrEF. Methods and Results A total of 79 patients with HFrEF (age, from 26 to 77 years; the clinical manifestations of HFrEF corresponded to NYHA III in 52 patients (71%), NYHA IV in 27 patients (29%); LV EF ≤ 35%). The etiology of HFrEF was mainly connected to patients with ischemic heart disease- 50 (63.2%), non-ischemic genesis 29 (36, 7%).The primary endpoint was a death in the follow-up period of up to 3 years in 33 patients (45,2%). An adverse outcomes and mortality during the first year was 17 (23,2%). All patients were divided into subgroups 1 (n = 40) - survived during the 3-year, subgroups 2 (n = 33) - died during the 3-year follow-up period. The presence of RV dysfunction in patients with HFrEF was independently associated with concomitant LV dysfunction but not with PASP (PASP/GLSLV, % (р=0,94), PASP/FWLS RV, % (р=0,97). RV contractility was realized through systolic and diastolic ventricular interactions, mediated through the shared IVS. This putative mechanism was supported by the independent association between septal S’ and S (HR - 1,12; 95%; Cl 0,99-1,26; p = 0,049), GLS BS LV, % и FWLS BS RV, % (HR - 0,90; 95%; Cl 0,79-1,00; p = 0,040). Kaplan–Meier plot, RVFWS > -15%, (χ2 – 4,438; р < 0,035), GLS >-10%, (χ2 – 3,796; р< 0,05), RVBSLS >-15%, (χ2 – 11,986; р = 0,0005), 3DERVEF <25% (χ2 – 7,518; р = 0,006), %CVCI <30% (χ2 – 7,85; р = 0,005), 3DE RAV > 100 ml (χ2 – 4,36; р = 0,036) were an independent predictors of worse prognosis in patients with HFrHF. The curves of the ROC analysis demonstrated a sensitivity of GLSRV - 80.7% as a prognostic factor of survival in patients with HrEF. At the same time, FWLS RV had a specificity (87.5%) compared to GLSRV, %, the longitudinal deformation of the isolated segments of the FWRV, FAC, %VCI collapse, ESDA/SA of RV, RAV. Conclusions RV systolic dysfunction is a strong and independent predictor of in HFrEF. In case of HFrEF the longitudinal mechanism of RV reduction is more sensitive than others. GLSRV, FWS RV, 3DRVEF, %VCI collapse has been proposed as a more accurate and sensitive tool to evaluate RV function in longitudinal displacement of patients with HFrEF. Abstract Figure. Kaplan–Meier plot GLS, 3DEEFRV, FWLS Abstract Figure. ROC analysis

Neuregulin-1 enhances cell-cycle activity, delays cardiac fibrosis, and improves cardiac performance in rat pups with right ventricular pressure load

ObjectivesRight ventricular (RV) failure is a leading cause of death in patients with congenital heart disease. RV failure is kept at bay during childhood. Limited proliferation of cardiomyocytes is present in the postnatal heart. We propose that cardiomyocyte proliferation improves RV adaptation to pressure load (PL). We studied adaptation in response to increased RV PL and the role of increased cardiomyocyte cell cycle activity (CCA) in rat pups growing into adulthood. MethodsWe induced RV PL at day of weaning in rats (3 weeks; 30-40 g) by pulmonary artery banding and followed rats into adulthood (300 g). We performed histological analyses and RNA sequencing analysis. To study the effects of increased cardiomyocyte cell cycle activity, we administered neuregulin-1 (NRG1), a growth factor involved in cardiac development. ResultsPL induced an increase in CCA, with subsequent decline of CCA (sham/PL at 4 weeks: 0.14%/0.83%; P = .04 and 8 weeks: 0.00%/0.00%; P = .484) and cardiac function (cardiac index: control/PL 4 weeks: 4.41/3.29; P = .468 and 8 weeks: 3.57/1.44; P = .024). RNA sequencing analysis revealed delayed maturation and increased CCA pathways. NRG1 stimulated CCA (PL vehicle/NRG1 at 2 weeks: 0.62%/2.28%; P = .003), improved cardiac function (cardiac index control vs vehicle/NRG1 at 2 weeks: 4.21 vs 3.07/4.17; P = .009/.705) and postponed fibrosis (control vs vehicle/NRG1 at 4 weeks: 1.66 vs 4.82%/2.97%; P = .009/.078) in RV PL rats during childhood. ConclusionsRV PL during growth induces a transient CCA increase. Further CCA stimulation improves cardiac function and delays fibrosis. This proof-of-concept study shows that stimulation of CCA can improve RV adaptation to PL in the postnatal developing heart and might provide a new approach to preserve RV function in patients with congenital heart disease.

Relationship between right ventricle remodeling index and outcomes in patients with pulmonary arterial hypertension and pre-tricuspid shunts

New multidimensional echocardiographic markers have been developed to assess right ventricle remodeling and function in patients with pulmonary arterial hypertension (PAH). Their prognostic value in patients with congenital heart diseases (CHD) remains little known. We assess the prognostic value of right ventricle end-systolic remodeling index (RVESRI), RV global longitudinal strain (GLS), RV fractional area change (FAC) in 34 patients (47.7 ± 12.6-year-old) with PAH and pre-tricuspid shunt. Associations between baseline echocardiographic values and major adverse cardiovascular events (MACE) were assessed using a univariate Cox regression analysis. Eisenmenger syndrome was observed in 15 patients (44.1%). Mean pulmonary artery pressure was 48.7 ± 12.7 mmHg. Median pulmonary vascular resistance was 9.4 wood-unit [5.1–15]. Mean RV GLS was -15.1 ± 5.0%. Mean TAPSE was 18.9 ± 5.8. Mean RV FAC was 30.0 ± 8.6%. Mean RVESRI was 1.6 ± 0.3. Mean right atrium area was 21.8 ± 6.4 mm 2 . Mean right to left atrium area ratio was 1.5 ± 0.5. Pericardial effusion was noted in 7 patients (20.6%). Mean systole to diastole duration ratio (S/D) was 1.3 ± 0.5. After a mean follow-up of 16.6 ± 8.4 months, a major adverse cardiovascular event (MACE) was reported in 8 patients (23.5%) including 1 death, 3 transplantation and 4 waitlisting. Echocardiographic data associated with outcome were RV ESRI (HR = 25.2, P = 0.02); right atrium area (HR = 1.3, P = 0.002); RV GLS (HR = 1.8, P = 0.03); right to left atrium area ratio (HR = 6.6, P = 0.02) and S/D (HR = 7.3, P = 0.004). A non-significant trend towards an association with MACE was observed for pericardial effusion (HR = 3.4, P = 0.1); RV FAC (HR = 0.9, P = 0.1); TAPSE (HR = 0.9, P = 0.1) and RV systolic area (HR = 1.1, P = 0.07). RVESRI and RV GLS carries strong relationships with outcome in addition to conventional echocardiographic parameters of RV function in patients with PAH and CHD.

Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance

BackgroundRight ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEFCMR), however this is a crude measure. New CMR measures of RV function beyond RVEFCMR have emerged, such as RV lateral atrio-ventricular plane displacement (AVPDlat), maximum emptying velocity (S’CMR), RV fractional area change (FACCMR) and feature tracking of the RV free wall (FWSCMR). However, it is not fully elucidated if these CMR measures are in parity with the equivalent echocardiography-derived measurements: tricuspid annular plane systolic excursion (TAPSE), S’-wave velocity (S’echo), RV fractional area change (FACecho) and RV free wall strain (FWSecho). The aim of this study was to compare regional RV function parameters derived from CMR to their echocardiographic equivalents in patients with pulmonary hypertension and to RVEFCMR.MethodsFifty-five patients (37 women, 62 ± 15 years) evaluated for pulmonary hypertension underwent CMR and echocardiography. AVPDlat, S’CMR, FACCMR and FWSCMR from cine 4-chamber views were compared to corresponding echocardiographic measures and to RVEFCMR delineated in cine short-axis stack.ResultsA strong correlation was demonstrated for FAC whereas the remaining measurements showed moderate correlation. The absolute bias for S’ was 2.4 ± 3.0 cm/s (relative bias 24.1 ± 28.3%), TAPSE/AVPDlat 5.5 ± 4.6 mm (33.2 ± 25.2%), FWS 4.4 ± 5.8% (20.2 ± 37.5%) and for FAC 5.1 ± 8.4% (18.5 ± 32.5%). In correlation to RVEFCMR, FACCMR and FWSecho correlated strongly, FACecho, AVPDlat, FWSCMR and TAPSE moderately, whereas S’ had only a weak correlation.ConclusionThis study has demonstrated a moderate to strong correlation of regional CMR measurements to corresponding echocardiographic measures. However, biases and to some extent wide limits of agreement, exist between the modalities. Consequently, the equivalent measures are not interchangeable at least in patients with pulmonary hypertension. The echocardiographic parameter that showed best correlation with RVEFCMR was FWSecho. At present, FACecho and FWSecho as well as RVEFCMR are the preferred methods to assess and follow up RV function in patients with pulmonary hypertension. Future investigations of the CMR right ventricular measures, beyond RVEF, are warranted.

Right Ventricular Function Assessment in patients with chronic stable angina with Type II DM Versus Non Diabetic Patients by TAPSE and TDI Echocardiography

Abstract Background In patients with documented right coronary artery (RCA) lesions, right ventricular function could be affected. In addition, the presence of diabetes mellitus is found to be a risk factor for cardiomyopathy. Objective The aim of the study is to assess the effect of type II DM on RV function in patients with chronic stable angina who have significant RCA lesion, using TAPSE and TDI by echocardiography Patients and Methods One hundred patients who underwent elective coronary angiography for suspected coronary artery disease and were found to have significant RCA lesion were divided into two groups according to presence of Type II DM. Echocardiography was done for all patients and RV function assessment by TAPSE and TDI was done. Results In our study 100 patients were included; 73 of patients were males and 27 were females with mean age of 56.70 ± 8.51 years. almost one fourth of the candidates were smokers, 23% were ex-smokers and about half of the candidates were non-smokers (51%).About half of the patients were known hypertensive (48%) while the rest were not. As regarding LVEF it ranged between 35-73% with a Mean ± SD of 54.10 ± 8.94, TAPSE ranged between 17-30 mm with a mean ± SD of 22.81 ± 3.08 and S ‘was ranged between 9-19cm/s with a mean ± SD of 13.50 ± 2.24. Comparison between both groups showed that control group (Group I) had a mean age of (57.34 ± 8.74) and 86% were males . All Diabetic patients (Group II) had a mean age of (56.06 ± 8.30) years, (60%) were males. There was no significant difference between the two groups with respect to age and gender. As regarding smoking status in Group II (20%) were smokers and for Group I (32%) . As regarding hypertension, in Group II (72%) were hypertensive and for the Group I (32%) were hypertensive which was significantly different in both groups.The presence of associated significant LAD lesions was found in 52% of Group II and only 32% in Group I, which was significantly differenct between 2 groups. (p = 0.043).As regarding Echocardiographic data, there was no significant difference in both groups regarding TAPSE (P value .629) and S’(P value .247). Conclusions The results of this study shows that TAPSE and S’ showed normal values in patients with chronic stable angina and there was no additional effect for type II D.M.

P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation

Abstract Background Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use. The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters. Methods Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22. Results The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1. Prevalence of RV dysfunction Conclusions The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

Abstract 824: Thromboxane/Prostanoid Receptor Activation Increases Calpain-Mediated Proteolysis and Alters Calcium Handling and Fibrosis Following Right Ventricular Pressure Overload

In pulmonary arterial hypertension (PAH), the right ventricle undergoes remodeling and fibrosis as it struggles to adapt to the increased pressure overload. RV dysfunction and failure is the primary cause of death in PAH patients. The G protein-coupled thromboxane/prostanoid receptor (TPr) is expressed in vascular smooth muscle, myofibroblasts, and immune cells, and is upregulated in cardiomyocytes following PAH. Activation of the cardiomyocyte TPr increases intracellular calcium via G αq /IP 3 ; activation of the receptor in other cells leads to fibrosis and vasoconstriction. The TPr is activated by isoprostane as well as thromboxane, which suggests that the receptor could contribute to deleterious remodeling during cardiac stress. Our previous studies demonstrate that TPr antagonism prevents RV fibrosis and dilatation in murine models of PAH, without affecting pressures. Because the TPr can signal through Gq, we hypothesized that its activation in PAH causes changes in cardiomyocyte calcium-handling proteins which contribute to remodeling and failure. In this study, we used pulmonary arterial banding (PAB) to induce fixed pressure overload of the RV. Mice were treated for 4 weeks past PAB with normal drinking water or water containing 25 mg/kg/day of the TPr antagonist ifetroban, and either underwent pressure-volume catheterization and whole RV evaluation, or cardiomyocytes were isolated for calcium handling and protein. PAB caused an increase in cardiomyocyte resting (end-diastolic) intracellular calcium, which was ameliorated in mice given TPr antagonist. The increased intracellular calcium following PAB was associated with increased activity of the calcium-activated protease calpain, also blocked with TPr antagonism. There was no decrease in caffeine-mediated release of calcium from the sarcoplasmic reticulum (SR) at 4 weeks past PAB, and phosphorylation of phospholamban was increased, suggesting compensation to drive calcium into the SR. Our findings suggest that TPr activation produces alterations in RV calcium handling, signaling, and calpain activity that contribute to deleterious remodeling and early failure in pressure overload. Therapeutic TPr antagonism may help preserve RV function in patients with PAH.

Assessment of right ventricular function after successful revascularization for acute anterior myocardial infarction without right ventricular infarction by echocardiography

BackgroundRight ventricular (RV) involvement in acute left ventricular (LV) myocardial infarction (MI) is frequently underestimated in the clinical setting owing to the diagnostic limitations of the electrocardiogram and echocardiography. ObjectiveTo assess RV function in patients presented with first acute anterior ST elevation myocardial infarction (STEMI) who underwent successful primary percutaneous coronary intervention (PCI) and factors affecting it. MethodsForty consecutive patients with anterior STEMI who underwent successful primary PCI were enrolled in the study. Presence of a coexisting clinical condition that might affect RV function, patients with RV infarction or those having significant stenosis (>50%) affecting RV branch or right coronary artery proximal to RV branch were excluded. Echocardiography was performed during the hospital stay to assess the LV and RV systolic and diastolic function with special focus on tricuspid annular plane systolic excursion, RV end-diastolic dimension, right atrial area, RV fractional area change, and tissue Doppler-derived myocardial performance index. Results and ConclusionRV dysfunction according to our definition in the first anterior MI occurred in (55%) of the study population. Independent predictors for abnormal RV function were left circumflex artery mid or proximal affection, eventful procedure, occurrence of no reflow, glucose level, LV end-systolic dimension, LV end-diastolic dimension, and LV ejection fraction.

Assessing Rv Function in Patients with Corpulmonale by Using Newer Echocardiographic Parameters

Assessing Rv Function in Patients with Corpulmonale by Using Newer Echocardiographic Parameters

Nimura lecture: why are you evaluating RV function in patients with pulmonary arterial hypertension?

LV is a pressure-generating pump which endures pressure overload, while RV is a flow-generating pump intolerant of pressure overload. Therefore, RV pump function (but not RV myocardial contractility) can easily fail in face of severe pulmonary arterial hypertension (PH) because of increased afterload. Available indexes of RV function are load dependent and incapable of accurately reflecting RV myocardial contractility. Animal RV in which myocardium is damaged extensively by either soldering iron or coronary occlusion can work well without causing systemic congestion or decreased SV. In clinical settings, evaluation of pre-treatment RV function in patients with PH has limited value in predicting prognosis. Furthermore, in virtually all patients with PH after successful lung transplantation, RV function has been reported to improve indicating that deteriorated RV function in patients with PH is due to an increase in RV afterload, but not to decreased RV myocardial contractility. In view of these facts, evaluation of RV function seems hardly useful in patients with PH.

Prevalence and determinants or right ventricular dysfunction in severe aortic stenosis

Systolic pulmonary artery pressure (sPAP) is a well-known predictor of outcome in patients with valvular heart disease. In spite of this fact, limited data are available regarding the assessment of RV function in patients with aortic stenosis (AS). Aim of this study is therefore to evaluate the prevalence and the determinants of RV dysfunction in severe AS patients 301 patients (mean age: 79.7 ± 8.7, male sex 55.5%) with severe AS underwent 2D echocardiography and speckle tracking echocardiography (STE) for the evaluation of left ventricular and RV function, aortic valve gradients and sPAP. A tricuspid annular plane systolic excursion (TAPSE) ≤ 17 mm was used to define reduced RV ventricular function. RV function was impaired in 24% of patients (patients with reduced TAPSE had an impaired LV ejection fraction (LVEF) (49.2 ± 15.4 vs. 57.9 ± 10.9%, P < 0.0001), significantly altered STE parameters (GLS: −10.3 ± 3.9 vs. −13.2 ± 3.5%, GCS: −7.0 ± 3.0 vs. −10.4 ± 4.9%, GRS: 18.7 ± 11.6 vs. 28.4 ± 15.6, all P < 0.001) and a higher sPAP (48.4 ± 15.8 vs. 40.9 ± 12.7 mmHg, P = 0.002) with respec to patients with a normal RV function. Correlates of a reduced TAPSE were: LVEF ( β = 0.35, P < 0.0001), LV global longitudinal, circumferential and radial strain ( β = −0.40, β = −0.40, β = 0.37 respectively, all P < 0.0001), LV indexed stroke volume ( β = 0.44, s < 0.0001), lnNT-proBNP ( β = −0.51, P < 0.0001) and sPAP ( β = −0.27, P < 0.0001). At Kaplan-Meier survival curve, a TAPSE ≤ 17 mm was associated with a reduced survival in patients with AS (Log-Rank test, P = 0.034). In patients with severe AS, RV function impairment is frequent and is associated with a poor prognosis. The correlations of TAPSE highlight the RV-LV interdependence in AS patients. Further studies will clarify the real and independent prognostic value of RV function in severe AS patients and test for the RV reverse remodelling after treatment of the AS.

Feasibility and accuracy of gated blood pool SPECT equilibrium radionuclide ventriculography for the assessment of left and right ventricular volumes and function in patients with left ventricular assist devices

BackgroundLeft ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs. MethodsTwenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later. ResultsReliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC). Conclusiont-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.

Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study

ObjectiveThe response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR. MethodsA 1.5T CMR scan was performed preoperatively and 6months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres. ResultsTAVI patients were older (80.4±6.7 vs. 72.8±7.2years, p<0.05) with a higher STS score (2.13±0.73 vs. 5.54±3.41%, p<0.001). At 6months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m2, p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108–1.666, p=0.003). ConclusionsSAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.

Effects of long-term iloprost treatment on right ventricular function in patients with Eisenmenger syndrome

BackgroundRight ventricular (RV) function is an important prognostic factor of pulmonary arterial hypertension (PAH), but there is insufficient data regarding RV function after long-term inhaled iloprost treatment. We evaluated the effect of long-term iloprost treatment on RV function in patients with Eisenmenger syndrome (ES). MethodsEleven consecutive patients with ES associated with congenital heart disease underwent echocardiographic measurements at baseline and 48 weeks after iloprost therapy. In addition, we recorded World Health Organization (WHO) functional class, 6-minute walk distance (6MWD), systemic arterial oxygen saturation (SaO2), and laboratory values such as hemoglobin, serum creatinine, and N-terminal pro-B natriuretic peptide. ResultsAfter 48 weeks of iloprost therapy, mean pulmonary arterial pressure (mPAP), pulmonary arterial systolic pressure (PASP), and pulmonary vascular resistance (PVR) were significantly decreased [mPAP, 42.5 (38.5–61.0) to 36.5 (29.1–40.0)mmHg; PASP, 92.6±19.9 to 74.5±23.8mmHg; PVR, 23.4 (19.8–26.0) to 23.4 (19.8–26.0)Wood unit respectively, all p<0.05]. There was also significant improvement in RV myocardial performance index [0.68 (0.61–0.80) to 0.52 (0.51–0.62), p=0.003] and RV longitudinal strain (−15.7±1.6 to −18.1±1.5%, p<0.001). In clinical assessment, WHO functional class (p=0.006), 6MWD (310.6±44.7 to 399.7±80.8m, p<0.001), and SaO2 (90.9±6.0% to 92.5±6.0%, p=0.022) were significantly improved. ConclusionThe improvement in echocardiographic parameters of the RV function after 48 weeks of iloprost therapy may provide insight on the efficacy of long-term iloprost treatment for RV functional improvement, which is a prognostic factor in patients with ES.

SPECT equilibrium radionuclide ventriculography for the assessment of ventricular volumes and function in patients with left ventricular assist devices

Objectives Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Transthoracic echocardiography (TTE) is limited by acoustic window and cardiac multidetector computed tomography (MDCT) is considered as the best tool to monitor patients with LVADs. We evaluated the feasibility and the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the assessment of LV and RV volumes and function in patients with LVADs. Materials and methods Twenty-four patients with LVAD (23 HeartMate II and 1 HeartWare) underwent ERV. Because of limited acoustic window, TTE was only feasible in 19 patients. Functional evaluation including six-minutes walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac MDCT. Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later for inter-scan reliability assessment. Results Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume and RV ejection fraction (RVEF) was 0.900 (P = 0.001), 0.911 (P = 0.001), 0.765 (P = 0.021), 0.728 (P = 0.042), 0.875 (P = 0.004) and 0.781 (P = 0.023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = 0.027). A cut-off value of 40% for RVEF measured by ERV could discriminate patients with poor functional status (P = 0.048 for NYHA stage; P = 0.016 for 6MWT and P = 0.007 for POC). Intra-, inter-rater and inter-scan reliabilities were over 0.9 for the assessment of LV and RV volumes and function by t-ERV. Conclusions t-ERV is a simple, reproducible and accurate technique for the assessment of RV function in patients with LVADs. Because of its good correlation with functional parameters and good inter-scan reliability, t-ERV warrants consideration in the evaluation and monitoring of symptomatic patients with LVADs.

0081: Prevalence and determinants or right ventricular dysfunction in severe aortic stenosis

systolic pulmonary artery pressure (sPAP) is a well known predictor of outcome in patients with valvular heart disease. In spite of this fact, limited data are available regarding the assessment of RV function in patients with aortic stenosis (AS). of this study is therefore to evaluate the prevalence and the determinants of RV dysfunction in severe AS patients 201 patients (mean age:79.7±8.7, male sex 55.5%) with severe AS underwent 2D echocardiography and speckle tracking echocardiography (STE) for the evaluation of left ventricular and RV function, aortic valve gradients and sPAP. A tricuspid annular plane systolic excursion (TAPSE) ≤17mm was used to define reduced RV ventricular function. RV function was impaired in 48 patients (24%). Patients with reduced TAPSE had an impaired LV ejection fraction (LVEF) (49.2±15.4 vs 57.9±10.9%, p<0.0001), significantly altered STE parameters (GLS: –10.3 ±3.9 vs –13.2±3.5%, GCS: –7.0±3. vs –10.4±4.9%, GRS: 18.7±11.6 vs 28.4±15.6, all p<0.001) and a higher sPAP (48.4±15.8 vs 40.9±12.7 mmHg, p=0.002) with respecto to patients with a normal RV function. Correlates of a reduced TAPSE were: LVEF (β=0.35, p<0.0001), LV global longitudinal, circumferential and radial strain (β=–0.40, β=–0.40, β=0.37 respectively, all p<0.0001), LV indexed stroke volume (β=0.44, s<0.0001), lnNT-proBNP (β=–0.51, p<0.0001) and sPAP (β=–0.27, p<0.0001). At Kaplan-Meier survival curve, a TAPSE ≤17mm was associated with a reduced survival in patients with AS (Log Rank test, p=0.034). In patients with severe AS, RV function impairment is frequent and is associated with a poor prognosis. The correlations of TAPSE highlight the RV-LV interdependence in AS patients. Further studies will clarify the real and independent prognostic value of RV function in severe AS patients and test for the RV reverse remodelling after treatment of the AS.

Abstract 15125: Percutaneous Transluminal Pulmonary Angioplasty Improves Hemodynamics and Right Ventricular Function in Patients with Chronic Thromboembolic Pulmonary Hypertension -One Year Follow-up Study

Objectives: Right ventricular function (RV) is an important prognostic indicator of pulmonary hypertension. Recent studies have demonstrated that percutaneous transluminal pulmonary angioplasty (PTPA) improves pulmonary hemodynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we examined whether PTPA also improves right ventricular dysfunction in those patients. Methods: We performed a total of 252 PTPA procedures (median 4 procedures per patient) for 56 consecutive patients with inoperable CTEPH, after stabilizing their condition using conventional pulmonary vasodilators. Among them, we enrolled 33 patients who had finished 1-year follow-up after final PTPA in the present study (female 81.8%, median age 60 yrs.). RV function was evaluated by tricuspid annular plane systolic excursion (TAPSE) on echocardiogram (42.4%, n=14) and RV ejection fraction (RVEF) on cardiac magnetic resonance imaging (39.4%, n=13) before and after PTPA. Results: No patient died during the PTPA procedure or during the 1-year follow-up period. Comparisons before and after PTPA showed marked improvement of WHO functional class III/IV (75.7 to 0%, P&lt;0.001), 6-min walking distance (316 to 480 m, P&lt;0.001), and brain natriuretic peptide level (93 to 23 pg/ml, P&lt;0.001) and significant hemodynamic improvements for mean pulmonary artery pressure (42.3±10.7 to 24.4±5.7mmHg, P&lt;0.001), cardiac index (2.2±0.6 to 2.7±0.6 L/min•m2, P&lt;0.001) and pulmonary vascular resistance (786±384 to 265±93 dyn•sec•cm5, P&lt;0.001). Furthermore, RV function was also significantly improved for both TAPSE (18.0±4.0 to 23.4±4.3mm, P&lt;0.001) and RVEF (37.9±11.0 to 52.4±7.1%, P&lt;0.001) (Figure). Conclusions: PTPA improves not only pulmonary hemodynamics but also RV function in patients with inoperable CTEPH.

Assessment of RV function in patients with CTEPH, both pre and post pulmonary thromboendarterectomy, at tertiary care centre

Assessment of RV function in patients with CTEPH, both pre and post pulmonary thromboendarterectomy, at tertiary care centre