Right Ventricle Size Research Articles

Right Ventricular Enlargement and Dysfunction Are Associated With Increased All-Cause Mortality in Hypertrophic Cardiomyopathy

ObjectiveTo assess whether right ventricular enlargement (RVE) and right ventricular dysfunction (RVD) adversely affect prognosis in hypertrophic cardiomyopathy (HCM). Patients and MethodsData were retrieved from Mayo Clinic’s prospectively collected HCM registry between January 1, 2000, and September 30, 2012. Right ventricle (RV) size and function were semiquantitatively categorized via echocardiography as normal (RV-Norm) versus abnormal (RV-Abn) (RVE or RVD). All-cause mortality was the primary endpoint. ResultsOf 1878 HCM patients studied (mean age 53±15 years; 41.6% female), only 71 (3.8%) had RV-Abn (24 RVE, 28 RVD, 19 combined RVE and RVD). Compared with HCM patients with RV-Norm, RV-Abn patients were older (57±14 vs 53±15 years, P=.02), more symptomatic (New York Heart Association functional class III-IV in 62.0% vs 48.6%, P=.03), had more atrial fibrillation (53.5% vs 17.3%, P<.001), and more prior implantable cardioverter-defibrillator implantation (23.9% vs 11.3%, P=.02). Median follow-up was 9.4 years with 311 deaths. Patients who were RV-Abn had higher all-cause mortality compared with RV-Norm (log-rank P<.001); 24.1% (95% CI, 15.5% to 35.3%) vs 6.1% (95% CI, 5.1% to 7.3%) at 5 years. In multivariable Cox modeling, RV-Abn (hazard ratio, 1.89; 95% CI, 1.18 to 3.03; P=.008) was associated independently with all-cause mortality after adjusting for age, female sex, New York Heart Association functional class, atrial fibrillation, hypertension, coronary artery disease, implantable cardioverter-defibrillator implantation, beta blocker use, prior septal reduction therapy, resting LV outflow tract gradient, maximal LV wall thickness, and moderate or greater tricuspid regurgitation. ConclusionAlthough perturbations in RV size and function were observed in fewer than 5% of patients with HCM, they were associated with nearly two-fold higher all-cause mortality at long-term follow-up.

Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study).

PurposeSeverely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).MethodsRetrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).ResultsSix hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU).ConclusionAlmost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-022-06685-2.

Early echocardiographic predictors of unfavorable yearly prognosis in patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Objective to determine the most informative in the prognostic plan echocardiographic indices in patients with acute myocardial infarction and diabetes mellitus. Methods A retrospective analysis of outcomes of 97 diabetic patients with acute myocardial infarction (AMI), with lesions of two or more coronary arteries was performed. All patients received conventional basic therapy comprising, acetylsalicylic acid, clopidogrel, beta-blocker, an ACE inhibitor, statins, and insulin therapy on a stationary phase for a minimum of 2 weeks, followed by a transition to oral antidiabetics. According to the 12 month follow depending on the outcomes two groups were established: favorable prognosis n = 46 and unfavorable prognosis n = 51, having one or more of the following complications: death, reinfarction (nonfatal), development or progression of heart failure. Results Differences in echocardiographic parameters, characterizing myocardial hypertrophy of left ventricular (LV) were revealed between patients with different outcomes of AMI. Thus, patients with adverse outcome were characterized by a significant increase of LV mass (from 191.2 ± 35.7g to 255.7 ± 46.2 g, p = 0.004) and LV posterior wall thickness (from 8.7 ± 1.04mm to 10.6 ± 1.37mm, p = 0.004) in dynamics. Moreover, a smaller LV ejection fraction (LVEF) was observed in the group with an unfavorable outcome (both initially and in dynamics), as well as large LV end-diastolic volume and end-systolic volume. Single-factor analysis has shown, that EF &amp;lt;40%, LV aneurysm, the involvement of the apical LV myocardial segments at any location were echocardiography predictors of poor outcome. In the group of patients with unfavorable course of AMI, the index of left atrium (LA) increased from 35.8 ± 3.8mm to 37.3 ± 1.8mm (p = 0.04), which is significantly higher than in the second group, where the LA index was 33.8 ± 3.2mm and 34.2 ± 2.9mm (p = 0.7). In the first group, the right ventricle (RV) remained practically unchanged (22.3 ± 2.7mm and 22 ± 3.5 mm, respectively, p = 0.89), while in the second group the size of the RV decreased from 23.2 ± 3.9mm to 20.7 ± 2.9mm (p = 0.38). Initially, when comparing between groups, p = 0.38) and after 1 month p = 0.5). The negative role of pressure in the pulmonary artery (PA) in patients with AMI was also demonstrated. The systolic pressure in the PA index in the group with a favorable outcome in the dynamics significantly decreased, in contrast to the group with an unfavorable outcome (from 19.9 ± 4.5 mmHg to 16.2 ± 2.6 mmHg, p = 0.03 and from 22.1 ± 5.7mmHg to 18.0 ±3.6 mmHg, p = 0.15, respectively). Conclusion AMI with a high risk of adverse 12-month outcomes, characterized by the following echocardiographic signs: engagement apical segments of the LV regardless of the localization of myocardial infarction, reduced LVEF, as well as increased PA pressure, combined with the increase in the size of RV.

Variability of right ventricular linear measurements of size and function using a standardized echocardiographic protocol

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular size and function have a prognostic value not only in right heart conditions (pulmonary hypertension, congenital heart disease), but also in left ventricular (LV) disease states. The right ventricle (RV) has a unique shape, for which a simple geometrical model is not achievable as is the case for the LV. In clinical practice simple measurements are used for the RV, since these are considered to be most reliable and reproducible: linear cavity dimensions, tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler systolic velocity s’ at the tricuspid annulus. The latest RV quantitation guidelines made important modifications to RV measurements, in particular, by shifting from the apical 4-chamber view to the RV focused apical view. Very scarce data exist on the variability of these measurements. Purpose In this study we aim to analyze the intra and inter-observer variability of the linear measurements of RV size and function using a standardized methodology. Methods A mixed cohort, randomly selected from the echocardiographic database, comprising 50 patients, was retrospectively analyzed. We measured linear diameters (basal = 1, longitudinal = 2, mid = 3) in apical RV-focused view, TAPSE and s’. Based on computer simulations, we propose a step-by-step approach: tracing the longitudinal diameter as perpendicular to the mid of the basal and generally parallel with the interventricular septum, and the mid as perpendicular to the middle of the longitudinal (Figure). Two observers measured independently the same images at baseline, three (inter-observer) and six months (intra-observer). Results The longitudinal diameter had the lowest relative bias (3% inter and 4% intra-observer), followed by the basal (7% and 2%), and mid (6% and 6%). The limits of agreement (LOA) were small for s’ (-3 to 1 intra and -1 to 1mm inter-observer), TAPSE (-6 to 5 and -3 to 3mm), and larger for diameters (1=-5 to 10 and -8 to 6; 2=-13 to 17 and -11 to 6; 3=-11 to 7 and -9 to 4mm). ICCs for individual measurements were very good (1= 0.94 intra and 0.94 inter; 2 = 0.78 and 0.94; 3: 0.72 and 0.56; TAPSE: 0.86 and 0.94; s’=0.94 and 0.98), p &amp;lt; 0.001 for all (Table). Conclusion A systematic approach to linear RV-focused apical view measurements may lead to reproducible results. It is essential that size measurements be performed in the RV focused view. Our study shows best consistency and reproducibility for the basal diameter and the linear functional parameters. Echocardiographic laboratories may benefit from implementing a consistent analysis protocol and assessing its reproducibility. Abstract Figure: linear RV measurements Abstract Table: variability results

Takotsubo syndrome: the need to evaluate the left and right atria, in addition to the left and right ventricles.

Takotsub o syndrome (TTS) is an acute reversible heart failure condition which morphologically is expressed via imaging modalities [transthoracic echocardiography (TTE) (conventional and strain deformation TTE), contrast ventriculography, or cardiac magnetic resonance imaging (cMRI)], as segmental left ventricular (LV) phenotypes of hypokinesis/akinesis/dyskinesis involving the apical, mid-ventricular, basal (i.e. reverse or inverse), focal, and rarely global LV territories. This pre-occupation with the LV is understandable, considering that morbid symptoms and signs of TTS are ascribed to a compromise of the LV, contrast ventriculography at cardiac catheterization is restricted to the LV, and diagnostic TTE is focused on the LV, with an often cursory reference to the right ventricle (RV), for which a brief statement in TTE reports commonly includes that the ‘RV size and function were normal’, or that the RV could not be adequately evaluated. It is conceivable that if systematic and careful attention, during TTE evaluation was paid to...

Short and Mid-Term Outcomes of Percutaneous Ostium Secundum Atrial Septal Defect Closure in a Single-Centre Adult Population within the National Program of Percutaneous Procedures in Adults with Congenital Heart Disease

Abstract Background Atrial septal defect (ASD) is the most common congenital heart defect diagnosed in adulthood, causing a left-to-right shunt with subsequent right ventricle (RV) volume overload, increased pulmonary flow and overloading of the pulmonary circulation. Surgical or percutaneous closure of ASD is associated with reverse right heart remodelling, improved functional class and exercise capacity, irrespective of age. In the present study we aimed to assess the short and mid-term outcomes of ASD closure in terms of hemodynamic response, cardiac remodelling and clinical data in a population of adult patients with ostium secundum ASD eligible for percutaneous closure. Methods Patients with ostium secundum ASD referred to our institution from November 1st 2017 to September 30th 2021 were assessed for percutaneous closure within the National Program for percutaneous procedures in adults with congenital heart disease. All patients underwent a clinical and echocardiographic evaluation; demographics and biological data were collected. A transo esophageal echocardiography was available for all patients in order to assess the feasibility of percutaneous closure. Results The study population included 37 adult patients (29 women, mean age 43.5 ± 14.4 years) and 33 age- and gender-matched healthy volunteers. Eight patients had a history of supraventricular arrhythmias. The ASD patients had a significant RV and right atrial (RA) dilation, a higher pulmonary artery (PA) size and systolic pressures, a smaller left ventricle diastolic diameter. At least 1 follow-up visit data was available in 23 patients and the mean follow-up was 12 ± 8 months. The functional class significantly improved after ASD closure; 4 patients presented with supraventricular arrythmias after ASD closure. Data showed a significant decrease in RV and RA size after the ASD closure, the RV longitudinal function parameters also decreased. At the follow-up visit, the PA trunk diameter and the systolic PAP were significantly lower (p &lt;0.001) compared with the pre-procedural values. The LV end-diastolic diameter increased after ASD closure. The reverse remodelling of the right chambers was similar in patients aged less and more or equal to 60 years, but the decrease in estimated systolic PAP was higher in older patients. Conclusion In adult patients with ostium secundum ASD, percutaneous closure leads to significant changes in functional class and echocardiographic parameters of right and left heart size and RV function and in pulmonary artery size and pressure. The beneficial effect seems to be similar in patients younger and older than 60 years.

Arrhythmogenic right ventricular cardiomyopathy associated with arrhythmia-induced cardiomyopathy: A case report

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of inherited cardio-myopathy, which is characterized by fibro-fatty replacement of right ventricular myocardium, leading to ventricular arrhythmia. However, rapid atrial arrhythmias are also common, including atrial fibrillation, atrial flutter and atrial tachycardia. Long term rapid atrial arrhythmia can lead to further deterioration of cardiac function. This case is a 51-year-old male. He was admitted to Department of Cardiology, Peking University Third Hospital with palpitation and fatigue after exercise. Electrocardiogram showed incessant atrial tachycardia. Echocardiography revealed dilation of all his four chambers, especially the right ventricle, with the left ventricular ejection fraction of 40% and the right ventricular hypokinesis. Cardiac magnetic resonance imaging found that the right ventricle was significantly enlarged, and the right ventricular aneurysm had formed; the right ventricular ejection fraction was as low as 8%, and the left ventricular ejection fraction was 35%. The patients met the diagnostic criteria of ARVC, and both left and right ventricles were involved. His physical activities were restricted, and metoprolol, digoxin, spironolactone and ramipril were given. Rivaroxaban was also given because atrial tachycardia could cause left atrial thrombosis and embolism. His atrial tachycardia converted spontaneously to normal sinus rhythm after these treatments. Since the patient had severe right ventricular dysfunction, frequent premature ventricular beats and non-sustained ventricular tachycardia on Holter monitoring, indicating a high risk of sudden death, implantable cardioverter defibrillator (ICD) was implanted. After discharge from hospital, physical activity restriction and the above medicines were continued. As rapid atrial arrhythmia could lead to inappropriate ICD shocks, amiodarone was added to prevent the recurrence of atrial tachycardia, and also control ventricular arrhythmia. After 6 months, echocardiography was repeated and showed that the left ventricle diameter was reduced significantly, and the left ventricular ejection fraction increased to 60%, while the size of right ventricle and right atrium decreased slightly. According to the clinical manifestations and outcomes, he was diagnosed with ARVC associated with arrhythmia induced cardiomyopathy. According to the results of his cardiac magnetic resonance imaging, the patient had left ventricular involvement caused by ARVC, and the persistent atrial tachycardia led to left ventricular systolic dysfunction.

Cardiac reverse remodelling by 2D and 3D echocardiography in heart failure patients treated with sacubitril/valsartan: a prospective study

Abstract Background Left ventricular (LV) reverse remodelling induced by sacubitril/valsartan (S/V) has been shown in heart failure patients with reduced ejection fraction (HFrEF) by two-dimensional (2D) transthoracic echocardiography (TTE). Data about S/V effect on the right ventricle (RV) are scarce. Aims We aimed to evaluate S/V-induced changes in NT-proBNP levels, and cardiac remodelling indices by 2D and three-dimensional (3D) TTE in HFrEF patients, classifying patients according to aetiology. Methods We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-months follow-up (6MFU) after S/V treatment optimization, we i) assessed NT-proBNP; ii) performed 2D TTE according to guidelines for the assessment of biventricular size and function, mitral regurgitation grade and LV diastolic function; and iii) performed 3D TTE, using the Dynamic HeartModel software for the evaluation of LV volumes and function, the 4D LV-Analysis software for the assessment of LV longitudinal strain, and the 4D RV-Analysis software for the assessment of RV volumes and function (Figure 1). Results In non-ischaemic patients, both 2D and 3D TTE showed an improvement in LV volumes and biventricular function, whereas only 3D detected a reduction in RV size at 6MFU vs baseline (Table 1). In ischaemic patients, only 3D TTE showed an improvement in biventricular size and LV function (Table 1). Finally, S/V induced a significant improvement in NT-proBNP (Table 1) and diastolic function both in ischaemic and non-ischaemic groups: patients with elevated left atrial pressure (as assessed by 2D parameters of diastolic function) decreased from 45% to 20% in ischaemic and from 40% to 10% in non-ischaemic patients (p&amp;lt;0.05). Conclusions S/V induced a significant improvement in NTproBNP and diastolic function in both aetiologic groups. A clinically significant improvement in biventricular function was shown only in non-ischaemic patients. 3D TTE may be advantageous to ascertain subtle changes in LV size and function, undetected by 2D imaging, and to evaluate RV dimensions and function, which have a major impact on HFrEF prognosis. Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

The application experience of focused ultrasound heart examination in patients with COVID-19 in Prone-position

Aim of the study. To study the experience of using focused transthoracic echocardiography in patients with COVID-19 in prone position (fEchoPr) in intensive care units (ICU).Materials and methods. The retrospective observational study included 53 patients (period from 15 April to 31 December 2020). Inclusion criteria: confirmed diagnosis of COVID-19, availability of fEchoPr data, outcome certainty (discharge/death). We analyzed electronic medical records. The fEchoPr was performed in patients in the prone position with a bolster under the left side of the chest and left arm raised (‘swimmer’s position’). We assessed the systolic function of the right ventricle (RV) (tricuspid annular plane systolic excursion (TAPSE)), RV size, RV/LV ratio, systolic function of the left ventricle (LV) (left ventricular outflow tract velocity time integral. (LVOT VTI)), and pulmonary hypertension (PH) (tricuspid regurgitation peak gradient (PGTR). Depending on the results, the patients were divided into 2 groups: informative (+fEchoPr) and non-informative (–fEchoPr) examinations.Results. There was no statistically significant difference in the groups (+fEcho n = 35 vs –fEcho n = 18) by age (65.6 ± 15.3 vs 60.2 ± 15.8, p &gt; 0.05), by gender (male: 23 (65.7%) vs 14 (77.8%), p &gt; 0.05), by body mass index (31.3 ± 5.3 kg/m 2 vs 29.5 ± 5.4 kg/m2 , p &gt; 0.05), by mechanical ventilation support (24 (68.6%) vs 17 (94.4%), p = 0.074), by NEWS scale indicators (6.9 ± 3.7 vs 8.5 ± 3.5 points), by mortality (82.8% vs 94.4%, p &gt; 0.05). Correlation analysis revealed a moderate inverse relationship between being on mechanical ventilation and the informative value of the study (Spearman's r = −0.30 at p = 0.033). In the +fEchoPr group, the correct measurement of TAPSE and RV/LV was carried out in 100%: a decrease in RV systolic function was recorded in 5 patients (14%), expansion of the RV in 13 patients (37%). Signs of PH were detected in 11 patients (31%), PGTR could not be measured in 10 patients (28%). LV systolic dysfunction was detected in 7 patients (20%). No pathology was detected in 16 patients (46%). One patient was diagnosed with infective endocarditis of native mitral valve, which was later confirmed by autopsy.Conclusion. In 66% of cases, fEchoPr examinations were informative, especially in terms of assessing the state of the right heart. fEchoPr examination is an affordable, valid and reproducible method to assess and monitor the state of the heart in ICU patients.

Right Ventricle Pressure Volume Loop Measurement Trends Predicted by End‐Diastolic Volume

To examine Right Ventricle (RV) size as a predicting factor of pressure volume loop (PV loop) measurement, we assessed PV loop functional dependence on end-diastolic volume (EDV) from twenty animal and human RV datasets [1]. Methods PV loop sequences were processed to compute end-systolic elastance (Ees), ejecting pressure-volume-area (PVA), isovolumic mode pressure-volume-area (PVAiso), and isovolumic mode peak developed pressure (Piso). The outcomes of Ees, Piso, PVA, and PVAiso were then applied as dependent variables of EDV predicted trends with linear and power regression model fitting. Results Over the EDV range from 25 mL to 150 mL, the PVA and PVAiso measures were positively correlated to EDV. The Ees elastance measures were inversely EDV correlated, and Piso pressures were uncorrelated to EDV. Results of regression shown in the table, indicate PVA (R2 =.74) and PVAiso (R2 =.74) measures of contractile mechanism energy output were the optimally fitted indices by EDV prediction. Conclusions Decreasing RV elastance with increasing EDV size, may reflect a structural adaptation of larger chambers to a more extensive pulmonary vascular network. Positively correlated trends of PVA and PVAiso to the RV size, also suggest these measures form a promising basis to interpret ranges of normal function during different stages of pediatric patient growth. [1] E .N. Marcus, A Study of Cardiac Ventricle Performance Indices Estimated with Data from Single-Beat Pressure Volume Loops, Sensors & Transducers, Vol. 244, Issue 5, September 2020, pp. 1-6.

Interaction between veno-arterial extracorporeal membrane oxygenation and the right ventricle

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Fundación Alfonso Martín Escudero The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is unpredictable. We hypothesized if presence of uni- or bi-ventricular failure before implantation and cannulation strategy may influence. We assessed RV performance during VA-ECMO support and identify RV-related predictors of weaning. Methods. Changes of RV size and function during VA-ECMO by echocardiography were retrospectively analyzed in 87 patients. Predictors of weaning were evaluated by logistic regression. Results. RV echocardiographic parameters did not vary significantly during VA-ECMO, neither after stratification by cannulation type or presence of isolated or biventriular failure. Succesful weaning was conditioned by absence of RV dysfunction before implantation (OR 14.7,95%CI 13.3-140.3;p = 0.025) or in the last day of support (OR 9.5; 95%CI 1.6-54;p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR 6.2; 95%CI 1.7-22.4;p = 0.005). RV improvement was more often observed in patients with acute RV failure, while VA-ECMO configuration had no effect. Conclusions. Preservation or improvement of RV function during VA-ECMO support is essential for weaning. RV echocardiographic performance does not change significantly during VA-ECMO and is not influenced by cannulation type or presence of uni- or bi-ventricular failure before implantation. Echo parameters evolution during VA-ECMOPre-ECMO&amp;lt; 24h on ECMO&amp;gt; 24h on ECMOpNn = 68n = 68n = 63LV diastolic diameter, mm (mean ± SD)53.34 ± 15.5954.86 ± 13.8956.18 ± 14.620.317LV systolic diameter, mm45.28 ± 11.6745.17 ± 14.5846.07 ± 15.590.963LVEF, n (%)20 (10-38.75)17.5 (10-30)25 (10-40)0.102RV basal diameter, mm (mean ± SD)41.05 ± 9.7938.92± 9.1740.05 ± 9.560.484RV systolic disfunction, n (%)65 (95.6)65 (95.5)43 (68.2)0.073Tricuspid regurgitation, n (%)50 (73.4)37 (54.3)49 (77.8)0.146Pulmonary systolic pressure, mmHg (mean ± SD)41.54 ± 24.1339.09 ± 20.2445.29 ± 25.730.783Aortic regurgitation, n (%)47 (69.1)39 (57.4)35 (55.5)0.775Mitral regurgitation, n (%)64 (94.1)48 (70.5)44 (69.8)0.591Dd diastolic diameter; EF: ejection fraction; LV: left ventricle; LVOT: left ventricle outflow tract; RV: right ventricle; RVOT: right ventricle outflow tract; VTI: velocity time integralAbstract Figure. Right ventricular function predictors

Clinical outcome analysis in patients with COVID 19 using echocardiography and biochemical markers

Funding AcknowledgementsType of funding sources: None. BACKGROUND AND PURPOSECardiac involvement in patients with COVID-19 is still unclear. We made a systematic echocardiographic and biochemical assessment of patients admitted with COVID-19 infection to assess correlation with various clinical outcomes.METHODSWe prospectively assessed 119 consecutive COVID-19 positive in-patients with full echocardiography studies, including left ventricle (LV) systolic function, right ventricle (RV) basal dimension and systolic function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and systolic pulmonary artery pressure (SPAP). We excluded all patients with known left ventricular systolic dysfunction (LVSD) prior to admission. We also recorded laboratory biochemical findings including troponin-T, D-dimer and NT-proBNP levels. We carried out correlation analyses of the echocardiography and the laboratory biochemical findings with various clinical outcomes including mortality, length of stay (LOS), admission to Intensive Care Unit (ICU) and the three month re-admission rates.RESULTS119 patients (38% female); age range 35 to 96 years (mean 71, median 73). 37 (31%) patients died during hospital admission. The mean LOS for surviving patients was 32 days.20 (17%) patients had significant LSVD (by biplane Simpson method, EF cut off 45%), 31 (26%) patients had RV dilatation, 28 patients (24%) had RV systolic dysfunction by TAPSE and 41 (35%) patients had raised pulmonary artery pressures. There was a weak Pearson’s correlation between mortality and LVSD (0.184, p 0.046), a moderate correlation with RVSD (0.303, p 0.001) and RV dilatation (0.231, p 0.012). Raised troponin-T and NT-proBNP levels correlated moderately with mortality (0.254, p 0.013 and 0.253, p 0.02 respectively). D-dimer levels did not correlate with mortality or any of the other clinical outcomes. Raised troponin-T levels had moderate correlation with admission to ICU and LOS (0.210, p 0.043 and 0.267, p 0.01 respectively). SPAP in isolation did not correlate with any of the clinical outcomes. None of the echocardiography or laboratory biochemical variants correlated with re-admission rates.CONCLUSIONIn our cohort of patients with COVID-19 infection there is a weak to moderate mortality correlation with LV function, RV function and RV size. Laboratory biochemical markers especially troponin-T correlated more widely and moderately with clinical outcomes.

From Safety to Benefit in Cell Delivery During Surgical Repair of Ebstein Anomaly: Initial Results

BackgroundThe objective of this study is to assess the safety and early impact of intramyocardial delivery of autologous bone marrow–derived mononuclear cells (BM-MNC) at time of surgical Ebstein repair. MethodsPatients with Ebstein anomaly (ages 6 months to 30 years) scheduled to undergo repair of the tricuspid valve were eligible to participate in this open-label, non-randomized phase I clinical trial. BM-MNC target dose was 1-3 million cells/kg. Ten patients have undergone surgical intervention and cell delivery to the right ventricle (RV) and completed 6-month follow-up. ResultsAll patients underwent surgical tricuspid valve repair and uneventful BM-MNC delivery; there were no ventricular arrhythmias and no adverse events related to study product or delivery. Echocardiographic RV myocardial performance index improved and RV fractional area change showed an initial decline and then through study follow-up. There was no evidence of delayed myocardial enhancement or regional wall motion abnormalities at injection sites on 6-month follow-up magnetic resonance imaging. ConclusionsIntramyocardial delivery of BM-MNC after surgical repair in Ebstein anomaly can be performed safely. Echocardiography variables suggest a positive impact of cell delivery on the RV myocardium with improvements in both RV size and wall motion over time. Additional follow-up and comparison to control groups are required to better characterize the impact of cell therapy on the myopathic RV in Ebstein anomaly.

Echocardiographic and Electrocardiographic Findings in COVID-19 Patients: A Cross-Sectional Study

Background: There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to find out the effect of SARS-CoV-2 infection on cardiac function in patients without any history of structural heart disease by electrocardiographic and echocardiographic evaluations. Methods: This was a cross-sectional study on patients with COVID-19 infection admitted to Imam Reza hospital, Mashhad, Iran between 14 April and 21 September 2020. COVID-19 infection was verified by a positive reverse-transcriptase polymerase chain reaction (PCR) assay for SARS-CoV-2 using nasopharyngeal/oropharyngeal samples. We enrolled all patients over 18 years old with definite diagnosis of COVID-19 infection. At admission, demographic data, comorbid conditions, physical examination, Lung CT scan and laboratory findings were recorded. All patients underwent a comprehensive transthoracic echocardiography at the first week of admission. Clinical and imaging data were collected prospectively. Findings: In total, 142 patients were enrolled in this study. The mean age of participants was 60.69± 15.70 years (range: 30-90 years). Most patients were male (82, 57.7%). The most common findings were left axis deviation (15.5%) in ECG and Right ventricle (RV) dysfunction (34.5%) in echocardiography. Multivariate analysis showed that O2 saturation at admission was independently a predictor of re-hospitalization (P<0.001). Moreover, pulmonary artery systolic pressure (PASP) (P=0.026), RV enlargement (P=0.037) and also dyslipidemia (P=0.002) were significant predictors of in-hospital mortality after adjusting the analysis for potential cofounders. RV size (P<0.001), dyslipidemia (P<0.001), ejection fraction (EF) (P<0.001), age (P=0.020), systolic blood pressure (P=0.001), O2 saturation (P=0.018) and diabetes (P=0.025) independently predicted 30-days mortality. Interpretation: Echocardiography can be used for risk assessment in patients with COVID-19, especially in those with previous history of diabetes and dyslipidemia. The infection could result in Ventricular dysfunction, even in those without previous history of structural heart disease. Funding Statement: There is no funding. Declaration of Interests: Authors declared no conflict of interest. Ethics Approval Statement: Mashhad University of Medical Sciences was the approved the study design and its ethical committee approved the study.

Handheld Echocardiography in a Clinical Practice Scenario: Concordances Compared to Standard Echocardiographic Reports.

BACKGROUNDThe purpose of this study was to assess the utility of a handheld device (HH) used during common daily practice and its agreement with the results of a standard echocardiography study (STD) performed by experienced sonographers and echocardiographer.METHODSA prospective follow-up was conducted in an adult outpatient echocardiography clinic. Experienced sonographers performed the STD and an experienced echocardiographer performed the HH. STD included 2-dimensional images, Doppler and hemodynamics analysis. Hemodynamic assessment was not performed with the HH device because the HH does not include such technology. The images were interpreted by blinded echocardiographers, and the agreement between the reports was analyzed.RESULTSA total of 108 patients were included; and the concordance for left ventricle (LV) ejection fraction (EF), wall motion score index, LV and right ventricle (RV) function, RV size, and mitral and aortic stenosis was excellent with κ values greater than 0.80. Wall motion abnormalities had good concordance (κ value 0.78). The agreement for LV hypertrophy, mitral and aortic regurgitation was moderate, and tricuspid and pulmonary regurgitation agreements were low (κ values of 0.26 and 0.25, respectively).CONCLUSIONSIn a daily practice scenario with experienced hands, HH demonstrated good correlation for most echocardiography indications, such as ventricular size and function assessment and stenosis valve lesion analyses.

Does thrombolysis for pulmonary embolism reduce the risk of chronic complications?

We assessed the efficacy of thrombolysis in avoiding long-term complications. Notes of patients thrombolysed for PE in the 2-year period were reviewed. The initial CTPA and echocardiogram results before thrombolysis were compared to the results of follow up imaging repeated after 6 months. Twenty-two patients were thrombolysed for PE. 14 patients had sub-massive PE and 8 patients had massive PE. The right ventricle (RV) was dilated on pre-thrombolysis echocardiogram in 16 patients. On follow up echocardiography all patients with massive PE (6 studies) had a normal RV size, with pulmonary artery pressures (PAP) of 29mmHg. Follow up echocardiography of patients with submassive PE (13 studies) showed 11 patients with a normal RV, with PAP of 28 mmHg.

Evaluation of right heart functions by echocardiography and tissue Doppler imaging echocardiography in obese and non-obese patients with obstructive sleep apnea

Purpose: The aim of our study was to compare the right ventricular systolic and diastolic functions and pulmonary artery pressure (PAP) in obese and non-obese patients with obstructive sleep apnea syndrome (OSAS) by tissue Doppler imaging (TDI) echocardiography.&#x0D; Materials and Methods: This study was conducted with 69 patients, 34 obese and 35 non-obese, diagnosed moderate or severe OSAS by an overnight polysomnographic sleep study. In all patients, LV (left ventricle) and RV (right ventricle) size, left atial (LA) and RA (right atrial) dimensions, LV and RV systolic and diastolic functions and systolic PAPs were measured by M-mode, two-dimensional analysis, color flow Doppler and TDI.&#x0D; Results: RV diastolic dysfunction was detected in both groups; this impairment was significantly higher in the obese group (lateral tricuspid late diastolic myocardial annular zone velocity A'a: 0.13 ± 0.03 in non-obese patients and 0.11 ± 0.04 in obese patients). The mean systolic PAP was significantly higher in obese patients (31.2±5.6, 27.1±5.8, respectively)&#x0D; Conclusion: Obstructive Sleep Apnea Syndrome increases cardiovascular morbidity and mortality. In our study,left ventricul and right ventricul diastolic dysfunction was determined by tissue Doppler imaging in patients with moderate and severe Obstructive Sleep Apnea Syndrome. Obesity contributes to this impairment regardless of Obstructive Sleep Apnea Syndrome .

Abstract 12806: Anatomic Correlates of Systolic Anterior Motion in D-looped Transposition of the Great Arteries Post Atrial Switch

Introduction: A paucity of data exists of the anatomic-physiological mechanisms for sub-pulmonic systolic anterior motion (SAM) of the mitral valve (MV) in d-looped transposition of the great arteries post atrial switch (d-TGA/AtS). Hypothesis: The development of SAM may be inherent to the anatomy of the MV or affected by external factors such as a dilated systemic right ventricle (RV) or pectus deformity. Methods: Clinical and cardio-imaging analysis of 18 adult patients with d-TGA/AtS (Age 42±6 years old, 56% Male) between 2015-2019 was performed. Echocardiography data included mitral apparatus anatomy (Figure) and CT/MRI data included biventricular dimensions, function, and Haller index (HI). Results: Patients with leaflet SAM (n=5) compared to patients without SAM (n=13) had significantly higher MV protrusion height (2.1 ± 0.4 vs 1.5 ± 0.4 cm p ≤0.01, respectively, Table) and longer anterior MV leaflet length (3.0 ± 0.24 vs 2.6 ± 0.34 cm p ≤0.05, respectively, Table) when compared to those without. CT/MRI showed higher sub-pulmonic left ventricular ejection fraction (LVEF) in the SAM group relative to No SAM (68 ± 5 vs 54 ± 7 % p ≤0.005, respectively, Table). RV size and function, chest deformity (HI&gt;3.5), presence of a ventricular lead pacemaker, and septal thickness did not play a role in development of SAM (Table). Conclusions: An elongated mitral apparatus is associated with the development of SAM in d-TGA/AtS and the development of LVOT obstruction. Increased sub-pulmonic LVEF contributes to SAM, whereas the systemic RV dimensions, septal thickness, and degree of chest deformity do not correlate with SAM.

Subtle Right Ventricular Affection in Patients with Acute Myocardial Infarction, Echocardiographic Assessment

BACKGROUND: The right ventricle (RV) has historically received less attention than its counterpart of the left side of the heart, yet there is a substantial body of evidence showing that RV size and function are perhaps equally important in predicting adverse outcomes in cardiovascular diseases.&#x0D; AIM: The aim of our work was to evaluate incidence and impact of right ventricular (RV) affection in patients with acute left ventricular myocardial infarction subjected to primary percutaneous coronary intervention (1ry PCI).&#x0D; METHODS: The study was conducted on 80 patients who had acute left ventricle ST elevated myocardial infarction (LV STEMI) and subjected to 1ry PCI. The study was done in Cairo University, critical care department. All patients were studied within 2 days after 1ry PCI, RV function was assessed by echocardiography through tricuspid annular plane systolic excursion (TAPSE) and speckle tracking echocardiography. We excluded patients with RV infarction, moderate to severe tricuspid regurgitation, pulmonary hypertension, dilated cardiomyopathy, atrial or ventricular septal defect, and patients who had cardiac dysrhythmias.&#x0D; RESULTS: Out of 80 patients (64 men and 16 women) included in the study, 38 patients (47.5%) had TAPSE &lt;1.7 cm, and 48 patients (60%) had RV longitudinal strain less negative than −19%.There was a statistically significant relationship between RV affection and anterior STEMI, left anterior descending artery as an infarct-related artery, duration of intensive care unit stay, impairment of LV global and regional systolic function, in-hospital complications, and 1-year mortality.&#x0D; CONCLUSION: RV dysfunction is not uncommon in acute LV STEMI when using the definition of TAPSE &lt;17 cm and RV longitudinal strain less negative than −19%.There was a significant relationship between RV dysfunction and poor outcome in patients with acute LV STEMI.

Cardiac Measurements of Size and Shape in Fetuses With Absent or Reversed End-Diastolic Velocity of the Umbilical Artery and Perinatal Survival and Severe Growth Restriction Before 34 Weeks' Gestation.

The purpose of this study was to evaluate the end-diastolic size and shape of the 4-chamber view as well as the right ventricle (RV) and left ventricle (LV) in growth-restricted fetuses before 34 weeks' gestation with absent or reversed end-diastolic velocity of the umbilical artery and compare the results between those with perinatal deaths and those who survived the neonatal period. Forty-nine fetuses with growth restriction and absent or reversed end-diastolic velocity of the umbilical artery were studied. The size, shape, and sphericity index of the 4-chamber view, RV, and LV were assessed. The number and percentage of fetuses with z score values of less than -1.65 and greater than 1.65 were computed. Of the 49 fetuses, there were 13 perinatal deaths (27%) and 36 (63%) neonatal survivors. Measurements that were unique for neonatal survivors were an increased RV apical transverse width and decreased measurements of the following: LV and RV widths, LV and RV areas, as well as RV sphericity indices. Fetuses with a smaller RV and LV size and area and those with a globular-shaped RV were at significantly lower risk for perinatal death.