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Keskin B, Karagoz A, Hakgor A, Kultursay B, Tanyeri S, Tokgoz HC, Kulahcioglu S, Tosun A, Bulus C, Sekban A, Tanboga IH, Ozdemir N, Kaymaz C. A novel method for the evaluation of right ventricular dysfunction in acute pulmonary embolism: Myocardial work indices. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38760961 DOI: 10.1002/jcu.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE The presence of right ventricular dysfunction indicates a higher risk status in patients with pulmonary embolism (PE). The RV strain evaluated by speckle-tracking echocardiography seems to be more reliable method in the evaluation of RV dysfunction as compared to standard echocardiographic measures. In this study, we aimed to determine the value of myocardial-work indices in evaluating serial changes of RV function in acute PE. METHODS Our study comprised 83 consecutive acute PE patients who admitted to our tertiary cardiovascular hospital. Echocardiography was performed within the first 24-hours of hospitalization, and RV and LV myocardial-work parameters were obtained along with standard echocardiographic parameters. The change in the RV/LVr detected on tomography was selected as the primary outcome measure, and its' predictors were analyzed with classical linear regression and a generalized additive model (GAM). RESULTS Among the LV-RV strain and myocardial work parameters, the RV global longitudinal strain (GLS) has borderline statistical significance in predicting the RV/LVr change whereas the RV global work efficiency (RV-GWE) strongly predicted RV/LVr change (p: 0.049 and <0.001, respectively). CONCLUSION In this study, classical linear regression and GAM analyses showed that RV-GWE seems to offer a better prediction of RV/LVr change in patients with acute PE.
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Affiliation(s)
- Berhan Keskin
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
| | - Ali Karagoz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | | | - Barkın Kultursay
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
| | - Hacer Ceren Tokgoz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Seyhmus Kulahcioglu
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cagdas Bulus
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Sekban
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim H Tanboga
- Department of Cardiology, Nisantası University, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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Scott A, Chen Z, Kligerman S, Kim P, Tran H, Adler E, Narezkina A, Contijoch F. Regional Strain of Right Ventricle From Computed Tomography Improves Risk Stratification of Right Ventricle Failure. ASAIO J 2024; 70:358-364. [PMID: 38166039 PMCID: PMC11062830 DOI: 10.1097/mat.0000000000002123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
Patients who undergo implantation of a left ventricular assist device (LVAD) are at a high risk for right ventricular failure (RVF), presumably due to poor right ventricular (RV) function before surgery. Cine computerized tomography (cineCT) can be used to evaluate RV size, function, and endocardial strain. However, CT-based strain measures in patients undergoing workup for LVAD implantation have not been evaluated. We quantified RV strain in the free wall (FW) and septal wall (SW) in patients with end-stage heart failure using cineCT. Compared to controls, both FW and SW strains were significantly impaired in heart failure patients. The difference between FW and SW strains predicted RV failure after LVAD implantation (area-under-the curve [AUC] = 0.82). Cine CT strain can be combined with RV volumetry to risk-stratify patients. In our study, patients with preserved RV volumes and poor strain had a higher rate of RV failure (57%), than those with preserved volume and preserved strain (0%). This suggests that CT could improve risk stratification of patients receiving LVADs and that strain metrics were particularly useful in risk-stratifying patients with preserved RV volumes.
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Affiliation(s)
- Anderson Scott
- Shu Chien-Gene Lay Department of Bioengineering, UC San Diego, La Jolla CA
| | - Zhennong Chen
- Shu Chien-Gene Lay Department of Bioengineering, UC San Diego, La Jolla CA
| | - Seth Kligerman
- Department of Radiology, National Jewish Health, Denver, CO
| | - Paul Kim
- Division of Cardiology, Department of Medicine, UC San Diego, La Jolla CA
| | - Hao Tran
- Division of Cardiology, Department of Medicine, UC San Diego, La Jolla CA
| | - Eric Adler
- Division of Cardiology, Department of Medicine, UC San Diego, La Jolla CA
| | - Anna Narezkina
- Division of Cardiology, Department of Medicine, UC San Diego, La Jolla CA
| | - Francisco Contijoch
- Shu Chien-Gene Lay Department of Bioengineering, UC San Diego, La Jolla CA
- Department of Radiology, UC San Diego, La Jolla CA
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Tao R, Dharmavaram N, El Shaer A, Heffernan S, Tu W, Ma J, Garcia-Arango M, Baber A, Dhingra R, Runo J, Masri SC, Rahko P, Raza F. Relationship of TAPSE Normalized by Right Ventricular Area With Pulmonary Compliance, Exercise Capacity, and Clinical Outcomes. Circ Heart Fail 2024; 17:e010826. [PMID: 38708598 PMCID: PMC11108738 DOI: 10.1161/circheartfailure.123.010826] [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: 04/29/2023] [Accepted: 01/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND While tricuspid annular plane systolic excursion (TAPSE) captures the predominant longitudinal motion of the right ventricle (RV), it does not account for ventricular morphology and radial motion changes in various forms of pulmonary hypertension. This study aims to account for both longitudinal and radial motions by dividing TAPSE by RV area and to assess its clinical significance. METHODS We performed a retrospective analysis of 71 subjects with New York Heart Association class II to III dyspnea who underwent echocardiogram and invasive cardiopulmonary exercise testing (which defined 4 hemodynamic groups: control, isolated postcapillary pulmonary hypertension, combined postcapillary pulmonary hypertension, and pulmonary arterial hypertension). On the echocardiogram, TAPSE was divided by RV area in diastole (TAPSE/RVA-D) and systole (TAPSE/RVA-S). Analyses included correlations (Pearson and linear regression), receiver operating characteristic, and survival curves. RESULTS On linear regression analysis, TAPSE/RVA metrics (versus TAPSE) had a stronger correlation with pulmonary artery compliance (r=0.48-0.54 versus 0.38) and peak VO2 percentage predicted (0.23-0.30 versus 0.18). Based on the receiver operating characteristic analysis, pulmonary artery compliance ≥3 mL/mm Hg was identified by TAPSE/RVA-D with an under the curve (AUC) of 0.79 (optimal cutoff ≥1.1) and by TAPSE/RVA-S with an AUC of 0.83 (optimal cutoff ≥1.5), but by TAPSE with only an AUC of 0.67. Similarly, to identify peak VO2 <50% predicted, AUC of 0.66 for TAPSE/RVA-D and AUC of 0.65 for TAPSE/RVA-S. Death or cardiovascular hospitalization at 12 months was associated with TAPSE/RVA-D ≥1.1 (HR, 0.38 [95% CI, 0.11-0.56]) and TAPSE/RVA-S ≥1.5 (HR, 0.44 [95% CI, 0.16-0.78]), while TAPSE was not associated with adverse outcomes (HR, 0.99 [95% CI, 0.53-1.94]). Among 31 subjects with available cardiac magnetic resonance imaging, RV ejection fraction was better correlated with novel metrics (TAPSE/RVA-D r=0.378 and TAPSE/RVA-S r=0.328) than TAPSE (r=0.082). CONCLUSIONS In a broad cohort with suspected pulmonary hypertension, TAPSE divided by RV area was superior to TAPSE alone in correlations with pulmonary compliance and exercise capacity. As a prognostic marker of right heart function, TAPSE/RVA-D <1.1 and TAPSE/RVA-S <1.5 predicted adverse cardiovascular outcomes.
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Affiliation(s)
- Ran Tao
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Naga Dharmavaram
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ahmed El Shaer
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Shannon Heffernan
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Wanxin Tu
- Department of Statistics, School of Computer, Data & Information, University of Wisconsin-Madison, Madison, WI
| | - James Ma
- Department of Statistics, School of Computer, Data & Information, University of Wisconsin-Madison, Madison, WI
| | - Mariana Garcia-Arango
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Aurangzeb Baber
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ravi Dhingra
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - James Runo
- Division of Pulmonary and Critical Care, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - S Carolina Masri
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Peter Rahko
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Farhan Raza
- Division of Cardiovascular Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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Costescu A, Riendeau Beaulac G, Guensch DP, Lalancette JS, Couture P, Denault AY. Perioperative echocardiographic strain analysis: what anesthesiologists should know. Can J Anaesth 2024; 71:650-670. [PMID: 38600285 DOI: 10.1007/s12630-024-02713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 10/28/2023] [Indexed: 04/12/2024] Open
Abstract
PURPOSE Echocardiographic strain analysis by speckle tracking allows assessment of myocardial deformation during the cardiac cycle. Its clinical applications have significantly expanded over the last two decades as a sensitive marker of myocardial dysfunction with important diagnostic and prognostic values. Strain analysis has the potential to become a routine part of the perioperative echocardiographic examination for most anesthesiologist-echocardiographers but its exact role in the perioperative setting is still being defined. CLINICAL FEATURES This clinical report reviews the principles underlying strain analysis and describes its main clinical uses pertinent to the field of anesthesiology and perioperative medicine. Strain for assessment of left and right ventricular function as well as atrial strain is described. We also discuss the potential role of strain to aid in perioperative risk stratification, surgical patient selection in cardiac surgery, and guidance of anesthetic monitor choice and clinical decision-making in the perioperative period. CONCLUSION Echocardiographic strain analysis is a powerful tool that allows seeing what conventional 2D imaging sometimes fails to reveal. It often provides pathophysiologic insight into various cardiac diseases at an early stage. Strain analysis is readily feasible and reproducible thanks to the use of highly automated software platforms. This technique shows promising potential to become a valuable tool in the arsenal of the anesthesiologist-echocardiographer and aid in perioperative risk-stratification and clinical decision-making.
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Affiliation(s)
- Adrian Costescu
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Geneviève Riendeau Beaulac
- Department of Anesthesiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Simon Lalancette
- Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - André Y Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
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Ameri P, Mercurio V, Pollesello P, Anker MS, Backs J, Bayes-Genis A, Borlaug BA, Burkhoff D, Caravita S, Chan SY, de Man F, Giannakoulas G, González A, Guazzi M, Hassoun PM, Hemnes AR, Maack C, Madden B, Melenovsky V, Müller OJ, Papp Z, Pullamsetti SS, Rainer PP, Redfield MM, Rich S, Schiattarella GG, Skaara H, Stellos K, Tedford RJ, Thum T, Vachiery JL, van der Meer P, Van Linthout S, Pruszczyk P, Seferovic P, Coats AJS, Metra M, Rosano G, Rosenkranz S, Tocchetti CG. A roadmap for therapeutic discovery in pulmonary hypertension associated with left heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Pulmonary Circulation & Right Ventricular Function. Eur J Heart Fail 2024. [PMID: 38639017 DOI: 10.1002/ejhf.3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/23/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova, Genoa, Italy
- Cardiac, Thoracic, and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Piero Pollesello
- Content and Communication, Branded Products, Orion Pharma, Espoo, Finland
| | - Markus S Anker
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin (Campus CBF), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, University Hospital Heidelberg, University of Heidelberg and DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Sergio Caravita
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
- Department of Cardiology, Istituto Auxologico Italiano IRCCS Ospedale San Luca, Milan, Italy
| | - Stephen Y Chan
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
| | - Frances de Man
- PHEniX laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aránzazu González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA, Pamplona, Spain
- CIBERCV, Madrid, Spain
| | - Marco Guazzi
- University of Milan, Milan, Italy
- Cardiology Division, San Paolo University Hospital, Milan, Italy
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cristoph Maack
- Comprehensive Heart Failure Center (CHFC) and Medical Clinic I, University Clinic Würzburg, Würzburg, Germany
| | | | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Oliver J Müller
- Department of Internal Medicine V, University Hospital Schleswig-Holstein, and German Centre for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Soni Savai Pullamsetti
- Department of Internal Medicine and Excellence Cluster Cardio-Pulmonary Institute (CPI), Justus-Liebig University, Giessen, Germany
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- Department of Medicine, St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
| | | | - Stuart Rich
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gabriele G Schiattarella
- Max-Rubner Center (CMR), Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Hall Skaara
- Pulmonary Hypertension Association Europe, Vienna, Austria
| | - Kostantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Heidelberg and Mannheim, Germany
- Department of Cardiology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
| | - Jean Luc Vachiery
- Department of Cardiology, Hopital Universitaire de Bruxelles Erasme, Brussels, Belgium
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité, BIH Center for Regenerative Therapies, University of Medicine, Berlin, Germany
- German Center for Cardiovascular Research (DZHK, partner site Berlin), Berlin, Germany
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade University Medical Center, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Stephan Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Interdepartmental Center for Clinical and Translational Research (CIRCET), and Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
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Wen X, Gao Y, Guo Y, Zhang Y, Zhang Y, Shi K, Li Y, Yang Z. Assessing right ventricular peak strain in myocardial infarction patients with mitral regurgitation by cardiac magnetic resonance feature tracking. Quant Imaging Med Surg 2024; 14:3018-3032. [PMID: 38617148 PMCID: PMC11007518 DOI: 10.21037/qims-23-1360] [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: 09/23/2023] [Accepted: 02/22/2024] [Indexed: 04/16/2024]
Abstract
Background Although it is known that mitral regurgitation (MR) in patients with myocardial infarction (MI) may increase the right ventricular (RV) afterload, leading to RV dysfunction, the exact detrimental effects on RV function and myocardial peak strain remain unresolved. In this study, we assessed the impact of MR on the impairment of RV myocardial deformation in patients with MI and explored the independent influential factors of RV peak strain. Methods A total of 199 MI participants without or with MR were retrospectively assessed in this study. The cardiovascular magnetic resonance examination protocol included a late gadolinium-enhanced (LGE) imaging technique and a cine-balanced steady-state free precession sequence. Statistical tests, including two independent sample t-test or Mann-Whitney U-test, analysis of variance, Kruskal-Wallis test, and multiple linear regression analysis models were performed. Results The MI (MR+) group exhibited significantly lower RV strain parameters in the radial, circumferential and longitudinal directions when compared to the control and the MI (MR-) groups (both P<0.05). The RV global longitudinal peak strain (GLPS) in the MI group significantly decreased when compared with that in the control group (P<0.05). As moderate-severe MR worsened in patients with MI, RV myocardial global peak strain and the peak systolic strain rate (PSSR) gradually decreased. Multiple linear regression analysis revealed that left ventricular (LV) GLPS, triglycerides, and age were independently correlated with RV GLPS (all P<0.05). RV end-systolic volume (RVESV) acted as an independent association factor for RV global peak strain. Conclusions MR may exacerbate the impairment of RV peak strain and functions in patients with MI. LV GLPS was positively correlated with RV GLPS. However, RVESV, triglycerides, and age acted as independent risk factors associated with worsening RV GLPS.
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Affiliation(s)
- Xiaoling Wen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Zhang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Zhang
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhigang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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7
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Bart NK, Macdonald PS. Understanding Tricuspid Regurgitation Post Cardiac Transplantation; Why "Anatomical" and "Functional" Just Won't Cut It. Transplantation 2024; 108:662-668. [PMID: 37578343 DOI: 10.1097/tp.0000000000004740] [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: 08/15/2023]
Abstract
Tricuspid regurgitation (TR) is common after cardiac transplantation and results in poorer outcomes. Transplant recipients are at high prohibitive risk for redo surgical procedures because of risks associated with a subsequent sternotomy, immunosuppression, and renal failure. Percutaneous therapies have recently become available and may be an option for transplant recipients. However, transplant recipients have complex geometry, and there is a myriad of causes of TR posttransplant. There is a need for careful patient selection for all percutaneous valve interventions, and this is particularly true in transplant recipients who suffer from right ventricular failure and rejection and may undergo repeated endomyocardial biopsies. Cognizant of the rapid developments in this space, this review article focuses on the causes of TR, treatments, and future therapies in heart transplantation recipients to the transplant cardiologist navigate this complex area.
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Affiliation(s)
- Nicole K Bart
- Heart Transplant Program, St Vincent's Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
| | - Peter S Macdonald
- Heart Transplant Program, St Vincent's Hospital, Darlinghurst, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
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8
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Espersen C, Skaarup KG, Lassen MCH, Johansen ND, Hauser R, Jensen GB, Schnohr P, Møgelvang R, Biering-Sørensen T. Right ventricular free wall and four-chamber longitudinal strain in relation to incident heart failure in the general population. Eur Heart J Cardiovasc Imaging 2024; 25:396-403. [PMID: 37878747 DOI: 10.1093/ehjci/jead281] [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: 08/10/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Right ventricular free wall (RVFWLS) and four-chamber longitudinal strain (RV4CLS) are associated with adverse events in various patient populations including patients with heart failure (HF). We sought to investigate the prognostic value of RVFWLS and RV4CLS for the development of incident HF in participants from the general population. METHODS AND RESULTS Participants from the 5th Copenhagen City Heart Study (2011-2015) without known chronic ischaemic heart disease or HF at baseline were included. RVFWLS and RV4CLS were obtained using two-dimensional speckle-tracking echocardiography from the right ventricular (RV)-focused apical four-chamber view. The primary endpoint was incident HF. Among 2740 participants (mean age 54 ± 17 years, 42% male), 43 (1.6%) developed HF during a median follow-up of 5.5 years (IQR 4.5-6.3). Both RVFWLS and RV4CLS were associated with an increased risk of incident HF during follow-up independent of age, sex, hypertension, diabetes, body mass index and tricuspid annular plane systolic excursion (TAPSE), (HR 1.06, 95%CI 1.00-1.11, P = 0.034, per 1% absolute decrease and HR 1.14, 95%CI 1.05-1.23, P = 0.001, per 1% absolute decrease, respectively). Left ventricular ejection fraction (LVEF) modified the association between RV4CLS and incident HF (P for interaction = 0.016) such that RV4CLS was only of prognostic importance among those with LVEF < 55% (HR 1.21, 95%CI 1.11-1.33, P < 0.001 vs. HR 0.94, 95%CI 0.80-1.10, P = 0.43 in patients with LVEF ≥ 55%). CONCLUSION In participants from the general population, both RVFWLS and RV4CLS were associated with a greater risk of incident HF independent of important baseline characteristics and TAPSE, and LVEF modified the relationship between RV4CLS and incident HF.
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Affiliation(s)
- Caroline Espersen
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Raphael Hauser
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiac Non-Invasive Imaging Research Laboratory, The Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, 3. th., 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
- The Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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9
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Beyls C, Yakoub-Agha M, Hermida A, Martin N, Crombet M, Hanquiez T, Fournier A, Jarry G, Malaquin D, Michaud A, Abou-Arab O, Leborgne L, Mahjoub Y. Prognostic Value of a New Right Ventricular-to-Pulmonary Artery Coupling Parameter Using Right Ventricular Longitudinal Shortening Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prospective Echocardiography Study. J Clin Med 2024; 13:1006. [PMID: 38398319 PMCID: PMC10889072 DOI: 10.3390/jcm13041006] [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: 12/19/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58-0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49-0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg-1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38-74]) for patients with RV-LSF/PASP < 0.30%.mmHg-1 and 17% (95%CI = [12-23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg-1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg-1 was associated with MACE at 6 months.
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Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
| | - Mathilde Yakoub-Agha
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Alexis Hermida
- Rythmology Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France;
| | - Nicolas Martin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Maxime Crombet
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Thomas Hanquiez
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Alexandre Fournier
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Geneviève Jarry
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Dorothée Malaquin
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Audrey Michaud
- Biostatistics Unit, Clinical Research and Innovation Directorate, Amiens-Picardie University Hospital Centre, F-80054 Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
| | - Laurent Leborgne
- Cardiac Intensive Care Unit, Department of Cardiology, Amiens University Hospital, F-80054 Amiens, France; (N.M.); (T.H.); jarry.geneviè (D.M.); (L.L.)
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, F-80054 Amiens, France; (M.Y.-A.); (M.C.); (O.A.-A.); (Y.M.)
- UR UPJV 758 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, F-80054 Amiens, France
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10
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Cersosimo A, Gavazzoni M, Inciardi RM, Radulescu CI, Adamo M, Arabia G, Metra M, Raddino R, Vizzardi E. Right ventricle assessment before tricuspid valve interventions. J Cardiovasc Med (Hagerstown) 2024; 25:95-103. [PMID: 38149699 PMCID: PMC10906196 DOI: 10.2459/jcm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 12/28/2023]
Abstract
In the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions.
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Affiliation(s)
- Angelica Cersosimo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Mara Gavazzoni
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Riccardo Maria Inciardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Crina Ioana Radulescu
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Gianmarco Arabia
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Riccardo Raddino
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Brescia
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11
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Mendelson JB, Sternbach JD, Doyle MJ, Mills L, Hartweck LM, Tollison W, Carney JP, Lahti MT, Bianco RW, Kalra R, Kazmirczak F, Hindmarch C, Archer SL, Prins KW, Martin CM. Multi-omic and multispecies analysis of right ventricular dysfunction. J Heart Lung Transplant 2024; 43:303-313. [PMID: 37783299 PMCID: PMC10841898 DOI: 10.1016/j.healun.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/14/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Right ventricular failure (RVF) is a leading cause of morbidity and mortality in multiple cardiovascular diseases, but there are no treatments for RVF as therapeutic targets are not clearly defined. Contemporary transcriptomic/proteomic evaluations of RVF are predominately conducted in small animal studies, and data from large animal models are sparse. Moreover, a comparison of the molecular mediators of RVF across species is lacking. METHODS Transcriptomics and proteomics analyses defined the pathways associated with cardiac magnetic resonance imaging (MRI)-derived values of RV hypertrophy, dilation, and dysfunction in control and pulmonary artery banded (PAB) pigs. Publicly available data from rat monocrotaline-induced RVF and pulmonary arterial hypertension patients with preserved or impaired RV function were used to compare molecular responses across species. RESULTS PAB pigs displayed significant right ventricle/ventricular (RV) hypertrophy, dilation, and dysfunction as quantified by cardiac magnetic resonance imaging. Transcriptomic and proteomic analyses identified pathways associated with RV dysfunction and remodeling in PAB pigs. Surprisingly, disruptions in fatty acid oxidation (FAO) and electron transport chain (ETC) proteins were different across the 3 species. FAO and ETC proteins and transcripts were mostly downregulated in rats but were predominately upregulated in PAB pigs, which more closely matched the human response. All species exhibited similar dysregulation of the dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy pathways. CONCLUSIONS The porcine metabolic molecular signature was more similar to human RVF than rodents. These data suggest there may be divergent molecular responses of RVF across species, and pigs may more accurately recapitulate metabolic aspects of human RVF.
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Affiliation(s)
- Jenna B Mendelson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota
| | - Jacob D Sternbach
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Michelle J Doyle
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Lauren Mills
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lynn M Hartweck
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota
| | - Walt Tollison
- Department of Surgery, Experimental Surgical Services Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - John P Carney
- Department of Surgery, Experimental Surgical Services Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - Matthew T Lahti
- Department of Surgery, Experimental Surgical Services Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - Richard W Bianco
- Department of Surgery, Experimental Surgical Services Laboratory, University of Minnesota, Minneapolis, Minnesota
| | - Rajat Kalra
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Charles Hindmarch
- Queen's Cardiopulmonary Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen L Archer
- Queen's Cardiopulmonary Unit, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kurt W Prins
- Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota; Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Cindy M Martin
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas
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12
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Pawar SG, Khan N, Salam A, Joshi M, Saravanan PB, Pandey S. The association of Pulmonary Hypertension and right ventricular systolic function - updates in diagnosis and treatment. Dis Mon 2024; 70:101635. [PMID: 37734967 DOI: 10.1016/j.disamonth.2023.101635] [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] [Indexed: 09/23/2023]
Abstract
Right ventricular (RV) systolic function is an essential but neglected component in cardiac evaluation, and its importance to the contribution to overall cardiac function is undermined. It is not only sensitive to the effect of left heart valve disease but is also more sensitive to changes in pressure overload than the left ventricle. Pulmonary Hypertension is the common and well-recognized complication of RV systolic dysfunction. It is also the leading cause of pulmonary valve disease and right ventricular dysfunction. Patients with a high pulmonary artery pressure (PAP) and a low RV ejection fraction have a seven-fold higher risk of death than heart failure patients with a normal PAP and RV ejection fraction. Furthermore, it is an independent predictor of survival in these patients. In this review, we examine the association of right ventricular systolic function with Pulmonary Hypertension by focusing on various pathological and clinical manifestations while assessing their impact. We also explore new 2022 ESC/ERS guidelines for diagnosing and treating right ventricular dysfunction in Pulmonary Hypertension.
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Affiliation(s)
| | - Nida Khan
- Jinnah Sindh Medical University, Pakistan
| | - Ajal Salam
- Government Medical College Kottayam, Kottayam, Kerala, India
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
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13
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Ballas C, Lakkas L, Kardakari O, Konstantinidis A, Exarchos K, Tsiara S, Kostikas K, Naka KΚ, Michalis LK, Katsouras CS. What is the real incidence of right ventricular affection in patients with acute pulmonary embolism? Acta Cardiol 2023; 78:1089-1098. [PMID: 37581357 DOI: 10.1080/00015385.2023.2246197] [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: 11/01/2022] [Revised: 12/19/2022] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Echocardiographic markers of right ventricular dysfunction or pressure overload (RVd/PO) have been used in risk assessment of patients with acute pulmonary embolism (APE). Nevertheless, the role of echocardiography in these patients is incompletely determined. We evaluated the right ventricular function using 'non-conventional' markers of RVd/PO in patients with APE. METHODS This was a prospective, single-arm, single-centre study. Consecutive adult patients hospitalised for APE were included. The RV free wall longitudinal strain (RV-FWLS), the fractional area change (FAC), the ratio tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP), and the pulmonary vascular resistance (PVR) were evaluated. RESULTS One hundred patients (mean age 70.0 ± 13.9 years, female 48%) were screened and 73 had adequate RV-FWLS images. The most common abnormal echocardiographic marker was RV-FWLS (44/73; p < 0.001, for all other echocardiographic indices). Thirty-one patients had either PASP ≥ 36 mmHg or PVR > 2 WU (49.2% of the patients with both indices available). There were significant correlations between RV-FWLS, TAPSE/PASP and PVR with both D-Dimers and B-type natriuretic peptide (BNP), and between FAC and BNP. RF-FWLS differed significantly between patients with a simplified pulmonary embolism severity index (sPESI) score 0 and those with a score ≥1 (p < 0.001). CONCLUSIONS RVd/PO coexists with APE in a large proportion of patients. RV-FWLS is the most abnormal echocardiographic sign and is related to clinical and biochemical prognostic indices.
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Affiliation(s)
- Christos Ballas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros Lakkas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Olga Kardakari
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Stavroula Tsiara
- Second Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
| | | | - Katerina Κ Naka
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Christos S Katsouras
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
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14
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Kersten J, Hackenbroch C, Gann P, Hoestermann AS, Bernhardt P. Myocardial deformation parameters assessed by CMR feature tracking in chronic heart failure: the influence of an optimal medical therapy on myocardial remodelling. Acta Cardiol 2023; 78:1045-1050. [PMID: 37606342 DOI: 10.1080/00015385.2023.2246202] [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: 05/02/2022] [Revised: 01/02/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Myocardial deformation parameters have been shown to yield early detection of pathological changes in chronic heart failure (CHF). Aim of our study was to evaluate myocardial deformation changes under optimal medical therapy (OMT) in CHF patients. METHODS CHF patients were examined longitudinally with two cardiac magnetic resonance imaging (CMR) examinations at a median time interval of 140 days. Left and right ventricular volumes were quantified, and deformation analysis was performed using feature tracking, respectively. RESULTS 57 patients were included into the study. There was a high rate of OMT with a prescription of beta blockers in 98.2% and ACE-inhibitors/Angiotensin receptor blockers in 93.0%. In the total cohort, there were indications of positive remodelling with a significant improvement in left ventricular (LV) ejection fraction (38.9% ± 11.6 vs. 43.0% ± 12.7, p = 0.009), LV enddiastolic volume indexed (92.1 ml/m2 ± 23.5 vs. 87.2 ml/m2 ± 21.2, p = 0.007), LV mass (140.3 g ± 35.7 vs. 128.0 g ± 34.4, p = 0.001) and right ventricular global longitudinal strain (RV GLS) (-18.1% ± 5.1 vs. -20.3% ± 4.5, p < 0.001) during follow-up. DISCUSSION Patients with CHF and OMT show positive reverse remodelling with improvement of LV volumes and function and RV GLS. This has a potential impact on the surveillance of this patient group, which should be further investigated in larger prospective studies.
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Affiliation(s)
- Johannes Kersten
- Division of Sports and Rehabilitation Medicine, University of Ulm, Ulm, Germany
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15
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Vacek JL. Right Ventricular Function in Acute Myocardial Infarction: Is It Important and How Should We Assess It? Am J Cardiol 2023; 206:351-352. [PMID: 37689494 DOI: 10.1016/j.amjcard.2023.08.132] [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: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/11/2023]
Affiliation(s)
- James L Vacek
- The Department of Cardiovascular Medicine, The University of Kansas School of Medicine and Health Care System, Kansas City, Kansas..
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16
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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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17
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Hida Y, Imamura T. Detailed association between hepatic dysfunction and tricuspid valve surgery. J Thorac Dis 2023; 15:5258-5259. [PMID: 37868847 PMCID: PMC10586973 DOI: 10.21037/jtd-23-1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Yuki Hida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Winkler NE, Anwer S, Reeve KA, Michel JM, Kasel AM, Tanner FC. Right vs. left ventricular longitudinal strain for mortality prediction after transcatheter aortic valve implantation. Front Cardiovasc Med 2023; 10:1252872. [PMID: 37745112 PMCID: PMC10513390 DOI: 10.3389/fcvm.2023.1252872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction This study aims at exploring biventricular remodelling and its implications for outcome in a representative patient cohort with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods and results Pre-interventional echocardiographic examinations of 100 patients with severe AS undergoing TAVI were assessed by speckle tracking echocardiography of both ventricles. Association with mortality was determined for right ventricular global longitudinal strain (RVGLS), RV free wall strain (RVFWS) and left ventricular global longitudinal strain (LVGLS). During a median follow-up of 1,367 [959-2,123] days, 33 patients (33%) died. RVGLS was lower in non-survivors [-13.9% (-16.4 to -12.9)] than survivors [-17.1% (-20.2 to -15.2); P = 0.001]. In contrast, LVGLS as well as the conventional parameters LV ejection fraction (LVEF) and RV fractional area change (RVFAC) did not differ (P = ns). Kaplan-Meier analyses indicated a reduced survival probability when RVGLS was below the -14.6% cutpoint (P < 0.001). Lower RVGLS was associated with higher mortality [HR 1.13 (95% CI 1.04-1.23); P = 0.003] independent of LVGLS, LVEF, RVFAC, and EuroSCORE II. Addition of RVGLS clearly improved the fitness of bivariable and multivariable models including LVGLS, LVEF, RVFAC, and EuroSCORE II with potential incremental value for mortality prediction. In contrast, LVGLS, LVEF, and RVFAC were not associated with mortality. Discussion In patients with severe AS undergoing TAVI, RVGLS but not LVGLS was reduced in non-survivors compared to survivors, differentiated non-survivors from survivors, was independently associated with mortality, and exhibited potential incremental value for outcome prediction. RVGLS appears to be more suitable than LVGLS for risk stratification in AS and timely valve replacement.
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Affiliation(s)
- Neria E. Winkler
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kelly A. Reeve
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jonathan M. Michel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Albert M. Kasel
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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19
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Koca F, Levent F, Tatlı AB, Demir M, Tenekecioglu E. The impact of invasive treatment of superficial venous insufficiency of the lower extremities on cardiac functions. Phlebology 2023; 38:561-569. [PMID: 37461132 DOI: 10.1177/02683555231190452] [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] [Indexed: 09/21/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. METHODS Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3 months after the invasive treatment. RESULTS In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter (p = 0.006), TAPSE (p = 0.006), tricuspid E wave velocity (p = 0.004), tricuspid E/A ratio (p < 0.001), sPAB (p = 0.017), tricuspid lateral s' wave velocity (p = 0.004), and right ventricular free wall longitudinal strain rate (p = 0.011) were observed. CONCLUSIONS The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.
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Affiliation(s)
- Fatih Koca
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Fatih Levent
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Ahmet Burak Tatlı
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Demir
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Erhan Tenekecioglu
- Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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20
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Shvilkina T, Shapiro N. Sepsis-Induced myocardial dysfunction: heterogeneity of functional effects and clinical significance. Front Cardiovasc Med 2023; 10:1200441. [PMID: 37522079 PMCID: PMC10375025 DOI: 10.3389/fcvm.2023.1200441] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
Sepsis is a life-threatening disease state characterized by organ dysfunction and a dysregulated response to infection. The heart is one of the many organs affected by sepsis, in an entity termed sepsis-induced cardiomyopathy. This was initially used to describe a reversible depression in ejection fraction with ventricular dilation but advances in echocardiography and introduction of new techniques such as speckle tracking have led to descriptions of other common abnormalities in cardiac function associated with sepsis. This includes not only depression of systolic function, but also supranormal ejection fraction, diastolic dysfunction, and right ventricular dysfunction. These reports have led to inconsistent definitions of sepsis-induced cardiomyopathy. Just as there is heterogeneity among patients with sepsis, there is heterogeneity in the cardiac response; thus resuscitating these patients with a single approach is likely suboptimal. Many factors affect the heart in sepsis including inflammatory mediators, catecholamine responsiveness, and pathogen related toxins. This review will discuss different functional effects characterized by echocardiographic changes in sepsis and their prognostic and management implications.
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21
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Wiliński J, Skwarek A, Borek R, Medygrał M, Chrzan I, Lechowicz-Wilińska M, Chukwu O. Indexing of Speckle Tracking Longitudinal Strain of Right Ventricle to Body Surface Area Does Not Improve Its Efficiency in Diagnosis and Mortality Risk Stratification in Patients with Acute Pulmonary Embolism. Healthcare (Basel) 2023; 11:healthcare11111629. [PMID: 37297770 DOI: 10.3390/healthcare11111629] [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: 04/21/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (PE) is associated with a serious mortality rate. Thus, the rapid diagnosis and identification of patients at high risk of death is pivotal. The search for echocardiographic parameters for this purpose continues. Recent publications reveal correlations between myocardial longitudinal strain (LS) and body surface area (BSA). The aim of the study was to evaluate the usefulness of indexing the right ventricular (RV) speckle tracking LS to BSA in detecting PE and stratifying the risk of 30-day all-cause mortality. METHODS the prospective cross-sectional observational study group consisted of 167 consecutive patients (76 men, 45.5%) aged 69.5 ± 15.3 years, and they were referred for computed tomography pulmonary angiography. Patients underwent a transthoracic echocardiographic examination within 24 h of admission to the hospital ward. RVLS and their derivatives indexed to BSA were included in the analysis. RESULTS PE was confirmed in 88 patients, while 79 patients had no radiological features of PE. The only echocardiographic parameters that differed between subgroups were pulmonary flow acceleration (Act), McConnell's sign, LS of the middle segment of the RV free wall, and its derivative indexed to BSA. During the 30-day follow-up of a subgroup of subjects with PE, 12 patients died. The mortality predictors with increasing prediction value included a RV free wall mid-segment LS (cut-off value: -21%, Area Under the Curve-AUC 0.6, p = 0.02) and its derivative indexed to BSA (-14 %/m2, AUC 0.62, p = 0.003), body mass index (24.7 kg/m2, AUC 0.63, p = 0.002), D-dimer serum concentration (3559 pg/mL, AUC 0.66, p < 0.001), Act (67 ms, AUC 0.67, p < 0.001), septal basal LS (-15%, AUC 0.68, p = 0.02), RV free wall basal segment LS (-14%, AUC 0.7, p = 0.015), age (66 years, AUC 0.74, p = 0.004), NT-proBNP (1120 pg/mL, AUC 0.75, p = 0.01), troponin T (66 ng/mL, AUC 0.78, p = 0.005), and the complex score of the Pulmonary Embolism Severity Index (AUC 0.88, p < 0.001). CONCLUSIONS indexing of RVLS to BSA does not improve its prognostic value in patients with acute PE.
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Affiliation(s)
- Jerzy Wiliński
- Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, 32-700 Bochnia, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sącz, Poland
| | - Anna Skwarek
- Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, 32-700 Bochnia, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sącz, Poland
| | - Radosław Borek
- Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, 32-700 Bochnia, Poland
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sącz, Poland
| | - Michał Medygrał
- Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, 32-700 Bochnia, Poland
| | - Iwona Chrzan
- Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sącz, Poland
| | - Marta Lechowicz-Wilińska
- Department of General, Plastic and Reconstructive Surgery, 5th Military Clinical Hospital with Polyclinic, 30-901 Krakow, Poland
| | - Ositadima Chukwu
- Department of Urology and Urological Oncology, Pomeranian Medical University, 71-899 Szczecin, Poland
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22
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Hameed A, Condliffe R, Swift AJ, Alabed S, Kiely DG, Charalampopoulos A. Assessment of Right Ventricular Function-a State of the Art. Curr Heart Fail Rep 2023; 20:194-207. [PMID: 37271771 PMCID: PMC10256637 DOI: 10.1007/s11897-023-00600-6] [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] [Accepted: 04/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) has a complex geometry and physiology which is distinct from the left. RV dysfunction and failure can be the aftermath of volume- and/or pressure-loading conditions, as well as myocardial and pericardial diseases. RECENT FINDINGS Echocardiography, magnetic resonance imaging and right heart catheterisation can assess RV function by using several qualitative and quantitative parameters. In pulmonary hypertension (PH) in particular, RV function can be impaired and is related to survival. An accurate assessment of RV function is crucial for the early diagnosis and management of these patients. This review focuses on the different modalities and indices used for the evaluation of RV function with an emphasis on PH.
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Affiliation(s)
- Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
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23
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Aydınyılmaz F, Guliyev İ, Özbeyaz NB, Algül E, Aker M, Şahan HF, Erzurum M, Felekoğlu MA, Kalkan K. Predicting hospitalization by TAPSE/SPAP and the role of spironolactone in asymptomatic heart failure patients. Biomark Med 2023; 17:197-207. [PMID: 37140253 DOI: 10.2217/bmm-2022-0737] [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: 05/05/2023] Open
Abstract
Aim: To appraise the prediction of tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (SPAP) with regard to hospitalization and the effect of spironolactone use. Materials & methods: A total of 245 patients were evaluated for the study. Patients were followed for 1 year and cardiovascular outcomes were determined. Results: It was determined that TAPSE/SPAP was an independent predictor of hospitalization. A 0.1-mmHg decrease in TAPSE/SPAP was associated with a 9% increase in relative risk. No event was observed above the 0.47 level. Negative correlation with TAPSE (uncoupling) began in the spironolactone group when SPAP was ≥43 and in nonusers when SPAP was 38 (Pearson's correlation coefficient: -,731 vs -,383; p < 0.001 vs p = 0.037). Conclusion: TAPSE/SPAP measurement may be useful in predicting 1-year hospitalization in asymptomatic heart failure patients. This ratio was also found to be higher in patients who used spironolactone.
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Affiliation(s)
- Faruk Aydınyılmaz
- Department of Cardiology, Erzurum Bolge Training & Research Hospital, University of Health Sciences, Erzurum, 25030, Turkey
| | - İlkin Guliyev
- Department of Cardiology, Gumushane State Hospital, Gumushane, 29010, Turkey
| | - Nail B Özbeyaz
- Department of Cardiology, Pursaklar State Hospital, Ankara, 06145, Turkey
| | - Engin Algül
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
| | - Mert Aker
- Department of Cardiology, Karabuk Training & Research Hospital, Karabuk, 78020, Turkey
| | - Haluk F Şahan
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
| | - Muhammed Erzurum
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, 26000, Turkey
| | - Mehmet A Felekoğlu
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, 26000, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training & Research Hospital, University of Health Sciences, Ankara, 06145, Turkey
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24
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Forfia P, Benza R, D'Alto M, De Marco T, Elwing JM, Frantz R, Haddad F, Oudiz R, Preston IR, Rosenkranz S, Ryan J, Schilz R, Shlobin OA, Vachiery J, Vizza CD, Noordegraaf AV, Sketch MR, Broderick M, McLaughlin V. The heart of the matter: Right heart imaging indicators for treatment escalation in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12240. [PMID: 37222992 PMCID: PMC10201108 DOI: 10.1002/pul2.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
Right heart (RH) structure and function are major determinants of symptoms and prognosis in pulmonary arterial hypertension (PAH). RH imaging provides detailed information, but evidence and guidelines on the use of RH imaging in treatment decisions are limited. We conducted a Delphi study to gather expert opinion on the role of RH imaging in decision-making for treatment escalation in PAH. A panel of 17 physicians with expertise in PAH and RH imaging used three surveys in a modified Delphi process to reach consensus on the role of RH imaging in PAH. Survey 1 used open-ended questions to gather information. Survey 2 contained Likert scale and other questions intended to identify consensus on topics identified in Survey 1. Survey 3 contained Likert scale questions derived from Survey 2 and summary information on the results of Survey 2. The Delphi panel reached consensus that RH imaging is likely to improve the current risk stratification algorithms and help differentiate risk levels in patients at intermediate risk. Tricuspid annular plane systolic excursion, right ventricular fractional area change, right atrial area, tricuspid regurgitation, inferior venae cavae diameter, and pericardial effusion should be part of routine echocardiography in PAH. Cardiac magnetic resonance imaging is valuable but limited by cost and access. A pattern of abnormal RH imaging results should prompt consideration of hemodynamic evaluation and possible treatment escalation. RH imaging is an important tool for decisions about treatment escalation in PAH, but systematically collected evidence is needed to clarify its role.
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Affiliation(s)
- Paul Forfia
- Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | | | | | - Teresa De Marco
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | | | | | | | - Ronald Oudiz
- Lundquist Institute for Biomedical Research at Harbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | | | | | - John Ryan
- University of UtahSalt Lake CityUtahUSA
| | | | | | | | | | - Anton Vonk Noordegraaf
- Department of Pulmonary MedicineAmsterdam UMC location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesPulmonary Hypertension and ThrombosisAmsterdamThe Netherlands
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25
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Affiliation(s)
- Brian A Houston
- From the Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (B.A.H., R.J.T.); and the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville (E.L.B.)
| | - Evan L Brittain
- From the Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (B.A.H., R.J.T.); and the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville (E.L.B.)
| | - Ryan J Tedford
- From the Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston (B.A.H., R.J.T.); and the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville (E.L.B.)
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26
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Tadic M, Cuspidi C. Obstructive Sleep Apnea and Right Ventricular Remodeling: Do We Have All the Answers? J Clin Med 2023; 12:jcm12062421. [PMID: 36983420 PMCID: PMC10054509 DOI: 10.3390/jcm12062421] [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: 12/30/2022] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is a very important sleep-related breathing disorder related to increased cardiovascular and overall morbidity and mortality. It is associated with multisystemic target organ damage due to micro- and macrovascular changes, resulting in carotid and coronary atherosclerosis, increased arterial stiffness, retinal damage, microalbuminuria, and cardiac remodeling. The latter consists of left ventricular (LV) hypertrophy, as well as diastolic and systolic dysfunction. The increasing burden of evidence shows that OSA also induces right ventricular (RV) remodeling that is more difficult to diagnose, but may also contribute to cardiovascular morbidity and mortality in these patients. Conventional echocardiographic parameters for assessment of RV systolic and diastolic functions are often not sensitive enough to detect subclinical and subtle changes in the RV function. Data published over last decade showed that the RV function, particularly systolic, is impaired in OSA patients and related with its severity. However, the introduction of speckle tracking echocardiography and the particularly longitudinal strain enabled the earlier detection of functional and mechanical changes even when conventional echocardiographic parameters of RV systolic function remained unchanged. The 3D echocardiography provided the possibility to evaluate the entire RV, with its unique shape, and determine 3D RV ejection fraction, which is comparable with results obtained by cardiac magnetic resonance. The use of this modality also provided a new insight into RV systolic (dys)function in OSA patients. In addition to weight loss, which has been proven very helpful in OSA patients, the only approved therapeutic approach is continuous positive airway pressure (CPAP) therapy. It is very important to assess if this therapy induces any improvement in cardiac structure and function. Limited data on this topic show that RV longitudinal strain is a more sensitive parameter rather than other conventional RV indexes in the detection of improvement in RV systolic function and mechanics. The aim of this review article is to summarize the current understanding of RV structural, functional, and mechanical changes in patients with OSA. Furthermore, we sought to provide the current knowledge regarding the effect of CPAP therapy on RV reverse remodeling in OSA patients.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Deparment of Cardiology, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20125 Milano, Italy
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27
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Mendelson JB, Sternbach JD, Doyle MJ, Mills L, Hartweck LM, Tollison W, Carney JP, Lahti MT, Bianco RW, Kalra R, Kazmirczak F, Hindmarch C, Archer SL, Prins KW, Martin CM. A Multi-omic and Multi-Species Analysis of Right Ventricular Failure. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.08.527661. [PMID: 36798212 PMCID: PMC9934613 DOI: 10.1101/2023.02.08.527661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Right ventricular failure (RVF) is a leading cause of morbidity and mortality in multiple cardiovascular diseases, but there are no approved treatments for RVF as therapeutic targets are not clearly defined. Contemporary transcriptomic/proteomic evaluations of RVF are predominately conducted in small animal studies, and data from large animal models are sparse. Moreover, a comparison of the molecular mediators of RVF across species is lacking. Here, we used transcriptomics and proteomics analyses to define the molecular pathways associated with cardiac MRI-derived values of RV hypertrophy, dilation, and dysfunction in pulmonary artery banded (PAB) piglets. Publicly available data from rat monocrotaline-induced RVF and pulmonary arterial hypertension patients with preserved or impaired RV function were used to compare the three species. Transcriptomic and proteomic analyses identified multiple pathways that were associated with RV dysfunction and remodeling in PAB pigs. Surprisingly, disruptions in fatty acid oxidation (FAO) and electron transport chain (ETC) proteins were different across the three species. FAO and ETC proteins and transcripts were mostly downregulated in rats, but were predominately upregulated in PAB pigs, which more closely matched the human data. Thus, the pig PAB metabolic molecular signature was more similar to human RVF than rodents. These data suggest there may be divergent molecular responses of RVF across species, and that pigs more accurately recapitulate the metabolic aspects of human RVF.
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28
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Brieger D, Rye EE, Hungerford SL. Editorial for "Risk Stratification and Outcomes in Patients with Pulmonary Hypertension: Insights into Right Ventricular Strain by MRI Feature-Tracking". J Magn Reson Imaging 2023; 57:557-558. [PMID: 35700221 DOI: 10.1002/jmri.28289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 01/20/2023] Open
Affiliation(s)
- Daniel Brieger
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Eleanor E Rye
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sara L Hungerford
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
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29
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Right Ventricle and Radiotherapy: More Questions than Answers. Diagnostics (Basel) 2023; 13:diagnostics13010164. [PMID: 36611456 PMCID: PMC9818447 DOI: 10.3390/diagnostics13010164] [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: 12/19/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The injury of the left ventricle (LV) during anticancer therapy has long been recognized, and guidelines recommend a specific set of parameters for determination of LV impairment. The influence of anticancer therapy on the right ventricle (RV) has been insufficiently investigated, and there are only a few studies that have considered the effect of radiotherapy on RV remodeling. On the other hand, large number of patients with different types of cancers located in the chest are treated with radiotherapy, and the negative clinical effects of this treatment such as accelerated coronary artery disease, valve degeneration and heart failure have been documented. The anatomical position of the RV, which is in the front of the chest, is responsible for its large exposure during radiation treatment, particularly in patients with left-sided breast and lung cancers and mediastinal cancers (hematological malignancies, esophagus cancers, thymomas, etc.). For the same reason, but also due to its anatomical complexity, the RV remains under-investigated during echocardiographic examination, which remains the cornerstone of cardiac imaging in everyday practice. In the last decade many new echocardiographic imaging techniques that enable better evaluation of RV structure, function and mechanics appeared, and they have been used in detection of early and late signs of RV injuries in oncological patients. These investigations are related to some important restrictions that include limited numbers of patients, used parameters and imaging techniques. Many questions about the potential impact of these changes and possible predictions of adverse events remain to be evaluated in future large longitudinal studies. The current body of evidence indicates an important role of radiotherapy in RV remodeling, and therefore, the aim of this review is to summarize currently available data regarding RV changes in patients with various oncological conditions and help clinicians in the assessment of possible cardiac damage.
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Mustapic I, Bakovic D, Susilovic Grabovac Z, Borovac JA. Impact of SGLT2 Inhibitor Therapy on Right Ventricular Function in Patients with Heart Failure and Reduced Ejection Fraction. J Clin Med 2022; 12:jcm12010042. [PMID: 36614843 PMCID: PMC9820989 DOI: 10.3390/jcm12010042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/17/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in addition to optimal medical therapy (OMT) on the right ventricular (RV) systolic function using advanced echocardiographic analysis among outpatients with heart failure and a reduced ejection fraction (HFrEF) has thus far been poorly investigated. Methods: This was a single-center, prospective, single-blinded study in which an echocardiographic expert was blinded to the allocation of the treatment. A total of 36 outpatients with HFrEF were randomized to either OMT or OMT+SGLT2i. Both groups underwent an echocardiographic examination of the RV systolic function at the baseline and at the 3-month follow-up (3mFU). Results: The patients in both groups did not significantly differ with respect to the relevant baseline comorbidities, therapy, and clinical characteristics. The patients receiving OMT+SGLT2i showed a significant improvement from the baseline to the 3mFU in all the measured RV echocardiographic parameters, while for the OMT group, a significant improvement after the 3mFU was observed for TAPSE and s'. The mean percent change from the baseline to the 3mFU was significant when comparing OMT+SGLT2i to the OMT group concerning RV FWS (+91% vs. +28%, p = 0.039), TR maxPG (-27% vs. +19%, p = 0.005), and TR Vmax (-17% vs. +13%, p = 0.008), respectively. Conclusions: Adding SGLT2i to OMT in patients with HFrEF resulted in a greater improvement in the RV systolic function from the baseline to the 3mFU compared to the OMT alone.
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Affiliation(s)
- Ivona Mustapic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-95-2276-970
| | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Physiology, University of Split School of Medicine, 21000 Split, Croatia
| | | | - Josip A Borovac
- Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Health Studies, University of Split, 21000 Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Johannesen J, Fukuda R, Zhang DT, Tak K, Meier R, Agoglia H, Horn E, Devereux RB, Weinsaft JW, Kim J. Direct comparison of echocardiography speckle tracking and cardiac magnetic resonance feature tracking for quantification of right ventricular strain: a prospective intermodality study in functional mitral regurgitation. Echo Res Pract 2022; 9:11. [PMID: 36316750 PMCID: PMC9623949 DOI: 10.1186/s44156-022-00011-8] [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: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Functional mitral regurgitation (FMR) is a known risk factor for right ventricular dysfunction (RVDYS). RV global longitudinal strain (GLS) is an emerging index of RV function; however, the magnitude of agreement between RV GLS by echocardiography (echo) and cardiac magnetic resonance (CMR) and the relative utility of each modality for both the diagnosis of RVDYS and prognostication of all-cause mortality and heart failure hospitalization remain unknown. Results 32% of patients had RVDYS (EF < 50%) on CMR, among whom there was more advanced NYHA class and lower LV and RV ejection fraction (all p < 0.05). RV GLS was impaired in patients with RVDYS whether quantified via STE or FT-CMR, with strong correlation between modalities (r = 0.81). Both STE and FT-CMR derived GLS yielded excellent detection of RVDYS (AUC 0.94 for both), paralleling similar performance for free wall strain by both modalities (FT-CMR AUC 0.94, STE AUC 0.92) with lower accuracy demonstrated by STE derived septal strain (STE AUC 0.78 and FT-CMR AUC 0.92). RV S’ and TAPSE showed lower diagnostic accuracy (RV S’ AUC 0.77 and TAPSE AUC 0.81). During median follow up of 51 months (IQR 42, 60 months), all-cause mortality or HF hospitalization occurred in 25% (n = 25). Both STE and FT-CMR derived RV GLS stratified risk for adverse prognosis (STE p = 0.007, FT-CMR p = 0.005) whereas conventional RV indices, TAPSE and RV S’, did not (TAPSE p = 0.30, S’ p = 0.69). Conclusion RV GLS is a robust marker of RVDYS irrespective of modality which provides incremental diagnostic value and improves risk stratification for event free survival beyond conventional RV indices.
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Affiliation(s)
- Justin Johannesen
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Rena Fukuda
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - David T. Zhang
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Katherine Tak
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Rachel Meier
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Hannah Agoglia
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Evelyn Horn
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Richard B. Devereux
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Jonathan W. Weinsaft
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Jiwon Kim
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
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Tadic M, Cuspidi C. Right Ventricle in Arterial Hypertension: Did We Forget Something? J Clin Med 2022; 11:6257. [PMID: 36362485 PMCID: PMC9655282 DOI: 10.3390/jcm11216257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
Right ventricular remodeling has been neglected in patients with arterial hypertension as all studies have concentrated on the left ventricle and left atrial-ventricular and ventricular-arterial coupling. The development of novel imaging techniques has revealed significant impairment in the RV structure, systolic and diastolic function, and, afterwards, RV longitudinal mechanics. However, these changes are subclinical and can be detected only after comprehensive imaging analysis. The latest findings confirm the importance of RV hypertrophy, systolic, and diastolic dysfunction in the prediction of cardiovascular adverse events in the hypertensive population, representing an important clinical implication of these parameters. In clinical practice, 2D echocardiography is widely used for the evaluation of RV remodeling. However, existing techniques are largely underused and limited to a few basic parameters (RV thickness and TAPSE), which are not nearly enough for a detailed assessment of RV remodeling. In addition, 3D echocardiography provides the possibility of accurate evaluation of RV volumes and ejection fraction, which are comparable with results obtained by cardiac magnetic resonance (CMR)-a gold standard for the evaluation of the RV. The use of 3D echocardiography is limited due to its low availability, the lack of adequate software necessary for the calculation of results, and the necessity for a higher level of expertise. CMR provides all information required for a detailed assessment of RV structural, functional, and mechanical remodeling, and it is considered the reference method for this type of evaluation. Furthermore, it is the only technique that may provide tissue characterization and evaluation of the interstitial space, which is essential for hypertensive heart disease. The aim of this review is to provide the current level of evidence regarding RV remodeling in patients with arterial hypertension evaluated with different imaging techniques and various parameters from each method.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy
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Xue J, Kang X, Qin Q, Miao J, Li S, Kang C. The impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with hypertension: A two-dimensional speckle tracking and three-dimensional echocardiographic study. Front Cardiovasc Med 2022; 9:929792. [DOI: 10.3389/fcvm.2022.929792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aimed to evaluate the impact of different left ventricular geometric patterns on right ventricular deformation and function in the elderly with essential hypertension via two-dimensional speckle tracking and three-dimensional echocardiography.MethodsA total of 248 elderly people with essential hypertension were divided into four groups based on the left ventricular mass index (LVMI) and relative wall thickness (RWT): the normal geometric, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups. Moreover, 71 participants were recruited as the control group. These participants were examined by two-dimensional speckle tracking and three-dimensional echocardiography to obtain the right ventricular strain parameters, three-dimensional volume, and function parameters.ResultsThe right ventricular strain parameters decreased gradually from the normal geometric group to the concentric hypertrophy group (P < 0.05), and the strain parameters in the concentric remodeling, eccentric hypertrophy, and concentric hypertrophy groups were lower than those in the control and normal geometric groups (P < 0.05). The right ventricular three-dimensional echocardiographic parameters only changed in the eccentric hypertrophy group (P < 0.05) and the concentric hypertrophy group (P < 0.05) in the form of an increase in volume and a decrease in function. Multivariate linear regression analysis showed that the right ventricular free wall longitudinal strain was independently associated with the systolic blood pressure (SBP), LVMI, and RWT (P < 0.05) and was primarily affected by the LVMI (normalized β = 0.637, P < 0.05).ConclusionThe systolic function of the right ventricular myocardium declined in the elderly with essential hypertension due to impaired myocardial mechanics. The right ventricular strain parameters could indicate mechanical damage in the concentric remodeling group earlier than the right ventricular three-dimensional volume and function parameters. The right ventricular free wall longitudinal strain was primarily subject to the LVMI.
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Lippmann MR, Maron BA. The Right Ventricle: From Embryologic Development to RV Failure. Curr Heart Fail Rep 2022; 19:325-333. [PMID: 36149589 PMCID: PMC9818027 DOI: 10.1007/s11897-022-00572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) and left ventricle (LV) have different developmental origins, which likely plays a role in their chamber-specific response to physiological and pathological stress. RV dysfunction is encountered frequently in patients with congenital heart disease (CHD) and right heart abnormalities emerge from different causes than increased afterload alone as is observed in RV dysfunction due to pulmonary hypertension (PH). In this review, we describe the developmental, structural, and functional differences between ventricles while highlighting emerging therapies for RV dysfunction. RECENT FINDINGS There are new insights into the role of fibrosis, inflammation, myocyte contraction, and mitochondrial dynamics in the pathogenesis of RV dysfunction. We discuss the current state of therapies that may potentially improve RV function in both experimental and clinical trials. A clearer understanding of the differences in molecular alterations in the RV compared to the LV may allow for the development of better therapies that treat RV dysfunction.
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Affiliation(s)
- Matthew R. Lippmann
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
| | - Bradley A. Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA,Department of Cardiology, VA Boston Healthcare System, West Roxbury, MA, USA
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A Holistic View of Advanced Heart Failure. Life (Basel) 2022; 12:life12091298. [PMID: 36143336 PMCID: PMC9501910 DOI: 10.3390/life12091298] [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: 07/27/2022] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 01/12/2023] Open
Abstract
Advanced heart failure (HF) may occur at any level of left ventricular (LV) ejection fraction (LVEF). The latter, which is widely utilized for the evaluation of LV systolic performance and treatment guidance of HF patients, is heavily influenced by LV size and geometry. As the accurate evaluation of ventricular systolic function and size is crucial in patients with advanced HF, the LVEF should be supplemented or even replaced by more specific indices of LV function such as the systolic strain and cardiac power output and size such as the LV diastolic diameters and volumes. Conventional treatment (cause eradication, medications, devices) is often poorly tolerated and fails and advanced treatment (mechanical circulatory support [MCS], heart transplantation [HTx]) is required. The effectiveness of MCS is heavily dependent on heart size, whereas HTx which is effective in the vast majority of the cases is limited by the small donor pool. Expanding the MCS indications to include patients with small ventricles as well as the HTx donor pool are major challenges in the management of advanced HF.
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Tadic M, Gherbesi E, Faggiano A, Sala C, Carugo S, Cuspidi C. Obstructive sleep apnea and right ventricular function: A meta-analysis of speckle tracking echocardiographic studies. J Clin Hypertens (Greenwich) 2022; 24:1247-1254. [PMID: 35942910 PMCID: PMC9581095 DOI: 10.1111/jch.14550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/28/2022]
Abstract
The authors investigated the association between obstructive sleep apnea (OSA) and right ventricular (RV) systolic dysfunction trough a meta‐analysis of echocardiographic studies providing data on RV mechanics as assessed by longitudinal strain (LS). A systematic search was conducted using PubMed, OVID‐MEDLINE, and Cochrane library databases to search English‐language review papers published from inception to March 31, 2022. Only studies reporting data on RV free‐wall or global LS in patients with OSA of different severity and non‐OSA controls were reviewed. Data of interest were pooled to obtain standard means difference (SMD) with 95% confidence interval (CI). The meta‐analysis included 628 participants (436 with OSA and 192 controls) from eight studies. Compared to controls, RV free wall LS was significantly reduced in the pooled OSA group (SMD 1.02 ± .33, CI:.17/1.24, P < .002); this was also the case for RV global LS (SMD: .72 ± .11, CI: .50/.93, P < .0001). Notably, compared to patients with mild‐OSA those with moderate and severe OSA exhibited significantly lower RV free‐wall LS and global LS values; this was not the case for tricuspid annular plane excursion. In conclusions, both RV free‐wall and global LS are impaired in patients with OSA; deterioration of these indices, unlike TAPSE, was already evident in the early stages and was related to the severity of the syndrome. Thus, RV myocardial strain should be considered to be included in echocardiographic evaluation of OSA patients in order to detect subclinical cardiac damage in these patients regardless of its degree of severity.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Berrill M, Ashcroft E, Fluck D, John I, Beeton I, Sharma P, Baltabaeva A. Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure. Front Cardiovasc Med 2022; 9:911053. [PMID: 35665249 PMCID: PMC9157539 DOI: 10.3389/fcvm.2022.911053] [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: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Aim The severity of cardiac impairment in acute heart failure (AHF) predicts outcome, but challenges remain to identify prognostically important non-invasive parameters of cardiac function. Left ventricular ejection fraction (LVEF) is relevant, but only in those with reduced LV systolic function. We aimed to assess the standard and advanced parameters of left and right ventricular (RV) function from echocardiography in predicting long-term outcomes in AHF. Methods A total of 418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bedside echocardiography within 24 h of recruitment. We retrospectively assessed 8 RV and 5 LV echo parameters of the cardiac systolic function to predict 2-year mortality, using both guideline-directed and study-specific cutoffs, based on the maximum Youden indices via ROC analysis. For the RV, these were the tricuspid annular plane systolic excursion, RV fractional area change, tissue Doppler imaging (TDI) peak tricuspid annular systolic wave velocity, both peak- and end-systolic RV free wall global longitudinal strain (RV GLS) and strain rate (mean RV GLSR), RV ejection fraction (RVEF) derived from a 2D ellipsoid model and the ratio of the TAPSE to systolic pulmonary artery pressure (SPAP). For the LV, these were the LVEF, mitral regurgitant ΔP/Δt (MR dP/dt), the lateral mitral annular TDI peak systolic wave velocity, LV GLS, and the LV GLSR. Results A total of 7/8 parameters of RV systolic function were predictive of 2-year outcome, with study cutoffs like international guidelines. A cutoff of < −1.8 s–1 mean RV GLSR was associated with worse outcome compared to > −1.8 s–1 [HR 2.13 95% CI 1.33–3.40 (p = 0.002)]. TAPSE:SPAP of > 0.027 cm/mmHg (vs. < 0.027 cm/mmHg) predicted worse outcome [HR 2.12 95% CI 1.53–2.92 (p < 0.001)]. A 3-way comparison of 2-year mortality by LVEF from the European Society of Cardiology (ESC) guideline criteria of LVEF > 50, 41–49, and < 40% was not prognostic [38.6% vs. 30.9 vs. 43.9% (p = 0.10)]. Of the 5 parameters of LV systolic function, only an MR dP/dt cutoff of < 570 mmHg was predictive of adverse outcome [HR 1.63 95% CI 1.01–2.62 (p = 0.047)]. Conclusion With cutoffs broadly like the ESC guidelines, we identified RV dysfunction to be associated with adverse prognosis, whereas LVEF could not identify patients at risk.
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Affiliation(s)
- Max Berrill
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
| | - Eshan Ashcroft
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
| | - David Fluck
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Isaac John
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Ian Beeton
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
| | - Pankaj Sharma
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
| | - Aigul Baltabaeva
- Department of Cardiology, St. Peter’s Hospital, Surrey, United Kingdom
- Department of Research and Development, St. Peter’s Hospital, Surrey, United Kingdom
- Institute of Cardiovascular Research, Royal Holloway, University of London, Egham, United Kingdom
- Department of Cardiology, Royal Brompton and Harefield Hospital, London, United Kingdom
- *Correspondence: Aigul Baltabaeva,
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Henning RJ. Tricuspid valve regurgitation: current diagnosis and treatment. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:1-18. [PMID: 35291509 PMCID: PMC8918740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe. Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease. The five-year survival with severe TR and HFrEF is 34%. Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease. Management includes diuretics, ACE inhibitors, and aldosterone antagonists. Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension. Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function. The diagnosis and treatment of TR, including coaptation, annuloplasty devices and prosthetic valves, success rates, morbidity/mortality, and trials are discussed. Transcatheter tricuspid valve repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis.
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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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.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- 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.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- 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.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- 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.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- 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
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- 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
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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Kerkhof PLM, Diaz-Navarro RA, Handly N. What reveals the right ventricle about prognosis in heart failure, and why appear metrics to be sex-specific? JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:914-917. [PMID: 34536022 DOI: 10.1002/jcu.23070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Peter L M Kerkhof
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Rienzi A Diaz-Navarro
- Department of Internal Medicine and Center for Biomedical Research, School of Medicine, Universidad de Valparaiso, Chile
| | - Neal Handly
- Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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