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Owyang C, Kim J. Moving Beyond Right Ventricular Ejection Fraction: Incremental Prognostic Role of Right Ventricular Strain on Postcardiac Transplant Outcomes. Circ Cardiovasc Imaging 2024; 17:e016789. [PMID: 38563155 PMCID: PMC11027957 DOI: 10.1161/circimaging.124.016789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Clark Owyang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
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Slivneva IV, Farulova IY, Skopin II, Pirushkina YD, Murysova DV, Marapov DI, Golukhova EZ. Right Ventricular Function in Surgical Treatment of Left Heart. KARDIOLOGIIA 2023; 63:11-21. [PMID: 38156485 DOI: 10.18087/cardio.2023.12.n2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/17/2023] [Indexed: 12/30/2023]
Abstract
Aim The aim of this study was to evaluate right ventricular (RV) function during left chamber surgery.Material and methods This was a single-site prospective cohort study. The study included 197 patients with valvular pathology of heart left chambers. Mean age of patients was 58 [47; 65] years. Precordial echocardiography was performed preoperatively and within one week after surgery.Results Decreased parameters of the right ventricular (RV) longitudinal function and global contractile function were observed postoperatively in the majority of patients. More noticeable decreases were observed in parameters of the longitudinal function (p<0.001). Analysis of the changes in RV contractility depending on the underlying pathology revealed the greatest changes in the contractile function in the mitral insufficiency group. In the mitral stenosis group, the greatest difference was observed in the tricuspid annular systolic excursion (TAPSE) (p=0.027). In the groups with aortic defects, all parameters of RV contractile function, except for the fractional area change (FAC), showed statistically significant decreases after correction of the underlying defect (p<0.05).Conclusions Surgical intervention for left heart valvulopathy can result in a decrease in RV function unrelated with systolic deficit of the left ventricle. Modern technologies allow multi-vector assessment of the RV contractile function. To assess the RV function, it is advisable to use a combination of parameters that reflect both global and longitudinal function.
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Affiliation(s)
- I V Slivneva
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - I Yu Farulova
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - I I Skopin
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - Yu D Pirushkina
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - D V Murysova
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - D I Marapov
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - E Z Golukhova
- Bakulev National Medical Research Center for Cardiovascular Surgery
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Nguyen VA, Nguyen DT, Ong LTT, Tran AV, Tran BLT, Tran CM. Early detection of reduced left ventricular systolic function by 2D speckle tracking echocardiography in patients with primary mitral regurgitation in a Vietnamese cohort. Glob Cardiol Sci Pract 2023; 2023:e202326. [PMID: 38623555 PMCID: PMC11017305 DOI: 10.21542/gcsp.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/12/2023] [Indexed: 04/17/2024] Open
Abstract
Background: Mitral regurgitation (MR) is a common heart valve disease, causing many serious complications in several organ systems, especially the cardiovascular system. The 2D speckle tracking echocardiography (STE) is a new technique for detecting potential cardiac dysfunction when only tissue function abnormalities are present. The study aimed to assess left ventricular (LV) systolic function early by STE in patients with primary MR through global LV deformity along the global longitudinal strain (GLS). Methods: An analytical cross-sectional study was performed on 46 patients with moderate to severe primary MR as recommended by the American Society of Echocardiography (ASE) 2017. Results: The prevalence of patients with GLS reduction with ejection fraction (EF) >60%, New York Heart Association (NYHA) I, and left ventricular internal diameter systolic (LVIDs) <40 mm was 38.1%, 35.7%, and 39.5%, respectively. 100% of patients with EF<60% and LVIDs ≥40 mm had reduced GLS (<16%). The GLS index strongly correlates with the NYHA classification, degree of MR, EF, and echocardiographic parameters. Conclusion: GLS index gives a significant sign in the early detection of cardiac function abnormalities before symptoms or other echocardiographic parameters in patients with MR.
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Affiliation(s)
- Vu Anh Nguyen
- Hue University of Medicine and Pharmacy, Hue, Viet Nam
| | - Diem Thi Nguyen
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
| | | | - An Viet Tran
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
| | | | - Chau Minh Tran
- Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
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Neuser J, Buck HJ, Oldhafer M, Sieweke JT, Bavendiek U, Bauersachs J, Widder JD, Berliner D. Right Ventricular Function Improves Early After Percutaneous Mitral Valve Repair in Patients Suffering From Severe Mitral Regurgitation. Front Cardiovasc Med 2022; 9:830944. [PMID: 35369337 PMCID: PMC8968125 DOI: 10.3389/fcvm.2022.830944] [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: 12/07/2021] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Percutaneous mitral valve edge-to-edge procedure (PMVR) using the MitraClip® system (Abbot Vascular, CA) is an established therapy for severe mitral regurgitation (MR) in patients judged inoperable or at high surgical risk. Besides determining exercise capacity, right ventricular (RV) function has prognostic value in heart failure and after cardiac surgery. We therefore investigated the impact of PMVR on RV function in patients with severe MR. Methods and Results Sixty-three patients undergoing PMVR at our department were prospectively enrolled. Transthoracic echocardiography was performed before, early (2–12d) after PMVR and after 3 months, including advanced echocardiographic analyses such as 3D imaging and strain analyses. At baseline, all patients presented with advanced heart failure symptoms. Etiology of MR was more often secondary and, if present, left ventricular (LV) dysfunction was predominantly caused by ischemic cardiomyopathy. PMVR substantially reduced MR to a grade ≤ 2 in most patients. Echocardiographic assessment revealed a largely unchanged LV systolic function early after PMVR, while in contrast RV function substantially improved after PMVR [3D RV EF (%): pre 33.7% [27.4; 39.6], post 40.0% [34.5; 46.0] (p < 0.01 vs. pre), 3 months 42.8% [38.3; 48.1] (p < 0.01 vs. pre); 2D RV GLS (%): pre −12.9% [−14.5; −10.5], post −16.0% [−17.9; −12.6] (p < 0.01 vs. pre), 3 months −17.2% [−21.7; −14.9] (p < 0.01 vs. pre)]. Factors that attenuated RV improvement were larger ventricular volumes, lower LV function, secondary MR, and a higher STS score (all p < 0.05). Conclusion By using advanced echocardiographic parameters, we discovered an early improvement of RV function after PMVR that is preserved for months, independent from changes in LV function. Improvement of RV function was less pronounced in patients presenting with an advanced stage of heart failure and a higher burden of comorbidities reflected by the STS score.
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Stanley A, Athanasuleas C, Nanda N. Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns. Curr Cardiol Rev 2022; 18:e060122200068. [PMID: 34994332 PMCID: PMC9893138 DOI: 10.2174/1573403x18666220106115117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent. Global RV systolic function, stroke volume and ejection fraction remain normal after uncomplicated CS, but regional contractile patterns are altered. There is a decrease in longitudinal shortening but an increase in transverse shortening in the endocardial and epicardial right ventricular muscle fibers, respectively. PSM is a secondary event as there is no loss of septal perfusion or thickening. The increased RV transverse shortening (free wall to septal fibers) may modify septal movement resulting in PSM that compensates for the reduced RV longitudinal shortening, thus preserving normal global right ventricular function.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, Section of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Navin Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
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Rong LQ, Menon A, Lopes AJ, Agoglia H, Tak K, Devereux RB, Rahouma M, Gaudino M, Weinsaft JW, Kim J. Left Atrial Strain Quantification by Intraoperative Transesophageal Echocardiography: Validation With Transthoracic Echocardiography. J Cardiothorac Vasc Anesth 2021; 36:2412-2417. [PMID: 34903459 PMCID: PMC9106762 DOI: 10.1053/j.jvca.2021.11.017] [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: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Whereas left atrial (LA) strain has been well-validated using transthoracic echocardiography (TTE), its detection using transesophageal echocardiography (TEE) has not been studied. Conventional transesophageal views are known to be limited due to the posterior location of the LA. Here, the feasibility and accuracy of the deep transgastric long-axis LA focused view for peak atrial longitudinal strain (PALS) quantification was tested. DESIGN This was a retrospective study of patients who underwent elective cardiac surgery between 2018 and 2020. TEE deep transgastric long-axis view was compared to TTE 4-chamber atrial focused view as the reference standard. LA area, volume, and PALS were quantified independently. SETTING At Weill Cornell Medicine, a single, large academic medical center. PARTICIPANTS The population comprised 42 patients undergoing cardiac surgery who had a TTE and TEE within 14.9 ± 20.8 days. INTERVENTIONS TTE, TEE, and cardiac surgery. MEASUREMENTS AND MAIN RESULTS TEE-derived PALS strongly correlated with TTE- derived PALS (r = 0.92, p < 0.001), though absolute PALS were lower (20.7 ± 6.0% v 25.7 ± 6.8%; p < 0.001). Mean TEE-derived atrial length was similar to TTE-derived length (5.18 ± 0.61 cm v 5.24 ± 0.61 cm; p = 0.38), but mean LA area was significantly smaller (16.7 ± 3.5 cm2v 18.9 ± 3.7 cm2; p < 0.001), with significant correlations between the 2 modalities for both (r = 0.74, 0.74, respectively; all p < 0.001). CONCLUSION This exploratory study supported the feasibility of TEE for assessing LA longitudinal strain. There was an excellent correlation between atrial strain derived via TEE versus TTE, although values tended to be smaller on TEE, and bias between values was highly variable, suggesting that the values were not interchangeable.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY.
| | - Ajay Menon
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Alexandra J Lopes
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | - Hannah Agoglia
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Katherine Tak
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Richard B Devereux
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Jonathan W Weinsaft
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
| | - Jiwon Kim
- Department of Cardiology/Medicine, Weill Cornell Medicine/New York Presbyterian, New York, NY
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Labus J, Winata J, Schmidt T, Nicolai J, Tomko M, Sveric K, Wilbring M, Fassl J. Perioperative Course of Three-Dimensional-Derived Right Ventricular Strain in Coronary Artery Bypass Surgery: A Prospective, Observational, Pilot Trial. J Cardiothorac Vasc Anesth 2021; 35:1628-1637. [PMID: 33582011 DOI: 10.1053/j.jvca.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Few data exist on perioperative three-dimensional-derived right ventricular strain. The authors aimed to describe the perioperative course of three-dimensional-derived right ventricular strain in coronary artery bypass graft (CABG) surgery patients. DESIGN Prospective, observational, pilot trial. SETTING Single university hospital. PARTICIPANTS The study comprised 40 patients with preserved left ventricular and right ventricular (RV) function undergoing isolated on-pump CABG surgery. INTERVENTIONS Three-dimensional strain analysis and standard echocardiographic evaluation of RV function were performed preoperatively (T1) and postoperatively (T4) with transthoracic echocardiography (TTE) and intraoperatively before sternotomy (T2) and after sternotomy (T3) with transesophageal echocardiography (TEE). All echocardiographic measurements were performed under stable hemodynamic conditions and predefined fluid management without any vasoactive support. MEASUREMENTS AND MAIN RESULTS The measurements of three-dimensional-derived RV free-wall strain (3D-RV FWS) and RV ejection fraction were performed using TomTec 4D RV-Function 2.0 software. Philips QLAB 10.8 was used to analyze tissue velocity of the tricuspid annulus, tricuspid annular systolic excursion, and RV fractional area change. There were no significant differences (median [interquartile range {IQR}]) between preoperative TTE and intraoperative TEE measurements for 3D-RV FWS (T1 v T2: -22.35 [IQR -17.70 to -27.22] v -24.35 [IQR -20.63 to -29.88]; not significant). 3D-RV FWS remained unchanged after sternotomy (T2 v T3: -24.35 [IQR -20.63 to -29.88] v -23.75 [IQR -20.25 to -29.28]; not significant) but deteriorated significantly after CABG (T1 v T4: -22.35 [IQR -17.70 to -27.22] v -18.5 [IQR -16.90 to -21.65]; p = 0.004). CONCLUSION In patients undergoing on-pump CABG, 3D-RV FWS values for awake, spontaneously breathing patients measured with TTE and values assessed in patients under general anesthesia with TEE did not significantly differ. Three-dimensional RV FWS did not change after sternotomy but deteriorated after on-pump CABG.
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Affiliation(s)
- Jakob Labus
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Johan Winata
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Torsten Schmidt
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Joachim Nicolai
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Matus Tomko
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Kunislav Sveric
- Department of Cardiology and Internal Medicine, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Manuel Wilbring
- Department of Heart Surgery, Heart Center Dresden, University Hospital, Dresden, Germany
| | - Jens Fassl
- Department of Cardiac Anesthesiology, Heart Center Dresden, University Hospital, Dresden, Germany.
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Assessment of right ventricular systolic function by two dimensional speckle tracking echocardiography in rheumatic mitral valve disease. Indian Heart J 2021; 73:239-241. [PMID: 33865528 PMCID: PMC8065355 DOI: 10.1016/j.ihj.2021.01.003] [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: 07/27/2020] [Revised: 10/03/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022] Open
Abstract
We assessed the Right Ventricular (RV) systolic function using two dimensional (2D) speckle tracking echocardiography (STE) in Mitral valve disease before and after intervention. 90 patients divided into 3 groups of Mitral stenosis [MS], Mitral regurgitation [MR] and MS with MR were the study subjects. All the patients were subjected to conventional echocardiography and measurement of Right ventricular global longitudinal strain (RVGLS). Prior to intervention, subjects who demonstrated normal RV function by conventional methods, it was found that RVGLS was impaired significantly in the MS and MS with MR groups but normal in the MR group. After intervention, the RVGLS improved significantly in the MS group but not in the other groups. Right ventricular systolic pressure (RVSP) had a significant negative correlation to RVGLS in all 3 groups.
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Keller M, Heller T, Lang T, Patzelt J, Schreieck J, Schlensak C, Rosenberger P, Magunia H. Acute changes of global and longitudinal right ventricular function: an exploratory analysis in patients undergoing open-chest mitral valve surgery, percutaneous mitral valve repair and off-pump coronary artery bypass grafting. Cardiovasc Ultrasound 2020; 18:32. [PMID: 32787878 PMCID: PMC7425536 DOI: 10.1186/s12947-020-00218-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic indicator. The acute effects of cardiac interventions or cardiac surgery on global and longitudinal RV function are not entirely understood. In this study, acute changes of RV function during mitral valve surgery (MVS), percutaneous mitral valve repair (PMVR) and off-pump coronary artery bypass surgery (OPCAB) were investigated employing 3D echocardiography. Methods Twenty patients scheduled for MVS, 23 patients scheduled for PMVR and 25 patients scheduled for OPCAB were included retrospectively if patients had received 3D transesophageal echocardiography before and immediately after MVS, PMVR or OPCAB, respectively. RV global and longitudinal function was assessed using a 3D multiparameter set consisting of global right ventricular ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), longitudinal contribution to RVEF (RVEFlong) and free wall longitudinal strain (FWLS). Results Longitudinal RV function was significantly depressed immediately after MVS, as reflected by all parameters (RVEFlong: 20 ± 5% vs. 13 ± 6%, p < 0.001, TAPSE: 13.1 ± 5.1 mm vs. 11.0 ± 3.5 mm, p = 0.04 and FWLS: −20.1 ± 7.1% vs. -15.4 ± 5.1%, p < 0.001, respectively). The global RVEF was slightly impaired, but the difference did not reach significance (37 ± 13% vs. 32 ± 9%, p = 0.15). In the PMVR group, both global and longitudinal RV function parameters were unaltered, whereas the OPCAB group showed a slight reduction of RVEFlong only (18 ± 7% vs. 14 ± 5%, p < 0.01). RVEFlong yielded moderate case-to-case but good overall reproducibility. Conclusions TAPSE, FWLS and RVEFlong reflect the depression of longitudinal compared to global RV function initially after MVS. PMVR alone had no impact, while OPCAB had a slight impact on longitudinal RV function. The prognostic implications of these phenomena remain unclear and require further investigation.
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Affiliation(s)
- Marius Keller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
| | - Tim Heller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Tobias Lang
- Chair of Visual Computing, Department of Computer Science, Eberhard-Karls-University, Sand 14, 72076, Tuebingen, Germany
| | - Johannes Patzelt
- Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital, University Heart Center Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Juergen Schreieck
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard-Karls-University, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
| | - Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany
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Qu YY, Li H, Rottbauer W, Ma GS, Buckert D, Rasche V. Right ventricular free wall longitudinal strain and strain rate quantification with cardiovascular magnetic resonance based tissue tracking. Int J Cardiovasc Imaging 2020; 36:1985-1996. [PMID: 32462446 PMCID: PMC7497525 DOI: 10.1007/s10554-020-01895-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/21/2020] [Indexed: 12/24/2022]
Abstract
Cardiovascular magnetic resonance based tissue tracking (CMR-TT) was reported to provide detailed insight into left ventricular mechanical features. However, inadequate knowledge of the right ventricle (RV) mechanical deformation has been acquired by this advanced technique so far. It was the aim of this study to establish reference values of RV free wall (RVFW) global, regional and segmental longitudinal peak strain and strain rate (LS and LSR), and to investigate the gender- and age-related difference as well as the base-to-apex gradient of RVFW-LS and LSR with CMR-TT. 150 healthy volunteers (75 males/females) were retrospectively and continuously recruited and subdivided into three age groups (G20–40, G41–60 and G61–80). RVFW global, regional (basal, middle-cavity and apical) and segmental LS (GLS, RLS, SLS) along with systolic and diastolic LSR were generated by post-hoc CMR-TT analysis of standard steady-state free precession long-axis four-chamber view cine images acquired at 1.5T field strength. The reference value of myocardial RVFW-GLS was − 24.9 ± 5.2%. We found that females showed more negative GLS than males except in the youngest group, and no age-related difference of GLS was observed in both gender groups. RLS and SLS presented with the same age-related tendency as GLS. The basal and middle-cavity LS were similar between each other and significantly larger than apical LS. RVFW-GLSR resulted as − 1.73 ± 0.58 s−1 and 1.69 ± 0.65 s−1 during systolic and diastolic phases, respectively. The diastolic GLSR of males tended to decline with the ageing and was significantly lower than that of females in G61–80 group. Regional and segmental LSR showed significant gender-related differences in certain basal and apical region/segments without any age-related effects. CMR-TT overcomes the difficulty in measuring RV global and segmental deformation. The establishment of the vendor-, gender- and segment-specific reference values of RVFW-LS and LSR is essential for the rapid and efficient utilization of CMR-TT modality in the clinical routine.
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Affiliation(s)
- Yang-Yang Qu
- Internal Medicine II, Ulm University Medical Center, Ulm, Germany.,Medical School of Southeast University, Nanjing, China
| | - Hao Li
- Internal Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Gen-Shan Ma
- Medical School of Southeast University, Nanjing, China.,Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Dominik Buckert
- Internal Medicine II, Ulm University Medical Center, Ulm, Germany.
| | - Volker Rasche
- Internal Medicine II, Ulm University Medical Center, Ulm, Germany.
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11
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Weidenmann V, Robinson NB, Rong LQ, Hameed I, Naik A, Morsi M, Grieshaber P, Böning A, Girardi LN, Gaudino M. Diagnostic dilemma of perioperative myocardial infarction after coronary artery bypass grafting: A review. Int J Surg 2020; 79:76-83. [PMID: 32442689 DOI: 10.1016/j.ijsu.2020.05.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/22/2023]
Abstract
Coronary artery bypass grafting (CABG) is one of the most commonly performed cardiac procedures in the United States (US) and Europe. In the US, perioperative morbidity and mortality related to CABG are below 5%. One of the most significant complications following CABG, however, is perioperative myocardial infarction (PMI). Cardiac biomarkers, intra- and post-operative echocardiography, and electrocardiography are routinely used to monitor for evidence of PMI. In this review, we seek to summarize how each of these modalities is used in the clinical setting to differentiate PMI from expected procedure-related changes, and how these findings impact patients' outcomes. We conclude that while no perfect diagnostic test for the detection of clinically meaningful PMI exists, using a combination of existing modalities with knowledge of expected post-procedure changes allows for early and reliable detection. Future development is needed to create more sensitive and specific modalities for the detection of PMI in patients undergoing CABG.
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Affiliation(s)
- Viola Weidenmann
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA, 10065
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Ajita Naik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mahmoud Morsi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, 10065, USA.
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12
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Donauer M, Schneider J, Jander N, Beyersdorf F, Keyl C. Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial Deformation Analysis and 3-Dimensional Echocardiography. J Cardiothorac Vasc Anesth 2020; 34:708-718. [DOI: 10.1053/j.jvca.2019.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
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Hamidzad M, Khani M, Bayat F, Esfahani M, Saffarian F, Bakhshande H, Talebzade S. 2D Speckel Tracking of RV Function after CABG and CPB Time. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rong LQ, Rahouma M, Neuburger PJ, Arguelles G, Emerson J, Mauer E, Tam C, Shore-Lesserson L, Pryor KO, Gaudino M. Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:1220-1225. [PMID: 31653496 DOI: 10.1053/j.jvca.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population. DESIGN This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019. SETTING Weill Cornell Medicine, a single large academic medical center. PARTICIPANTS The study comprised 119 patients undergoing elective cardiac surgery. INTERVENTIONS Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery. MEASUREMENTS AND MAIN RESULTS Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (<35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]). CONCLUSIONS PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, New York University Hospital, New York, NY
| | | | | | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Christopher Tam
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | | | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Rong LQ, Neuburger PJ, De Paulis S, Kim J. Thinking Outside the Heart: An Innovative Approach of Speckle Tracking With Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2019; 33:2645-2646. [DOI: 10.1053/j.jvca.2019.07.143] [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: 07/16/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/11/2022]
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