Tricuspid Annular Systolic Velocity Research Articles

Multi-plane echocardiographic assessment of right ventricular function in adults with repaired Tetralogy of Fallot

In patients with repaired Tetralogy of Fallot (ToF), detailed assessment of right ventricular (RV) function is important for management and timing of possible pulmonary valve re-intervention. The aim of this study was to evaluate RV function using two-dimensional multi-plane echocardiography (2D MPE), a novel four-wall imaging method obtained from one apical acoustic window utilising electronic plane rotation. In sixty-two ToF patients (aged - 28 [22, 39] years, 65% male), systolic function of four different RV walls (lateral, anterior, inferior and inferior coronal) were evaluated using MPE. Tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (RV-S′) and RV wall longitudinal strain (RV-LS) measurements were compared with those of matched healthy individuals. 2D MPE measurements were highly feasible across the four RV walls (93.5–100% for TAPSE/S′; 66.1–95.1% for RVLS) and could be performed more reliably than 3D RV ejection fraction (RVEF − 56.5%). All functional values were significantly reduced when compared to the control group (p < 0.001). Higher RV-LS values were seen in the lateral (− 17.8 ± 4.5%) and inferior (− 17.8 ± 4.2%) walls compared to the anterior (− 15.9 ± 3.8%) and inferior coronal (− 15.1 ± 3.9%) walls. 3D RVEF correlated strongest with RV-LS values from the lateral (r − 0.50; p = 0.002) and anterior walls (r − 0.74; p < 0.001) and furthermore the four-wall average (r − 0.57; p = 0.001). 2D MPE evaluation of the RV is highly feasible in ToF patients. This novel method provides new insights into regional RV wall function, enabling a more comprehensive and quantitative approach to RV assessment in daily clinical practice.

Right Ventricular Function and Region-Specific Adaptation in Athletes Engaged in High-Dynamic Sports: A Meta-Analysis.

Structural remodeling of the right ventricle (RV) is widely documented in athletes. However, functional adaptation, including RV pressure generation and systolic free-wall longitudinal mechanics, remains equivocal. This meta-analysis compared RV pressure and function in athletes and controls. A systematic review of online databases was conducted up to June 4, 2020. Meta-analyses were performed on RV systolic pressures, at rest and during exercise, tricuspid annular plane systolic displacement, myocardial velocity (S'), and global and regional longitudinal strain. Bias was assessed using Egger regression for asymmetry. Data were analyzed using random-effects models with weighted mean difference and 95% CI. Fifty-three studies were eligible for inclusion. RV systolic pressure was obtained from 21 studies at rest (n=1043:1651; controls:athletes) and 8 studies during exercise (n=240:495) and was significantly greater in athletes at rest (weighted mean difference, 2.9 mmHg [CI, 1.3-4.5 mmHg]; P=0.0005) and during exercise (11.0 [6.5-15.6 mm Hg]; P<0.0001) versus controls. Resting tricuspid annular plane systolic displacement (P<0.0001) and S' (P=0.001) were greater in athletes. In contrast, athletes had similar RV free-wall longitudinal strain (17 studies; n=450:605), compared with controls but showed greater longitudinal apical strain (16 studies; n=455:669; 0.9%, 0.1%-1.8%; P=0.03) and lower basal strain (-2.5% [-1.4 to -3.5%]; P<0.0001). Functional RV adaptation, characterized by increased tricuspid annular displacement and velocity and a greater base-to-apex strain gradient, is a normal feature of the athlete's heart, together with a slightly elevated RV systolic pressure. These findings contribute to our understanding of RV in athletes and highlight the importance of considering RV function in combination with structure in the clinical interpretation of the athlete's heart.

Effect of Levosimendan on Ventricular Systolic and Diastolic Functions in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials.

Levosimendan, a calcium sensitizer, exerts inotropic action through improving left ventricular ejection fraction. We noticed that only few clinical studies are published in which the effects of levosimendan on cardiac function are studied by echocardiography. When screening the literature (PubMed, Embase, and CENTRAL, from inception to August 2020), we found 29 randomized controlled trials on levosimendan containing echocardiographic data. We included those studies, describing a total of 574 heart failure patients, in our meta-analysis and extracted 14 ultrasonic parameters, pooling the effect estimates using a random-effect model. Our analysis of the diastolic parameters of the left ventricle shows that levosimendan reduce the early/late transmitral diastolic peak flow velocity ratio [standardized mean difference (SMD) -0.45 to 95% confidence interval (CI) (-0.87 to -0.03), P = 0.037] and E/e' (e': mitral annulus peak early diastolic wave velocity using tissue-doppler imaging) [SMD -0.59, 95% CI (-0.8 to -0.39), P < 0.001]. As it regards the systolic parameters of the right ventricle, levosimendan increased tricuspid annular plane systolic excursion [SMD 0.62, 95% CI (0.28 to 0.95), P < 0.001] and tricuspid annular peak systolic velocity [SMD 0.75, 95% CI (0.35 to 1.16), P < 0.001], and reduced systolic pulmonary artery pressure [SMD -1.02, 95% CI (-1.32, -0.73), P < 0.001]. As it regards the diastolic parameters of the right ventricle, levosimendan was associated with the decrease of Aa (peak late diastolic tricuspid annular velocity using tissue-doppler imaging) [SMD -0.38, 95% CI (-0.76 to 0), P = 0.047] and increase of Ea (peak early diastolic tricuspid annular velocity using tissue-doppler imaging) [SMD 1.03, 95% CI (0.63 to 1.42), P < 0.001] and Ea/Aa [SMD 0.86, 95% CI (0.18 to 1.54), P = 0.013]. We show that levosimendan is associated with an amelioration in the diastolic and systolic functions of both ventricles in heart failure patients.

Right Ventricular Pulmonary Artery Coupling and Mortality in Cardiac Intensive Care Unit Patients.

BackgroundImpaired right ventricular (RV) pulmonary artery coupling has been associated with higher mortality in patients with chronic heart disease, but few studies have examined this metric in critically ill patients. We sought to evaluate the association between RV pulmonary artery coupling, defined by the ratio of tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP), and mortality in cardiac intensive care unit patients.Methods and ResultsUsing a database of unique cardiac intensive care unit admissions from 2007 to 2018, we included patients with TASV/RVSP ratio measured within 1 day of hospitalization. Hospital mortality was analyzed using multivariable logistic regression, and 1‐year mortality was analyzed using multivariable Cox proportional‐hazards analysis. We included 4259 patients with a mean age of 69±15 years (40.1% women). Admission diagnoses included acute coronary syndrome in 56%, heart failure in 52%, respiratory failure in 24%, and cardiogenic shock in 12%. The mean TASV/RVSP ratio was 0.31±0.14, and in‐hospital mortality occurred in 7% of patients. Higher TASV/RVSP ratio was associated with lower in‐hospital mortality (adjusted unit odds ratio, 0.68 per each 0.1‐unit higher ratio; 95% CI, 0.58–0.79; P<0.001) and lower 1‐year mortality among hospital survivors (adjusted unit hazard ratio, 0.83 per each 0.1‐unit higher ratio; 95% CI, 0.77–0.90; P<0.001). Stepwise decreases in hospital and 1‐year mortality were observed in each higher TASV/RVSP quintile. The TASV/RVSP ratio remained associated with mortality after adjusting for left ventricular systolic and diastolic function.ConclusionsA low TASV/RVSP ratio is associated with increased short‐term and long‐term mortality among cardiac intensive care unit patients, emphasizing importance of impaired RV pulmonary artery coupling as a determinant of poor prognosis. Further study is required to determine whether interventions to optimize RV pulmonary artery coupling can improve outcomes.

Longitudinal Associations of Fitness and Obesity in Young Adulthood With Right Ventricular Function and Pulmonary Artery Systolic Pressure in Middle Age: The CARDIA Study.

BackgroundLow cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood.Methods and ResultsParticipants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow‐up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow‐up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable‐adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow‐up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age.ConclusionsHigher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age‐related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.

Phase 2 Clinical Study to Evaluate the Efficacy and Safety of Inhaled GB002 for the Treatment of World Health Organization Group 1 Pulmonary Arterial Hypertension

Purpose Despite currently available therapy, the morbidity and mortality of pulmonary arterial hypertension (PAH) remains high. PAH is characterized by abnormal proliferation of pulmonary arterial smooth muscle cells, endothelial cells, and myofibroblasts. GB002 is a unique, highly potent, small molecule that targets PDGFRα/β, CSF1R, and c-KIT and modulates BMPR2, kinases implicated in the development of PAH. GB002 is formulated for inhalation delivery to directly target the diseased lung to limit systemic exposure and thereby potentially improve efficacy and tolerability. A Phase 2 study has been initiated to evaluate the efficacy and safety of inhaled GB002 in adult subjects with World Health Organization (WHO) Group 1 PAH. (NCT04456998). Methods This is a randomized, double-blind, placebo-controlled study. Patients with Functional Class II/III PAH on therapy and with a pulmonary vascular resistance (PVR) greater than or equal to 400 dyne•s/cm5 will be eligible. The planned treatment period is 24 weeks, with a target enrollment of 80 patients. Endpoints The primary endpoint is change in PVR measured by right heart catheterization from baseline to 24 weeks. The key secondary endpoint is change (baseline to 24 weeks) in 6-minute walk test (6MWT). Exploratory endpoints include quality of life, change in risk score, time to clinical worsening, and the following echocardiographic parameters: tricuspid annular systolic velocity, right ventricular (RV) Tei index and right ventricular free wall strain (RVFWS). Sub-studies include 6MWT heart rate expenditure change from baseline to 24 weeks, and changes in pulmonary arterial blood volume measured by CT imaging (baseline to 24 weeks). An Independent Data Monitoring Committee (IDMC) will ensure that benefits and risks remain acceptable during the conduct of the study. In this phase 2 study, the effects of GB002 on hemodynamics, 6MWT and other endpoints at 24 weeks will be assessed. Exploratory biomarkers will be evaluated for target engagement and response to treatment.

Right ventricular functions can predict left ventricular reverse remodeling in patients with ischemic cardiomyopathy after revascularization

Background: Left Ventricular reverse remodeling is a major indicator of functional improvement in patients with ischemic cardiomyopathy undergoing revascularization. We aimed at investigating the ability of right ventricular functions to predict left ventricular reverse remodeling (LVRR) in those patients. Patients and methods: Subjects presented with ICM (n=52) were included and underwent right ventricular (RV) functions assessment. By the end of study patients were divided into two groups depending on positive LVRR response defined as ≥15% decrease in LV end-systolic volume (LVESV). Group 1 (n=28) with positive LVRR and group 2 (n= 24) without. Results: A significant difference between the two groups regarding right ventricular systolic tricuspid annular velocity (RV S'), RV myocardial performance index (RV MPI), RV free wall strain (RVFWS) and RV global longitudinal strain (RV GLS) was noticed. RV GLS was superior to RVFWS in prediction of LVRR (AUC difference of 0. 12, P=

Noninvasive Assessment of Right Ventricle Function and Pulmonary Artery Pressure Using Transthoracic Echocardiography in Women With Pre-Eclampsia: An Exploratory Study.

Background and objectivePre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC.Materials and methodsWe conducted a case-control study at a tertiary care academic center. Ten early PEC (<34-week gestation) and nine late PEC (≥34-week gestation) patients with 11 early and 10 late gestational age-matched controls were enrolled. Two-dimensional TTE was performed on all patients. The estimated mean PA pressure (eMPAP) was calculated based on PA acceleration time (PAAT). PVR was estimated from eMPAP and RV cardiac output (RV CO). RV myocardial performance index (RV MPI), tricuspid annular plane systolic excursion (TAPSE), tissue tricuspid annular displacement (TTAD), and lateral tricuspid annular tissue peak systolic velocity (S’) were measured.ResultsCompared to early controls, in early PEC, the eMPAP and estimated PVR (ePVR) were elevated, PAAT was reduced, RV MPI was increased, TTAD was reduced, and TAPSE and TV S’ were unchanged. Compared to late controls, in late PEC, the eMPAP and ePVR were elevated, PAAT was reduced, and RV MPI was increased, while TAPSE, TTAD, and TV S’ were unchanged.ConclusionsIn a sample of women with PEC, early PEC was found to be associated with increased eMPAP and ePVR and subclinical decrement of RV function as assessed by TTE. TTE may be a useful noninvasive screening tool for early detection of pulmonary hypertension and RV dysfunction in PEC. An adequately powered longitudinal study is needed to determine the implications of these findings on long-term outcomes.

Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

Detection of persistent systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot patients with preserved ejection fraction: a CMR feature tracking study.

A fast cardiovascular magnetic resonance (CMR) feature tracking was applied to assess ventricular systolic and diastolic function. This study sought to detect right ventricular (RV) systolic and diastolic abnormalities in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients with preserved RV ejection fraction (EF). One hundred asymptomatic pediatric rTOF patients with preserved RVEF ≥ 45% and 52 control subjects underwent cine CMR examinations. Tricuspid annular plane systolic excursion (TAPSE); peak tricuspid annular systolic (Sm), early diastolic (Em), and late diastolic (Am) velocities; and biventricular global radial (GRS), circumferential (GCS), and longitudinal strains (GLS) were analyzed using CMR feature tracking. TAPSE, Sm, Em, Am, and RV GLS were significantly lower in rTOF patients compared with controls (all p < 0.01). The lower limits (mean-2·standard deviations) of TAPSE, Sm, Em, and Am among controls were 10.9 mm, 6.3 cm/s, 8.9 cm/s, and 2.4 cm/s, respectively, and 78%, 75%, 75%, and 19% of rTOF patients had corresponding measurements below these thresholds. Among rTOF patients, RV GLS was significantly lower in females than in males (p < 0.05). Despite preserved RVEF, there was a high prevalence of RV systolic and diastolic dysfunction among pediatric rTOF patients, which was detected using fast CMR feature tracking. • There was high prevalence of systolic and diastolic dysfunction in asymptomatic pediatric repaired tetralogy of Fallot (rTOF) patients despite preserved right ventricular (RV) ejection fraction (EF). • Significant correlations were observed between right ventricular (RV) measurements (strains, tricuspid annular plane systolic excursion (TAPSE), peak tricuspid annular early diastolic velocity (Em), peak tricuspid annular late diastolic velocity (Am)), and left ventricular (LV) strain measurements, which indicates ventricular-ventricular interactions at systolic and diastolic function level. • Right ventricular (RV) global longitudinal strain (GLS) was lower in female repaired tetralogy of Fallot (rTOF) patients than in males, suggesting females with rTOF may be at a higher risk of developing RV systolic dysfunction than males.

Assessment of Right Ventricular Function in Patients with Cor Pulmonale: Strain Imaging Study

Background: Cor pulmonale is one of the leading causes of heart failure. Speckle tracking echocardiography is a potential modality for evaluation of systolic and diastolic functions, myocardial mechanics and other cardiac pathophysiological processes. Objective: This study aims to assess the right ventricular (RV) function in patients with cor pulmonale using Strain Imaging and conventional echocardiography. Methods: Fifty patients with cor pulmonale compared to twenty age and sex matched controls selected for echocardiographic examination for assessment of RV indices; Pulmonary Artery Systolic Pressure (PASP), Tricuspid Annular systolic Excursion (TAPSE), Fractional Area Change (FAC), Tissue Doppler Imaging (TDI), Strain and Strain rate of RV free wall in addition to conventional left ventricular data. Results: TAPSE (1.4±0.16 vs 2.3±0.31 cm), RV FAC (30.5±4.3% vs 47.2±4.5%), PASP (60.98±15.6 vs 18.9±5.41 mmHg) and Systolic velocity of tricuspid annulus S' (8.9±1.4 vs 13.4±1.9 cm/sec) were significantly impaired in patients vs controls respectively with p<0.001 for all. Also, The global RV free wall peak systolic longitudinal strain (ε sys) for patients was 16.9±3.4% vs 25.2±2.9%, The RV free wall systolic strain rate (S^-1 s) was 0.98±0.18 vs 1.7±0.18, RV free wall early diastolic strain rate (S^-1 e) was 1.2±0.25 vs 1.92±0.28 and RV free wall late diastolic strain rate (S^-1 a) was 1.11±0.27 vs 1.8±0.21 with (p<0.001 for all). The RV free wall systolic Longitudinal Strain (ε sys) was negatively correlated with PASP (r=-0.950, p<0.001) and positively correlated with TAPSE, RV FAC and Systolic velocity of tricuspid annulus S' (r=0.635, r=0.919, r=0.890 respectively with p<0.001 for all). Conclusion: Strain and Strain Rate are reliable tools to assess systolic and diastolic functions of the RV in patients with cor pulmonale even at early disease stages and correlate well with other conventional echo parameters for RV assessment.

Prognostic value of early alteration of right ventricular longitudinal function after aortic valve replacement

Evaluate the effect of early postoperative decline in right ventricular longitudinal function on mid term prognosis after aortic valve replacement for severe aortic stenosis. The study was prospective observational, including all consecutive patients referred for severe aortic stenosis necessitating aortic valve replacement. Were excluded patients with decreased left ventricular ejection fraction (< 50%) and those with paradoxical low flow low gradient aortic stenosis. Right ventricular longitudinal function was assessed by tricuspid annular plane systolic excursion (TAPSE) and peak systolic velocity of tricuspid annulus (S). These parameters were assessed at 2 weeks and 1 year after aortic valve replacement and were considered abnormal if TAPSE < 16 mm ans S < 11.5 cm/s. The primary end point was composite of death or hospitalization for cardiac causes. 242 patients were included between 2013 January and 2017 December, with a mean age of 74 ± 11.6 years and 60.3% of men. Longitudinal right ventricular function was decreased in 143 patients (59.1%) at 2 weeks after surgery, with an incomplete but significant recovery 1 year after aortic valve replacement. After a median follow up of 2.9 ± 2.3 years, there wasn’t a significant association between early alteration of longitudinal right ventricular function and death or hospitalization for cardiac causes ( P = 0.38 by log-rank test). Early decrease in the parameters of longitudinal right ventricular function after aortic valve replacement for aortic stenosis doesn’t impact the mid term outcome.

Nonselective versus selective His bundle pacing: An acute intrapatient speckle‐tracking strain echocardiographic study

We aimed to compare the acute differences in left ventricular (LV) function and mechanical synchrony during nonselective His bundle pacing (ns-HBP) versus selective His bundle pacing (s-HBP) using strain echocardiography. Consecutive patients with permanent His bundle pacing, in whom it was possible to obtain both s-HBP and ns-HBP, were studied in two centers. In each patient, echocardiography was performed sequentially during s-HBP and ns-HBP. Speckle-tracking echocardiography parameters were analyzed: Global longitudinal strain (GLS), the time delay between peak systolic strain in the basal septaland basal lateral segments (BS-BL delay), peak strain dispersion (PSD) and strain delay index. Right ventricle function was assessed using tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of the lateral tricuspid annulus (S'). A total of 69 patients (age: 75.6 ± 10.5 years; males: 75%) were enrolled. There were no differences in LV ejection fraction and GLS between s-HBP and ns-HBP modes: 59% versus 60%, and -15.6% versus -15.7%, respectively; as well as no difference in BS-BL delay and strain delay index. The PSD value was higher in the ns-HBP group than in the s-HBP group with the most pronounced difference in the basal LV segments. No differences in right ventricular function parameters (TAPSE and S') were found. The ns-HBP and s-HBP modes seem comparable regarding ventricular function. The dyssynchrony parameters were significantly higher during ns-HBP, however, the difference seems modest and clarification of its impact on LV function requires a larger long-term study.

Cardiac hemodynamic disorders in patients with active chronic viral hepatitis and the effectiveness of antiviral therapy

Aim. To study cardiac hemodynamic disorders in patients with chronic viral hepatitis (CVH) and evaluate the effectiveness of antiviral therapy (AVT).Material and methods. Seventy-nine patients with CVH (mean age, 38,6 years, disease duration, 4,7 years) were examined. The patients were divided into two groups: group 1 (n=42) — normal level of alanine aminotransferase (ALT), group 2 — ALT 3-10 times higher than normal (n=37). Fourteen patients with CVH underwent AVT. Control group consisted of 23 people. Doppler echocardiography was performed. Statistical processing was carried out using Statistica 10.0.Results. In patients with active hepatitis, atrial volume, end diastolic volume, left ventricular (LV) mass index, LV stroke volume increased, and the tricuspid (TC) annular systolic velocity decreased in comparison with the control and 1st groups. In patients with normal ALT levels, the left atrial volume index increased by 8% in comparison with control group. Concentric remodeling was the predominant variant of LV remodeling in patients with active hepatitis. In patients with active hepatitis, LV lateral wall, interventricular septal (IVS), and TC Em/Am ratio decreased. LV diastolic dysfunction was reported in 12 patients with active and 3 patients with inactive CVH. After AVT, left atrium (LA) volume, IVS thickness, LV mass decreased, while TC and mitral annular systolic velocity increased. The viral load has a relationship with mitral annular systolic velocity (r=0,91, p=0,001) and LV mass (r=0,64, p=0,05).Conclusion. In patients with active hepatitis, along with LV and LA dilatation and hypertrophy, a relative right atrial increase, a decrease in the right ventricular longitudinal systolic velocity, and the formation of biventricular diastolic dysfunction develop. In patients with inactive hepatitis, only the left atrial volume increased. The established correlations indicate possible LV damage. Antiviral therapy has a beneficial effect on the main structural and functional cardiac parameters.

Abstract 15733: CD34 + Cell Therapy is Associated With Improved Right Ventricular Function in Heart Failure With Preserved Ejection Fraction

Introduction: Right ventricular (RV) dysfunction is an important predictor of adverse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Hypothesis: We sought to investigate the effects of transendocardial CD34 + cell therapy on RV function in HFpEF patients. Methods: We enrolled 30 patients with HFpEF who underwent transendocardial CD34 + cell transplantation. At baseline, all patients received granulocyte-colony stimulating factor; cells were collected by apheresis and immunomagnetic selection and injected transendocardialy in the left ventricle targeting the areas of local diastolic dysfunction. Patients were followed for 6 months and changes in RV function were assessed by tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (St), and fractional area change (FAC). Impaired RV function was defined as TAPSE&lt;1.8 cm. Results: At baseline, RV function was impaired in 11 (37%, Group A), and preserved in 19 (63%, Group B) of patients. The groups did not differ in age (64±6 years in Group A vs. 61±11 years in Group B, P=0.37), gender (male: 82% vs. 74%, P=0.61), or left ventricular E/e' (17.7±2.3 vs. 17.3±3.4, P=0.74). Patients in Group A had lower LVEF (55.6±5.1% vs. 61.3±6.5% in Group B, P=0.02), and higher NTproBNP levels (1750±1139 pg/ml vs. 1038±658 pg/ml, P=0.05). At 6 months after cell transplantation we found an overall improvement in all parameters of RV function (TAPSE: +0.21±0.37 cm, P=0.01; St: +0.7±2.1 cm/s, P=0.03; FAC: +8.5±1.9%, P=0.02). However, RV function improvement was significant in Group A (TAPSE: +0.43±0.37 cm, P=0.004; St: +1.4±2.3 cm/s; P=0.01; FAC: +9.8±2.0%, P=0.01), but not in Group B (TAPSE: +0.04±0.27 cm, P=0.65; St: +0.4±1.3 cm/s, P=0.32; FAC: +7.1±3.7%, P=0.08). In both groups we found comparable changes in E/e' (-5.1±3.0 in Group A vs. -5.9±3.2 in Group B, P=0.53), LVEF (1.2±5.7% vs. 1.9±6.5%, P=0.45) and NTproBNP (-462±410 pg/ml vs. -390±398 pg/ml, P=0.64) at 6 months after cell transplantation. Conclusions: Transendocardial CD34 + cell therapy appears to be associated with improvement of right ventricular dysfunction in patients with HFpEF.

Effects of the MitraClip on right heart function and tricuspid valve regurgitation

Abstract The MitraClip has been established as a therapeutic option for patients with symptomatic mitral regurgitation (MR) and increased risk of Surgery. MR is often combined with a decrease in right heart function due to the volume and pressure overload it leads to. The effects of MR reduction by MitraClip on right heart function is currently not adequately determined. The study further addresses the question of whether and when it makes sense to correct combined tricuspid regurgitation (TR). Methods All Patients that took part in this study underwent 2D and 3D Echocardiography before MitraClip implantation as well as six months afterwards. RV Function was evaluated through 4 Parameters: Tricuspid annular plane systolic excursion (TAPSE) in mm, tricuspid annular systolic velocity (TASV) in cm/s, right ventricular fractional area change (RVFAC) in % and myocardial performance index (MPI). Estimated right ventricular systolic pressure (RVSP) in mmHg was used as evidence for the presence of pulmonic Hypertension. Further Parameters determined the severity of TR and the dimensions of the right ventricle (RV) and atrium (RA) in cm respectively the volume in ml. Results 60 Patients were recruited (63% male, Age 81.4±7.1). Six Months (±3) after MitraClip implantation a significant improvement in right heart parameters was noticed. Most of the parameters used in this study showed a significant change. (TASV 9.3±2.4 vs. 10.5±2.6, p=0.01), (RVFAC 33.1±10.9 vs. 39.0±9.6, p&amp;lt;0.05). TAPSE showed an improvement by trend (16.1±4.6 vs. 17.4±4.8, p=0.06). RVSP showed a significant decrease (51.9±12.3 vs. 44.6±13.4, P&amp;lt;0.05). However, Dimensions and Volume of the right atrium and ventricle showed no significant change. On the other hand, the average TR severity has noticeably declined after 6 months (2.1±0.7 vs. 1.6±0.6, p&amp;lt;0.05). Flow Convergence and Vena contracta of Tricuspid regurgitation also demonstrated a significant reduction (Flow Convergence 7.6±4.5 vs. 5.9±2.5, P=0.01), (Vena contracta 6.8±2.5 vs. 5.4±1.9, p&amp;lt;0.05). Conclusion MitralClip leads to a reduction in Mitral regurgitation which leads to a significant improvement in the right heart parameters, especially the RV Function. A noticeable decrease in the TR severity was often seen as an accompanying effect. An initially wait-and-see approach to a residual TR appears justified. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Heart Center University Clinic Dresden, Germany

Right ventricular morphology and function undergo complex changes after cardiac surgery

Abstract Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 122 patients (92 men, mean age 65±11 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2±2 days prior to surgery (TTE1), and 7±4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12±2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function (such as TAPSE, systolic velocity of tricuspid annulus (S'), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS), as well as a new parameter introduced by our team - RV shortening fraction (RV SF), calculated as the change in mid RV transverse diameter. Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S' and GLS; p&amp;lt;0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. Additionally during the postoperative period an increase in the value of a RV SF by 12.85% was observed. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function. Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Grant Polish Cardiac Society

Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study

Abstract Introduction Being born at very low birth weight (VLBW, &amp;lt;1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts. Purpose To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls. Methods The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight &amp;lt;1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained. Results VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different. Conclusion Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction. Graph 1 Funding Acknowledgement Type of funding source: None

Right atrial mechanics by strain echocardiography in chronic thromboembolic pulmonary hypertension

Abstract Introduction Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial. Purpose We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH. Methods A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC. Results There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p&amp;lt;0,001), and in a multivariate linear regression model, RASr was an independent predictor of Log-transformed BNP values (β=−0.448, 95% CI: −0.046 to −0.009; p=0.005). There was no correlation between RASr and the percentage of obstruction in V/Q SPECT (r=0.164, p=0.388). Conclusion 2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH. Right atrial strain components Funding Acknowledgement Type of funding source: None

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281–2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72–88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.