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Jani VP, Strom JB, Gami A, Beussink-Nelson L, Patel R, Michos ED, Shah SJ, Freed BH, Mukherjee M. Optimal Method for Assessing Right Ventricular to Pulmonary Arterial Coupling in Older Healthy Adults: The Multi-Ethnic Study of Atherosclerosis. Am J Cardiol 2024; 222:11-19. [PMID: 38643925 DOI: 10.1016/j.amjcard.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024]
Abstract
Right ventricular (RV) to pulmonary arterial (PA) coupling describes the ability of the RV to augment contractility in response to increased afterload. Several echocardiographic indexes of RV-PA coupling have been defined; however, the optimal numerator in the coupling ratio is unclear. We sought to establish which of these ratios is best for assessing RV-PA coupling based on their relations with 6-minute walk distance (6MWD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the Kansas City Cardiomyopathy Questionnaire (KCCQ) in aging adults. In this study of 1,611 Multi-Ethnic Study of Atherosclerosis participants who underwent echocardiography at Exam 6, we evaluated the association between different numerators, including tricuspid annular planar systolic excursion (TAPSE), fractional area change (FAC), RV free wall strain, and tissue Doppler imaging S' velocity to pulmonary artery systolic pressure (PASP) with 6MWD, NT-proBNP, and KCCQ score, adjusted for socioeconomic and cardiovascular disease risk factors. Our cohort had a mean age of 73 ± 8 years, 54% female, 17% Chinese American, 22% African American, 22% Hispanic, and 39% White participants. The mean ( ± SD) TAPSE/PASP, FAC/PASP, tissue Doppler imaging S' velocity/PASP, and RV free wall strain:PASP ratios were 0.7 ± 0.2, 1.3 ± 0.3, 0.5 ± 0.1, and 0.8 ± 0.2, respectively. All RV-PA coupling indices decreased with age (p <0.0001 for all). TAPSE:PASP ratio was lower in older (³85 years) female (0.59 ± 0.14) versus male (0.65 ± 0.17) participants (p = 0.01), whereas FAC/PASP ratio was higher in the same female versus male participants (p <0.01). TAPSE/PASP and FAC/PASP ratios were significantly and strongly associated with all NT-proBNP, 6MWD, and KCCQ scores in fully adjusted and receiver operating characteristic analysis. In older community-dwelling adults free of heart failure and pulmonary hypertension, both FAC/PASP and TAPSE:PASP ratios are optimal for assessment of RV-PA coupling based on its association with 6MWD, NT-proBNP, and KCCQ score. FAC/PASP ratio has the additional benefit of reflecting age and gender-related geometric and functional changes.
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Affiliation(s)
- Vivek P Jani
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jordan B Strom
- Division of Cardiology, Beth Israel Deaconess, Harvard Medical School, Boston, Massachusetts
| | - Abhishek Gami
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren Beussink-Nelson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ravi Patel
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin H Freed
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Di Virgilio E, Basile P, Carella MC, Monitillo F, Santoro D, Latorre MD, D’Alessandro S, Fusini L, Fazzari F, Pontone G, Guaricci AI. The Postoperative Paradoxical Septum (POPS): A Comprehensive Review on Physio-Pathological Mechanisms. J Clin Med 2024; 13:2309. [PMID: 38673582 PMCID: PMC11050797 DOI: 10.3390/jcm13082309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The interventricular septum (IVS) is a core myocardial structure involved in biventricular coupling and performance. Physiologically, during systole, it moves symmetrically toward the center of the left ventricle (LV) and opposite during diastole. Several pathological conditions produce a reversal or paradoxical septal motion, such as after uncomplicated cardiac surgery (CS). The postoperative paradoxical septum (POPS) was observed in a high rate of cases, representing a unicum in the panorama of paradoxical septa as it does not induce significant ventricular morpho-functional alterations nor negative clinical impact. Although it was previously considered a postoperative event, evidence suggests that it might also appear during surgery and gradually resolve over time. The mechanism behind this phenomenon is still debated. In this article, we will provide a comprehensive review of the various theories generated over the past fifty years to explain its pathological basis. Finally, we will attempt to give a heuristic interpretation of the biventricular postoperative motion pattern based on the switch of the ventricular anchor points.
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Affiliation(s)
| | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
| | - Francesco Monitillo
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
| | - Daniela Santoro
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
| | - Michele Davide Latorre
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
| | | | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.F.); (F.F.); (G.P.)
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.F.); (F.F.); (G.P.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.F.); (F.F.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, “Aldo Moro” University School of Medicine, AOUC Polyclinic, 70121 Bari, Italy; (P.B.); (M.C.C.); (F.M.); (D.S.); (M.D.L.)
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Berg-Hansen K, Gopalasingam N, Clemmensen TS, Andersen MJ, Mellemkjaer S, Poulsen SH, Jensen JK, Nielsen R. Myocardial work across different etiologies of right ventricular dysfunction and healthy controls. Int J Cardiovasc Imaging 2024; 40:675-684. [PMID: 38305942 PMCID: PMC10950966 DOI: 10.1007/s10554-023-03038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024]
Abstract
Evaluating right ventricular (RV) function remains a challenge. Recently, novel echocardiographic assessment of RV myocardial work (RVMW) by non-invasive pressure-strain loops was proposed. This enables evaluation of right ventriculoarterial coupling and quantifies RV dyssynchrony and post-systolic shortening. We aimed to assess RVMW in patients with different etiologies of RV dysfunction and healthy controls. We investigated healthy controls (n=17), patients with severe functional tricuspid regurgitation (FTR; n=22), and patients with precapillary pulmonary hypertension (PCPH; n=20). Echocardiography and right heart catheterization were performed to assess 1) RV global constructive work (RVGCW; work needed for systolic myocardial shortening and isovolumic relaxation), 2) RV global wasted work (RVGWW; myocardial shortening following pulmonic valve closure), and 3) RV global work efficiency (RVGWE; describes the relation between RV constructive and wasted work). RVGCW correlated with invasive RV stroke work index (r=0.66, P<0.001) and increased in tandem with higher afterload, i.e., was low in healthy controls (454±73 mmHg%), moderate in patients with FTR (687±203 mmHg%), and highest among patients with PCPH (881±255 mmHg%). RVGWE was lower and RVGWW was higher in patients with FTR (86±8% and 91 mmHg% [53-140]) or PCPH (86±10% and 110 mmHg% [66-159]) as compared with healthy controls (96±3% and 10 mmHg%). RVMW by echocardiography provides a promising index of RV function to discriminate between patients with RV volume or pressure overload. The prognostic value of this measure needs to be settled in future studies.
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Affiliation(s)
- Kristoffer Berg-Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Nigopan Gopalasingam
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Søren Mellemkjaer
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Jesper Khedri Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
| | - Roni Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, DK-8200, Denmark
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Espersen C, Skaarup KG, Lassen MCH, Johansen ND, Hauser R, Olsen FJ, Jensen GB, Schnohr P, Møgelvang R, Biering-Sørensen T. Normal age- and sex-based values of right ventricular free wall and four-chamber longitudinal strain by speckle-tracking echocardiography: from the Copenhagen City heart study. Clin Res Cardiol 2024; 113:456-468. [PMID: 37968333 PMCID: PMC10881734 DOI: 10.1007/s00392-023-02333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
AIM To promote the implementation of right ventricular (RV) longitudinal strain in clinical practice, we sought to propose normal values for RV free wall (RVFWLS) and four-chamber longitudinal strain (RV4CLS) and investigate the association with clinical and echocardiographic parameters in participants from the general population. METHODS AND RESULTS Participants from the 5th Copenhagen City Heart Study (2011-2015)-a prospective cohort study-with available RV longitudinal strain measurements were included. RVFWLS and RV4CLS were assessed using two-dimensional speckle-tracking echocardiography. In total, 2951 participants were included. Amongst 1297 participants without cardiovascular disease or risk factors (median age 44, 63% female), mean values of RVFWLS and RV4CLS were - 26.7% ± 5.2 (95% prediction interval (PI) - 36.9, - 16.5) and - 21.7% ± 3.4 (95%PI - 28.4, - 15.0), respectively. Women had significantly higher absolute values of RVFWLS and RV4CLS than men (mean - 27.5 ± 5.5 vs. - 25.4 ± 4.5, p < 0.001 and - 22.3 ± 3.5 vs. - 20.6 ± 3.0, p < 0.001, respectively). Absolute values of RVFWLS but not RV4CLS decreased significantly with increasing age in unadjusted linear regression. Tricuspid annular plane systolic excursion, RV s' and left ventricular global longitudinal strain were the most influential parameters associated with both RVFWLS and RV4CLS in multiple linear regression. Participants with cardiovascular disease (n = 1531) had a higher proportion of abnormal values of RVFWLS and RV4CLS compared to the healthy population (8% vs. 4%, p < 0.001 and 8% vs. 3%, p < 0.001, respectively). CONCLUSION This study proposed normal age- and sex-based values of RVFWLS and RV4CLS in a healthy population sample and showed significant sex differences in both measurements across ages.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark.
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Raphael Hauser
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Semino T, Rosa GM, Monacelli F, Pellicano R, Testino G, Porto I. Right ventricle: current knowledge of echocardiographic evaluation of this "forgotten" chamber. Minerva Med 2024; 115:45-60. [PMID: 36988493 DOI: 10.23736/s0026-4806.23.08575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
In the past the right ventricle (RV) has been traditionally regarded as a simple conduit between the venous system and the pulmonary circulation and it has aroused little interest in both clinical and echocardiographic cardiologists to such an extent that it has been defined as the "forgotten chamber." Subsequently it was clearly shown that the right heart (RH) plays an important physiologic role in cardiac activity, and that congenital or acquired alterations in its structure and function have an important prognostic value. Aim of this review is to shed the light on the echocardiographic approach to this cardiac chamber. In this narrative review we critically explored the most recent literature on this topic using PubMed and Medline and examining the most recent guidelines on the echocardiographic approach to the RV. Echocardiographic approach to RV presents some technical difficulties, which stem from the position of the RV inside the thorax and around the LV and from its particular anatomy, which precludes geometric assumptions. However, RV may now be evaluated quantitatively and qualitatively in many ways, and some new methods can partially overcome some of the limits imposed by its complex anatomy, thereby yielding a quantitative evaluation. Furthermore, due to the wide range of pathologies which may involve the RV a disease-oriented approach should be considered in the echocardiographic investigation of right heart disease.
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Affiliation(s)
- Tommaso Semino
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Gian M Rosa
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy -
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Clinic of Geriatric Diseases, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Li Q, Zhang M. Echocardiography assessment of right ventricular-pulmonary artery coupling: Validation of surrogates and clinical utilities. Int J Cardiol 2024; 394:131358. [PMID: 37704177 DOI: 10.1016/j.ijcard.2023.131358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Right ventricular-pulmonary artery (RV-PA) coupling indicates efficiency of energy transfer from the right ventricle to the pulmonary circulation. The gold standard measurement, end-systolic elastance/arterial elastance ratio (Ees/Ea), is derived from invasive pressure-volume loop, which is technically demanding, expensive and limited in clinical practice. Recent studies have proposed various non-invasive surrogates of Ees/Ea based on echocardiography assessment, of which TAPSE/PASP ratio is an easily-obtained and validated parameter in severe pulmonary hypertension and rapidly applicated in the diagnosis and risk evaluation of various diseases and cardiac intervention. In this review, we summarized principles and validations of echocardiographic surrogates, and their clinical utilities and also limitations. The goal is to systematically review the research advances of echocardiography assessment of RV-PA coupling and help to guide clinical practice.
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Affiliation(s)
- Qimou Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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Ji M, Zhang L, Gao L, Lin Y, He Q, Xie M, Li Y. Application of Speckle Tracking Echocardiography for Evaluating Ventricular Function after Transcatheter Pulmonary Valve Replacement. Diagnostics (Basel) 2023; 14:88. [PMID: 38201397 PMCID: PMC10795743 DOI: 10.3390/diagnostics14010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Pulmonary regurgitation usually leads to right heart dilatation and eventually right heart dysfunction, which is associated with a poor prognosis. Transcatheter pulmonary valve replacement is a developing treatment for pulmonary valve dysfunction that can take the place of traditional surgery and make up for the shortcomings of a large injury. Echocardiography plays a significant role in assessing ventricular function; however, conventional echocardiographic parameters have several limitations. Speckle tracking echocardiography has been regarded as a more accurate tool for quantifying cardiac function than conventional echocardiography. Therefore, the aim of this review was to summarize the application of speckle tracking echocardiography for evaluating right and left ventricular functions in patients after transcatheter pulmonary valve replacement.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (L.Z.); (L.G.); (Y.L.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Ali AA, Habib SA, AbdElaziz OH, Mohammad SA. Right ventricular systolic function and mechanical dyssynchrony in ischemic or non-ischemic dilated cardiomyopathy: A speckle-tracking study. Echocardiography 2023; 40:1166-1176. [PMID: 37676474 DOI: 10.1111/echo.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/17/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
AIM This study assessed RV dyssynchrony (irrespective to QRS duration) and RV systolic function in non-ischemic dilated cardiomyopathy (NIDCM) versus ischemic dilated cardiomyopathy (IDCM) patients by using different echo-Doppler modalities. METHODS Eighty-five cases (48 patients with DCM [whether ischemic or non-ischemic] and 37 age-matched healthy controls) were studied. Conventional echo-Doppler study, tissue Doppler (TDI), and speckle tracking (STE) were carried out to measure LV and RV systolic function. Time-to-peak negative longitudinal strain at the four RV sites were assessed by TDI derived strain and 2D speckle tracking. RESULTS Patients with DCM (whether ischemic or non-ischemic) had significantly lower fractional area change, RV tricuspid annular systolic velocity (p < .001 for both), tricuspid annular plane systolic excursion (p = .01), RV-GLS whether TDI or 2D derived (p < .001). Twenty-nine patients (60%) showed right intraventricular delay (RV4SD > 60 ms). The RV-dyssynchrony index was negatively correlated to %FAC (r = -.362, p = .01), RV Sm (r = -.312, p = .04), and 2D-RV GLS (r = -.305, p = .05). Insignificant higher RV-dysynchrony index was detected in NIDCM compared to IDCM group; however, the basal septal segment was significantly delayed in dilated group. More impaired RV systolic function was detected in ischemic group. 2D STE and TDI showed a significant correlation in the assessment of the right-intraventricular delay (p = .001). CONCLUSION Right-intraventricular dyssynchrony are detectable in patients with dilated cardiomyopathy (whether ischemic or non-ischemic) with a higher statistically insignificant value in non-ischemic group by using tissue Doppler imaging and 2D speckle tracking. More impairment of the RV systolic function was noticed in the ischemic group. Impaired RV systolic function was associated with right intraventricular delay.
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Affiliation(s)
- Asmaa Ahmed Ali
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Shaimaa Ahmed Habib
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
| | - Ola Hassan AbdElaziz
- Department of Cardiology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
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9
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Lupi L, Italia L, Pagnesi M, Pancaldi E, Ancona F, Stella S, Pezzola E, Cimino G, Saccani N, Ingallina G, Margonato D, Inciardi RM, Lombardi CM, Tomasoni D, Agricola E, Metra M, Adamo M. Prognostic value of right ventricular longitudinal strain in patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair. Eur Heart J Cardiovasc Imaging 2023; 24:1509-1517. [PMID: 37194460 DOI: 10.1093/ehjci/jead103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023] Open
Abstract
AIMS To evaluate the prognostic impact of pre-procedural right ventricular longitudinal strain (RVLS) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge repair (TEER) in comparison with conventional echocardiographic parameters of RV function. METHODS AND RESULTS This is a retrospective study including 142 patients with SMR undergoing TEER at two Italian centres. At 1-year follow-up 45 patients reached the composite endpoint of all-cause death or heart failure hospitalization. The best cut-off value of RV free-wall longitudinal strain (RVFWLS) to predict outcome was -18% [sensitivity 72%, specificity of 71%, area under curve (AUC) 0.78, P < 0.001], whereas the best cut-off value of RV global longitudinal strain (RVGLS) was -15% (sensitivity 56%, specificity 76%, AUC 0.69, P < 0.001). Prognostic performance was suboptimal for tricuspid annular plane systolic excursion, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity and fractional area change (FAC). Cumulative survival free from events was lower in patients with RVFWLS ≥ -18% vs. RVFWLS < -18% (44.0% vs. 85.4%; < 0.001) as well as in patients with RVGLS ≥ -15% vs. RVGLS < -15% (54.9% vs. 81.7%; P < 0.001). At multivariable analysis FAC, RVGLS and RVFWLS were independent predictors of events. The identified cut-off of RVFWLS and RVGLS both resulted independently associated with outcomes. CONCLUSION RVLS is a useful and reliable tool to identify patients with SMR undergoing TEER at high risk of mortality and HF hospitalization, on top of other clinical and echocardiographic parameters, with RVFWLS offering the best prognostic performance.
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Affiliation(s)
- Laura Lupi
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Leonardo Italia
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Elisa Pezzola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Giuliana Cimino
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Nicola Saccani
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Riccardo Maria Inciardi
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Marco Metra
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Marianna Adamo
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
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10
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Webb L, Burton L, Manchikalapati A, Prabhakaran P, Loberger JM, Richter RP. Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy. Front Med (Lausanne) 2023; 10:1216538. [PMID: 37654664 PMCID: PMC10466806 DOI: 10.3389/fmed.2023.1216538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized complication of severe PARDS that may contribute to its untoward outcomes. Indeed, recent evidence suggest significantly worse outcomes in children who develop RV failure in their course of PARDS. However, in this narrative review, we highlight the dearth of evidence regarding the incidence of and risk factors for PARDS-associated RV dysfunction. While we wish to draw attention to the absence of available evidence that would inform recommendations around surveillance and treatment of RV dysfunction during severe PARDS, we leverage available evidence to glean insights into potentially helpful surveillance strategies and therapeutic approaches.
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Affiliation(s)
- Lece Webb
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luke Burton
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ananya Manchikalapati
- Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Priya Prabhakaran
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeremy M. Loberger
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert P. Richter
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
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11
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De Raffele M, Di Domenico A, Balla C, Vitali F, Boccadoro A, Pavasini R, Micillo M, Cocco M, Campo G, Bertini M, Tonet E. Structural Abnormalities in Brugada Syndrome and Non-Invasive Cardiac Imaging: A Systematic Review. BIOLOGY 2023; 12:biology12040606. [PMID: 37106806 PMCID: PMC10136319 DOI: 10.3390/biology12040606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
The aim of this review is to identify possible structural abnormalities of BrS and their potential association with symptoms, risk stratification, and prognosis. (1) Background: BrS has always been considered a purely electrical disease and imaging techniques do not currently play a specific role in the diagnosis of this arrhythmic syndrome. Some authors have recently hypothesized the presence of structural and functional abnormalities. Therefore, several studies investigated the presence of pathological features in echocardiography and cardiac magnetic resonance imaging (MRI) in patients with BrS, but results were controversial. (2) Methods: We performed a systematic review of the literature on the spectrum of features detected by echocardiography and cardiac MRI. Articles were searched in Pubmed, Cochrane Library, and Biomed Central. Only papers published in English and in peer-reviewed journals up to November 2021 were selected. After an initial evaluation, 596 records were screened; the literature search identified 19 relevant articles. (3) Results: The imaging findings associated with BrS were as follows: right ventricular dilation, right ventricular wall motion abnormalities, delayed right ventricular contraction, speckle and feature tracking abnormalities, late gadolinium enhancement, and fat infiltration in the right ventricle. Furthermore, these features emerged more frequently in patients carrying the genetic mutation on the sodium voltage-gated channel α-subunit 5 (SCN5A) gene. (4) Conclusions: Specific imaging features detected by echocardiography and cardiac magnetic resonance are associated with BrS. However, this population appears to be heterogeneous and imaging anomalies emerged to be more frequent in patients carrying genetic mutations of SCN5A. Future studies with an evaluation of BrS patients are needed to identify the specific association linking the Brugada pattern, imaging abnormalities and their possible correlation with prognosis.
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Affiliation(s)
- Martina De Raffele
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Assunta Di Domenico
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Matteo Bertini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
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12
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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13
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Stolz L, Doldi PM, Weckbach LT, Stocker TJ, Braun D, Orban M, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair. Front Cardiovasc Med 2022; 9:993618. [PMID: 36312295 PMCID: PMC9596758 DOI: 10.3389/fcvm.2022.993618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,*Correspondence: Lukas Stolz,
| | - Philipp M. Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T. Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mirjam G. Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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14
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Fu Z, Tao X, Xie W, Yang P, Gao Q, Wang J, Zhai Z. Different response of the oxygen pathway in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy versus balloon pulmonary angioplasty. Front Cardiovasc Med 2022; 9:990207. [PMID: 36237910 PMCID: PMC9551285 DOI: 10.3389/fcvm.2022.990207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundOxygen pathway limitation exists in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA) are two effective interventions for CTEPH, but their effects and comparison of these two interventions on the oxygen pathway are not well demonstrated.MethodsCTEPH patients with available pulmonary function test, hemodynamics, and blood gas analysis before and after the interventions were included for comparison of oxygen pathway in terms of lung ventilation, lung gas exchange, oxygen delivery, and oxygen extraction between these two interventions.ResultsThe change in the percentage of the predicted forced expiratory volume in the 1 s (−3.4 ± 12.7 vs. 3.8 ± 8.7%, P = 0.006) and forced vital capacity (−5.5 ± 13.0 vs. 4.2 ± 9.9%, P = 0.001) among the PEA group (n = 24) and BPA group (n = 46) were significantly different. Patients in the PEA group had a significant increase in their arterial oxygen saturation (from 92.5 ± 3.6 to 94.6 ± 2.4%, P = 0.022), while those in the BPA group had no change, which could be explained by a significant improvement in ventilation/perfusion (−0.48 ± 0.53 vs. −0.17 ± 0.41, P = 0.016). Compared with patients post-BPA, patients post-PEA were characterized by higher oxygen delivery (756.3 ± 229.1 vs. 628.8 ± 188.5 ml/min, P = 0.016) and higher oxygen extraction (203.3 ± 64.8 vs. 151.2 ± 31.9 ml/min, P = 0.001).ConclusionPartial amelioration of the oxygen pathway limitations could be achieved in CTEPH patients treated with PEA and BPA. CTEPH patients post-PEA had better performance in lung gas exchange, oxygen delivery, and extraction, while those post-BPA had better lung ventilation. Cardiopulmonary rehabilitation may assist in improving the impairment of the oxygen pathway.
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Affiliation(s)
- Zhihui Fu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Xincao Tao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Wanmu Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Peiran Yang
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- State Key Laboratory of Medical Molecular Biology, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qian Gao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jinzhi Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
- *Correspondence: Zhenguo Zhai,
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15
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Ünlü S, Bézy S, Cvijic M, Duchenne J, Delcroix M, Voigt JU. Right ventricular strain related to pulmonary artery pressure predicts clinical outcome in patients with pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2022; 24:635-642. [PMID: 35852912 DOI: 10.1093/ehjci/jeac136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/29/2022] [Indexed: 12/18/2022] Open
Abstract
Abstract
Aims
In pulmonary arterial hypertension (PAH), the right ventricle (RV) is exposed to an increased afterload. In response, RV mechanics are altered. Markers which would relate RV function and afterload could therefore aid to understand this complex response system and could be of prognostic value. The aim of our study was to (i) assess the RV-arterial coupling using ratio between RV strain and systolic pulmonary artery pressure (sPAP), in patients with PAH, and (ii) investigate the prognostic value of this new parameter over other echocardiographic parameters.
Methods and results
Echocardiograms of 65 pre-capillary PAH patients (45 females, age 61 ± 15 years) were retrospectively analysed. Fractional area change (FAC), sPAP, tricuspid annular plane systolic excursion, and RV free-wall (FW) longitudinal strain (LS) were measured. A primary endpoint of death or heart/lung transplantation described clinical endpoint. Patients who reached a clinical endpoint had worse functional capacity (New York Heart Association), reduced RV function, and higher sPAP. Left ventricle function was similar in both groups. Only RVFW LS/sPAP ratio was found as an independent predictor of clinical endpoint in multivariable analysis (hazard ratio 8.3, 95% confidence interval 3.2–21.6, P < 0.001). The RWFW LS/sPAP (cut-off 0.19) demonstrated a good accuracy for the prediction of reaching the clinical endpoint, with a sensitivity of 92% and specificity of 82.5%.
Conclusion
RVFW LS/sPAP ratio significantly predicts all-cause mortality and heart–lung transplantation, and was superior to other well-established parameters, in patients with pre-capillary PAH. We therefore propose RVFW LS/sPAP as a new prognostic echocardiographic marker.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
- Department of Cardiology, Gazi University Faculty of Medicine , Ankara , Turkey
| | - Stéphanie Bézy
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
- Department of Cardiology, University Medical Centre Ljubljana, Slovenia Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
| | - Marion Delcroix
- Department of Pulmonology, University Hospitals Leuven , Leuven , Belgium
| | - Jens Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
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Rodríguez-Pérez Á, Bos L, Podzamczer I, Meseguer ML, Mayos-Pérez M, Leta R. Right Ventricular Postsystolic Strain Curve Morphology before and after Vasodilator Treatment in Idiopathic Pulmonary Arterial Hypertension. CASE 2022; 6:228-232. [PMID: 35832825 PMCID: PMC9271414 DOI: 10.1016/j.case.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RV function is an important prognostic factor in pulmonary arterial hypertension. Several echocardiographic parameters are needed for a complete RV function assessment. RV postsystolic strain patterns have a prognostic impact in IPAH. RV postsystolic strain patterns may help in evaluating treatment response.
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Affiliation(s)
- Álvaro Rodríguez-Pérez
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
- Correspondence: Álvaro Rodríguez-Pérez, MD, Cardiac Imaging Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Lidia Bos
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
| | - Inés Podzamczer
- Pneumology Department, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
| | | | - Mercedes Mayos-Pérez
- Pneumology Department, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Ruben Leta
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
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Jellis CL, Park MM, Abidov A, Borlaug BA, Brittain EL, Frantz R, Hassoun PM, Horn EM, Jaber WA, Jiwon K, Karas MG, Kwon D, Leopold JA, Maron B, Mathai SC, Mehra R, Rischard F, Rosenzweig EB, Tang WHW, Vanderpool R, Thomas JD. Comprehensive echocardiographic evaluation of the right heart in patients with pulmonary vascular diseases: the PVDOMICS experience. Eur Heart J Cardiovasc Imaging 2022; 23:958-969. [PMID: 34097027 PMCID: PMC9212349 DOI: 10.1093/ehjci/jeab065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS There is a wide spectrum of diseases associated with pulmonary hypertension, pulmonary vascular remodelling, and right ventricular dysfunction. The NIH-sponsored PVDOMICS network seeks to perform comprehensive clinical phenotyping and endophenotyping across these disorders to further evaluate and define pulmonary vascular disease. METHODS AND RESULTS Echocardiography represents the primary non-invasive method to phenotype cardiac anatomy, function, and haemodynamics in these complex patients. However, comprehensive right heart evaluation requires the use of multiple echocardiographic parameters and optimized techniques to ensure optimal image acquisition. The PVDOMICS echo protocol outlines the best practice approach to echo phenotypic assessment of the right heart/pulmonary artery unit. CONCLUSION Novel workflow processes, methods for quality control, data for feasibility of measurements, and reproducibility of right heart parameters derived from this study provide a benchmark frame of reference. Lessons learned from this protocol will serve as a best practice guide for echocardiographic image acquisition and analysis across the spectrum of right heart/pulmonary vascular disease.
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Affiliation(s)
- Christine L Jellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Margaret M Park
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Aiden Abidov
- Wayne State University, 4646 John R Street, Detroit, MI 48201USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902USA
| | - Evan L Brittain
- Vanderbilt University Medical Center and Vanderbilt Translational and Clinical Cardiovascular Research Center2525 West End Avenue, Suite 300A, Nashville, TN 37203USA
| | - Robert Frantz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902USA
| | - Paul M Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St, Room 540, Baltimore, MD 21205USA
| | - Evelyn M Horn
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Kim Jiwon
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Maria G Karas
- Weill Cornell Medicine, Division of Cardiology, 520 East 70th Street, Starr 443, New York, NY 10021USA
| | - Deborah Kwon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Department of Cardiology, VA Boston Healthcare system, 77 Ave Louis Pasteur, NRB 0630-N, Boston MA 02115USA
| | - Bradley Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Department of Cardiology, VA Boston Healthcare system, 77 Ave Louis Pasteur, NRB 0630-N, Boston MA 02115USA
| | - Stephen C Mathai
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument St, Room 540, Baltimore, MD 21205USA
| | - Reena Mehra
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue Cleveland, OH 44195USA
| | - Franz Rischard
- Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics and Medicine, Columbia University Medical Center-New York Presbyterian Hospital, 3959 Broadway, New York, NY 10032USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rebecca Vanderpool
- Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, 676 N Saint Clair, Chicago Illinois 60611USA
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18
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Elhawary EE, Tolba OA, Elkaffas AA, Shabana AH. Right ventricular function in β-thalassemia children: comparing three-dimensional echocardiography with other functional parameters. Pediatr Res 2022; 91:1709-1714. [PMID: 34903834 DOI: 10.1038/s41390-021-01900-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiomyopathy is a major cause of mortality and morbidity in beta-thalassemia major (β-TM), and its early detection is critical for prompt management. We aimed to evaluate right ventricle (RV) function in β-TM, in absence of cardiac symptoms, using 3D echocardiography, and compare it with other functional parameters. METHODS Cross-sectional cohort study was conducted on 50 β-TM children with no cardiac manifestations and 50 healthy controls of matched age and sex. We evaluated RV function using; Fraction Area Change (2DE-RV FAC), Ejection Fraction (3D-RVEF), Tricuspid annular plane systolic excursion (TAPSE), Tissue Doppler imaging (TDI) systolic (S') and diastolic (E', A'), Myocardial performance index (MPI), and speckle tracking (2D-STE) of RV global longitudinal strain (LSS), systolic strain rate (SSR), early diastolic strain rate (DSR E), and late diastolic strain rate (DSR A). RESULTS 3D-RVEF, MPI, and 2D-STE showed significant differences between the two groups. ROC curve analysis measurements had an AUC above 0.7-which indicate at least a fair discriminatory power between the β-TM group with RV dysfunction and normal controls. CONCLUSIONS β-TM patients have decreased RV function indices at a pre-symptomatic stage. Early detection of RV dysfunction is feasible and can allow for closer follow-up to detect pre-clinical changes. IMPACT The key message of this article is to emphasize the importance of the evaluation of right ventricular function in children with beta-thalassemia major. This article adds to the existing literature the use of recent echocardiographic modalities as three-dimensional echocardiography and two-dimensional speckle tracking in the evaluation of right ventricular dysfunction in beta-thalassemia children while cardiac affection is still subclinical. IMPACT Recent echocardiographic functional parameters can be effectively used to evaluate the right ventricle in beta-thalassemia and can detect dysfunction in asymptomatic patients allowing for early intervention.
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Affiliation(s)
- Eslam E Elhawary
- Hematology and Bone Marrow Transplantation Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Osama A Tolba
- Cardiology Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa A Elkaffas
- Hematology and Bone Marrow Transplantation Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed H Shabana
- Cardiology Unit, Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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19
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Usuku H, Takashio S, Yamamoto E, Yamada T, Egashira K, Morioka M, Nishi M, Komorita T, Oike F, Tabata N, Ishii M, Yamanaga K, Fujisue K, Sueta D, Arima Y, Araki S, Oda S, Misumi Y, Kawano H, Matsushita K, Ueda M, Matsui H, Tsujita K. Prognostic value of right ventricular global longitudinal strain in transthyretin amyloid cardiomyopathy. J Cardiol 2022; 80:56-63. [DOI: 10.1016/j.jjcc.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/21/2021] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
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20
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Computed Tomographic Assessment of Right Ventricular Long Axis Strain for Prognosis after Transcatheter Aortic Valve Replacement. Eur J Radiol 2022; 149:110212. [DOI: 10.1016/j.ejrad.2022.110212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
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22
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Peters AC, Madhan AS, Kislitsina O, Elenbaas C, Nishtala A, Freed B, Schimmel D, Thomas JD, Cuttica M, Malaisrie SC. Temporal trends in right heart strain in patients undergoing pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Echocardiography 2021; 38:1932-1940. [PMID: 34747056 DOI: 10.1111/echo.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pulmonary thromboendarterectomy (PTE) is a curative procedure for chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricular free wall strain (RV FWS) and right atrial strain (RAS) are not well studied in a CTEPH population. We sought to determine temporal trends in RAS and RV FWS in patients post-PTE. METHODS 28 patients undergoing PTE for CTEPH were prospectively enrolled in a surgical database. Comprehensive echocardiographic assessment of the right heart was performed including RV FWS, right atrial volume, and the three components of RAS: reservoir, conduit, and booster strain. RESULTS Patients undergoing PTE demonstrated improvement in NYHA functional class (P < 0.001). Hemodynamic assessment showed improvement in mean pulmonary artery pressure from 49.7 ± 8.5 mm Hg to 23.9 ± 6.5 mm Hg (P < 0.001) and pulmonary vascular resistance decreased from 7.8 ± 3.2 wu to 2.4 ± 1.3 wu (P < 0.001). Tricuspid annular plane systolic excursion (TAPSE) and lateral S` declined immediately post-op. RV FWS improved from -14.4 ± 4% to -19 ± 3.4% post-op and -21.2 ± 4.7% at long-term follow-up (P < 0.001). Improvement in RV FWS post-op was driven primarily by increases in the apical and mid segments. RA volume declined significantly during the study period. RA reservoir and conduit strain improved after PTE. CONCLUSION Patients undergoing PTE for CTEPH had significant improvement in right heart hemodynamics immediately post-op. Traditional echo metrics of RV performance including TAPSE and lateral S` did not improve. RV FWS improved, which was driven by changes in the apical and mid segments. This highlights that RV FWS is a viable and useful metric to follow in CTEPH patients post-PTE.
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Affiliation(s)
- Andrew C Peters
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - Ashwin Shaan Madhan
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - Olga Kislitsina
- Feinberg School of Medicine at Northwestern University, Division of Cardiothoracic Surgery, Chicago, Illinois, USA
| | - Christian Elenbaas
- Feinberg School of Medicine at Northwestern University, Division of Cardiothoracic Surgery, Chicago, Illinois, USA
| | - Arvind Nishtala
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - Benjamin Freed
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - Daniel Schimmel
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - James D Thomas
- Feinberg School of Medicine at Northwestern University, Division of Cardiology, Chicago, Illinois, USA
| | - Michael Cuttica
- Feinberg School of Medicine at Northwestern University, Division of Pulmonology, Chicago, Illinois, USA
| | - S Christopher Malaisrie
- Feinberg School of Medicine at Northwestern University, Division of Cardiothoracic Surgery, Chicago, Illinois, USA
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23
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Clinical Significance of Right Ventricular Function in Pulmonary Hypertension. Keio J Med 2021; 70:60-67. [PMID: 33456013 DOI: 10.2302/kjm.2020-0015-ir] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease characterized by increased pulmonary vascular resistance that leads to right ventricular (RV) failure, a condition that determines its prognosis. This review focuses on the clinical value of the evaluation of RV function in PH. First, the pathophysiology of PH, including hemodynamics, RV function, and their interaction (known as ventriculoarterial coupling), are summarized. Next, non-invasive imaging modalities and the parameters of RV function, mainly assessed by echocardiography, are reviewed. Finally, the clinical impacts of RV function in PH are described. This review will compare the techniques that yield comprehensive information on RV function and their roles in the assessment of PH.
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24
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Sanna GD, Canonico ME, Santoro C, Esposito R, Masia SL, Galderisi M, Parodi G, Nihoyannopoulos P. Echocardiographic Longitudinal Strain Analysis in Heart Failure: Real Usefulness for Clinical Management Beyond Diagnostic Value and Prognostic Correlations? A Comprehensive Review. Curr Heart Fail Rep 2021; 18:290-303. [PMID: 34398411 DOI: 10.1007/s11897-021-00530-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a highly prevalent clinical syndrome characterized by considerable phenotypic heterogeneity. The traditional classification based on left ventricular ejection fraction (LVEF) is widely accepted by the guidelines and represents the grounds for patient enrollment in clinical trials, even though it shows several limitations. Ejection fraction (EF) is affected by preload, afterload, and contractility, it being problematic to express LV function in several conditions, such as HF with preserved EF (HFpEF), valvular heart disease, and subclinical HF, and in athletes. Over the last two decades, developments in diagnostic techniques have provided useful tools to overcome EF limitations. Strain imaging analysis (particularly global longitudinal strain (GLS)) has emerged as a useful echocardiographic technique in patients with HF, as it is able to simultaneously supply information on both systolic and diastolic functions, depending on cardiac anatomy and physiology/pathophysiology. The use of GLS has proved helpful in terms of diagnostic performance and prognostic value in several HF studies. Universally accepted cutoff values and variability across vendors remain an area to be fully explored, hence limiting routine application of this technique in clinical practice. In the present review, the current role of GLS in the diagnosis and management of patients with HF will be discussed. We describe, by critical analysis of the pros and cons, various clinical settings in HF, and how the appropriate use and interpretation of GLS can provide important clues.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.
| | - Mario E Canonico
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Petros Nihoyannopoulos
- Imperial College London (National Heart and Lung Institute), Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
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25
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Bidviene J, Muraru D, Kovacs A, Lakatos B, Ereminiene E, Liptai C, Vaskelyte JJ, Zaliunas R, Surkova E, Badano LP. Global and regional right ventricular mechanics in repaired tetralogy of Fallot with chronic severe pulmonary regurgitation: a three-dimensional echocardiography study. Cardiovasc Ultrasound 2021; 19:28. [PMID: 34362392 PMCID: PMC8349004 DOI: 10.1186/s12947-021-00260-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/20/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Data about the right ventricular (RV) mechanics adaptation to volume overload in patients with repaired tetralogy of Fallot (rToF) are limited. Accordingly, we sought to assess the mechanics of the functional remodeling occurring in the RV of rToF with severe pulmonary regurgitation. METHODS We used three-dimensional transthoracic echocardiography (3DTE) to obtain RV data sets from 33 rToF patients and 30 age- and sex- matched controls. A 3D mesh model of the RV was generated, and RV global and regional longitudinal (LS) and circumferential (CS) strain components, and the relative contribution of longitudinal (LEF), radial (REF) and anteroposterior (AEF) wall motion to global RV ejection fraction (RVEF) were computed using the ReVISION method. RESULTS Corresponding to decreased global RVEF (45 ± 6% vs 55 ± 5%, p < 0.0001), rToF patients demonstrated lower absolute values of LEF (17 ± 4 vs 28 ± 4), REF (20 ± 5 vs 25 ± 4) and AEF (17 ± 5 vs 21 ± 4) than controls (p < 0.01). However, only the relative contribution of LEF to global RVEF (0.39 ± 0.09 vs 0.52 ± 0.05, p < 0.0001) was significantly decreased in rToF, whereas the contribution of REF (0.45 ± 0.08 vs 0.46 ± 0.04, p > 0.05) and AEF (0.38 ± 0.09 vs 0.39 ± 0.04, p > 0.05) to global RVEF was similar to controls. Accordingly, rToF patients showed lower 3D RV global LS (-16.94 ± 2.9 vs -23.22 ± 2.9, p < 0.0001) and CS (-19.79 ± 3.3 vs -22.81 ± 3.5, p < 0.01) than controls. However, looking at the regional RV deformation, the 3D CS was lower in rToF than in controls only in the basal RV free-wall segment (p < 0.01). 3D RV LS was reduced in all RV free-wall segments in rToF (p < 0.0001), but similar to controls in the septum (p > 0.05). CONCLUSIONS 3DTE allows a quantitative evaluation of the mechanics of global RVEF. In rToF with chronic volume overload, the relative contribution of the longitudinal shortening to global RVEF is affected more than either the radial or the anteroposterior components.
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Affiliation(s)
- Jurate Bidviene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania.
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Denisa Muraru
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | - Attila Kovacs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Csilla Liptai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jolanta-Justina Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu str. 2, 50009, Kaunas, Lithuania
| | - Elena Surkova
- Royal Brompton Hospital, Part of Guy's and St Thomas' NHS Foundation Trust, London, SW3 6NP, UK
| | - Luigi P Badano
- Department of Cardiological, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
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Tanasa A, Burlacu A, Popa IV, Covic A. Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease-A Single-Center, Prospective, Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57070704. [PMID: 34356985 PMCID: PMC8307593 DOI: 10.3390/medicina57070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Two-dimensional speckle tracking echocardiography (2D-STE) is viewed as an outstanding technique, competent of uncovering earlier subclinical myocardial anomalies compared to conventional echocardiography. A few endeavors adopted 2D-STE as a tool to estimate right ventricular (RV) function in subjects with end-stage kidney disease (ESKD). There is no published prospective study on an adult ESKD cohort exploring the consequences of commencing elective hemodialysis (HD) on RV behavior. Materials and Methods: We investigated the RV systolic function using traditional (tricuspid annular plane systolic excursion-TAPSE, RV fractional area change-FAC) and 2D-STE (RV free wall longitudinal strain-RVFWLS) parameters following the initiation of HD. We enrolled 79 consecutive patients with ESKD and assessed them in four steps-at baseline, before HD, and at 3, 6, and 12 months. Results: RVFWLS, FAC, and TAPSE values had a significant increase at 3, 6, and 12 months from baseline (p < 0.001) and a significant increase at 6 months from 3 months (p < 0.001). However, differences between 12 months and 6 months were not significant (p > 0.05) according to Dunn-Bonferroni post hoc tests. Seventeen deaths were recorded before the completion of the study. RVFWLS, FAC, and TAPSE values significantly decreased at 3 and 6 months in all 17 deceased patients, in clear opposition with the values survivors had. All the studied parameters had a significant prediction power on mortality (p < 0.001) having an outstanding performance: baseline-RVFWLS (AUC: 1.000 (95% C.I.: 1.000-1.000)), baseline-FAC (AUC: 0.974 (95% C.I.: 0.942-1.000)), and baseline-TAPSE (AUC: 0.962 (95% C.I.: 0.920-1.000). Conclusions: Our study is the first to investigate RV function by 2D-STE and correlate it with traditional methods in patients with ESKD before and after the initiation of HD. RV function was significantly ameliorated at 3, 6, and 12 months compared to the pre-HD values. FAC and RVFWLS gain an outstanding prognostic role on mortality in this population.
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Affiliation(s)
- Ana Tanasa
- Nephrology Clinic, Dialysis, Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (A.C.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (A.B.); (I.V.P.); Tel.: +40-744488580 (A.B.); +40-723651930 (I.V.P.)
| | - Iolanda Valentina Popa
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Correspondence: (A.B.); (I.V.P.); Tel.: +40-744488580 (A.B.); +40-723651930 (I.V.P.)
| | - Adrian Covic
- Nephrology Clinic, Dialysis, Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (A.C.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
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Cobra SDB, Rodrigues MP, de Melo FX, Ferreira NMC, Melo-Silva CA. Right ventricular contractility decreases during exercise in patients with non-advanced idiopathic pulmonary fibrosis. Medicine (Baltimore) 2021; 100:e25915. [PMID: 34232164 PMCID: PMC8270621 DOI: 10.1097/md.0000000000025915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
Early right ventricular dysfunction in patients with non-advanced idiopathic pulmonary fibrosis (IPF) has not been fully elucidated. Thus, we aimed to assess right ventricular functions in IPF patients and controls by speckle-tracking strain echocardiography at rest and peak exercise.We screened 116 IPF patients from February to August 2019 to include 20 patients with no history of oxygen therapy, peripheral saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, and modified Medical Research Council score ≤3. Additionally, we enrolled 10 matched controls. Transthoracic echocardiography images were acquired at rest and during a cardiopulmonary exercise test. We analyzed 2-dimensional echocardiographic parameters and right ventricular function using the global longitudinal strain assessed by the 2-dimensional speckle-tracking technique.In the control group, we found normal values of right ventricle longitudinal strain (RVLS) at rest and at peak exercise, the latter being much more negative (-23.6 ± 2.2% and -26.8 ± 3.1%, respectively; P < .001). By contrast, RVLS values in the IPF group increased from -21.1 ± 3.8% at rest to -17.0 ± 4.5% at peak exercise (P < .001). The exercise revealed a difference between the 2 groups as the mean RVLS values moved during peak exercise in opposite directions. Patients with IPF got worse, whereas control patients presented improved right ventricular contractility.Right ventricular dysfunction was unveiled by speckle-tracking echocardiography during exercise in non-advanced IPF patients. We suggest that this reflects an inadequate right ventricular-arterial coupling decreasing the right ventricular longitudinal contraction during exercise in these patients. This parameter may be useful as an early index of suspected pulmonary hypertension.
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Affiliation(s)
- Sandra de Barros Cobra
- Department of Cardiology, Federal District Base Hospital Institute and School of Medicine, University of Brasília, Brasília 70.330-150 – DF
| | | | | | | | - César Augusto Melo-Silva
- Laboratory of Respiratory Physiology, University of Brasília
- Division of Physical Therapy, University Hospital of Brasília, Brasília 70.910-900 – DF
- Núcleo de Integração Funcional, Rehabilitation Center, Brasília 70.830-350 – DF, Brazil
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Badano LP, Muraru D, Parati G, Haugaa K, Voigt JU. How to do right ventricular strain. Eur Heart J Cardiovasc Imaging 2021; 21:825-827. [PMID: 32504092 DOI: 10.1093/ehjci/jeaa126] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Luigi P Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Denisa Muraru
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, 20149 Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital and University of Oslo, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, Cath. University Leuven, Herestrat49, 3000 Leuven, Belgium
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Gavazzoni M, Badano LP, Vizzardi E, Raddino R, Genovese D, Taramasso M, Sciatti E, Palermo C, Metra M, Muraru D. Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease. Eur Heart J Cardiovasc Imaging 2021; 21:1013-1021. [PMID: 31596464 DOI: 10.1093/ehjci/jez246] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease. METHODS AND RESULTS We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was -21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948-0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was -22% (area under the curve 0.677; P < 0.001; sensitivity 70%; 65% specificity). CONCLUSION RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.
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Affiliation(s)
- Mara Gavazzoni
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy.,Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Luigi P Badano
- IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, P.zza Brescia n 20, 20149, Milan, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Riccardo Raddino
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova School of Medicine, Nicolo Giustiniani Street, n 2, 35128, Padova, Italy
| | - Maurizio Taramasso
- Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Edoardo Sciatti
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Chiara Palermo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova School of Medicine, Nicolo Giustiniani Street, n 2, 35128, Padova, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy
| | - Denisa Muraru
- Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.,IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, P.zza Brescia n 20, 20149, Milan, Italy
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A randomized controlled trial of enhancing hypoxia-mediated right cardiac mechanics and reducing afterload after high intensity interval training in sedentary men. Sci Rep 2021; 11:12564. [PMID: 34131157 PMCID: PMC8206117 DOI: 10.1038/s41598-021-91618-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Hypoxic exposure increases right ventricular (RV) afterload by triggering pulmonary hypertension, with consequent effects on the structure and function of the RV. Improved myocardial contractility is a critical circulatory adaptation to exercise training. However, the types of exercise that enhance right cardiac mechanics during hypoxic stress have not yet been identified. This study investigated how high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) influence right cardiac mechanics during hypoxic exercise A total of 54 young and healthy sedentary males were randomly selected to engage in either HIIT (3-min intervals at 40% and 80% of oxygen uptake reserve, n = 18) or MICT (sustained 60% of oxygen uptake reserve, n = 18) for 30 min/day and 5 days/week for 6 weeks or were included in a control group (CTL, n = 18) that did not engage in any exercise. The primary outcome was the change in right cardiac mechanics during semiupright bicycle exercise under hypoxic conditions (i.e., 50 watts under 12% FiO2 for 3 min) as measured by two-dimensional speckle tracking echocardiography.: After 6 weeks of training, HIIT was superior to MICT in improving maximal oxygen consumption (VO2max). Furthermore, the HIIT group showed reduced pulmonary vascular resistance (PVR, pre-HIIT:1.16 ± 0.05 WU; post-HIIT:1.05 ± 0.05 WU, p < 0.05) as well as an elevated right ventricular ejection fraction (RVEF, pre-HIIT: 59.5 ± 6.0%; post-HIIT: 69.1 ± 2.8%, p < 0.05) during hypoxic exercise, coupled with a significant enhancement of the right atrial (RA) reservoir and conduit functions. HIIT is superior to MICT in dilating RV chamber and reducing radial strain but ameliorating radial strain rate in either systole (post-HIIT: 2.78 ± 0.14 s-1; post-MICT: 2.27 ± 0.12 s-1, p < 0.05) or diastole (post-HIIT: - 2.63 ± 0.12 s-1; post-MICT: - 2.36 ± 0.18 s-1, p < 0.05). In the correlation analysis, the changes in RVEF were directly associated with improved RA reservoir (r = 0.60, p < 0.05) and conduit functions (r = 0.64, p < 0.01) but inversely associated with the change in RV radial strain (r = - 0.70, p < 0.01) and PVR (r = - 0.70, p < 0.01) caused by HIIT. HIIT is superior to MICT in improving right cardiac mechanics by simultaneously increasing RA reservoir and conduit functions and decreasing PVR during hypoxic exercise.
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Grieco D, Bressi E, Curila K, Padala SK, Sedlacek K, Kron J, Fedele E, Ionita O, Giannuzzi S, Fagagnini A, Panattoni G, De Ruvo E, Ellenbogen KA, Calò L. Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:986-994. [PMID: 33890685 DOI: 10.1111/pace.14249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND His-Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. METHODS We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. RESULTS A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV-FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31-37) vs. RVP 33 IQR (29.7-37.2),p = .602; 6-months: HBP 37 IQR (33-39) vs. RVP 30 IQR (27.7-35), p < .0001] and RV-GLS (Global Longitudinal Strain)% [baseline: HBP -18 IQR (-20.2 to -15) vs. RVP -16 IQR (-18.7 to -14), p = .150; 6-months: HBP -20 IQR(-23 to -17) vs. RVP -13.5 IQR (-16 to -11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p < .0001) and S wave velocity (p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32-42) mmHg vs. RVP 34 IQR (31.5-37) mmHg,p = .060; 6-months: HBP 32 IQR (26-38) mmHg vs. RVP 39 IQR (36-41) mmHg, p < .0001] and tricuspid regurgitation (p = .005) irrespectively from lead position above or below the tricuspid valve. CONCLUSIONS In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.
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Affiliation(s)
- Domenico Grieco
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Edoardo Bressi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy.,Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Karol Curila
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Santosh K Padala
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kamil Sedlacek
- 1st Department of Internal Medicine - Cardiology and Angiology, University Hospital and Charles University Medical Faculty, Hradec Kralove, Czech Republic
| | - Jordana Kron
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elisa Fedele
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | - Oana Ionita
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Sara Giannuzzi
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Germana Panattoni
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
| | | | - Kenneth A Ellenbogen
- Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino of, Rome, Rome, Italy
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Yuan F, Liu C, Yu S, Bian S, Yang J, Ding X, Zhang J, Tan H, Ke J, Yang Y, He C, Zhang C, Rao R, Liu Z, Yang J, Huang L. The Association Between Notching of the Right Ventricular Outflow Tract Flow Velocity Doppler Envelope and Impaired Right Ventricular Function After Acute High-Altitude Exposure. Front Physiol 2021; 12:639761. [PMID: 33868004 PMCID: PMC8047424 DOI: 10.3389/fphys.2021.639761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/26/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction Pulmonary artery pressure (PAP) is increased and right ventricular (RV) function is well preserved in healthy subjects upon exposure to high altitude (HA). An increase in PAP may trigger notching of the right ventricular outflow tract Doppler flow velocity envelope (RVOT notch), which is associated with impaired RV function in patients with pulmonary hypertension. However, whether HA exposure can induce RVOT notch formation and the subsequent impact on cardiac function in healthy subjects remains unclear. Methods A total of 99 subjects (69 males and 30 females) with a median age of 25 years were enrolled in this study; they traveled from 500 to 4100 m by bus over a 2-day period. All subjects underwent a comprehensive physiological and echocardiographic examination 1 day before ascension at low altitude and 15 ± 3 h after arrival at HA. The RVOT notch was determined by the presence of a notched shape in the RVOT Doppler flow velocity envelope. The systolic PAP (SPAP) was calculated as Bernoulli equation SPAP = 4 × (maximum tricuspid regurgitation velocity)2+5 and mean PAP (mPAP) = 0.61 × SPAP+2. Cardiac output was calculated as stroke volume × heart rate. Pulmonary capillary wedge pressure (PCWP) was calculated as 1.9+1.24 × mitral E/e’. Pulmonary vascular resistance (PVR) was calculated as (mPAP-PCWP)/CO. Results After HA exposure, 20 (20.2%) subjects had an RVOT notch [notch (+)], and 79 (79.8%) subjects did not have an RVOT notch [notch (−)]. In the multivariate logistic regression analysis, the SPAP, right ventricular global longitude strain (RV GLS), and tricuspid E/A were independently associated with the RVOT notch. The SPAP, mPAP, PVR, standard deviations of the times to peak systolic strain in the four mid-basal RV segments (RVSD4), peak velocity of the isovolumic contraction period (ICV), and the peak systolic velocity (s’) at the mitral/tricuspid annulus were increased in all subjects. Conversely, the pulse oxygen saturation (SpO2), RV GLS, and tricuspid annulus plane systolic excursion (TAPSE)/SPAP were decreased. However, the increases of SPAP, mPAP, PVR, and RVSD4 and the decreases of SpO2, RV GLS, and TAPSE/SPAP were more pronounced in the notch (+) group than in the notch (−) group. Additionally, increased tricuspid ICV and mitral/tricuspid s’ were found only in the notch (−) group. Conclusion HA exposure-induced RVOT notch formation is associated with impaired RV function, including no increase in the tricuspid ICV or s’, reduction of RV deformation, deterioration in RV-pulmonary artery coupling, and RV intraventricular synchrony.
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Affiliation(s)
- Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shiyong Yu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shizhu Bian
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaohan Ding
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jihang Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuanqi Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunyan He
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rongsheng Rao
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhaojun Liu
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Yang
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Vijiiac A, Onciul S, Guzu C, Scarlatescu A, Petre I, Zamfir D, Onut R, Deaconu S, Dorobantu M. Forgotten No More-The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective. Diagnostics (Basel) 2021; 11:diagnostics11030548. [PMID: 33808566 PMCID: PMC8003573 DOI: 10.3390/diagnostics11030548] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/28/2022] Open
Abstract
During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.
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Affiliation(s)
- Aura Vijiiac
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
- Correspondence: ; Tel.: +40-(75)-2298-189
| | - Sebastian Onciul
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Claudia Guzu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Alina Scarlatescu
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Ioana Petre
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Diana Zamfir
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Roxana Onut
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Silvia Deaconu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
| | - Maria Dorobantu
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 050513 Bucharest, Romania; (S.O.); (I.P.); (S.D.); (M.D.)
- Department of Cardiology, Emergency Clinical Hospital, 014461 Bucharest, Romania; (C.G.); (A.S.); (D.Z.); (R.O.)
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Radwan H, Hussein EM, Refaat H. Short- and long-term prognostic value of right ventricular function in patients with first acute ST elevation myocardial infarction treated by primary angioplasty. Echocardiography 2021; 38:249-260. [PMID: 33462899 DOI: 10.1111/echo.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Limited data are known about the prognostic value of right ventricle (RV) function in patients with first acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the prognostic value of RV dysfunction in predicting both in-hospital and long-term outcomes in these patients, irrespective of the site of necrosis. METHODS We enrolled 502 consecutive patients with first acute STEMI treated with primary angioplasty and underwent echocardiography within 48 hours of admission. RV function was evaluated by RV myocardial performance index (RVMPI), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler S' wave velocity, and RV global longitudinal strain (RVGLS) of the free wall. The occurrence of in-hospital major adverse cardiac events (MACE) and 1-year survival rate were recorded. RESULTS In MACE group, RVFAC, TAPSE, and RV S' wave velocity were lower. However, RVMPI, RVGLS, and TR Vmax. were higher than MACE free group (P < .001). In multivariable analysis adjusted for other variables that predicted adverse outcomes, RVFAC < 35% (P < .001), TAPSE < 17 mm (P < .001), RVGLS > -17% (P < .001), RV S' wave velocity < 9.5 cm/s (P = .02), RVMPI > 0.43 (P < .001), and TR Vmax. > 2.8 m/s (P = .01) were strong independent predictors of in-hospital MACE. Lower 1-year survival was noted in patients with RV dysfunction, documented by these cutoffs values. CONCLUSION RV dysfunction, evidenced by multiparametric echocardiography, is predictive for adverse in-hospital outcomes, and lower 1-year survival rate in first acute STEMI regardless of the site of necrosis.
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Affiliation(s)
- Hanan Radwan
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | | | - Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt
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Balloon pulmonary angioplasty reverse right ventricular remodelling and dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. Eur Radiol 2020; 31:3898-3908. [PMID: 33201287 DOI: 10.1007/s00330-020-07481-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Right ventricular (RV) function is considered the major determinant of prognosis in patients with chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this meta-analysis was to evaluate RV remodelling and function following balloon pulmonary angioplasty (BPA) in patients with inoperable CTEPH or persistent/recurrent pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). METHODS We reviewed all studies evaluating RV function by cardiac magnetic resonance (CMR) and/or echocardiography pre- and post-BPA from PubMed/Medline prior to 15 December 2019. Ten (299 patients) of the 29 studies retrieved met the inclusion criteria: 5 CMR and 5 echocardiography studies. The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. RESULTS Pooled data from CMR studies revealed BPA resulted in a significantly decreased RV end-diastolic volume index (weighted mean difference (WMD) - 28.33 ml/m2, p < 0.00001) and RV end-systolic volume index (WMD - 29.06 ml/m2, p < 0.00001) accompanied by an increased RV ejection fraction (RVEF, WMD 8.97%, p < 0.00001). Data from the echocardiography studies showed BPA resulted in decreased RV basal diameter (WMD - 0.37 cm, p = 0.0009) and an increase of RV fractional area change (WMD 5.97 %, p = 0.003), but improvements of tricuspid annular plane systolic excursion (TAPSE) and S' were not significant. CONCLUSIONS BPA improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA. KEY POINTS • Balloon pulmonary angioplasty improves RVEF and decreases RV volumes in patients with inoperable CTEPH or persistent/recurrent PH after PEA.
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Cobra SDB, Rodrigues MP, de Melo FX, Ferreira NMC, Passini VV, Amado VM, Melo-Silva CA. Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study. Expert Rev Respir Med 2020; 15:249-256. [PMID: 33070645 DOI: 10.1080/17476348.2021.1834856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about right ventricular dysfunction in non-advanced idiopathic pulmonary fibrosis (IPF) patients without hypoxemia at rest. We evaluated it at rest and during exercise. RESEARCH DESIGN AND METHODS 123 IPF patients were evaluated, and 27 met all the following criteria: Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea score ≤3, peripheral oxygen saturation ≥92% at rest, and no history of oxygen therapy. They were submitted to two-dimensional speckle-tracking echocardiography at rest and during cardiopulmonary exercise to analyze right ventricular global longitudinal strain. RESULTS Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular (RV) dysfunction. No patients had abnormalities observed in conventional echocardiographic parameters. Significant differences in mPAP were observed between patients with RV dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). CONCLUSIONS RV dysfunction was detected in 37% of non-advanced IPF patients and early recognition was only possible using speckle-tracking echocardiography. Special attention should be given to these patients as RV dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.
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Affiliation(s)
- Sandra de Barros Cobra
- Federal District Base Hospital Institute and School of Medicine, University of Brasília , Brasília, Brazil
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Rézaiguia-Delclaux S, Haddad F, Pilorge C, Amsallem M, Fadel E, Stéphan F. Limitations of right ventricular annular parameters in the early postoperative period following pulmonary endarterectomy: an observational study. Interact Cardiovasc Thorac Surg 2020; 31:191-198. [PMID: 32577738 DOI: 10.1093/icvts/ivaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Echocardiographic right ventricular (RV) annular parameters are probably not as reliable to evaluate the surgical success in the postoperative period after pulmonary endarterectomy (PEA), whereas RV end-diastolic/left ventricular end-diastolic area ratio (RVEDA/LVEDA ratio) could be more useful. This study examined the relationship between RV annular parameters or RVEDA/LVEDA ratio and ideal cardiac index (ICI), before and after PEA. METHODS Among 80 patients who underwent PEA, the relationships between RVEDA/LVEDA ratio (21 patients), or tricuspid annular plane systolic excursion (32 patients), or systolic tricuspid annular velocity (55 patients) and ICI were modelled. RESULTS Forty-eight hours following PEA, mean pulmonary artery pressure decreased (26 ± 6 vs 46 ± 12 mmHg, P < 0.0001) and ICI improved (2.8 ± 0.8 vs 3.0 ± 0.9 l/min/m2, P = 0.02). In contrast to the moderate association between RV annular indices and ICI in the preoperative period, no significant relationship was found in the postoperative period (r = 0.54 and 0.17 for tricuspid annular plane systolic excursion and r = 0.46 and 0.16 for systolic tricuspid annular velocity, respectively). The RVEDA/LVEDA ratio significantly decreased postoperatively (0.97 ± 0.21 vs 1.19 ± 0.43, P = 0.002) and was correlated with ICI both in preoperative and postoperative periods (r = 0.57 and 0.57, respectively). There was a significant correlation between changes in RVEDA/LVEDA ratio and changes in total pulmonary resistance. CONCLUSIONS Improved ICI and RVEDA/LVEDA ratio reflected the surgical success of PEA and lowering of total pulmonary resistances. In contrast to the RV/left ventricular area ratio, annular RV indices associated poorly with postoperative ICI. Recognizing this limitation is important in minimizing the overdiagnosis of RV dysfunction after PEA.
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Affiliation(s)
| | - François Haddad
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Catherine Pilorge
- Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - François Stéphan
- Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Lejeune S, Roy C, Ciocea V, Slimani A, de Meester C, Amzulescu M, Pasquet A, Vancraeynest D, Beauloye C, Vanoverschelde JL, Gerber BL, Pouleur AC. Right Ventricular Global Longitudinal Strain and Outcomes in Heart Failure with Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 33:973-984.e2. [PMID: 32387031 DOI: 10.1016/j.echo.2020.02.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Right ventricular (RV) strain has emerged as an accurate tool for RV function assessment and is a powerful predictor of survival in patients with heart failure with reduced ejection fraction. However, its prognostic impact in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the prognostic value of RV global longitudinal strain (RVGLS) by two-dimensional speckle-tracking echocardiographic (STE) imaging in patients with HFpEF against conventional RV function parameters. METHODS Patients with HFpEF were prospectively recruited, and 149 of 183 (81%) with analyzable STE RVGLS images constituted the final study population (mean age, 78 ± 9 years; 61% women), compared with 28 control subjects of similar age and sex. All control subjects and 120 patients also underwent cardiac magnetic resonance imaging. Patients were followed up for a primary end point of all-cause mortality and first heart failure hospitalization, and Cox regression analysis was performed. RESULTS Mean STE RVGLS was significantly altered in patients with HFpEF compared with control subjects (-21.7 ± 4.9% vs -25.9 ± 4.2%, P < .001). STE RVGLS correlated well with RV ejection fraction by cardiac magnetic resonance (r = -0.617, P < .001). Twenty-eight patients with HFpEF (19%) had impaired STE RVGLS (>-17.5%). During a mean follow-up period of 30 ± 9 months, 91 patients with HFpEF (62%) reached the primary end point. A baseline model was created using independent predictors of the primary end point: New York Heart Association functional class III or IV, hemoglobin level, estimated glomerular filtration rate, and the presence of moderate or severe tricuspid regurgitation. Impaired STE RVGLS provided significant additional prognostic value over this model (χ2 to enter = 7.85, P = .005). Impaired tricuspid annular plane systolic excursion and fractional area change, however, did not. CONCLUSIONS In patients with HFpEF, impaired RVGLS has strong prognostic value. STE RVGLS should be considered for systematic evaluation of RV function to identify patients at high risk for adverse events.
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Affiliation(s)
- Sibille Lejeune
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Clotilde Roy
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Victor Ciocea
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Alisson Slimani
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe de Meester
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Mihaela Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Agnes Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe Beauloye
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium.
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Zaidi A, Knight DS, Augustine DX, Harkness A, Oxborough D, Pearce K, Ring L, Robinson S, Stout M, Willis J, Sharma V. Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2020. [PMID: 32105053 PMCID: PMC7077526 DOI: 10.1530/erp-19-0051] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.
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Affiliation(s)
| | | | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, UK
| | | | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Vishal Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Bootsma IT, Scheeren TWL, de Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. J Cardiothorac Vasc Anesth 2020; 34:2140-2147. [PMID: 32139346 DOI: 10.1053/j.jvca.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to identify whether the decrease of longitudinal parameters after cardiothoracic surgery (ie, tricuspid annular systolic plane excursion [TAPSE] and systolic excursion velocity [S']) is accompanied by a reduction in global right ventricular (RV) performance. DESIGN Prospective, observational study. SETTING Single-center explorative study in a tertiary teaching hospital. PARTICIPANTS The study comprised 20 patients who underwent aortic valve replacement with or without coronary artery bypass grafting. INTERVENTIONS During cardiac surgery, simultaneous measurements of RV function were performed with a pulmonary artery catheter and transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS TAPSE and S' were reduced significantly directly after surgery compared with the time before surgery (TAPSE from 20.8 [16.6-23.4] mm to 9.1 [5.6-15.5] mm; p < 0.001 and S' from 8.7 [7.9-10.7] cm/s to 7.2 [5.7-8.6] cm/s; p = 0.041). However, the reduction in TAPSE and S' was not accompanied by a reduction in RV performance, as assessed with the TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF). Both remained statistically unaltered before and after the procedure (MPI from 0.52 [0.43-0.58] to 0.50 [0.42-0.88]; p = 0.278 and RVEF from 27% [22%-32%] to 26% [22%-28%]; p = 0.294). CONCLUSIONS In the direct postoperative phase, the reduction of echocardiographic parameters of longitudinal RV contractility (TAPSE and S') were not accompanied by a reduction in global RV performance, expressed as MPI and RVEF. Solely relying on a single RV parameter as a marker for global RV performance may not be adequate to assess the complex adaptation of the right ventricle to aortic valve replacement.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Liu BY, Wu WC, Zeng QX, Liu ZH, Niu LL, Tian Y, Luo Q, Zhao ZH, Quan RL, Lin JR, Wang H, He JG, Xiong CM. The value of three-dimensional echocardiography in risk stratification in pulmonary arterial hypertension: a cross-sectional study. Int J Cardiovasc Imaging 2019; 36:577-584. [PMID: 31853819 DOI: 10.1007/s10554-019-01743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
To explore the value of right ventricular (RV) parameters detected by three-dimensional echocardiography (3DE) in risk stratification in pulmonary arterial hypertension (PAH) patients. We prospectively recruited 130 pulmonary hypertension patients from National Center for Cardiovascular Diseases, Fuwai Hospital. Each participant was performed a transthoracic echocardiography and 3DE parameters were measured using an off-line software (4D RV Function 2.0, TomTec). Patients were classified into low, intermediate-high risk group based on 2015 ESC Guidelines. A total of 91 PAH patients (34 ± 12 years old, 25 males) were enrolled, among which, 42 were classified into low risk group, while 49 were intermediate-high risk group. Compared with low-risk patients, those with intermediate-high risk had significantly larger 3DE-RV volumes, worse ejection fraction (EF) and tricuspid annular plane systolic excursion, and decreased longitudinal strain (LS). Receive operating characteristic curves illustrated all the 3DE parameters were able to predict intermediate-high risk stratification, especially 3D-RVEF (area under curve, 0.82, 95% CI 0.73-0.91, P < 0.001). And 3D-RVEF < 26.39% had a 81.6% sensibility and 73.8% specificity to predict intermediate-high risk stratification. Univariate and multivariate Logistic regression analyses identified 3D-RV end-diastolic (OR 1.02, 95% CI 1.01-1.03, P = 0.002) and end-systolic (OR 1.03, 95% CI 1.01-1.04, P < 0.001) volumes, 3D-RVEF (OR 0.82, 95% CI 0.75-0.90, P < 0.001) and LS of free wall (OR 1.17, 95% CI 1.05-1.31, P = 0.005) as independent predictors of intermediate-high risk stratification. In conclusion, RV volumes, EF and free wall strain detected by 3DE were independent predictors of intermediate-high risk stratification in PAH patients, among which, RVEF showed the best predictive capacity.
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Affiliation(s)
- Bing-Yang Liu
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Qi-Xian Zeng
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhi-Hong Liu
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Li-Li Niu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yue Tian
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Qin Luo
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhi-Hui Zhao
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Rui-Lin Quan
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Jing-Ru Lin
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian-Guo He
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Chang-Ming Xiong
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
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Magunia H, Jordanow A, Keller M, Rosenberger P, Nowak-Machen M. The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: an echocardiography-based prospective observational study. BMC Anesthesiol 2019; 19:199. [PMID: 31684877 PMCID: PMC6829832 DOI: 10.1186/s12871-019-0870-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6–8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results After anesthesia induction TAPSE (mean difference − 1.6 mm (95% CI − 2.6 mm to − 0.7 mm; p = 0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference − 1.9% (95% CI: − 2.6 to − 1.2; p < 0.0001), but global right ventricular ejection fraction (RVEF; p = 0.1607) and right ventricular stroke volume (RVSV; p = 0.1838) did not change. Conclusions This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.
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Affiliation(s)
- Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Anne Jordanow
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Marius Keller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Nowak-Machen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Department of Anesthesia and Intensive Care Medicine, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany
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Abuelkasem E, Wang DW, Subramaniam K. Pro: Myocardial Deformation Imaging Should Be Used Perioperatively for Assessment of Cardiac Function. J Cardiothorac Vasc Anesth 2019; 33:3196-3200. [DOI: 10.1053/j.jvca.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022]
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Abuelkasem E, Wang DW, Omer MA, Abdelmoneim SS, Howard-Quijano K, Rakesh H, Subramaniam K. Perioperative clinical utility of myocardial deformation imaging: a narrative review. Br J Anaesth 2019; 123:408-420. [DOI: 10.1016/j.bja.2019.04.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/09/2019] [Accepted: 04/28/2019] [Indexed: 01/25/2023] Open
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Addetia K, Muraru D, Badano LP, Lang RM. New Directions in Right Ventricular Assessment Using 3-Dimensional Echocardiography. JAMA Cardiol 2019; 4:936-944. [DOI: 10.1001/jamacardio.2019.2424] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Roberto M. Lang
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
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Waziri F, Mellemkjær S, Clemmensen TS, Hjortdal VE, Ilkjær LB, Nielsen SL, Poulsen SH. Long‐term changes of resting and exercise right ventricular systolic performance in patients with chronic thromboembolic pulmonary hypertension following pulmonary thromboendarterectomy – A two‐dimensional and three‐dimensional echocardiographic study. Echocardiography 2019; 36:1656-1665. [DOI: 10.1111/echo.14456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Farhad Waziri
- Department of Cardiology Aarhus University Hospital Aarhus N Denmark
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
- Department of Internal Medicine Regional Hospital of Randers Aarhus N Denmark
| | - Søren Mellemkjær
- Department of Cardiology Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Lars Bo Ilkjær
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
| | - Sten Lyager Nielsen
- Department of Cardiothoracic and Vascular Surgery Aarhus University Hospital Aarhus N Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology Aarhus University Hospital Aarhus N Denmark
- Department of Clinical Medicine Aarhus University Aarhus N Denmark
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Meng H, Chandrasekaran K, Villarraga HR, Shah AA, Kittipovanonth M, Cha SS, Pellikka PA, Seward JB. Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging. Echocardiography 2019; 36:877-887. [DOI: 10.1111/echo.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | | | - Aijaz A. Shah
- Department of CardiologyPrince Sultan Cardiac Center Riyadh Saudi Arabia
| | | | - Stephen S. Cha
- Division of BiostatisticsMayo Clinic Rochester Minnesota
| | | | - James B. Seward
- Division of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
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Genovese D, Mor-Avi V, Palermo C, Muraru D, Volpato V, Kruse E, Yamat M, Aruta P, Addetia K, Badano LP, Lang RM. Comparison Between Four-Chamber and Right Ventricular–Focused Views for the Quantitative Evaluation of Right Ventricular Size and Function. J Am Soc Echocardiogr 2019; 32:484-494. [DOI: 10.1016/j.echo.2018.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 01/01/2023]
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Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplasty. Int J Cardiol 2019; 280:176-181. [DOI: 10.1016/j.ijcard.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/23/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
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