Right Ventricular Myocardial Performance Index Research Articles

Prognostic value of combined myocardial performance index in patients with acute ST-elevation myocardial infarction

Abstract Background Myocardial performance index (MPI) also known as Tei index is a unique echocardiographic parameter which can estimate both systolic and diastolic performances of left and right ventricles. We previously suggested the echocardiographic parameter combined MPI (CMPI) as a new predictor of the prognosis of acute ST-elevation myocardial infarction (STEMI). The CMPI is the sum of left ventricular (LV) MPI and right ventricular (RV) MPI (CMPI = LV MPI + RV MPI). We supposed that CMPI might be a better predictor in STEMI, because it reflects both ventricular systolic and diastolic functions. Objectives The purpose of this study is to assess the prognostic value of a new echocardiographic parameter CMPI in STEMI patients calculated in acute phase. Methods 240 STEMI patients who underwent primary PCI have been included in the study. Echocardiography (EchoCG) was performed, and LV MPI and RV MPI were assessed within 24 hours after the symptom onset, prior to primary PCI. The MPI was calculated as the sum of isovolumic contraction time (ICT) and isovolumic relaxation time (IRT), divided by the ejection time (ET): MPI = (ICT + IRP) / ET. 50 % of the patients had anterior STEMI. 30 patients (12.5%) had concomitant RV myocardial infarction (MI). Patients were divided into two groups: Group 1 – CMPI > 0.9 (110 patients), Group 2 – CMPI ≤ 0.9 (130 patients). Baseline demographic and clinical characteristics were similar in both groups. Also, there were no differences in LV MI localization and concomitant RV MI between the groups. Primary endpoints were in-hospital and the one-year cardiovascular mortality rates. The secondary endpoint was the one-year heart failure hospitalization rate. Results In Group 1 the in-hospital mortality rate was 9.1%, and 3.1% in Group 2 (p = 0.0489). One-year cardiovascular mortality rate was 12.7% in and 5.4%, respectively (p = 0.0465). One-year heart failure hospitalization was also significantly lower in Group 2 (22.7% vs. 12.3%, p = 0.0332). Conclusion CMPI can be offered as a new predictor for the in-hospital and one-year cardiovascular mortality and one-year heart failure hospitalization rate in patients with acute STEMI.

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

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

Evaluation of right ventricular function in patients with Behcet's disease by four-dimensional echocardiography.

Behcet's disease (BD) is a systemic disorder characterized by vasculitis, resulting in thickened vascular walls that reduce elasticity and impair function. BD can involve the cardiovascular system in three ways: cardiac, arterial, and venous. In this study, our objective was to evaluate the efficacy of pulmonary arterial stiffness (PAS) and pulmonary pulse transit time (PPTT) measures in demonstrating right ventricular functions in asymptomatic BD patients. We aimed to objectively evaluate right ventricular function in patients with BD using four-dimensional echocardiography (4DE). This study included 40 patients diagnosed with BD and 40 healthy subjects. Demographic, clinical, laboratory, and echocardiographic parameters were compared. In addition to standard transthoracic echocardiographic evaluation, right ventricle quantification (RVQ) by using the 4DE and 2D-speckle tracking echocardiography were performed. The sPAP, 4D RVQ, and right ventricular strain values exhibited significant differences between the BD and control groups. Right ventricular end-diastolic diameter (RVDD), right ventricular end-systolic diameter (RVSD), right atrium (RA) area, right ventricular myocardial performance index (RVMPI), and PAS were increased in BD patients compared to the control group. Right ventricular ejection fraction (RVEF), right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), Tricuspid S', and PPTT were decreased in BD patients compared to control subjects. PPTT correlated with right ventricular free wall strain (RV-FWS) and PAS. In a multivariate linear regression analysis, PAS and RVFAC were found to be independent predictors of RVFWS. In addition, RVFAC and TAPSE are independent predictors for PPTT. Patients with BD may have elevated pulmonary arterial stiffness (PAS) in correlation with decreased PPTT. To ascertain the prognosis for these individuals, right ventricular (RV) functions must be evaluated. Measurements of RVFAC and RVEF via 4DE and deformation imaging techniques may be more useful in identifying subclinical impairment of RV. Individuals with BD, PAS, and PPTT may suggest a link between early pulmonary vascular remodeling and RV subclinical impairment.

Right ventricular function indices and platelet parameters for early prediction value of bronchopulmonary dysplasia: a retrospective study

BackgroundTo examine the value of early echocardiographic indices for the right ventricular function combined with platelet(PLT) parameters for predicting bronchopulmonary dysplasia (BPD) in preterm infants.MethodsThis retrospective study included infants with gestational age (GA) below 32 weeks, who were admitted to the neonatal intensive care unit(NICU). The detection rate of tricuspid regurgitation jet velocity (TRVJ), ventricular septal flattening, pulmonary artery widening, right ventricular dilation, and right atrial enlargement on the 7th day of life (DOL 7) were compared between BPD and non-BPD infants. Echocardiographic indices of the right ventricular function including tricuspid annular plane systolic excursion (TAPSE) and right ventricular index of myocardial performance (RIMP) were measured on 1 day of life (DOL 1)、on DOL 7 and on 14 day of life (DOL 14) respectively. The PLT parameters including the PLT count, mean platelet volume (MPV), platelet hematocrit (PCT) level, and platelet distribution width (PDW) were measured on the DOL 1,DOL 7, and DOL 14. Multivariate logistic regression was used to analyze the relationship between these parameters and BPD. Receiver operating characteristic curve analysis was performed to assess the predictive value of the right ventricular function indices and PLT parameters for BPD.ResultsA total of 220 preterm infants were included in this study, and of these, 85 infants developed BPD among them. The RIMP of the BPD group on DOL 14 was higher than that of the non-BPD group (P < 0.05). The TAPSE of the BPD group on DOL 14 was lower than that of the non-BPD group (P < 0.05). The PLT count of the BPD group on DOL 1 was lower than that of the non-BPD group (P < 0.05), and the MPV of the BPD group on DOL 1 was higher than that of the non-BPD group (P < 0.05). Using multivariate logistic regression, GA、invasive mechanical ventilation duration ≥ 7 days、 PLT、 MPV、 TAPSE and RIMP were found to be independent risk factors for BPD. The area under the receiver operating characteristic curve was 0.846 (95CI: 0.794∼0.899), which improved when using right ventricular function indices combined with platelet parameters.ConclusionTAPSE and RIMP combined with PLT count and MPV can help identify preterm infants at an increased risk of developing BPD.

Role of speckle tracking echocardiography in assessing right ventricle function after percutaneous closure of atrial septal defect

Background; Atrial septal defect (ASD) is one of the most common congenital heart diseases. Right ventricular (RV) dysfunction is closely related to patient outcome in open and closed ASD closure. Aim of work; to quantify RV function in patients with chronic RV volume overload due to an ASD before and after its percutaneous closure. Subjects &amp; methods; In this prospective study which included 40 patients with secundum type ASD and normal sinus rhythm who underwent successful percutaneous ASD closure procedure at Cardiology Department, Faculty of Medicine, Benha University; and Cardiology Department, national-heart-institute. All patients underwent full history taking, clinical examination, ecg &amp; echocardiography including assessment of LA, LV, RA &amp; RV functions &amp; dimensions with special emphasis on TAPSE, RV MPI &amp; 2D speckle tracking. Result: LA diameters (mm) were decreased significantly after ASD closure; Antero-posterior, Medio-lateral, and Apico-basal. RA diameters (mm) were decreased significantly after ASD closure; PASP was decreased significantly after ASD closure. LVEF% was increased significantly after ASD closure. TAPSE was increased significantly after ASD closure. RV end diastolic diameters were decreased significantly after ASD closure. Pulsed Doppler RV MPI was decreased significantly after ASD closure. RV longitudinal strain (%) was increased significantly after ASD closure. there was a positive correlation among delta RVSTE and delta LVEF and TAPSE. Also, there was a negative correlation among delta RVSTE and delta RV MPI, RV end diastolic diameter, RA diameters, and PASP. Conclusion; Our study demonstrated significant improvements in multiple echocardiographic measures of cardiac structure and function including reduced LA/RA diameters, decreased PASP, increased LVEF, higher TAPSE, reduced RVEDD, lower RV MPI, and increased RV longitudinal strain at one month post-procedure. These changes indicate reversal of the chronic volume and pressure overload on the right heart caused by the left-to-right shunt, resulting in measurable reverse remodeling and improved mechanics of the right ventricle.

Combined myocardial performance index as an echocardiographic predictor of prognosis in acute ST-elevation myocardial infarction

Abstract Background Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. Right ventricular (RV) dysfunction can occasionally coexist with LV dysfunction. The most popular techniques for assessing systolic and diastolic function, respectively, the ejection fraction (EF) and transmitral flow, both have significant limitations. The myocardial performance index (MPI) is a single parameter that does not have these restrictions and can estimate both combined systolic and diastolic performance. We used the combined myocardial performance index (CMPI) (LV MPI + RV MPI) as a new predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI). Objectives The purpose of this study was to evaluate the CMPI as an echocardiographic prognostic indicator in STEMI patients. Methods 200 STEMI patients who underwent primary PCI were enrolled. Echocardiography was done within 24 h of clinical signs with measurement of LV MPI and RV MPI. The MPI was calculated as (isovolumic contraction time + relaxation time)/ejection time. The one-year cardiovascular mortality rate from the time of admission was selected as a prognostic indicator. Results The one-year cardiovascular mortality rate was 9% (18 patients). LV MPI was found to have a significant positive correlation with the development of 1-year death (p = 0.036), while CMPI was found to have a highly significant positive correlation (p = 0.0001). A cut-off point of MPI &amp;gt; 0.50 showed 65.9% specificity and 94.4% sensitivity for the prediction of one-year death (Area-0.659). On the other hand, a cut-off point of CMPI &amp;gt; 0.92 has shown 94.4% sensitivity and 95.1% specificity for identifying patients with a one-year death risk (Area - 0891). Conclusions The CMPI might be a strong prognostic predictor after acute STEMI.LVMPICMPI

Speckle tracking echocardiography detects subtle right ventricular systolic dysfunction in post Covid syndrome after mild severity Covid-19

Abstract Introduction Now that the global COVID-19 pandemic has come to an end, many patients seek medical help for its aftermath giving rise to post COVID syndrome. Post COVID syndrome describes individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and no alternative diagnosis can be explained. The affection of the right ventricular (RV) systolic function is a cornerstone in the pathogenesis underlying Post COVID syndrome. Many modalities were used to assess the RV with a widespread debate as to the most accurate one. However, echocardiography remains the modality of choice for the evaluation of RV systolic function, especially when using its novel features as myocardial deformation imaging by speckle tracking echocardiography (STE) to surpass the RV’s peculiar anatomy, retrosternal position and complex architecture. Purpose The aim was to assess RV systolic function by STE 3-6 months after recovery from mild severity COVID-19 disease and correlate these findings with Post COVID syndrome. Methods This study included 96 adults (above 18 years of age) who were classified into three equal groups; the first group recruited 32 subjects 3-6 months after recovery from mild severity COVID-19 disease without post COVID syndrome, the second group included 32 subjects 3-6 months after recovery from mild severity COVID-19 disease with post COVID syndrome and the third group recruited 32 gender-matched healthy subjects of similar ages without previous COVID-19 disease (control group). Each subject underwent a detailed transthoracic echocardiography including RV function assessment using 2D RV STE imaging. Results RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) were significantly lower in patients after recovery from mild severity COVID-19 disease with post COVID syndrome (P-value= 0.010) in comparison to the other groups. There was a statistically significant negative correlation found between RV 2D STE parameters and RV end-diastolic dimension, systolic pulmonary artery pressure and RV myocardial performance index. Also, there was a statistically significant positive correlation found between RV 2D STE parameters and RV fractional area change, tricuspid annular plane systolic excursion and RV S'. The cardiac symptomatology in patients with post COVID syndrome was analyzed showing that the most common three symptoms were fatigue, palpitations and chest pain with a prevalence of 65.6%, 40.6% and 31% respectively. These three symptoms showed a significant negative relation with RV-GLS and RV-FWLS. Conclusion RV function assessed using STE occupied the lower normal ranges in patients recovering from mild severity COVID-19 disease, particularly those with post COVID syndrome. 2D STE may be used for the detection and follow-up of possible subtle long term RV dysfunction after mild severity COVID-19 disease.RV-GLS and RV-FWLS in the studied groupsRV-GLS and RV-FWLS using 2D STE

The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis.

Rheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients. Forty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four-dimensional echocardiography (4DE). There was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C-reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT. In RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.

Assessment of myocardial function in late preterm and term infants with transient tachypnea of the newborn using tissue Doppler imaging - a pilot observational study.

The aim of this study was to compare conventional and tissue Doppler echocardiography parameters between transient tachypnea of the newborn (TTN) and healthy control infants. This cross sectional pilot observational study was conducted in a level 3 neonatal care unit of India. Consecutively born late preterm and term infants (LPTI) with TTN were eligible for enrollment. Control group was selected from healthy LPTI. Conventional and tissue Doppler (myocardial velocities, myocardial performance index (MPI)) echocardiography was done within first 12h (D1) and 48-72h (D3) of life. Conventional echocardiography parameters were fractional shortening (FS), ejection fraction (EF), ventricular output, E/A ratio, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and pulmonary artery acceleration to ejection time ratio (PATET). Baseline characteristics and echocardiography images were compared between TTN and control groups. Out of 60 infants enrolled, 34 from TTN and 20 from control group were finally analyzed. Mean (SD) gestational age and birth weight of the study population was 366/7(1.8) weeks and 2398(376) g respectively. Left ventricular (LV) parameters were similar between both groups. On D1, right ventricular (RV)e' was smaller (6.42(1) cm/s vs. 7.68(1.68) cm/s, p 0.022), and E/e' (7.79(1.51) vs. 6.08(2.59), p 0.037) was larger in TTN group, indicating RV diastolic dysfunction. RV MPI (0.61(0.11) vs. 0.44(0.12), p < 0.001) was also larger, signifying RV global myocardial dysfunction. Similar findings were observed on D3. PATET was lower in TTN group on both D1 (0.34 (0.05) vs. 0.42 (0.05), p < 0.001) and D3 (0.38 (0.05) vs. 0.43 (0.02), p 0.004) suggesting persistently raised pulmonary arterial pressure, although only 2 infants developed pulmonary hypertension identified by standard echocardiography. Conclusion: Myocardial tissue Doppler imaging of TTN infants revealed occult right ventricular diastolic dysfunction secondary to persistently raised pulmonary arterial pressure. What is Known: •Transient tachypnea of the newborn may be associated with pulmonary arterial hypertension. What is New: •Tissue Doppler imaging in infants with transient tachypnea of the newborn revealed occult right ventricular diastolic dysfunction secondary to raised pulmonary arterial pressure, not detected by standard echocardiography.

Echocardiography parameters used in identifying right ventricle dysfunction in preterm infants with early bronchopulmonary dysplasia: A scoping review.

Bronchopulmonary Dysplasia (BPD) is a chronic condition that affects preterm infants and is associated with long-term complications. Haemodynamic effects of BPD can lead to right ventricular (RV) dysfunction. To synthesise and map the evidence of echo parameters used in identifying RV dysfunction in the first two weeks-after-birth (WAB) of preterm infants with early BPD. This scoping review included the databases: Medline, CINAHL, PubMed, EMBASE, Scopus, ProQuest, Web of Science, Cochrane Library, JBI Evidence-Based Practise and Gray Literature. The search utilised Boolean operators and descriptors registered in Medical Subject Headings. Included were studies utilising echo parameters to examine RV function in preterm infants with early BPD in the first two WAB. The results are presented as a map of the extracted findings in a tabular format with a narrative summary. Eight studies were included. Differences were observed in the number and timing of echo scans performed in the first two WAB and the variations in the echo parameters used to compare preterm infants with and without early BPD. Only echo scans performed at the end of the first WAB, demonstrated significant differences in the echo parameters measurements between preterm infants with and without BPD. Studies using RV Myocardial Performance Index (MPI) to identify RV-dysfunction associated with early BPD demonstrated similar findings. The Pulsed-Wave Doppler technique identified differences in RV-MPI between preterm infants with and without BPD, while Tissue-Doppler-Imaging did not demonstrate similar results. Speckle tracking can measure strain (S) and strain rate (SR) and diagnose RV-dysfunction. However, the findings of studies that utilised speckle tracking varied. Finally, two of the included studies added blood tests to their diagnostic model of early BPD, which was able to demonstrate significant differences in blood test results between BPD-affected and control preterm infants. BPD could adversely affect the myocardium function of the RV; these negative influences can be captured in the first two WAB. However, there are still knowledge gaps regarding the appropriate number, timing and the most suitable echo parameters to assess RV function.

Wpływ treningu i biegu półmaratońskiego na prawą komorę u biegaczy amatorów

Introduction. Endurance running may lead to heart remodelling. There are little data on the right ventricular (RV) changes in amateur athletes running shorter than marathon distances. The study aimed to investigate whether training and running a half marathon affect the anatomy and function of the RV in amateur runners and whether these changes affect the athlete’s competitive performance. Material and methods. The study included 45 recreational runners with a mean age of 32.96 (5.12) years, 27 men. Echocardiography was performed before the ten-weeks training period and before and after the half marathon run. The morphological and functional parameters of the RV were analysed, including two-dimensional, Doppler and speckle-tracking echocardiography. Results. In training period, the RV outflow tract (27.98 [5.46] vs. 30.07 [4.90]; p = 0.003) and the RV index of myocardial performance (0.36 [0.29; 0.45] vs. 0.39 [0.33; 0.52]; p = 0.017) increased significantly and no changes were found for E/e’. After the half marathon run, the absolute value of the RV free wall global longitudinal strain increased significantly (–25.89 [3.08] vs. –27.20 [3.42]; p = 0.008). Athletes who trained more intensively during the training period achieved significantly better half marathon results (r = –0.4; p ≤ 0.05). Conclusions. More enhanced physiological RV remodelling under exercise in amateur athletes results in better half marathon finishing times. The preparation period and 21.0975 kilometres run do not affect the diastolic function of the RV in recreational runners. The RV systolic function improves immediately after the half marathon performance.

Echocardiographic assessment of the right ventricular function in acute myocardial infarction

Background: Assessment of the right chamber function has not given much importance; this could be due to complex structure, asymmetric shape, and difficulty in visualization, and resulted in poor understanding of the impact of the right ventricular (RV) function on prognosis. Echocardiography commonly used and most readily available investigation modality for the assessment of the right ventricular function. AIMS AND OBJECTIVES: The aim of this study was to evaluate the relation between RV function and left ventricle (LV) dysfunction and Killip class in acute myocardial infarction (AMI) exclusive of RV infarction. MATERIAL AND METHODS: A total of 21 consecutive patients admitted to the coronary care unit with AMI were included and echocardiography was performed within 24 h of admission to assess RV and LV functions. RV function was quantified with a tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), RV longitudinal strain, RV myocardial performance index (RVMPI), and compared with the LV ejection fraction and Killip class. Results: Statistical analysis revealed that the majority of patients were male (90.5%) and only 9.5% of patients were female with a mean age of 50.9 years. Anterior wall MI was more common (58%) than inferior wall MI (42%). The study findings revealed that the RV longitudinal strain had a significant negative correlation (r2 = 0.803, P = 0.001) with Killip class and LV ejection fraction, whereas TAPSE, RVMPI, and RVFAC were poorly correlated with RV dysfunction.Conclusion: From the study findings, we concluded that echocardiographic assessment of RV functions demonstrated that larger infarcts correlated with RV dysfunction. RV involvement was more pronounced in anterior MI than inferior MI. Hence, the earliest recognition of RV dysfunction is warranted. Keywords: Acute myocardial infarction, echocardiograph, right ventricular function.

Assessment of right ventricular remodeling in chronic thromboembolic pulmonary hypertension by 2D-speckle tracking echocardiography: A comparison with cardiac magnetic resonance.

Right heart remodeling occurs in a substantial proportion of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and significantly affects their prognosis. Two-dimensional speckle-tracking echocardiography (2D-STE) can be used to evaluate myocardial deformation under physiological and pathological conditions. This study aimed to assess the feasibility of 2D-STE for evaluating right ventricular (RV) remodeling in CTEPH patients. This retrospective study included 21 CTEPH patients who underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR). Data for the following parameters that can reflect RV function were collected: tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), right ventricular index of myocardial performance (RIMP), peak systolic velocity of the tricuspid annulus (S'), and CMR-right ventricular ejection fraction (CMR-RVEF). The following strain parameters were calculated using post-processing software: STE-RV global longitudinal strain (STE-RVGLS), STE-RV free wall longitudinal strain (STE-RVFWLS), and CMR-RVGLS. As CMR-RVEF deteriorated, RV remodeling in CTEPH patients became more apparent and was mainly characterized by significant enlargement of the RV, weakening of myocardial deformation, and a decrease in RV contractility (RV area, STE-RVFWLS, STE-RVGLS: mild vs. severe and moderate vs. severe, p < 0.05; CMR-RVGLS: mild vs. severe, p < 0.05; TAPSE: moderate vs. severe, p < 0.05). Moreover, the Pearson correlation coefficient for correlation with CMR-derived RVEF was stronger for RVFWLS than for CMR-GLS (r-value: 0.70 vs. 0.68), and the strain values measured by 2D-STE showed a weak correlation with right heart catheterization data. Bland-Altman analysis showed good agreement between 2D-STE and CMR-feature tracking (FT) for RVGLS (bias = -0.96; 95% limit of agreement from -8.42 to 6.49). For the measurement of RVGLS, 2D-STE is similarly feasible to CMR-FT and could sensitively identify right heart remodeling.

High-Resolution Transthoracic Echocardiography Accurately Detects Pulmonary Arterial Pressure and Decreased Right Ventricular Contractility in a Mouse Model of Pulmonary Fibrosis and Secondary Pulmonary Hypertension.

Background To date, assessment of right ventricular (RV) function in mice has relied extensively on invasive measurements. Echocardiographic advances have allowed adaptation of measures used in humans for serial, noninvasive RV functional assessment in mice. We evaluated the diagnostic performance of tricuspid annular plane systolic excursion (TAPSE), RV peak systolic myocardial velocity (s'), RV myocardial performance index (MPI), and RV fractional area change (FAC) in a mouse model of pulmonary hypertension. Methods and Results Echocardiography was performed on mice at baseline and 3 weeks after induction of pulmonary hypertension using inhaled bleomycin or saline, including adapted measures of TAPSE, s', MPI, and FAC. RV systolic pressure was measured by invasive catheterization, and RV contractility was measured as the peak slope of the RV systolic pressure recording (maximum change pressure/change time). Postmortem morphological assessment of RV hypertrophy was performed. RV systolic pressure was elevated and maximum change pressure/change time was reduced in bleomycin versus control (n=8; P=0.002). Compared with controls, bleomycin mice had reduced TAPSE (0.79±0.05 versus 1.06±0.04 mm; P=0.003), s' (21.3±1.2 versus 29.2±1.3 mm/s; P<0.001), and FAC (20.3±0.7% versus 31.0±1.3%; P<0.001), whereas MPI was increased (0.51±0.03 versus 0.37±0.01; P=0.006). All measures correlated with RV systolic pressure and maximum change pressure/change time. Intraobserver and interobserver variability were minimal. Receiver operating characteristic curves demonstrated that TAPSE (<0.84 mm), s'(<23.3 mm/s), MPI (0.42), and FAC (<23.3%) identified maximum change pressure/change time ≤2100 mm Hg/s with high accuracy. Conclusions TAPSE, s', MPI, and FAC are measurable consistently using high-resolution echocardiography in mice, and are sensitive and specific measures of pulmonary pressure and RV function. This validation opens the opportunity for serial noninvasive measures in mouse models of pulmonary hypertension, enhancing the statistical power of preclinical studies of novel therapeutics.

Long-term impacts of different dialysis modalities on right ventricular function in patients with end-stage renal disease.

Right ventricular dysfunction is a major cause of heart failure and mortality in end-stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long-term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end-stage renal disease patients with preserved left ventricular function. The study included 120 patients grouped as follows: PD (n=40), HD with arterio-venous fistula (n =40), and healthy control subjects (n=40). Conventional echocardiography was performed on all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV-MPI), fractional area change (FAC), and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using the right ventricular dysfunction score, clinical, and echocardiographic parameters. The mean age of the study population was 51.9±13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV-MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. RV function was impaired in patients undergoing HD compared with patients on PD.

Assessment of right ventricular functions in acromegaly: comparison of active disease with remission.

Aim Cardiac involvement in acromegaly is defined as acromegalic cardiomyopathy, an insidious and chronic disease. Previous research on acromegalic cardiomyopathy was largely focused on morphological and functional assessment of the left heart. Since the literature data regarding right heart function in acromegalic patients are limited, we aimed to evaluate the structure and function of the right heart in such patients.Material and Methods We included 43 adult participants as the acromegaly group and 42 individuals as the control group. All patients underwent echocardiographic evaluation. The results were compared between acromegaly and control groups and between active and controlled acromegaly groups.Results The acromegaly group had increased interventricular septum thickness, right ventricular (RV) free wall thickness, right atrium (RA) minor diameter, RV basal and longitudinal diameters, RV end-diastolic and end-systolic areas, E / E' ratio, isovolumetric relaxation time, and RV ejection time. The E / A ratio and E' velocity were reduced. GH and IGF-1 were positively correlated with RV longitudinal diameter, indexed RA minor-axis dimension, and indexed RV end-diastolic area. Patients with active acromegaly had increased RV index of myocardial performance (RVIMP) and isovolumetric contraction time and shortened RV ejection time compared to patients in remission. A RVIMP value of 0.435 predicted active acromegaly with a sensitivity and specificity of 0.83 and 0.64, respectively (p=0.002).Conclusions Increases in the size and diameters of the right heart chambers along with RV free wall thickness may be attributed to acromegalic cardiomyopathy. RVIMP, isovolumetric contraction time, and ejection time are parameters that can be used in the evaluation of active acromegaly disease.

Sensitivity and Specificity of Myocardial Performance Indexing Assessing Acute Right Ventricular Infarction

The goal of this study was to determine the sensitivity and specificity of the Myocardial Performance Index (MPI)for the assessment of acute right ventricular Infraction. This was a descriptive type of cross-sectional study. The study was carried out in the Coronary Care Unit, Department of Cardiology, Sir Salimulla Medical College, and Mitford Hospital. After exclusion total of 72 patients were included in this study, of which 24 had acute inferior MI with RV involvement diagnosed by ≥ 1mm ST-segment elevation in V3R-V5R of right-sided ECG (group-I) and 48 had acute inferior MI without RV involvement (group-II). All patients underwent echocardiography within 24 hours of admission. The study revealed that RV MPI was significantly increased (0.57± 0.13) in RVMI patients compared to IMI without RVMI (0.24± 0.12). MPI detected RVMI in 08 patients (0.45± 0.09) who did not have ECG findings of RVMI (Group-II). Repeat MPI estimation after 05 days in 21 RVMI (Group-I) and 08 isolated IMI (Group-II) patients who had RVMPI &gt; 0.30showed dramatic reduction of MPI (0.19± 0.07 and 0.22±0.09), respectively. RV MPI ≥ 0.30 has high sensitivity (100%) and specificity (89%) for the diagnosis of RVMI in the presence of acute IMI. The study recommended that MPI may be a new non-invasive echocardiographic gold standard tool in diagnosing acute RVMI and also assessment of right ventricular function in acute inferior myocardial infarction with high sensitivity and specificity. MPI changes can be serially followed in acute RVMI patients to assess changes in RV function.&#x0D; TAJ 2022; 35: No-1: 17-24

Correlations among noninvasive right ventricular myocardial work indices and the main parameters of systolic and diastolic functions.

BackgroundRight ventricular (RV) myocardial work (RVMW) is the latest method used to assess RV function. To date, correlations among RVMW indices and RV systolic and diastolic functions have not been studied.MethodsA total of 106 healthy volunteers (median age, 34 years; 46% male) were prospectively enrolled. RVMW indices were measured using the RV pressure–strain loop using specific software. The correlations among RVMW indices and other RV functions were analyzed.ResultsDuring the multivariate analysis, the RV global work index (RVGWI) was significantly correlated with RV global longitudinal strain (RV GLS) (p < .0001), pulmonary systolic artery pressure (PASP) (p < .0001), and tricuspid annular (TA) plane systolic excursion (TAPSE) (p = .036). RV global constructive work (RVGCW) was correlated with RV GLS (p < .0001) and PASP (p < .0001). RV global wasted work (RVGWW) was correlated with RV GLS (p = .008) and TA isovolumetric acceleration (TA IVA) (p = .008). RV global work efficiency (RVGWE) was correlated with RV GLS (p < .0001) and tissue Doppler (TD) RV myocardial performance index (TD RMPI) (p = .043).ConclusionRVMW indices showed good correlations with RV myocardial systolic function.

Early Impairment of Right Ventricular Functions in Patients with Moderate Asthma and the Role of Isovolumic Acceleration

Introduction: Asthma is a common chronic lung disease that affects people all over the world. Pulmonary hypertension and right ventricular (RV) dysfunction are possible complications that may develop in the advanced stages of asthma. However, the number of studies investigating asthma and its implications on new RV parameters are very rare. This study aims to evaluate the RV functions in patients with moderate asthma before the development of pulmonary hypertension. Patients and Methods: Forty-one patients with moderate asthma and 40 healthy individuals were enrolled in this case-control study. All participants underwent a detailed two-dimensional echocardiographic examination. RV functions were measured through RV isovolumic acceleration (IVA) index in addition to conventional parameters. RV IVA, a tissue doppler derived parameter, was calculated as the ratio between maximum isovolumic myocardial velocity during isovolumic contraction and the time interval from the onset of this wave to the time at its maximum velocity. Results: There were no significant differences between the two groups in terms of baseline clinical characteristics, laboratory findings and echocardiographic parameters measuring left ventricular functions (p&gt; 0.05). In asthmatic patients, RV isovolumic relaxation time and RV myocardial performance index were higher (p= 0.027 and p&lt;0.001 respectively), while RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and RV IVA values were all lower (p&lt;0.001). RV IVA was found to be inversely proportional to asthma duration. TAPSE [β= 0.632, 95% CI= (0.121) - (0.225), p&lt;0.001] and pulmonary artery systolic pressure [β= -0.188, 95% CI= (-0.057) - (-0.003), p= 0.032] were shown as independent predictors of RV IVA. Conclusion: Asthma is an important disease that may result in subclinical RV dysfunction even before the development of pulmonary hypertension. RV IVA, an easily obtained and load-independent parameter, may be a useful and reliable index that sensitively analyzes subtle deteriorations in the contractile function of RV in asthmatic patients. RV IVA may also correlate with asthma duration.

Right ventricular performance in patients with heart failure with mildly reduced ejection fraction: the forgotten ventricle.

Right ventricular (RV) function is a major determinant of prognosis and adverse outcomes in patients with heart failure (HF). It is largely unknown if HF with mildly reduced ejection fraction (HFmrEF) patients have some special characteristics in RV function (RVF) that may distinguish them from HF with reduced or preserved ejection fraction (HFrEF or HFpEF) patients. Standard echocardiography was performed to estimate RVF [tricuspid annular systolic velocity (TDSV), plane systolic excursion (TAPSE), TAPSE to pulmonary artery systolic pressure (TAPSE/PASP) and RV myocardial performance index (MPI-TEI index)] in a cross-sectional study. In 306 participants, the RV systolic function evaluated with TAPSE and TDSV was impaired in 39.1 and 24.2%, respectively. TAPSE, TAPSE/PASP and TDSV were lower in HFmrEF compared with HFpEF and higher compared with HFrEF (p < 0.001 for among-groups comparison). RV diastolic dysfunction varied between 12.6 and 43.8% depending on the echocardiographic parameter. Diastolic RVF determined by tricuspid inflow E/A wave ratio (Et/At) was impaired in less patients with HFmrEF compared with those with HFpEF or HFrEF (25.9% vs 48.4% vs 56.3%; p = 0.030, respectively). RV diastolic dysfunction by et'/at' (tissue Doppler tricuspid valve annulus e' and a' waves) was impaired in less patients with HFmrEF compared with HFrEF (11.8% vs 33.3%; p = 0.019). A multivariate regression analysis revealed a significant association between RV and LV systolic dysfunction. The present study shows a high prevalence of RV dysfunction in HFmrEF patients. Study findings provides some new insights on RV and LV systolic dysfunction coupling whereas RV diastolic dysfunction was not dependent on LV systolic dysfunction.