Tricuspid Annular Plane Systolic Excursion Values Research Articles

Detection of Cardiotoxicity Using Right Ventricular Free Wall Longitudinal Strain in Low Cardiovascular Risk Breast Cancer Patients Receiving Low-Dose Anthracycline Treatment.

Objective Breast cancer patients who receive chemotherapy may develop cancer therapy-related cardiovascular toxicity, particularly if they have pre-existing cardiovascular risk factors. Notably, right ventricle dysfunction may manifest before the left ventricle. Our study aims to compare conventional echocardiography with global longitudinal strain (GLS) in low cardiovascular risk patients on low-dose anthracycline, focusing on early cardiotoxicity detection. Additionally, we explore the predictive role of right ventricular free wall longitudinal strain (RVFWLS) in cardiotoxicity. Methods In a recent study, 28 women with low cardiovascular risk who underwent low-dose anthracycline chemotherapy for breast cancer were assessed for cardiac function using two-dimensional echocardiography and speckle-tracking echocardiography. The measurements included left ventricular ejection fraction (LVEF), right ventricular systolic function (RVS'), tricuspid annular plane systolic excursion (TAPSE), left ventricular global longitudinal strain (LVGLS), and RVFWLS. All patients had normal LVEF at the beginning of the study. Cardiotoxicity was defined as a new decrease in LVEF by 10% or below 53% and/or changes in LVGLS/RVFWLS by 15%. Results In our study, no significant changes were observed in the LVEF following chemotherapy treatment. The LVEF values remained stable, changing slightly from 63 ± 3.7 to 65.0 ± 3.4, with a t-test value of 1.790 and a p-value of 0.079. Similarly, the analysis found no significant changes in RVS' and TAPSE values following chemotherapy treatment. However, significant changes were observed in strain measurements. LVGLS decreased from -21.2 ± 2.1 to -18.6 ± 2.6 (t-test = -4.116; df = 54, p=0.001), and RVFWLS decreased from -25.2 ± 2.9 to -21.4 ± 4.4 (t-test = -3.82; df = 54, p=0.001). Notably, 35% of participants showed changes in RVFWLS greater than 15%, whereas LVGLS changed by less than 15%. This indicates that RVFWLS is more sensitive to the treatment compared to LVGLS. Conclusions The study results indicate that during the initial phases of chemotherapy treatment in low cardiovascular risk patients, early changes in strain measures reveal subclinical cardiotoxicity. This suggests that GLS measurements are more effective at detecting early signs of myocardial damage and potential deterioration in cardiac function than traditional echocardiographic parameters. Additionally, it is noteworthy that RVFWLS exhibits greater sensitivity to these changes, regardless of the chemotherapy dosage and regimen.

#5367 CLINICAL SIGNIFICANCE OF NORMO-HYDRATION STATE IN PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The assessment of fluid status in dialysis patients is of paramount importance. Managing persistent volume overload and instability during dialysis is a significant challenge, with concomitant symptomatic and asymptomatic intradialytic hypotension (IDH) that results in dialysis-induced myocardial ischemia (cardiac stunning) and long patient recovery times.Our aim was to estimate the status of hydration in our peritoneal dialysis population by body composition monitoring (BCM) device to modify our pharmacological and dialysis policy and to evaluate echocardiographic parameters of the RV functions in patients with end-stage renal disease (ESRD) undergoing PD. Method We used a Fresenius Body Composition Monitor (BCM), a whole-body bioimpedance spectroscopy (50 frequencies, 5–1,000 kHz), to assess the body composition of 35 patients on peritoneal dialysis in our centre..We measured body weight, 24 h diuresis and performed a BCM session. Analysed results of echocardiography focused on RV (tricuspid annular plane systolic excursion (TAPSE). As per statistics, comparisons between 2 groups done by students t test, Mann Whitney U test or Wilcoxon test. Correlation between data was done by Pearson or spearman correlation. And lastly categorical variables were assessed by fisher's exact, and Chi squared test. Results Average age was 47 years old (SD 9,45 t-test p = 0,1154:). Gender distribution was 54,3% of our patients were female. 8,6% of our patients were anuric, 91,4% had residual urine (more than 1 litre). TAPSE value were average 23,17 mm (±4,5).We measured over-hydration in 8 cases by BCM that followed dialysis policy modification. In 8 PD patients we measured more than 2 L volume overload (VO) with BCM followed by dialysis policy modification (fluid intake restriction, diuretic dose increasing, frequent solution exchange). Conclusion Our data raised the importance of regular echocardiography to identify it. More attention should be focused on improving BP and volume control and identifying treatment strategies that effectively lower further deterioration in PD patients. One way of doing this is monitoring with BCM. With this clinician can manage persistent overload in CAPD patients, to better modify the dialysis regime, restrict fluid intake and use diuretics, to all in all preserve LV and RV function, and to prevent deterioration of the peritoneal membrane, and most importantly improve their survival.

The predictive model of acute heart failure rehospitalization: A retrospective study in Prof. I.G.N.G Ngoerah Hospital

Introduction. Heart failure is one of the main causes of cardiovascular morbidity and mortality. Research stated that heart failure patients who have undergone 3 rehospitalizations have a survival rate of <50% within 1 year. Therefore, the purpose of this study is to characterize the risk factors that contribute to the occurrence of heart failure rehospitalization. Method. This is a retrospective analysis of 113 patients with a first hospitalization for heart failure at Prof. I.G.N.G. Ngoerah Hospital between July 2018–February 2020. We collected and compared demographic data, clinical findings, electrocardiogram, laboratory, and echocardiography parameters during the first hospitalization between rehospitalized and non-rehospitalized patients. Rehospitalization was defined as recurrent hospital admission due to worsening heart failure symptoms. Patients were followed for rehospitalization events until death or November 2021. Results. The rehospitalization rate in this study was 62.8% during a median follow-up of 234 days (12–1098 days). The average of heart failure rehospitalizations during follow-up was 1.73 times (±1.97), with an average length of stay of 6.40 days (±3.27 days). We discovered that the presence of mid/apical rales at admission (odds ratio [OR] 3.509; p=0.027), hyponatremia (<135 mmol/L) at pre-discharge (odds ratio [OR] 3.840; p=0.015), and tricuspid annular plane systolic excursion (TAPSE) values <1.80 cm (odds ratio [OR] 2.905; p=0.020) were independent risk factors for rehospitalization due to worsening heart failure symptoms. Patients with these three independent risk factors have a probability of 96.24% being readmitted. Conclusion. Mid/apical rales at admission, hyponatremia at pre-discharge, and TAPSE values <1.80 cm in patients admitted for heart failure are associated with further rehospitalization.

A Cardiac Magnetic Resonance Study: Comparison of Biventricular Longitudinal Function in Hypertrophic Cardiomyopathy Patients and Normal Individuals.

Hypertrophic cardiomyopathy (HCM) is a genetic disease with an incidence of0.2%-0.5%. It has a wide range of clinical presentations varying from coincidental diagnoses to heart failure, ventricular arrhythmias and sudden cardiac death.Mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) are M-mode-derivedpractical and reproduciblemeasurements of systolic longitudinal displacement of the annular plane. These two measuresmay be used as markers of the left ventricular and right ventricular longitudinal functions. Currently, there are only a fewstudies on cardiac magnetic resonance (CMR)-derived TAPSE and MAPSE measurement comparison between the HCM group andnormal control group. The aim of our study is to show the differences in CMR-derived TAPSE and MAPSE valuesbetween the HCM and normal population. We evaluatedCMR exams of patients diagnosed with HCM andof normal individuals scanned between 2020 and 2021 retrospectively. The patients were from our own institution's and other hospitals'in- and out-patient departments. Data was collected on36 HCMpatients and 34 adults with no known history ofcardiac and non-cardiac diseases. All CMR exams were performed on a 1.5 T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) scanner.CMR-derived MAPSE and TAPSE were measured on standard four-chamber steady-state free precession (SSFP) cine images and given in millimeters. From February 2020to December 2021, a total of 150 patients were diagnosed with hypertrophic cardiomyopathy. After exclusion, 36 patients with HCM were included in the study and the normal control group comprised 34 individuals. The mean age of the HCM groupwas 43.2+ 13.5 years, while it was 37.5 + 11.3 in the control group. The female ratio of the HCM group was found to be 36%, while it was56% in the healthy control group.MAPSEvalues were significantly higher in the normal control group when compared to the HCM patient group (MAPSE: 14.5 ± 2.9 mm vs. 11.7 ± 3.2 mm; p<0.001), while TAPSE values did not depict a significant difference between the two groups (p=0.627). This study suggests that MAPSE values are significantly lower in the HCM patient group in comparison with the normal control group on CMRscans. Although not statistically significant, TAPSE values are also lower in the HCMgroup.

Subclinical systolic dysfunction by speckle tracking echocardiography in patients with systemic lupus erythematosus.

We aimed to compare the prevalence of subclinical left ventricular systolic dysfunction in Hispanic systemic lupus erythematosus (SLE) patients versus healthy controls. This cross-sectional study included 46 SLE patients who fulfilled the 2019 European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classification criteria for SLE and with age ≥ 18years. For comparison, we included a control group with 46 non-SLE subjects matched by age (±5years) and gender. A transthoracic echocardiogram was performed on every participant. The echocardiographic measurements evaluated were left ventricular ejection fraction (LVEF), relative wall thickness (RWT), and tricuspid annular plane systolic excursion (TAPSE). Left ventricular-Global Longitudinal Strain (GLS) was evaluated, and a value higher than -18% was classified as subclinical left ventricular systolic dysfunction. Comparisons between groups were made using the Chi-square test or Fisher's exact test for qualitative variables, and Student's t-test or the Mann-Whitney's U test for quantitative variables. A p-value <.05 was considered significant. We found a significant difference in the presence of subclinical left ventricular systolic dysfunction between SLE-patients and controls (37.0% vs 8.7%, p = .001). We also found that SLE patients had a lower left ventricular GLS (-18.90% vs -20.51%, p = .011), TAPSE (21.63mm vs 23.60mm, p = .009), and LVEF (57.17% vs 62.47%, p = <.001) than controls. Systemic lupus erythematosus diagnosis was independently associated with the presence of subclinical left ventricular systolic dysfunction with an OR of 6.068 (CI 95% 1.675-21.987) (p = .006). Subclinical systolic dysfunction was more common in men (29.4% vs 3.4%, p = .020), patients with obesity (17.6% vs 0%, p = .045), or hypertension (47.1% vs 6.9%, p = .001). Systemic lupus erythematosus Hispanic patients had a higher prevalence of subclinical left ventricular systolic dysfunction, and worse left ventricular GLS, LVEF, and TAPSE values than matched healthy controls. Additionally, we found that male gender, obesity, and hypertension are associated with the presence of subclinical left ventricular systolic dysfunction in SLE patients. The inclusion of speckle tracking echocardiography as part of the cardiovascular evaluation of SLE patients may help identify high cardiovascular risk patients.

Impact of serial measurements of tricuspid annular plane systolic excursion on mortality and morbidity after heart transplantation.

The impact of right ventricular (RV) dysfunction on long-term post-HTx outcomes remains uncertain. We assessed the impact of serial measurements of Tricuspid Annular Plane Systolic Excursion (TAPSE) on post-HTx mortality and morbidity. This two-center retrospective cohort study included consecutive adult HTx recipients (2000-2017). We used multivariable extended hazard regression models to evaluate the association between TAPSE and left ventricular ejection fraction (LVEF), entered as time-dependent variables, and all-cause mortality, cardiac allograft vasculopathy (CAV), acute cellular rejection (ACR), and chronic kidney disease (CKD). TAPSE was modelled using cubic splines. We included 485 HTx recipients (9461 TAPSE measurements), median (25th- 75th percentile) 19 (10-27) mm; median age was 52 (41-59) years, and 71.3% were male. During a follow-up of 6.7 (3.0-10.8) years, 92 patients died, 225 had ACR >2R, 234 CAV, and 91 CKD. By multivariable analysis, for each 1-mm decrease in patients with a TAPSE value <15mm, mortality increased by 22% (P<.001). For the average HTx recipient with a TAPSE of 15mm, 10mm, and 6mm, 1-year mortality was 3%, 7%, and 17%, and 5-year mortality was 8%, 20%, and 43%, respectively. Reduced TAPSE was significantly associated with increased CAV but notACR and CKD. A decrease in TAPSE below 15mm represents clinically significant graft dysfunction, warranting close monitoring.

Tricuspid Annular Plane Systolic Excursion as a Potential Marker of Hospital Utilization in Patients with Sickle Cell Disease

Objective: Pulmonary Artery Hypertension (PAH) is an independent risk factor for increased morbidity in Sickle Cell Disease (SCD) patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) can be used as a surrogate measure for PAH. The objective of this study was to determine whether lower TAPSE values are associated with increased Emergency Department (ED) and hospital utilization. Methods: TAPSE measurements were retrospectively obtained from bedside echocardiograms from a convenience sample of 28 SCD patients presenting to the ED with SCD pain. TAPSE was considered abnormal if &lt;24.9mm, one standard deviation below the mean TAPSE for SCD patients. Medical records were reviewed to determine ED visits and hospital overnight stays over a two-year period. A t-test analysis and Pearson’s correlation were used for each variable. Results: The initial sample included 28 SCD patient encounters. TAPSE measurements were abnormal in 5 patients and normal in 23 patients. The mean number of ED visits/year for the abnormal and normal TAPSE group were 23.00 and 16.87, respectively (p=0.57) with moderate negative linearity (p=0.03). The mean number of hospitalized days for abnormal and normal TAPSE groups was 108.8 and 59.6, respectively (p=0.10) with moderate negative linearity (p=0.07). Conclusion: Lower TAPSE values (&lt;24.9mm) in SCD patients were associated with higher ED and hospital utilization. If findings are replicated in larger studies, TAPSE may serve as a marker of morbidity in SCD patients presenting to the ED.

Abstract 15571: Echocardiographic Characteristics and Their Association With Outcome in Hospitalized Covid-19 Patients With Cardiovascular Disease

Background: Echocardiographic characteristics and the prognostic value of echocardiographic parameters in COVID-19 patients with cardiovascular disease (CVD) remain unclear. Objectives: We aimedto describe and compare echocardiographic characteristics of hospitalized COVID-19 patients with and without CVD, and explore the prognostic value of echocardiographic parameters in COVID-19 patients with CVD. Methods: 157 consecutive hospitalized COVID-19 patients were enrolled in our study. Left ventricular (LV) and right ventricular (RV) structure and function were assessed using bedside echocardiography. Results: 89 (56.7 %) patients had underlying CVD.Compared with patients without CVD, those with CVD were more likely to havehigher levels of high-sensitivity troponin I (hs-TNI) and B-type natriuretic peptide, and higher incidence of ARDS, acute heart injury and deep vein thrombosis. During hospitalization, 23(14.6%) patients died. Mortality was significantly higher in CVD compared with non-CVD patients (22.5% vs. 4.4%, p =0.002). CVD patients had increased mitral E/e’, lower tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC), and higher pulmonary artery systolic pressure. TAPSE, RVFAC and elevated hs-TNI level were independent predictors of higher mortality.Furthermore, we found the incremental prognostic value of TAPSE over RVFAC and clinical parameters in COVID-19 patients with CVD using a likelihood ratio test, Akaike information criterion and C-index. Conclusions: COVID-19 patients with CVD displayed impaired cardiac function, which is associated with higher mortality. The additional prognostic value of TAPSE over the other clinical and echocardiographic parameters indicate that TAPSE measurement may be important for risk stratification in COVID-19 patients with CVD.

2252-PUB: Fetal Cardiac Evaluation by Ultrasound to Assess Pregnancies Complicated by Maternal Diabetes

Objectives: To evaluate fetal and neonatal cardiac morphology by echocardiography in pregnancies complicated by diabetes compared to normal healthy controls using ultrasound. Methods: Fetal echocardiography was performed in 121 women with uncomplicated singleton pregnancies and 50 women with diabetes in pregnancy. The women underwent ultrasound scans every four weeks from enrolment (between 18-28 weeks gestational age) until delivery. Neonatal echocardiography was performed on the offspring. M-mode assessment was used to assess interventricular septal (IVS) thickness, left ventricle diastolic dimensions (LVED), fractional shortening (FS), tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE). Results: There were differences in IVS thickness, LVED, FS and TAPSE values between women with uncomplicated pregnancies and women with diabetes in pregnancy. These differences persisted into the neonatal period. Conclusion: M-mode is a simple ultrasound technique to assess fetal cardiac function. Maternal diabetes was associated with increased IVS thickness, and reduction in TAPSE and FS measures. Prognostic implications of these findings may be useful in assessing pregnancies complicated by maternal diabetes in addition to current ultrasound assessment of fetal size and Doppler studies of fetal vessels. Disclosure A. Lee-Tannock: None. K. Hay: None. S. Kumar: None. Funding Mater Health Services; Australasian Society for Ultrasound in Medicine

P1678Feasibility of comprehensive multi-plane echocardiographic evaluation of right ventricular function pre-LVAD implantation - preliminary results from a single centre experience

Abstract Introduction Right sided heart failure (RVF) is recognized as a major cause of morbidity and mortality after left ventricular assist device (LVAD) implantation. Despite the publication of several risk scores and predication models, identifying patients at risk for RVF after LVAD implantation remains a challenge. The right ventricle is complex in structure and not possible to fully assess from one echocardiographic 2D plane. Our centre previously introduced a novel multi-plane approach whereby four different RV free wall segments (lateral, anterior, inferior and inferior coronal – figure 1) can be imaged from the same echocardiographic position using electronic plane rotation. Purpose The aim of the study was to determine the feasibility of using multi-plane echocardiography to quantify right ventricular function in a small cohort of advanced heart failure patients prior to LVAD implantation. Methods Twelve advanced heart failure patients underwent detailed RV assessment by multi-plane echocardiography prior to LVAD implantation (median -15 [6.3–29.8] days before). Feasibility and values of the established RV functional echo parameters tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler imaging derived tricuspid annular peak systolic velocity (TDI S') were assessed by an experienced sonographer on each of the 4 free wall segments. Mean values were calculated from an average of 3 measurements. Conventional 2D echo parameters and clinical outcome data post LVAD implantation were also collected. Results Feasibility of TAPSE and TDI measurements in all four RV free wall segments was 100%, with the exception of the inferior coronal wall (91.7% – TDI S' only). Mean 4 wall averaged TAPSE was 13.9±5.1mm, whilst mean TDI S' was 9.4±2.6cm/s. Mean TAPSE and TDI values were lower in the inferior and inferior coronal walls (13.3±5.8mm; 8.8±3.1cm/s and 10.9±5.7mm; 8.9±3.7cm/s) than those of the lateral and anterior walls (15.6±5.1mm; 9.9±2.3cm/s and 15.9±5.1mm; 10.1±2.6cm/s). The cohort was split by using a four wall averaged TAPSE value of 16mm as a cutoff. Mean 4 wall averaged TAPSE was 20.6±1.9mm in the &gt;16mm group compared to 10.5±1.7mm for the &lt;16mm group, whilst mean TDI S' was 9.4±2.6cm/s vs 7.7±0.7cm/s. Post LVAD implantation, there were 3 (25%) deaths and 6 (50%) incidences of acute kidney injury. Median length of stay in ICU and hospital was 4 (1–13.5) and 42.5 (30.3–65) days respectively. The &lt;16mm group had higher incidences of negative outcomes and longer stay in both ICU and hospital following LVAD implantation (p: 0.07). Conclusion Multi-plane echocardiographic evaluation of the right ventricle appears feasible in advanced heart failure with potential for a more comprehensive quantification of right ventricular function pre-LVAD implantation. Larger, ideally multi-centre studies are required to further assess these preliminary findings.

Serial echocardiographic changes with different body positions and sleeping side preference in heart failure patients.

The sleeping position plays an important role in overall health in both healthy individuals and heart failure (HF) patients, which complain of increasing dyspnea when adopting left lateral decubitus position (LLDP) that improves when turning over to the right lateral decubitus position (RLDP). Several theories have been proposed to explain this preference of HF patients; however, the underlying mechanisms remain unclear. We evaluated consecutive dilated cardiomyopathy (DCMP) patients with regard to whether they had a sleeping position preference and analyzed early and late left ventricular filling velocities, tissue Doppler recordings, tricuspid annular plane systolic excursion (TAPSE), and left ventricular outflow tract time-velocity integral (LVOT-TVI). Baseline echocardiographic parameters were obtained first by LLDP, followed by the supine position (SP) and finally RLDP in each position for 10minutes to ensure a stabilized hemodynamic milieu. A total of 26 DCMP patients were included in this study and a 78 echocardiographic examination performed. We detected that many HF patients preferred the right lateral decubitus sleeping position (RLDSP, 54%) and avoided from the left lateral decubitus sleeping position (LLDSP, 40%); the echocardiographic LVOT TVI and TAPSE parameters were statistically higher in RLDP compared to SP and LLDP. The echocardiographic LVOT TVI and TAPSE values as functional parameters of left and right ventricular function change with body position, and these hemodynamic changes may explain why HF patients willingly adopt RLDSP.

Assessment of acute pulmonary embolism outcome in hospital through Tricuspid Annular Plane Systolic Excursion versus Pulmonary Embolism Severity Index score

BackgroundIn-hospital mortality of acute pulmonary embolism ranging from 0 to 50%, depending upon hemodynamic status and right ventricular dysfunction. RV enlargement, in normotensive PE patients is considered as a predictor of poor clinical outcome, even in initially stable patients. Aim of the studyEvaluations of Tricuspid Annular Plane Systolic Excursion (TAPSE) as the prognostic tool for prediction of in hospital mortality in relation to the Pulmonary Embolism Severity Index (PESI) clinical risk score. Patients and methodsThis study was carried out in Dallah hospital Riyadh – Saudi Arabia including 50 patients diagnosed with APE. Those patients classified into three groups, Group I (20 patients) hemodynamically unstable, Group II (15 patients) hemodynamically stable with RV dysfunction and Group III (15 patients) hemodynamically stable with normal RV function. For all included patients TAPSE was measured, PESI risk score was calculated and recorded in the 1st day, 3rd day and 7th day of admission. ResultsReceiver operating characteristic (ROC) curve analysis of TAPSE determine that 14mm was the optimal cutoff value (AUC) 0.994, p<0.001 and for PESI determine that 124 points was the optimal cutoff value (AUC) 0.983, p<0.001. ConclusionTAPSE and PESI can be used as a good prognostic tool in acute PE during hospital course and TAPSE has higher accuracy than PESI in mortality prediction. TAPSE value ≤14mm can be used in judgment of thrombolytic therapy decision in hemodynamically stable APE patients.

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

IntroductionCardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. AimsTo identify baseline characteristics that might influence echocardiographic response to CRT. Methods and ResultsWe performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%).At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. ConclusionFrom a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response.ClinicalTrials.gov identifier: NCT02413151.

Predictors of response to cardiac resynchronization therapy: A prospective cohort study

IntroductionCardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. AimsTo identify baseline characteristics that might influence echocardiographic response to CRT. Methods and ResultsWe performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%).At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. ConclusionFrom a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response.ClinicalTrials.gov identifier: NCT02413151.

Plasma myostatin levels are related to the extent of right ventricular dysfunction in exacerbation of chronic obstructive pulmonary disease

Objective: To investigate the relationship between plasma myostatin levels and right ventricle (RV) dysfunction (RVD) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods: The study recruited 84 patients with AECOPD. Plasma myostatin was analyzed and tricuspid annular plane systolic excursion (TAPSE) < 16 mm was used as the main indicator for RVD.Results: Plasma myostatin levels were significantly higher in 47 patients with RVD than 37 ones without (P < 0.005). Multivariate regression analysis revealed that myostatin levels correlated significantly with TAPSE values and RV myocardial performance index (p < 0.001) among the study patients.Conclusion: Plasma myostatin is a potential biomarker for improving diagnosis of RVD in AECOPD.

The Effect of Tonsillectomy and Adenoidectomy on Right Ventricle Function and Pulmonary Artery Pressure by Using Doppler Echocardiography in Children.

ObjectivesThe purpose of the present study is to emphasize the efficacy of the myocardial performance index and tricuspid annular plane systolic excursion (TAPSE) in the determination of impaired cardiac functions and recovery period following the treatment in children with adenoid and/or tonsillar hypertrophy.MethodsFifty-three healthy children after routine laboratory, imaging and clinical examinations, with adenoid and/or tonsillar hypertrophy were evaluated before and 3 months after adenotonsillectomy for cardiac functions using M mode and Doppler echocardiography.ResultsThe mean age of cases was 6.4±3.0 years, 34 (65%) were male, and 19 (35%) were female. Pulmonary hypertension was observed to be mild in 3 patients and moderate in 1 patient preoperatively. When the preoperative and postoperative echocardiographic measurements of the patients were compared, the tricuspid valve E wave velocity, the E/A ratio (E, early diastolic flow rate; A, late diastolic flow rate), and the TAPSE values were determined to be significantly higher postoperatively (P<0.05). The tricuspid valve deceleration time, the isovolumetric relaxation time and the systolic pulmonary artery pressure were found to be significantly lower compared to the preoperative values (P<0.05).ConclusionAdenoidectomy and/or tonsillectomy may prevent cardiac dysfunctions that can develop in the later periods due to adenoid and/or tonsil hypertrophy in children, before the appearance of the clinical findings of cardiac failure.

197 Right ventricular function in Ukrainian children with cystic fibrosis

Objectives To evaluate the function of right heart using Tricuspid Annular Plane Systolic Excursion (TAPSE) measurement in relation to age, compliance, clinical and paraclinical parameters in Ukrainian children with cystic fibrosis. Methods The study includes 30 children with median age 10 years (range 1.3–18 years). The analysis of variances of multiple linear regression models that contained body surface area as a covariate was used to evaluate relationships between TAPSE and other parameters. The obtained regression coefficients with their standard errors are reported. Results The values of TAPSE in children with cystic fibrosis were in the normal range, but they were moving to lower percentiles with the age increase. Decreasing of TAPSE correlated with decreasing of oxygen saturation (SaO 2 ) (b = 0.35±0.12, p=0.0088), but was not related to the level of hemoglobin (p = 0.62), BMI (p = 0.88), VC% (p = 0.78), FEV1% (p = 0.80) and compliance (p = 0.82). There was some tendency of TAPSE decrease with increasing disease severity (lowering patient group in Shwachman–Kulczycki scale; b=0.63±0.32, p=0.063), and with worsening of chest X-ray scores (Brasfield scale; b=–0.10±0.07, p=0.19). Conclusion Contractile function of right ventricular in children with cystic fibrosis while being in normal range shows signs of deterioration. It is moderately correlated with SaO 2 , disease severity and chest X-ray data and it doesn't correlate with other clinical and paraclinical parameters.

Right ventricular systolic function of patients with pneumoconiosis based on the evaluation of systolic displacement of tricuspid annulus

To determine the tricuspid annular plane systolic excursion (TAPSE) using M-mode echocardiography, and to evaluate the right ventricular systolic function in patients with pneumoconiosis. One hundred and eighty-three patients with pneumoconiosis were enrolled as subjects, and one hundred and ninety-nine healthy volunteers were used as controls. According to the types of ventilation dysfunction, patients were divided into four groups: normal type, obstructive type, restrictive type, and mixed type. In the apex four-chamber sections, the displacement of tricuspid annular plane on the right ventricular free wall side was measured from end-diastole to end-systole using M-mode echocardiography. The average TAPSE in the pneumoconiosis group was significantly lower than that in the control group (18.61 ± 3.08 vs 22.38 ± 3.03 mm, P < 0.01). Along with the progression of pneumoconiosis, the TAPSE values in patients with stage I, II, and III pneumoconiosis were significantly decreased compared with those in the control group (P < 0.01). The TAPSE values in patients diagnosed with normal, obstructive, restrictive, and mixed types of pneumoconiosis in pulmonary function tests were all significantly lower than those in the control group (P < 0.01). Among all patients, patients with mixed type of pneumoconiosis had the most significant reduction in the TAPSE. The TAPSE is substantially decreased in patients with pneumoconiosis and further decreased along with the progression of pneumoconiosis. Measurement of the TAPSE is an easy way to evaluate the right ventricular systolic function in patients with pneumoconiosis.

Assessment of interventricular systolic relationship and infarct location in acute myocardial infarction

Background Longitudinal motion of the mitral valve, known as the mitral annular plane of systolic excursion (MAPSE), correlates well with LV systolic function. Similarly, tricuspid annular plane systolic excursion (TAPSE) correlates well with RV systolic function. Echocardiographically, the absolute value of TAPSE was greater than MAPSE, by 54.5% in a recent study of normal subjects and the MAPSE/TAPSE ratio is 0.66±0.14 (1). However, the interventricular systolic relationship has not been accurately defined in the presence of regional wall motion abnormalities. We hypothesised that the interventricular systolic relationship, measured by the ratio of averagedMAPSE and TAPSE, changes in the presence of acute myocardial infarction with regional wall motion abnormality.

Abstract 19512: Right Ventricular Global Longitudinal Strain Improves Diagnostic and Prognostic Assessment in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable cardiomyopathy characterized by right ventricular (RV) myocardium dysfunction leading to RV failure and fatal arrhythmias. Hypothesis: RV global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography (2DSTE) contributes to diagnostic and prognostic assessment in ARVC. Methods: We retrospectively evaluated the echocardiographic data of 67 patients referred with suspected ARVC and 27 age- and gender-matched healthy controls (Group C). Of 67 suspected ARVC patients, 34 patients (Group A) were diagnosed as ARVC, while remaining 33 patients (Group B) were not diagnosed due to not meeting criteria. Tricuspid annular plane systolic excursion (TAPSE), RV end-diastolic and end-systolic area (RVEDA, RVESA), RV fractional area change (RVFAC) and GLS were measured to assess the RV function. Outcome was assessed according to death and hospitalization with heart failure, fatal arrhythmia and appropriate defibrillator shock. Results: Patients in Group A had significantly reduced values of TAPSE, RVFAC and GLS, and significantly greater vales of RVEDA and RVESA in comparison among 3 groups. In Group A, 11 adverse cardiac events were observed during averaged 718 follow-up days. Multivariate Cox’s regression analysis showed that GLS was an independent prognostic factor. Kaplan-Meier survival analysis revealed there was a significant difference in outcome between patient groups divided by the median value (11%) of GLS in Group A. Conclusions: GLS in RV may be a tool to assist in diagnosis of ARVC, and be a superior prognostic factor in ARVC patients.