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Huang X, Lu G, Cai X, Xue Y, Wang X, Jiang Y, Ning Y. Myocardial strain is regulated by cardiac preload in the early stage of sepsis. BMC Cardiovasc Disord 2024; 24:426. [PMID: 39143461 PMCID: PMC11323523 DOI: 10.1186/s12872-024-04083-8] [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: 07/18/2023] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Owing to a lack of data, this study aimed to explore the effect of cardiac preload on myocardial strain in patients with sepsis. METHODS A total of 70 patients with sepsis in intensive care unit (ICU) of a tertiary teaching hospital in China from January 2018 to July 2019 and underwent transthoracic echocardiography were enrolled. Echocardiographic data were recorded at ICU admission and 24 h later. Patients were assigned to low left ventricular end-diastolic volume index (LVEDVI) and normal LVEDVI groups. We assessed the impact of preload on myocardial strain between the groups and analyzed the correlation of echocardiographic parameters under different preload conditions. RESULTS Thirty-seven patients (53%) had a low LVEDVI and 33 (47%) a normal LVEDVI. Those in the low LVEDVI group had a faster heart rate (121.7 vs. 95.3, p < 0.001) and required a greater degree of fluid infusion (3.67 L vs. 2.62 L, P = 0.019). The left ventricular global strain (LVGLS) (-8.60% vs. -10.80%, p = 0.001), left ventricular global circumferential strain (LVGCS) (-13.83% vs. -18.26%, p = 0.006), and right ventricular global longitudinal strain (RVGLS) (-6.9% vs. -10.60%, p = 0.001) showed significant improvements in the low LVEDVI group after fluid resuscitation. However, fluid resuscitation resulted in a significantly increased cardiac afterload value (1172.00 vs. 1487.00, p = 0.009) only in the normal LVEDVI group. Multivariate backward linear regression showed that LVEDVI changes were independently associated with myocardial strain-related improvements during fluid resuscitation. The baseline LVEDVI was significantly negatively correlated with the LVGLS and RVGLS (r = -0.44 and - 0.39, respectively) but not LVGCS. LVEDVI increases during fluid resuscitation were associated with improvements in the myocardial strain degree. CONCLUSIONS Myocardial strain alterations were significantly influenced by the cardiac preload during fluid resuscitation in sepsis.
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Affiliation(s)
- Xiaolong Huang
- Department of Intensive Care Unit, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Guiyang Lu
- Department of Intensive Care Unit, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiaoyang Cai
- Department of Intensive Care Unit, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yingchang Xue
- Department of Intensive Care Unit, People's Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xinxin Wang
- Department of Intensive Care Unit, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yuanyuan Jiang
- Department of Ultrasound, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China
| | - Yaogui Ning
- Department of Intensive Care Unit, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, China.
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.
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Gerhardy B, Sivapathan S, Bowcock E, Orde S, Morgan L. Right Ventricular Dysfunction on Transthoracic Echocardiography and Long-Term Mortality in the Critically Unwell: A Systematic Review and Meta-Analysis. J Intensive Care Med 2024; 39:203-216. [PMID: 38056074 DOI: 10.1177/08850666231218713] [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: 12/08/2023]
Abstract
OBJECTIVE Right ventricular dysfunction (RVD) is common in the critically ill. To date studies exploring RVD sequelae have had heterogenous definitions and diagnostic methods, with limited follow-up. Additionally much literature has been pathology specific, limiting applicability to the general critically unwell patient. METHOD AND STUDY DESIGN We conducted a systematic review and meta-analysis to evaluate the impact of RVD diagnosed with transthoracic echocardiography (TTE) on long-term mortality in unselected critically unwell patients compared to those without RVD. A systematic search of EMBASE, Medline and Cochrane was performed from inception to March 2022. All RVD definitions using TTE were included. Patients were those admitted to a critical or intensive care unit, irrespective of disease processes. Long-term mortality was defined as all-cause mortality occurring at least 30 days after hospital admission. A priori subgroup analyses included disease specific and delayed mortality (death after hospital discharge/after the 30th day from hospital admission) in patients with RVD. A random effects model analysis was performed with the Dersimionian and Laird inverse variance method to generate effect estimates. RESULTS Of 5985 studies, 123 underwent full text review with 16 included (n = 3196). 1258 patients had RVD. 19 unique RVD criteria were identified. The odds ratio (OR) for long term mortality with RVD was 2.92 (95% CI 1.92-4.54, I2 76.4%) compared to no RVD. The direction and extent was similar for cardiac and COVID19 subgroups. Isolated RVD showed an increased risk of delayed mortality when compared to isolated left/biventricular dysfunction (OR 2.01, 95% CI 1.05-3.86, I2 46.8%). CONCLUSION RVD, irrespective of cause, is associated with increased long term mortality in the critically ill. Future studies should be aimed at understanding the pathophysiological mechanisms by which this occurs. Commonly used echocardiographic definitions of RVD show significant heterogeneity across studies, which contributes to uncertainty within this dataset.
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Affiliation(s)
- Benjamin Gerhardy
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Shanthosh Sivapathan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Emma Bowcock
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Sam Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Lucy Morgan
- Nepean Clinical School, University of Sydney School of Medicine, Sydney, NSW, Australia
- Department of Respiratory Medicine, Nepean Hospital, Kingswood, NSW, Australia
- Department of Respiratory Medicine, Concord Repatriation Hospital, Concord, NSW, Australia
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Kamal NM, Salih AF, Ali BM. Speckle tracking echocardiography for diagnosis of right ventricular failure in children with totally corrected tetralogy of Fallot in Sulaimani, Iraq. J Taibah Univ Med Sci 2024; 19:198-208. [PMID: 38124989 PMCID: PMC10730916 DOI: 10.1016/j.jtumed.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/21/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives The study was aimed at using speckle tracking echocardiography as a novel technique to diagnose right ventricular failure (RVF) in children with total correction of tetralogy of Fallot (TOF) through surgery. Methods A quasi-experimental study was performed at the Children's Heart Hospital of Sulaimani for 9 months. A total of 150 children with completely repaired TOF were enrolled to investigate RVF. Conventional echocardiographic data were recorded, including right ventricular (RV) ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), and RV end-systolic and diastolic volume (RVESV and RVEDV). Additionally, speckle tracking was performed for the regional and longitudinal strain and strain rate in four-chamber apical view. RVF diagnosis was determined on the basis of electrocardiography measurement of P-wave dispersion, T-wave dispersion, and QRS duration. Results Children with repaired TOF who were diagnosed with RVF through conventional echocardiography exhibited abnormalities with respect to children with normal RV function, including a TAPSE of 1.3 ± 0.11 cm, RVEF of 35.5 ± 6.72, RVESV of 69.8 ± 15.13 ml, RVEDV of 110.1 ± 14.13 ml, MPI of 0.60 ± 0.12, and Pmax of 52.4 ± 14.08. The use of speckle tracking in RVF diagnosis revealed a relatively lower longitudinal strain and strain rate (-12.1 ± 2.3 and -0.9 ± 0.3, respectively) in the children with RVF. Moreover, longitudinal right ventricular strain was positively correlated with TAPSE (r = 0.656) and EF (r = 0.675), and negatively correlated with RVEDV (r = -0.684), RVESV (r = -0.718), MPI (r = -0.735), and Pmax (r = -0.767). Conclusions The application of speckle tracking with the longitudinal RV strain and strain rate to estimate RV function in children with repaired TOF is a new advanced method that, compared with conventional echo, significantly improves the diagnosis of regional myocardial deformations and cardiac muscle motion velocity.
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Affiliation(s)
- Niaz M. Kamal
- Pediatrics Department, Technical Institute, Sulaymaniyah Polytechnic University, Sulaymaniyah, Iraq
| | - Aso F. Salih
- Pediatrics Department, Medicine College, Sulaymaniyah University, Sulaymaniyah, Iraq
| | - Bushra M. Ali
- Family and Community Medicine Department, Medicine College, Sulaymaniyah University, Sulaymaniyah, Iraq
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Higuchi S, Mochizuki Y, Omoto T, Matsumoto H, Masuda T, Maruta K, Aoki A, Shinke T. Clinical impact of the right ventricular impairment in patients following transcatheter aortic valve replacement. Sci Rep 2024; 14:1776. [PMID: 38245608 PMCID: PMC10799846 DOI: 10.1038/s41598-024-52242-w] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
The right ventricular (RV) impairment can predict clinical adverse events in patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Limited reports have compared impact of the left ventricular (LV) and RV disorders. This retrospective study evaluated two-year major adverse cardiac and cerebrovascular events (MACCE) in patients following TAVR for severe AS. RV sphericity index was calculated as the ratio between RV mid-ventricular and longitudinal diameters during the end-diastolic phase. Of 239 patients, 2-year MACCE were observed in 34 (14%). LV ejection fraction was 58 ± 11%. Tricuspid annular plane systolic excursion (TAPSE) and RV sphericity index were 20 ± 3 mm and 0.36 (0.31-0.39). Although the univariate Cox regression analysis demonstrated that both LV and RV parameters predicted the outcomes, LV parameters no longer predicted them after adjustment. Lower TAPSE (adjusted hazard ratio per 1 mm, 0.84; 95% confidence interval, 0.75-0.93) and higher RV sphericity index (adjusted hazard ratio per 0.1, 1.94; 95% confidence interval, 1.17-3.22) were adverse clinical predictors. In conclusion, the RV structural and functional disorders predict two-year MACCE, whereas the LV parameters do not. Impact of LV impairment can be attenuated after development of RV disorders.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tadashi Omoto
- Division of Cardiovascular Surgery, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoaki Masuda
- Division of Cardiovascular Surgery, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Kazuto Maruta
- Division of Cardiovascular Surgery, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Atsushi Aoki
- Division of Cardiovascular Surgery, Department of Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Bowcock E, Huang S, Yeo R, Walisundara D, Duncan CF, Pathan F, Strange G, Playford D, Orde S. The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy. Ann Intensive Care 2024; 14:10. [PMID: 38228991 DOI: 10.1186/s13613-024-01242-0] [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: 09/13/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. METHODS We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)-1), middle (≥ 5.9-8.02 mm.(m/s)-1), and high (≥ 8.03 mm.(m/s)-1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. RESULTS Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872-0.985], p < 0.05). Kaplan-Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)-1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. CONCLUSION The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making.
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Affiliation(s)
- Emma Bowcock
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia.
- University of Sydney, Sydney, Australia.
| | - Stephen Huang
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Rachel Yeo
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | | | - Chris F Duncan
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
| | - Faraz Pathan
- University of Sydney, Sydney, Australia
- Department of Cardiology, Nepean Hospital, Sydney, Australia
| | - Geoffrey Strange
- University of Sydney, Sydney, Australia
- The University of Notre Dame, Fremantle, Australia
| | | | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Isotani Y, Amiya E, Hatano M, Kiriyama H, Uehara M, Ishida J, Tsuji M, Bujo C, Narita K, Ishii S, Kakuda N, Minatsuki S, Yagi H, Saito A, Numata G, Yamada T, Kurihara T, Suzuki T, Komuro I. A new assessment method for right ventricular diastolic function using right heart catheterization by pressure-volume loop. Physiol Rep 2023; 11:e15751. [PMID: 37394657 PMCID: PMC10315326 DOI: 10.14814/phy2.15751] [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: 03/08/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Diastolic stiffness coefficient (β) and end-diastolic elastance (Eed) are ventricular-specific diastolic parameters. However, the diastolic function of right ventricle had not been investigated sufficiently due to the lack of established evaluation method. We evaluated the validity of these parameters calculated using only data of right heart catheterization (RHC) and assessed it in patients with restrictive cardiomyopathy (RCM) and cardiac amyloidosis. We retrospectively analyzed 46 patients with heart failure who underwent RHC within 10 days of cardiac magnetic resonance (CMR). Right ventricular end-diastolic volume and end-systolic volume were calculated using only RHC data, which were found to be finely correlated with those obtained from CMR. β and Eed calculated by this method were also significantly correlated with those derived from conventional method using CMR. By this method, β and Eed were significantly higher in RCM with amyloidosis group than dilated cardiomyopathy group. In addition, the β and Eed calculated by our method were finely correlated with E/A ratio on echocardiography. We established an easy method to estimate β and Eed of right ventricle from only RHC. The method finely demonstrated right ventricular diastolic dysfunction in patients with RCM and amyloidosis.
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Affiliation(s)
- Yoshitaka Isotani
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Advanced Medical Center for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Satoshi Ishii
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Nobutaka Kakuda
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroki Yagi
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Genri Numata
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Takanobu Yamada
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Takahiro Kurihara
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Tatsuya Suzuki
- Electrical Engineering Program, Graduate School of Science and TechnologyMeiji UniversityKawasakiJapan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
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Chetan IM, Gergely-Domokos B, Beyer R, Tomoaia R, Cabau G, Vulturar D, Chis A, Lesan A, Vesa CS, Pop D, Todea DA. The role of 3D speckle tracking echocardiography in the diagnosis of obstructive sleep apnea and its severity. Sci Rep 2022; 12:22347. [PMID: 36572720 PMCID: PMC9791147 DOI: 10.1038/s41598-022-26940-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
There is a consistent relationship between obstructive sleep apnea (OSA) and cardiovascular diseases. It is already recognized that OSA may influence the geometry and function of the right ventricle (RV). This has encouraged the development of echocardiographic evaluation for screening of OSA and its severity. Three-dimensional speckle tracking echocardiography (3D STE) is in assumption better, compared with 2D STE, because it overcomes the standard 2D echo limitations. Thus, the purpose of our study is to evaluate whether 3D STE measurements, could predict the positive diagnosis and severity of OSA. We enrolled 69 patients with OSA and 37 healthy volunteers who underwent a cardiorespiratory sleep study. 2DE was performed in all patients. RVEF and 3D RVGLS were measured by 3DSTE. NT pro BNP plasma level was also assessed in all participants. 3D RV GLS (- 13.5% vs. - 22.3%, p < 0.001) and 3D RVEF (31.9% vs. 50%, p < 0.001) were reduced in patients with OSA, compared with normal individuals. 3D Strain parameters showed better correlation to standard 2D variables, than 3D RVEF. Except for NT pro BNP (p = 0.059), all parameters served to distinguish between severe and mild-moderate cases of OSA. 3D STE may be a reliable and accurate method for predicting OSA. Consequently, 3D RV GLS is a good tool of assessing the RV global function in OSA, because it correlates well with other established measurements of RV systolic function. Furthermore, 3D RV GLS was a precise parameter in identifying severe cases of OSA, while NT pro BNP showed no association.
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Affiliation(s)
- Ioana Maria Chetan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bianca Gergely-Domokos
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Ruxandra Beyer
- Heart Institute "Nicolae Stancioiu", Cluj-Napoca, Romania
| | - Raluca Tomoaia
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Cabau
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Damiana Vulturar
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana Chis
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Lesan
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian Stefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Pop
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Adina Todea
- Department of Pneumology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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López-Candales A, Vallurupalli S. Echo-Doppler measures of right ventricular systolic function are affected by reduced left ventricular systolic function. Echocardiography 2022; 39:1540-1547. [PMID: 36433719 DOI: 10.1111/echo.15484] [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: 08/01/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Objective right ventricular (RV) systolic function assessment is attained using a series of well-described and validated echo-Doppler measurements. However, how left ventricular (LV) systolic function influences these RV functional measurements has not been previously studied. Consequently, we conducted a retrospective proof-of-concept analysis to answer this important question. METHODS A total of 100 echocardiographic studies were included and patients were divided into two groups according to their LV ejection fraction (LVEF). The following RV variables were acquired including, tricuspid annular systolic plane excursion (TAPSE), velocity of the systolic motion (TA TDI s'), RV outflow tract velocity time integral (VTI), pulmonary vascular resistance (PVR), and the TAPSE to pulmonary artery systolic pressure (PASP) ratio. RESULTS Not only TAPSE, TA DI s', RVOT VTI, PVR, and TAPSE/PASP were all significantly different between patients with normal versus abnormal LVEF; but most importantly, RVOT VTI (p < .0001) was the best discriminatory variable in assessing normal versus abnormal LVEF followed by TAPSE (p = .0001). Using receiver operating characteristic curve analysis, an RVOT VTI value > 11 identified patients with a normal LVEF with a sensitivity of 90% and specificity of 76%. CONCLUSION Based on our results, reduced LVEF affects the RV, likely mediated by mechanisms of interventricular dependence. Therefore, RV analysis cannot be performed in isolation as it not only reflects intrinsic RV systolic function but also, is dependent on LV systolic function. In cases of reduced LVEF, additional measures of RV assessment should be used to provide better objective assessments.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University Health Truman Medical Center, University, of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Srikanth Vallurupalli
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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9
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Bhende VV, Sharma TS, Trivedi BY, Kumar A, Parmar DM, Nerurkar P, Shah PM, Fumakiya NJ, Majmudar HP, Pathan SR. Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study. Health Sci Rep 2022; 5:e909. [PMID: 36320652 PMCID: PMC9617649 DOI: 10.1002/hsr2.909] [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: 05/06/2022] [Revised: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. Methods This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. Results The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively. Conclusions RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.
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Affiliation(s)
- Vishal V. Bhende
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Tanishq S. Sharma
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Bhadra Y. Trivedi
- Department of Pediatric Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Amit Kumar
- Department of Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Dushyant M. Parmar
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Paresh Nerurkar
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Prachi M. Shah
- Department of Perfusion Technology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Naresh J. Fumakiya
- Department of Echocardiography, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Hardil P. Majmudar
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
| | - Sohilkhan R. Pathan
- Clinical Research Coordinator, Central Research Services (Crs), Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityGujaratIndia
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10
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López-Candales A, Vallurupalli S. Utility of the tricuspid annular tissue doppler systolic velocity and pulmonary artery systolic pressure relationship in right ventricular systolic function assessment: A pilot study. Echocardiography 2022; 39:1276-1283. [PMID: 36100955 DOI: 10.1111/echo.15441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio has been validated as a valuable noninvasive measure of right ventricular (RV) elastance and systolic function. However, the more reliable TA systolic (s') velocity measure of RV systolic function compared to TAPSE has not been previously studied. METHODS We conducted a pilot study using several variables of RV function in 50 patients with the main aim to determine which numerical expression between TA TDI s'/PASP and TAPSE/PASP ratio was most useful. RESULTS In a stepwise multiple regression analysis, TA TDI s'/PASP ratio (p < .0002); LVOT VTI/RVOT VTI ratio (p < .0002); RVOT VTI (p < .0047); TAPSE/PASP ratio (p < .0259) and TA TDI e' (p < .0292) were best in discriminating normal versus abnormal RV systolic function. Using receiver operator curve analysis, cut-off values for both TA TDI s'/PASP (>3.9 mm/c/mmHg) had 82.1% sensitivity and 77.3% specificity while the TAPSE/PASP (>.61 mm/mmHg) had 89.3% sensitivity and 68.2% specificity in identifying normal RV function in our studied population. CONCLUSION Our results indicate that TA TDI s'/PASP is a better mathematical expression when examining the relationship between RV contractility and RV resistance relationship. Furthermore, we also found that inclusion of RVOT VTI, RV diastolic properties, and left ventricular systolic function are important determinants of RV systolic function assessments and should be routinely included. Additional prospective studies are now needed to confirm these results using hemodynamic data.
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Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Srikanth Vallurupalli
- Cardiology Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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11
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Tsukamoto K, Suzuki A, Shiga T, Arai K, Hagiwara N. Changes in the Left Ventricular Ejection Fraction and Outcomes in Hospitalized Heart Failure Patients with Mid-range Ejection Fraction: A Prospective Observational Study. Intern Med 2021; 60:1509-1518. [PMID: 33328410 PMCID: PMC8188035 DOI: 10.2169/internalmedicine.6388-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Current clinical guidelines have proposed heart failure (HF) with mid-range ejection fraction (HFmrEF), defined as a left ventricular ejection fraction (LVEF) of 40-49%, but the proportion and prognosis of patients transitioning toward HF with a reduced LVEF (LVEF <40%, HFrEF) or HF with a preserved LVEF (LVEF ≥50%, HFpEF) are not fully clear. The present study prospectively evaluated the changes in the LVEF one year after discharge and the outcomes of hospitalized patients with HFmrEF. Methods We prospectively studied 259 hospitalized patients with HFmrEF who were discharged alive at our institutions between 2015 and 2019. Among them, 202 patients with HFmrEF who underwent echocardiography at the one-year follow-up were included in this study. Patient characteristics, echocardiographic data and all-cause death were collected. Results Eighty-seven (43%) patients transitioned to HFpEF (improved group), and 35 (17%) transitioned to HFrEF (worsened group). During a median follow-up of 33 months, 27 (13%) patients died. After adjustment, patients in the worsened group had an increased risk of all-cause mortality compared with those in the improved group [hazard ratio 7.02, 95% confidence interval (CI) 1.13-43.48]. The baseline LVEF (per 1% decrease) and tricuspid annular plane systolic excursion (per 1 mm decrease) were independent predictors of the worsened LVEF category (odds ratio 2.13, 95% CI 1.25-3.63 and odds ratio 1.31, 95% CI 1.01-1.70, respectively). Conclusion Our study showed that a worsened LVEF one year after discharge was associated with a poor prognosis in hospitalized patients with HFmrEF.
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Affiliation(s)
- Kei Tsukamoto
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Japan
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University, Japan
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12
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Liu YT, Lai JZ, Zhai FF, Han F, Zhou LX, Ni J, Yao M, Tian Z, Zhu YL, Chen W, Bai H, Wang H, Zhang DD, Cui LY, Jin ZY, Zhu YC, Zhang SY. Right ventricular systolic function is associated with health-related quality of life: a cross-sectional study in community-dwelling populations. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:640. [PMID: 33987338 PMCID: PMC8106091 DOI: 10.21037/atm-20-6845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Considerable evidence has been presented that heart and health-related quality of life are directly linked in patients with various diseases. This exploratory study investigated whether cardiac structure and function were associated with health-related quality of life in the general population. Methods This cross-sectional study was performed in five villages of Shunyi, a suburban district of Beijing, from June 2013 to April 2016. All inhabitants aged 35 years or older living in five villages of Shunyi were invited to participate. Exclusion criteria were individuals who declined participation, who had incomplete Health-related quality of life (HRQoL) data, and who had suboptimal echocardiograms. HRQoL was evaluated by the Mandarin version of SF-36. The association between the echocardiography-derived cardiac structure and function and each domain of SF-36 was analyzed by the multivariate linear regression analysis after adjusted for conventional risk factors affecting HRQoL. Results The baseline data of 990 individuals were analyzed. The median age of the participants was 57 (50–63) years, and 367 (37.1%) were male, the average physical and mental component summary scores were 89.3 (79.8–94.3) and 90 (83.5–95) respectively. Tricuspid annular plane systolic excursion, an echocardiography-derived right ventricular parameter, was associated with all the subscales and summarized scores of SF-36 (all P<0.05). The independent association between tricuspid annular plane systolic excursion and physical/mental component summary scores remained after adjusting for age, gender, body mass index, education level, annual personal income, smoking and drinking status, and comorbidities (β=0.65, 95% confidence interval 0.30–1.01, P<0.01 and β=0.49, 95% confidence interval 0.23–0.76, P<0.01 for physical and mental component summary scores respectively). Compared with the participants with tricuspid annular plane systolic excursion ≥21 mm, the participants with tricuspid annular plane systolic excursion <21 mm had lower adjusted scores of physical and mental component summary scores (81.8 vs. 84.5, P=0.015, and 85.5 vs. 88.1, P<0.01 for physical and mental component summary scores respectively). Conclusions In this population-based study, right ventricular systolic function assessed by tricuspid annular plane systolic excursion was independently associated with health-related quality of life assessed by SF-36.
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Affiliation(s)
- Yong-Tai Liu
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jin-Zhi Lai
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Fei-Fei Zhai
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Fei Han
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yan-Lin Zhu
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Wei Chen
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Hua Bai
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Hui Wang
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Ding-Ding Zhang
- Central Research Laboratory, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
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13
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Tülümen E, Rudic B, Ringlage H, Hohneck A, Röger S, Liebe V, Kuschyk J, Overhoff D, Budjan J, Akin I, Borggrefe M, Papavassiliu T. Extent of peri-infarct scar on late gadolinium enhancement cardiac magnetic resonance imaging and outcome in patients with ischemic cardiomyopathy. Heart Rhythm 2021; 18:954-961. [PMID: 33515714 DOI: 10.1016/j.hrthm.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Only a minority of patients who receive an implantable cardioverter-defibrillator (ICD) on the basis of left ventricular ejection fraction receive appropriate ICD therapy. Peri-infarct scar zone assessed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a possible substrate for ventricular tachyarrhytmias (VTAs). OBJECTIVE The aim of our prospective study was to determine whether LGE-CMR parameters can predict the occurrence of VTA in patients with ischemic cardiomyopathy (ICM). METHODS Two hundred sixteen patients with ICM underwent CMR imaging before primary or secondary ICD implantation and were prospectively followed. We assessed CMR indices and CMR scar characteristics (infarct core and peri-infarct zone) to predict outcome and VTAs. RESULTS Patients were followed up for 1497 days (interquartile range 697-2237 days). Forty-seven patients (21%) received appropriate therapy during follow-up. Patients with appropriate ICD therapy had smaller core scar (31.5% ± 8.5% vs 36.8% ± 8.9%; P = .0004) but larger peri-infarct scar (12.4% ± 2.6% vs 10.5% ± 2.9%; P = .0001) than did patients without appropriate therapy. In multivariate Cox regression analysis, peri-infarct scar (hazard ratio 1.15; 95% confidence interval 1.07-1.24; P = .0001) was independently and significantly associated with VTAs whereas left ventricular ejection fraction, right ventricular ejection fraction, core scar, and left atrial ejection fraction were not. CONCLUSION Scar extent of peri-infarct border zone was significantly associated with appropriate ICD therapy. Thus, LGE-CMR parameters can identify a subgroup of patients with ICM and an increased risk of life-threatening VTAs.
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Affiliation(s)
- Erol Tülümen
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany.
| | - Boris Rudic
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Hannah Ringlage
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Anna Hohneck
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Daniel Overhoff
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Johannes Budjan
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site, Mannheim, Germany
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14
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Yuchi Y, Suzuki R, Teshima T, Matsumoto H, Koyama H. Utility of tricuspid annular plane systolic excursion normalized by right ventricular size indices in dogs with postcapillary pulmonary hypertension. J Vet Intern Med 2020; 35:107-119. [PMID: 33277735 PMCID: PMC7848373 DOI: 10.1111/jvim.15984] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is a common right ventricular (RV) function indicator. However, TAPSE was not decreased in dogs with myxomatous mitral valve disease (MMVD) and postcapillary pulmonary hypertension (PH) because of its load, angle, and body weight dependency, and TAPSE was considered a preload‐dependent index. Objectives To evaluate the utility of TAPSE normalized by RV size in dogs with postcapillary PH. Animals Twenty healthy dogs and 71 MMVD dogs with or without PH. Methods In this prospective observational study, end‐diastolic RV internal dimension (RVIDd), end‐diastolic and end‐systolic RV area, and end‐diastolic RV wall thickness were measured as RV size indices. The TAPSE was measured using B‐mode and M‐mode methods. Normalized TAPSE was calculated by dividing TAPSE by each RV size index. The RV strain was obtained as the detailed RV function using 2‐dimensional speckle tracking echocardiography. All indices were compared among the PH severity groups and in the presence of right‐sided congestive heart failure (R‐CHF). Results Although nonnormalized TAPSE was higher with PH severity progression, each normalized TAPSE showed a significant decrease in the severe PH group (P < .05). The TAPSEB‐mode/RVIDd ratio had high area under the curve to predict R‐CHF and had moderate correlation with RV strain (P < .05). The TAPSEB‐mode/RVIDd and left atrial‐to‐aortic diameter ratios were independent predictors for R‐CHF. Conclusions and Clinical Importance Normalized TAPSE could reflect RV systolic dysfunction in dogs with severe PH, which could not be detected by nonnormalized TAPSE. The TAPSEB‐mode/RVIDd ratio might predict R‐CHF with high sensitivity and reproducibility.
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Affiliation(s)
- Yunosuke Yuchi
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Ryohei Suzuki
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Takahiro Teshima
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hirotaka Matsumoto
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hidekazu Koyama
- Faculty of Veterinary Science, Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
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15
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Modin D, Møgelvang R, Andersen DM, Biering-Sørensen T. Right Ventricular Function Evaluated by Tricuspid Annular Plane Systolic Excursion Predicts Cardiovascular Death in the General Population. J Am Heart Assoc 2020; 8:e012197. [PMID: 31088196 PMCID: PMC6585329 DOI: 10.1161/jaha.119.012197] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Cardiovascular disease remains a leading cause of death. Right ventricular ( RV ) function is a strong predictor of outcome in many cardiovascular diseases, but its significance is often neglected. Little is known about the prognostic value of RV systolic function in the general population. Therefore, we aimed to determine the prognostic value of RV systolic function, evaluated by tricuspid annular plane systolic excursion ( TAPSE ), in predicting cardiovascular death ( CVD ) in the general population. Methods and Results A total of 1039 participants from the general population without heart failure or atrial fibrillation had an echocardiogram performed and TAPSE measured. The end point was CVD . During a median follow-up of 12.7 years (interquartile range, 12.0-12.9 years), 69 participants (6.6%) experienced CVD , whereas 162 participants (15.6%) experienced non-CVD. Decreasing RV systolic function, assessed as TAPSE , was a univariable predictor of CVD (hazard ratio, 1.13; 95% CI , 1.07-1.20; P<0.001, per 1-mm decrease). TAPSE remained an independent predictor of CVD after adjusting for clinical and echocardiographic parameters (hazard ratio, 1.08; 95% CI , 1.01-1.15; P=0.017, per 1-mm decrease). Furthermore, in net reclassification analysis, decreasing RV systolic function, assessed as TAPSE, significantly improved risk classification with respect to CVD when added to established cardiovascular risk factors from the Systematic Coronary Risk Evaluation chart or a modified version of the American Heart Association/American College of Cardiology Pooled Cohort Equation. Decreasing RV systolic function, assessed as TAPSE , did not predict non-CVD, indicating specificity for CVD . Conclusions RV systolic function, as assessed by TAPSE , is associated with CVD in the general population. In the general population, assessment of RV systolic function may provide novel prognostic information about the risk of CVD .
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Affiliation(s)
- Daniel Modin
- 1 Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,3 The Copenhagen City Heart Study Frederiksberg Hospital Frederiksberg Denmark
| | - Rasmus Møgelvang
- 1 Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,3 The Copenhagen City Heart Study Frederiksberg Hospital Frederiksberg Denmark
| | - Ditte Madsen Andersen
- 1 Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,3 The Copenhagen City Heart Study Frederiksberg Hospital Frederiksberg Denmark
| | - Tor Biering-Sørensen
- 1 Department of Cardiology Herlev and Gentofte Hospital University of Copenhagen Denmark.,2 Department of Biomedical Sciences Faculty of Health and Medical Sciences University of Copenhagen Denmark.,3 The Copenhagen City Heart Study Frederiksberg Hospital Frederiksberg Denmark
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Aryal SR, Sharifov OF, Lloyd SG. Emerging role of cardiovascular magnetic resonance imaging in the management of pulmonary hypertension. Eur Respir Rev 2020; 29:29/156/190138. [PMID: 32620585 DOI: 10.1183/16000617.0138-2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterised by elevation of pulmonary arterial pressure (PAP) above normal range due to various aetiologies. While cardiac right-heart catheterisation (RHC) remains the gold standard and mandatory for establishing the diagnosis of PH, noninvasive imaging of the heart plays a central role in the diagnosis and management of all forms of PH. Although Doppler echocardiography (ECHO) can measure a range of haemodynamic and anatomical variables, it has limited utility for visualisation of the pulmonary artery and, oftentimes, the right ventricle. Cardiovascular magnetic resonance (CMR) provides comprehensive information about the anatomical and functional aspects of the pulmonary artery and right ventricle that are of prognostic significance for assessment of long-term outcomes in disease progression. CMR is suited for serial follow-up of patients with PH due to its noninvasive nature, high sensitivity to changes in anatomical and functional parameters, and high reproducibility. In recent years, there has been growing interest in the use of CMR derived parameters as surrogate endpoints for early-phase PH clinical trials. This review will discuss the role of CMR in the diagnosis and management of PH, including current applications and future developments, in comparison to other existing major imaging modalities.
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Affiliation(s)
- Sudeep R Aryal
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Oleg F Sharifov
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Steven G Lloyd
- Dept of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA .,Birmingham VA Medical Center, Birmingham, AL, USA
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17
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Effect of kidney transplantation on right ventricular function, assessment by 2- dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2020; 18:16. [PMID: 32456642 PMCID: PMC7251705 DOI: 10.1186/s12947-020-00200-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Advanced chronic kidney disease often results in adverse cardiovascular outcomes and is the leading cause of mortality in patients with end stage renal diseases (ESRD). There is much information about the effect of chronic kidney diseases (CKD) on the left ventricle (LV) chamber, but the right ventricle (RV) as a neglected chamber had not been evaluated precisely, in spite of its importance. Objectives The aim of this study was to evaluate the impact of successful kidney transplants on the RV systolic and diastolic function using the advanced method of 2D speckle tracking echocardiography and comparison with the conventional methods. Method The study included 48 patients with CKD who were eligible for kidney transplantation and underwent successful kidney transplantations. Right ventricular indices were evaluated, while RV function was focused by conventional methods and 2D speckle tracking echocardiography before the successful kidney transplant and 1 week, 1 month, and 3 months after the successful kidney transplant. Results The results of the study showed that RV global longitudinal strain and RV free wall longitudinal strain improved over the time (P = 0.024, P < 0.001 respectively). It also represented that kidney transplantation did not have significant effect on the RV mid cavity diameter, tissue velocity, Myocardial performance index, RV longitudinal diameter, and Tricuspid annular plane systolic excursion indices, but for other indices this effect was significant. On the differences between the mean slope of regression line of the GLS variable in hypertensive subjects (1.0 ± 0.2) and non-hypertensive subjects (0.36 ± 0.32), an independent t-test showed that between the two groups in terms of the improvement of RVGLS, there was a significant statistical difference (P = 0.0067). Conclusion Most of the ESRD patients had subtle RV dysfunction which could be better detected by recent echocardiography methods than conventional methods. Moreover, kidney transplantation led to considerable improvements in RV function in this population.
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18
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Lemarié J, Maigrat CH, Kimmoun A, Dumont N, Bollaert PE, Selton-Suty C, Gibot S, Huttin O. Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study. Ann Intensive Care 2020; 10:24. [PMID: 32056017 PMCID: PMC7018922 DOI: 10.1186/s13613-020-0636-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients. RESULTS Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S', RV FAC). A RV global LSS value > - 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. CONCLUSIONS Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT.
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Affiliation(s)
- Jérémie Lemarié
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France.
| | - Charles-Henri Maigrat
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Antoine Kimmoun
- Service de Médecine Intensive et Réanimation, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Nathalie Dumont
- Plateforme d'Aide à la Recherche Clinique, Bâtiment Recherche, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Pierre-Edouard Bollaert
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
| | - Sébastien Gibot
- Service de Réanimation Médicale, Hôpital Central, CHRU de Nancy, 29 rue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, 54511, Vandoeuvre-lès-Nancy, France
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Echocardiographic evaluation of right heart functions in hemodialysis patients. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.588248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Magunia H, Jordanow A, Keller M, Rosenberger P, Nowak-Machen M. The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: an echocardiography-based prospective observational study. BMC Anesthesiol 2019; 19:199. [PMID: 31684877 PMCID: PMC6829832 DOI: 10.1186/s12871-019-0870-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6–8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results After anesthesia induction TAPSE (mean difference − 1.6 mm (95% CI − 2.6 mm to − 0.7 mm; p = 0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference − 1.9% (95% CI: − 2.6 to − 1.2; p < 0.0001), but global right ventricular ejection fraction (RVEF; p = 0.1607) and right ventricular stroke volume (RVSV; p = 0.1838) did not change. Conclusions This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.
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Affiliation(s)
- Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Anne Jordanow
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Marius Keller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Nowak-Machen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Department of Anesthesia and Intensive Care Medicine, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany
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21
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Daley JI, Dwyer KH, Grunwald Z, Shaw DL, Stone MB, Schick A, Vrablik M, Kennedy Hall M, Hall J, Liteplo AS, Haney RM, Hun N, Liu R, Moore CL. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Acad Emerg Med 2019; 26:1211-1220. [PMID: 31562679 DOI: 10.1111/acem.13774] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Focused cardiac ultrasound (FOCUS) is insensitive for pulmonary embolism (PE). Theoretically, when a clot is large enough to cause vital sign abnormalities, it is more likely to show signs of right ventricular dysfunction on FOCUS, although this has not been well quantified. A rapid bedside test that could quickly and reliably exclude PE in patients with abnormal vital signs could be of high utility in emergency department (ED) patients. We hypothesized that in patients with tachycardia or hypotension, the sensitivity of FOCUS for PE would increase substantially. METHODS We performed a prospective observational multicenter cohort study involving a convenience sample of patients from six urban academic EDs. Patients suspected to have PE with tachycardia (heart rate [HR] ≥ 100 beats/min) or hypotension (systolic blood pressure [sBP] < 90 mm Hg) underwent FOCUS before computed tomography angiography (CTA). FOCUS included assessment for right ventricular dilation, McConnell's sign, septal flattening, tricuspid regurgitation, and tricuspid annular plane systolic excursion. If any of these were abnormal, FOCUS was considered positive, while if all were normal, FOCUS was considered negative. We a priori planned a subgroup analysis of all patients with a HR ≥ 110 beats/min (regardless of their sBP). We then determined the diagnostic test characteristics of FOCUS for PE in the entire patient population and in the predefined subgroup, based on CTA as the criterion standard. Inter-rater reliability of FOCUS was determined by blinded review of images by an emergency physician with fellowship training in ultrasound. RESULTS A total of 143 subjects were assessed for enrollment and 136 were enrolled; four were excluded because they were non-English-speaking and three because of inability to obtain any FOCUS windows. The mean (±SD) age of enrolled subjects was 56 (±7) years, mean (±SD) HR was 114 (±12) beats/min, and 37 (27.2%) subjects were diagnosed with PE on CTA. In all subjects, FOCUS was 92% (95% confidence interval [CI] = 78% to 98%) sensitive and 64% specific (95% CI = 53% to 73%) for PE. In the subgroup of 98 subjects with a HR ≥ 110 beats/min, FOCUS was 100% sensitive (95% CI = 88% to 100%) and 63% specific (95% CI = 51% to 74%) for PE. There was substantial interobserver agreement for FOCUS (κ = 1.0, 95% CI = 0.31 to 1.0). CONCLUSIONS A negative FOCUS examination may significantly lower the likelihood of the diagnosis of PE in most patients who are suspected of PE and have abnormal vital signs. This was especially true in those patients with a HR ≥ 110 beats/min. Our results suggest that FOCUS can be an important tool in the initial evaluation of ED patients with suspected PE and abnormal vital signs.
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Affiliation(s)
- James I. Daley
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Kristin H. Dwyer
- Department of Emergency Medicine Warren Alpert Medical School of Brown University Providence RI
| | - Zachary Grunwald
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Daniel L. Shaw
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | | | - Alexandra Schick
- Department of Emergency Medicine Warren Alpert Medical School of Brown University Providence RI
| | - Michael Vrablik
- Department of Emergency Medicine The Brigham and Women's Hospital Harvard University School of Medicine Boston MA
| | - M. Kennedy Hall
- Department of Emergency Medicine The Brigham and Women's Hospital Harvard University School of Medicine Boston MA
| | - Jane Hall
- Department of Emergency Medicine The Massachusetts General Hospital Boston MA
| | - Andrew S. Liteplo
- Department of Emergency Medicine University of Washington School of Medicine Seattle WA
| | - Rachel M. Haney
- Department of Emergency Medicine University of Washington School of Medicine Seattle WA
| | - Nancy Hun
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Rachel Liu
- Department of Emergency Medicine Yale School of Medicine New Haven CT
| | - Chris L. Moore
- Department of Emergency Medicine Yale School of Medicine New Haven CT
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Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome. Crit Care Med 2019; 46:e1055-e1062. [PMID: 30095502 DOI: 10.1097/ccm.0000000000003358] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The prevalence and importance of early right ventricular dysfunction and pulmonary hypertension in pediatric acute respiratory distress syndrome are unknown. We aimed to describe the prevalence of right ventricular dysfunction and pulmonary hypertension within 24 hours of pediatric acute respiratory distress syndrome diagnosis and their associations with outcomes. DESIGN Retrospective, single-center cohort study. SETTING Tertiary care, university-affiliated PICU. PATIENTS Children who had echocardiograms performed within 24 hours of pediatric acute respiratory distress syndrome diagnosis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Between July 1, 2012, and June 30, 2016, 103 children met inclusion criteria. Echocardiograms were analyzed using established indices of right ventricular and left ventricular systolic function and for evidence of pulmonary hypertension. Echocardiographic abnormalities were common: 26% had low right ventricular fractional area change, 65% had low tricuspid annular plane systolic excursion, 30% had low left ventricular fractional shortening, and 21% had evidence of pulmonary hypertension. Abnormal right ventricular global longitudinal strain and abnormal right ventricular free wall strain were present in 35% and 40% of patients, respectively. No echocardiographic variables differed between or across pediatric acute respiratory distress syndrome severity. In multivariable analyses, right ventricular global longitudinal strain was independently associated with PICU mortality (odds ratio, 3.57 [1.33-9.60]; p = 0.01), whereas right ventricular global longitudinal strain, right ventricular free wall strain, and the presence of pulmonary hypertension were independently associated with lower probability of extubation (subdistribution hazard ratio, 0.46 [0.26-0.83], p = 0.01; subdistribution hazard ratio, 0.58 [0.35-0.98], p = 0.04; and subdistribution hazard ratio, 0.49 [0.26-0.92], p = 0.03, respectively). CONCLUSIONS Early ventricular dysfunction and pulmonary hypertension were detectable, prevalent, and independent of lung injury severity in children with pediatric acute respiratory distress syndrome. Right ventricular dysfunction was associated with PICU mortality, whereas right ventricular dysfunction and pulmonary hypertension were associated with lower probability of extubation.
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Akabane R, Shimano S, Sakatani A, Ogawa M, Nagakawa M, Miyakawa H, Miyagawa Y, Takemura N. Relationship between right heart echocardiographic parameters and invasive pulmonary artery pressures in canine models of chronic embolic pulmonary hypertension. J Vet Med Sci 2019; 81:1485-1491. [PMID: 31484835 PMCID: PMC6863729 DOI: 10.1292/jvms.19-0350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Basic information related to the association between right heart echocardiographic
parameters and invasive pulmonary artery pressure (PAP) in dogs with pulmonary hypetension
(PH) is scarce. The aim of this study was to examine the association between conventional
right heart echocardiographic parameters and invasive PAP by right heart catheterization
(RHC) before and after PH. Five female beagle dogs regarded as clinically healthy were
used. Echocardiography and RHC were conducted before and after creating chronic embolic
pulmonary hypertension (CEPH) models. The acceleration time to ejection time ratio in
pulmonary artery flow profile (AT/ET), the ratio of the pulmonary artery and aortic
diameter in diastole (PA/Ao), the right pulmonary artery distensibility index by M-mode
method (RPAD M-mode), the normalized right ventricular internal diameter in
diastole (RVIDdn), and the normalized tricuspid annular plane systolic excursion (TAPSEn)
were correlated with the invasive systolic PAP (sPAP), mean PAP (mPAP) and diastolic PAP
(dPAP). Multiple linear regression analysis identified AT/ET and RVIDdn as independent
predictors of sPAP, PA/Ao and RVIDdn as independent predictors of mPAP, and PA/Ao and RPAD
M-mode as independent predictors of dPAP. AT/ET and PA/Ao had high
sensitivity and specificity for predicting CEPH. In conclusion, AT/ET, PA/Ao, RPAD
M-mode, RVIDdn and TAPSEn were significantly correlated with invasive PAP and
alterations in PA/Ao or AT/ET might enable clinicians to predict PH, even if tricuspid
regurgitation is not observed.
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Affiliation(s)
- Ryota Akabane
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Shotaro Shimano
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Atsushi Sakatani
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Mizuki Ogawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Masayoshi Nagakawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Hirosumi Miyakawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Yuichi Miyagawa
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Naoyuki Takemura
- Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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Main AB, Braham R, Campbell D, Inglis AJ, McLean A, Orde S. Subcostal TAPSE: a retrospective analysis of a novel right ventricle function assessment method from the subcostal position in patients with sepsis. Ultrasound J 2019; 11:19. [PMID: 31456096 PMCID: PMC6712122 DOI: 10.1186/s13089-019-0134-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is frequently used as an objective measure of right-ventricular dysfunction. Abnormal TAPSE values are associated with poor prognosis in a number of disease states; however, the measure is not always easy to obtain in the critically ill. The purpose of this study is to assess the feasibility and accuracy of using a subcostal view and TAPSE measurement as a measure of right-ventricular dysfunction. A secondary aim was to perform a pilot study to assess whether right-ventricular dysfunction was associated with adverse outcomes including mortality. Results Subcostal TAPSE corresponds well with TAPSE obtained from the apical window at low and moderate TAPSE values (mean difference 1.2 mm (CI 0.04–2.36; 100% data pairs < 3-mm difference for TAPSE < 19 mm; 92% had < 3 mm difference at TAPDE < 24 mm). Subcostal TAPSE is able to accurately discriminate between abnormal and normal TAPSE results (sensitivity 97.8%, specificity 87.5%). There was no association between right-ventricular (RV) dysfunction and 90-day mortality. Conclusions Subcostal TAPSE is a feasible and accurate alternative to conventional TAPSE from the apical view in critically ill patients. Further research is required to elucidate the relationship between RV dysfunction and outcomes in sepsis.
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Affiliation(s)
- Alison B Main
- Alice Springs Hospital, Gap Road, The Gap, NT, 0870, Australia
| | - Rachel Braham
- Gold Coast University Hospital, Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Daniel Campbell
- Royal Darwin Hospital, Rocklands Dr, Tiwi, NT, 0810, Australia
| | | | - Anthony McLean
- Nepean Hospital, Derby St, Penrith, NSW, 2747, Australia
| | - Sam Orde
- Nepean Hospital, Derby St, Penrith, NSW, 2747, Australia.
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Li TG, Nie F, Li ZD, Wang YF, Li Q. Evaluation of right ventricular function in fetuses with isolated single umbilical artery using spatiotemporal image correlation M-mode. Cardiovasc Ultrasound 2019; 17:14. [PMID: 31325956 PMCID: PMC6642479 DOI: 10.1186/s12947-019-0164-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background Postnatal outcome of fetuses with isolated single umbilical artery (SUA) is determined mainly by right ventricular function. Our study examined whether there are differences in right ventricular function during the gestation period of fetuses with isolated SUA compared to healthy fetuses. Methods A prospective study was conducted on 77 fetuses with isolated SUA and 77 gestational age-matched controls from 22 to 39 weeks. For gestational age grouping, the isolated SUA fetuses and the control fetuses were divided into the second trimester group (22–27 weeks; 43 fetuses) and third trimester group (28–39 weeks; 34 fetuses). The fetal tricuspid annular plane systolic excursion (f-TAPSE) M-mode was applied to the tricuspid annulus, parallel to the ventricular septum, and the amplitude of the resulting wave was assessed using spatiotemporal image correlation (STIC) M-mode. We investigated the possible changes to the STIC M-mode indices during the course of pregnancy in both the isolated SUA and control groups. The relationship between f-TAPSE and gestational age was analyzed. Additionally, the correlations between f-TAPSE and birth weight was analyzed, and the birth weight differences between the isolated SUA and control groups in the third trimester were analyzed according to postpartum results. Results There was a significant difference in f-TAPSE between isolated SUA and control group in the third trimester (P < 0.05). There were significant correlations between gestational age (GA) and f-TAPSE among control fetuses (R2 = 0.9049; P < 0.01). A significant, positive correlation between GA and f-TAPSE was also found with isolated SUA fetuses (R2 = 0.8108; P < 0.01). The prevalence of small-for-gestational-age (SGA) fetuses and of discordant birth weight fetuses was significantly higher in the isolated SUA group than in the control group. In univariate analysis, the presence of an isolated SUA was associated with lower birth weight (2940 g compared with 3260 g) and with higher prevalence of SGA (13.0% compared with 3.9%; P < 0.01). The correlations between the birth weight and f-TAPSE in the two groups were analyzed in the third trimester, and the correlation in the isolated SUA group was better than that of the control group (R2 was 0.623 and 0.463 in the isolated SUA group and the control group, respectively). Conclusions Right ventricular function in isolated SUA is altered as early as in fetal third trimester. STIC M-mode can measure the right heart function of the fetus and may predict isolated SUA with SGA.
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Affiliation(s)
- Tian-Gang Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China.,Department of Ultrasound Diagnosis, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu Province, People's Republic of China
| | - Fang Nie
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China.
| | - Zhen-Dong Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
| | - Yan-Fang Wang
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
| | - Qi Li
- Department of Ultrasound Diagnosis, Lanzhou University Second Hospital, Lanzhou, 730030, Gansu Province, People's Republic of China
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Graupner O, Enzensberger C, Götte M, Wolter A, Müller V, Kawecki A, Weber S, Degenhardt J, Herrmann J, Axt-Fliedner R. Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage? Prenat Diagn 2019; 39:495-504. [PMID: 30957256 DOI: 10.1002/pd.5453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/25/2018] [Accepted: 03/11/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Cardiac remodeling due to renal dysfunction may have an impact on myocardial function (MF) of fetuses with lower urinary tract obstruction (LUTO). The aim was to identify possible differences in MF in LUTO fetuses compared with healthy controls and to look for interactions between urine biochemistry and MF indices. METHODS This is a cohort study consisting of 31 LUTO fetuses and 45 healthy controls. Subgroups were generated according to intrauterine therapy (group 1: LUTO after therapy, group 2: LUTO without therapy at the time of examination, and group 3: controls). MF indices were measured using pulsed wave tissue Doppler imaging and M-mode. Furthermore, results of fetal urine biochemistry were gathered retrospectively. RESULTS Among other findings, right ventricular (RV) e'/a' ratio was lower in group 1 compared with group 3 (p = .050). According to gestational age (GA) level-dependent analysis, RV isovolumetric relaxation time was significantly longer in group 2 compared with group 1 and group 3 at GA level 1 (19 wk of gestation). A significant positive correlation between RV e'/a' ratio and β-2-microglobulin as well as α-1-microglobulin and potassium could be observed. CONCLUSION We observed differences in MF and an association between ventricular filling pattern and renal protein secretion in LUTO fetuses. This can be interpreted as a sign of intrauterine cardiac remodeling.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Malena Götte
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Aline Wolter
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Vera Müller
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Andreea Kawecki
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Stefanie Weber
- Center for Pediatrics and Adolescent Medicine, Pediatric Nephrology, University Hospital UKGM, Philipps-University, Marburg, Germany
| | - Jan Degenhardt
- Pränatal plus, Praxis für Pränatale Medizin und Genetik, Köln, Germany
| | | | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
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Iragavarapu T, Tadi S, Babu KJ, Naresh KP, Sruthi M, Roopini A. Biventricular dysfunction and angiographic correlates of inferior wall myocardial infarction with high degree AV blocks. HEART INDIA 2019. [DOI: 10.4103/heartindia.heartindia_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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Li Y, Wang Y, Yang Y, Liu M, Meng X, Shi Y, Zhu W, Lu X. Tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography for predicting right ventricular function in pulmonary hypertension: A new approach to evaluating right ventricle dysfunction. Medicine (Baltimore) 2018; 97:e11710. [PMID: 30045334 PMCID: PMC6078723 DOI: 10.1097/md.0000000000011710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study aimed to determine the ability of tricuspid annular displacement measured by 2-dimensional speckle tracking echocardiography (STE) to predict right ventricular (RV) dysfunction in pulmonary hypertension (PH) patients. Here, we present a new method for assessing RV function that also employs STE and is based on measurement of tricuspid annular displacement.A total of 225 patients were divided into 2 groups according to the pulmonary artery systolic blood pressure (PASP), estimated by echocardiographic measurement of tricuspid regurgitation: group I (PASP ≥50 mm Hg) and group II (36 mm Hg ≤ PASP <50 mm Hg). The tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s'), and the tricuspid annular longitudinal displacement (TMAD) parameters were measured. Thirty patients underwent cardiac magnetic resonance (CMR) examination, and right ventricular ejection fraction (RVEF) was calculated.The conventional parameters as well as the TMAD parameters differed significantly between the 2 groups (all P < .01). Good correlation was observed between the TMAD parameters and CMR-derived RVEF (all P < .01). The TMAD parameters had moderate predictive value for predicting RV dysfunction in PH patients (all P < .01). From receiver operating characteristic curves, we determined the optimal cut-off values for TMAD parameters for detecting RV dysfunction with good sensitivity and specificity.The TMAD parameters can predict the decline of RV function in patients with PH and thus provide new diagnostic indices for clinical management of these patients.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center
| | - Yidan Wang
- Department of Echocardiography, Heart Center
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine
| | - Mingxi Liu
- Department of Radiology, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | | | - Yanping Shi
- Department of Echocardiography, Heart Center
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center
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29
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Chiadika S, Lim-Fung M, Llanos-Chea F, Serauto Canache A, Yang W, Paruthi C, Zhang X, McPherson DD, Idowu M. Echocardiographic parameters to identify sickle cell patients with cardio-pathology. Echocardiography 2018; 35:1271-1276. [PMID: 29756358 DOI: 10.1111/echo.14028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) affects millions of people and causes chronic hemolytic anemia leading to vasculopathies such as pulmonary hypertension and abnormalities in cardiac function that increase complications and mortality. It is therefore crucial to identify cardiac abnormalities in SCD. We aimed to assess the prevalence of echocardiographic parameters in SCD to help identify cardiopulmonary risk. METHODS Ninety-one patients (53% male), median age of 30, body surface area (BSA) of 1.79 m2 , hemoglobin of 8.8 g/dL, and creatinine of 0.7 mg/dL identified. We retrospectively measured laboratory and echocardiographic parameters in patients with SCD : left ventricular (LV) dimensions, LV ejection fraction (LVEF), LV Myocardial Performance Index (MPI), LV Mass Index (MI), Left Atrial Volume Index (LAVI), Tricuspid Regurgitation Velocity (TRV), tricuspid annular plane systolic excursion (TAPSE), right heart dimensions. RESULTS Prevalence of left heart abnormalities was 32%: increased LV end-diastolic diameter (EDD), 78%: LV MPI, 21%: diastolic dysfunction, 38%: decreased LVEF, 24%: increased LVMI, and 47%: increased LAVI. Right heart abnormalities were 39%: TAPSE, 38%: increased TRV, and 59%: increased pulmonary systolic pressure (PASP). Multivariate logistic regression analysis was significant for increased LVMI and LAVI in those with hemoglobin ≤8 g/dL (odds ratio (OR) 7.4, 95% confidence interval (CI) 2.23-24.6, P = .001) and (OR 3.32, 95% CI 1.18-9.33, P = .023). CONCLUSIONS We confirmed increased prevalence of abnormal LVEDD, LVMI, diastolic function, LAVI, and PASP in SCD. In addition, we identified abnormal LV MPI (78%), TAPSE (29%). These parameters may be useful and readily accessible echocardiographic prognostic tools in this population.
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Affiliation(s)
- Simbo Chiadika
- Division of Cardiology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Mary Lim-Fung
- Division of Cardiology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Fiorella Llanos-Chea
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Astrid Serauto Canache
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Wei Yang
- Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Christina Paruthi
- Division of Cardiology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Xu Zhang
- Division of Clinical and Translational Sciences, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - David D McPherson
- Division of Cardiology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
| | - Modupe Idowu
- Division of Hematology, Department of Internal Medicine, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA
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30
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Friedberg MK. Imaging Right-Left Ventricular Interactions. JACC Cardiovasc Imaging 2018; 11:755-771. [DOI: 10.1016/j.jcmg.2018.01.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/22/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
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Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study. PLoS One 2018; 13:e0193245. [PMID: 29684090 PMCID: PMC5912712 DOI: 10.1371/journal.pone.0193245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 02/07/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is a rare disorder with unfavorable prognosis despite implementation of specific PAH-oriented therapy. The aim of the study was to define predictors of poor prognosis in patients from one center treated according to the Polish National Health Fund program. PATIENTS AND METHODS Forty-seven consecutive patients (30 women; aged 39±17 years) with PAH diagnosis were enrolled to the study. Clinical assessment, laboratory measurements, electrocardiogram, echocardiography, 6-minute walk test, 24-hour Holter monitoring, cardiopulmonary exercise test and microvolt T-wave alternans test were performed during routine visits. Eight patients died during 2.6±1.7 years follow-up. RESULTS Parametrs which differentiated patients who died were brain natriuretic peptide (BNP) concentration ≥330 pg/mL (sensitivity 88%, specificity 92%, area under the ROC curve [AUC] 0.92); bilirubin concentration ≥1.2 mg/dL (sensitivity 88%, specificity 81%, AUC 0.85); right atrial area ≥21 cm2 (sensitivity 86%, specificity 69%, AUC 0.84), right ventricular (RV) dimension in the apical 4-chamber view ≥47 mm (sensitivity 86%, specificity 86%, AUC 0.85) and RV to left ventricular diastolic diameter ratio ≥1.5 (sensitivity 83%, specificity 84%; AUC 0.85). In multivariate analysis, independent predictors of mortality were higher BNP (p = 0.04) and bilirubin level (p = 0.03), higher right atrial area (p = 0.02) and lower tricuspid annular plane systolic excursion (p = 0.03). CONCLUSIONS In PAH patients treated with specific PAH-oriented therapy right atrial enlargement, impaired right ventricular systolic function, as well as increased BNP and bilirubin concentration was associated with an increased mortality risk.
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Ojji DB, Lecour S, Adeyemi OM, Sliwa K. Soluble ST2 correlates with some indicators of right ventricular function in hypertensive heart failure. Vasc Health Risk Manag 2017; 13:311-316. [PMID: 28860791 PMCID: PMC5566873 DOI: 10.2147/vhrm.s127430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose ST2 receptor, which is a member of the Toll-like/interleukin-1 (IL-1) receptor family, has been found to be increased in the serum of patients 1 day after myocardial infarction. Several other studies have shown that soluble ST2 levels correlate with severity of heart failure (HF), left ventricular ejection fraction, creatinine clearance, B-type natriuretic peptide and C-reactive protein, and are predictors of mortality in HF. Most of these studies were not only limited to ischemic heart disease but also concentrated on left-sided HF. We therefore decided to study the relationship between soluble ST2 and some markers of right ventricular (RV) function in a cohort of hypertensive HF subjects. Patients and methods This is a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, over a 12-month period. ST2 was measured in plasma sample by the enzyme-linked immunosorbent assay (ELISA) method. Right ventricular diameters in diastole (RVDD) and right atrial area (RAA) were obtained on echocardiography, while right ventricular systolic pressure (RVSP) was estimated from echocardiography by the addition of the pressure gradient between the right ventricle and right atrium (RA) to the pressure in the RA. Results There was a significant correlation between RVSP and soluble ST2 (t=0.75, p<0.0001), RVDD (t=0.28, p=0.004) and RAA (t=0.46, p=0.002). Conclusion In a cohort of hypertensive HF subjects, soluble ST2 correlates significantly with RVSP, RVDD and RAA.
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Affiliation(s)
- Dike B Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Sandrine Lecour
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Olusoji M Adeyemi
- Department of Medical Laboratory Sciences, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.,Mary McKillop Institute for Health Research, ACU, Melbourne, VIC, Australia
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Poser H, Berlanda M, Monacolli M, Contiero B, Coltro A, Guglielmini C. Tricuspid annular plane systolic excursion in dogs with myxomatous mitral valve disease with and without pulmonary hypertension. J Vet Cardiol 2017; 19:228-239. [PMID: 28579307 DOI: 10.1016/j.jvc.2017.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/02/2017] [Accepted: 03/07/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate tricuspid annular plane systolic excursion (TAPSE) in dogs with myxomatous mitral valve disease (MMVD) with or without pulmonary hypertension (PH) and to study the correlations with clinical and echocardiographic parameters. ANIMALS The study population included 99 dogs with MMVD and tricuspid regurgitation. METHODS This is a prospective clinical study. All dogs received a transthoracic echocardiographic evaluation, including 2D, M-mode, echo-Doppler, and tissue Doppler measurements. The TAPSE was measured from the left apical four-chamber view and normalized for the effect of body weight (nTAPSE). The dogs were grouped according to the severity of MMVD (American College of Veterinary Internal Medicine guidelines) and presence/absence and severity of PH. Significant differences between TAPSE or nTAPSE and echocardiographic parameters were analyzed among the MMVD and PH severity groups. Correlations between TAPSE or nTAPSE and echocardiographic parameters were calculated. RESULTS Tricuspid annular plane systolic excursion or nTAPSE were not significantly different among dogs of the MMVD or PH severity groups. Significant correlations were obtained between TAPSE and body weight, left ventricular and atrial dimensions, early diastolic septal and early diastolic and systolic tricuspid annulus velocity (p<0.001); nTAPSE was significantly correlated with normalized end-diastolic left ventricular dimension and fractional shortening (p<0.001). CONCLUSIONS The results show that neither TAPSE nor nTAPSE are reduced in dogs with MMVD with or without PH. It remains unclear if the right ventricle function is not reduced or if a reduced right ventricle function is masked by the contraction of the left ventricle through ventricular interdependence.
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Affiliation(s)
- H Poser
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy.
| | - M Berlanda
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy
| | - M Monacolli
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy
| | - B Contiero
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy
| | - A Coltro
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy
| | - C Guglielmini
- University of Padua, Department of Animal Medicine, Production and Health, Viale dell'Università, 16, 35020, Legnaro PD, Italy
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Spalla I, Payne JR, Borgeat K, Pope A, Fuentes VL, Connolly DJ. Mitral Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion in Cats with Hypertrophic Cardiomyopathy. J Vet Intern Med 2017; 31:691-699. [PMID: 28370313 PMCID: PMC5435071 DOI: 10.1111/jvim.14697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/03/2017] [Accepted: 02/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Left ventricular (LV) systolic dysfunction is associated with increased risk of death in cats with hypertrophic cardiomyopathy (HCM). Mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively) are measures of longitudinal systolic function and are reduced in human patients with HCM. Hypotheses Cats with HCM have lower MAPSE and TAPSE compared to control cats; lower MAPSE and TAPSE are associated with the presence of congestive heart failure (CHF) and reduced survival time. Animals 64 cats with HCM and 27 healthy cats. Forty‐five cats with HCM were not showing clinical signs, and 19 had CHF. Methods Retrospective study. Anatomic M‐mode from the left apical 4‐chamber view was used to record MAPSE from the free wall (MAPSE FW) and septum (MAPSE IVS) and TAPSE. Results Compared to controls, cats with HCM had lower MAPSE IVS (controls 5.2 [4.6–5.6] mm, asymptomatic HCM 4.7 [4.1–5.2] mm, HCM with CHF 2.6 [2.5–3.2] mm, P < .001), MAPSE FW (controls 5.9 [5.3–6.2] mm, asymptomatic HCM 4.7 [4.1–5.1] mm, HCM with CHF 2.8 [2.4–3.2] mm) and TAPSE (controls 8.6 [7.4–10.2] mm, asymptomatic HCM 7.2 [6.3–8.2] mm, HCM with CHF 4.6 [4.1–5.4] mm), with the lowest in the CHF group. Univariate survival analysis showed a shorter survival in cats displaying lower MAPSE IVS, MAPSE FW, and TAPSE. Conclusions and Clinical Importance MAPSE and TAPSE were lower in cats with HCM than in control cats and were lowest in CHF, suggesting that systolic longitudinal dysfunction is present in cats with HCM. MAPSE and TAPSE have potential prognostic significance.
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Affiliation(s)
- I Spalla
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - J R Payne
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.,Highcroft Veterinary Referrals, Whitchurch, Bristol, UK
| | - K Borgeat
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.,Highcroft Veterinary Referrals, Whitchurch, Bristol, UK
| | - A Pope
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - D J Connolly
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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35
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Serrano-Parreño B, Carretón E, Caro-Vadillo A, Falcón-Cordón Y, Falcón-Cordón S, Montoya-Alonso JA. Evaluation of pulmonary hypertension and clinical status in dogs with heartworm by Right Pulmonary Artery Distensibility Index and other echocardiographic parameters. Parasit Vectors 2017; 10:106. [PMID: 28241783 PMCID: PMC5330087 DOI: 10.1186/s13071-017-2047-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/18/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a frequent and severe phenomenon in heartworm disease caused by Dirofilaria immitis, mainly caused by intimal proliferation of the arteries and pulmonary thromboembolisms. Transthoracic echocardiography is the method of choice for diagnosing PH in dogs although the diagnosis is often based on indirect and subjective parameters. The Right Pulmonary Artery Distensibility Index (RPAD Index) is a method that has been recently validated to estimate the presence and severity of PH in heartworm-infected dogs. This study compared some echocardiographic parameters commonly used to estimate PH in 93 dogs infected by D. immitis and evaluated the impact of the parasite burden, microfilaremia, sex or origin of the dog (client-owned/shelter). RESULTS None of the studied echocardiographic variables seemed useful in the estimation of the evaluated clinical aspects, except for the PA/Ao ratio for parasite burden. The RPAD Index was determined in 88 of the dogs; of these, 70.4% had PH (mild: 37.5%, moderate: 19.3%, severe: 13.6%). This Index showed non-significant differences according to microfilaremia, sex, origin or parasite burden. Symptomatic dogs showed PH more often and displayed more severe PH, in addition the presence of symptoms was greater among dogs with high burden; on the other hand 64.4% of asymptomatic dogs had some degree of PH according to the RPAD Index. Apart from the PA/Ao ratio, the other evaluated echocardiographic variables were not useful in evaluating of the hypertensive status of the heartworm-infected dog compared to the RPAD Index. CONCLUSIONS The estimation of most common indirect parameters is not useful in predicting PH in heartworm-infected dogs. The results confirm the RPAD Index as an objective and supportive test in the monitoring and evaluation of PH in the heartworm-infected dog, and show a potential diagnostic value for the detection of PH in asymptomatic animals.
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Affiliation(s)
- B Serrano-Parreño
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - E Carretón
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - A Caro-Vadillo
- Department of Animal Medicine and Surgery, Veterinary Faculty, Complutense University of Madrid, Madrid, Spain
| | - Y Falcón-Cordón
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - S Falcón-Cordón
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - J A Montoya-Alonso
- Internal Medicine, Faculty of Veterinary Medicine, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Daley J, Grotberg J, Pare J, Medoro A, Liu R, Hall MK, Taylor A, Moore CL. Emergency physician performed tricuspid annular plane systolic excursion in the evaluation of suspected pulmonary embolism. Am J Emerg Med 2017; 35:106-111. [DOI: 10.1016/j.ajem.2016.10.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/30/2016] [Accepted: 10/09/2016] [Indexed: 10/20/2022] Open
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Grønlykke L, Ravn HB, Gustafsson F, Hassager C, Kjaergaard J, Nilsson JC. Right ventricular dysfunction after cardiac surgery – diagnostic options. SCAND CARDIOVASC J 2016; 51:114-121. [DOI: 10.1080/14017431.2016.1264621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lars Grønlykke
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens C. Nilsson
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Dini FL, Carluccio E, Simioniuc A, Biagioli P, Reboldi G, Galeotti GG, Raineri C, Gargani L, Scelsi L, Mandoli GE, Cannito A, Rossi A, Temporelli PL, Ghio S. Right ventricular recovery during follow-up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction. Eur J Heart Fail 2016; 18:1462-1471. [DOI: 10.1002/ejhf.639] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/18/2016] [Accepted: 05/21/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - Erberto Carluccio
- Division of Cardiology, University of Perugia; School of Medicine; Perugia Italy
| | - Anca Simioniuc
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - Paolo Biagioli
- Division of Cardiology, University of Perugia; School of Medicine; Perugia Italy
| | - Gianpaolo Reboldi
- Department of Internal Medicine; University of Perugia; Perugia Italy
| | | | - Claudia Raineri
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | - Luna Gargani
- Institute of Clinical Physiology; National Research Council; Pisa Italy
| | - Laura Scelsi
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | | | - Antonia Cannito
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences; Cardiology Section, University of Verona; Verona Italy
| | | | - Stefano Ghio
- Cardiac, Thoracic and Vascular Department; Fondazione IRCCS; Policlinico San Matteo Pavia Italy
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Garcia Gigorro R, Renes Carreño E, Mayordomo S, Marín H, Perez Vela JL, Corres Peiretti MA, Montejo González JC. Evaluation of right ventricular function after cardiac surgery: The importance of tricuspid annular plane systolic excursion and right ventricular ejection fraction. J Thorac Cardiovasc Surg 2016; 152:613-20. [DOI: 10.1016/j.jtcvs.2016.04.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/05/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
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40
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de Amorim Corrêa R, de Oliveira FB, Barbosa MM, Barbosa JAA, Carvalho TS, Barreto MC, Campos FTAF, Nunes MCP. Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain. Echocardiography 2016; 33:1326-34. [PMID: 27460782 DOI: 10.1111/echo.13267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two-dimensional (2D) speckle tracking strain. METHODS The study enrolled 37 group 1 PAH patients and 38 age- and gender-matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six-minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH. RESULTS The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (-17.9 ± 2.8 vs. -20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. CONCLUSIONS This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.
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Affiliation(s)
- Ricardo de Amorim Corrêa
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Fernanda Brito de Oliveira
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Ecocenter, Hospital Socor, Belo Horizonte, Brazil
| | | | | | | | | | | | - Maria Carmo Pereira Nunes
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Ju CR, Zhang JH, Chen M, Chen RC. Plasma myostatin levels are related to the extent of right ventricular dysfunction in exacerbation of chronic obstructive pulmonary disease. Biomarkers 2016; 22:246-252. [PMID: 27323660 DOI: 10.1080/1354750x.2016.1203999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the relationship between plasma myostatin levels and right ventricle (RV) dysfunction (RVD) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS The study recruited 84 patients with AECOPD. Plasma myostatin was analyzed and tricuspid annular plane systolic excursion (TAPSE) < 16 mm was used as the main indicator for RVD. RESULTS Plasma myostatin levels were significantly higher in 47 patients with RVD than 37 ones without (P < 0.005). Multivariate regression analysis revealed that myostatin levels correlated significantly with TAPSE values and RV myocardial performance index (p < 0.001) among the study patients. CONCLUSION Plasma myostatin is a potential biomarker for improving diagnosis of RVD in AECOPD.
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Affiliation(s)
- Chun-Rong Ju
- a State Key Lab of the Respiratory Disease, Guangzhou Institute of Respiratory Disease , First Affiliated Hospital of Guangzhou Medical University , Guangdong , China
| | - Jian-Heng Zhang
- a State Key Lab of the Respiratory Disease, Guangzhou Institute of Respiratory Disease , First Affiliated Hospital of Guangzhou Medical University , Guangdong , China
| | - Miao Chen
- a State Key Lab of the Respiratory Disease, Guangzhou Institute of Respiratory Disease , First Affiliated Hospital of Guangzhou Medical University , Guangdong , China
| | - Rong-Chang Chen
- a State Key Lab of the Respiratory Disease, Guangzhou Institute of Respiratory Disease , First Affiliated Hospital of Guangzhou Medical University , Guangdong , China
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Hamilton-Craig CR, Stedman K, Maxwell R, Anderson B, Stanton T, Chan J, Yamada A, Scalia GM, Burstow DJ. Accuracy of quantitative echocardiographic measures of right ventricular function as compared to cardiovascular magnetic resonance. IJC HEART & VASCULATURE 2016; 12:38-44. [PMID: 28616541 PMCID: PMC5454157 DOI: 10.1016/j.ijcha.2016.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/05/2022]
Abstract
Background Many echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR). Methods and results 92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland–Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes. Conclusion As compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.
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Key Words
- 3DE, three dimensional echocardiography
- 3DE-RV, three-dimensional echo right ventricular ejection fraction
- CMR, cardiovascular magnetic resonance
- DTI, Doppler tissue imaging
- EF, ejection fraction
- Echocardiography
- IVCT, isovolumic contraction time
- IVRT, isovolumic relaxation time
- LV, left ventricle
- MPI, myocardial performance index
- Magnetic resonance imaging
- RV, right ventricular
- RVOT, right ventricular outflow tract
- RVSm, peak systolic myocardial velocity
- RVSm, s prime: right ventricular peak systolic myocardial velocity
- Right ventricle
- Right ventricular function
- SR, strain rate
- TAPSE, tricuspid annular peak systolic excursion
- TOF, tetralogy of Fallot
- TR, tricuspid regurgitation
- ε, strain
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Affiliation(s)
- Christian R Hamilton-Craig
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,University of Washington, Seattle, WA, USA
| | - Kathy Stedman
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Ryan Maxwell
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia
| | - Bonita Anderson
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | | | - Jonathan Chan
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Australia
| | - Akira Yamada
- Fujita Health University School of Medicine, Japan.,Menzies Health Institute Queensland, Griffith University, Australia
| | - Gregory M Scalia
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Darryl J Burstow
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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43
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Koestenberger M, Friedberg MK, Nestaas E, Michel-Behnke I, Hansmann G. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction. Pulm Circ 2016; 6:15-29. [PMID: 27162612 PMCID: PMC4860554 DOI: 10.1086/685051] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eirik Nestaas
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; and Department of Paediatrics, Vestfold Hospital Trust, Vestfold, Norway
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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Meng S, Guo L, Li G. Early changes in right ventricular longitudinal function in chronic asymptomatic alcoholics revealed by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2016; 14:16. [PMID: 27094037 PMCID: PMC4837624 DOI: 10.1186/s12947-016-0058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart ventricular dysfunction has been characterized as reduced longitudinal function of the right ventricle (RV), and is associated with chronic alcohol abuse. This study investigated the use of two-dimensional speckle tracking echocardiography (2DSTE) to assess the longitudinal systolic and diastolic RV function of patients with alcoholic myocardial damage. METHODS We stratified 92 asymptomatic alcoholic men into three groups of increasing alcohol intake, Groups A-C. Thirty age-matched normal adult men served as the control group. Conventional echocardiography and tricuspid annulus peak systolic excursion (TAPSE) parameters were obtained. 2DSTE parameters were recorded from an apical 4-chamber view of the RV free wall. LV peak global longitudinal systolic strain was calculated from segmental averaging of the three apical long-axis views. RESULTS In Group C, the RV end diastolic diameter (RVEDD) was dramatically higher than that of Groups A, B and the control, while TAPSE was significantly lower in Group C compared with the other experimental groups. In Group B, the longitudinal early diastolic strain rate (SRe) and late diastolic strain rate (SRa) of the RV free wall, and LV longitudinal strain were significantly lower than that of Group A or the control. In Group C, all the 2DSTE parameters were significantly lower than that of the other groups. A significant negative linear correlation was noted between global RV systolic parameters systolic strain peak (S), peak systolic strain rate (SRs) and TAPSE (r1=-0.84, r2=-0.72, respectively, P <0.05). CONCLUSIONS Two-dimensional STE provided an effective and non-invasive method to assess the RV longitudinal function of patients with alcoholic myocardial damage. This methodology may be useful for diagnosing, directing treatment, and judging prognosis of alcoholic cardiac damage.
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Affiliation(s)
- Sisi Meng
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China
| | - Lijuan Guo
- Department of Echocardiography, Liaoning Provincial People's Hospital, Shenyang, 110000, China
| | - Guangsen Li
- Department of Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, 116027, China.
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45
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Ojji DB, Lecour S, Atherton JJ, Blauwet LA, Alfa J, Sliwa K. Right Ventricular Systolic Dysfunction Is Common in Hypertensive Heart Failure: A Prospective Study in Sub-Saharan Africa. PLoS One 2016; 11:e0153479. [PMID: 27073856 PMCID: PMC4830610 DOI: 10.1371/journal.pone.0153479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/30/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Right ventricular (RV) systolic dysfunction is now recognized widely as a strong and independent predictor of adverse outcomes in patients with heart failure (HF). Reduction of RV systolic function more closely predicts impaired exercise tolerance and poor survival than does left ventricular (LV) systolic function. In spite of this, there is a dearth of data on RV function in hypertensive HF which is the commonest form of HF in sub-Saharan Africa. We therefore conducted a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, Nigeria over an 8 year period. METHODS Each subject had transthoracic echocardiography performed on them according to the guidelines of American Society of Echocardiography. RV systolic function was defined as a tricuspid annular plane systolic excursion (TAPSE) <15 mm using M-mode echocardiography. RESULTS RV systolic dysfunction was identified in 272 (44.5%) of the 611 subjects that were studied. Subjects with TAPSE less than 15 mm had worse prognosis compared to those with TAPSE ≥15 mm.There was a significant correlation between TAPSE and other adverse prognostic markers including left and right atrial area, LV size, LV mass, LV ejection fraction, restrictive mitral inflow and RV systolic pressure (RVSP). However, LV ejection fraction and right atrial area were the only independent determinants of RV systolic dysfunction. CONCLUSIONS Hypertensive HF is a major cause of RV systolic dysfunction even in a population with a low prevalence of coronary artery disease, and RV systolic dysfunction is associated with poor prognosis in hypertensive HF. Detailed assessment of RV function should therefore be part of the echocardiography evaluation of patients with hypertensive HF.
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Affiliation(s)
- Dike B. Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John J. Atherton
- Department of Cardiology, Royal Brisbane and Women Hospital, and University of Queensland School of Medicine, Brisbane, Australia
| | - Lori A. Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jacob Alfa
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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46
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Evaluation of tricuspid annular plane systolic excursion measured with cardiac MRI in children with tetralogy of Fallot. Cardiol Young 2016; 26:718-24. [PMID: 26279488 PMCID: PMC4757514 DOI: 10.1017/s1047951115001456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Aneurysmal dilation of the right ventricular outflow tract complicates assessment of right ventricular function in patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is commonly used to estimate ejection fraction. We hypothesised that tricuspid annular plane systolic excursion measured by cardiac MRI approximates global and segmental right ventricular function, specifically right ventricular sinus ejection fraction, in children with repaired tetralogy of Fallot. METHODS Tricuspid annular plane systolic excursion was measured retrospectively on cardiac MRIs in 54 patients with repaired tetralogy of Fallot. Values were compared with right ventricular global, sinus, and infundibular ejection fractions. Tricuspid annular plane systolic excursion was indexed to body surface area, converted into a fractional value, and converted into published paediatric Z-scores. RESULTS Tricuspid annular plane systolic excursion measurements had good agreement between observers. Right ventricular ejection fraction did not correlate with the absolute or indexed tricuspid annular plane systolic excursion and correlated weakly with fractional tricuspid annular plane systolic excursion (r=0.41 and p=0.002). Segmental right ventricular function did not appreciably improve correlation with any of the tricuspid annular plane systolic excursion measures. Paediatric Z-scores were unable to differentiate patients with normal and abnormal right ventricular function. CONCLUSIONS Tricuspid annular plane systolic excursion measured by cardiac MRI correlates poorly with global and segmental right ventricular ejection fraction in children with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is an unreliable approximation of right ventricular function in this patient population.
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47
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Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Terenzi P, Bernardo P, Valente S, Gensini GF, Peris A. Pulmonary vascular dysfunction in refractory acute respiratory distress syndrome before veno-venous extracorporeal membrane oxygenation. Acta Anaesthesiol Scand 2016; 60:485-91. [PMID: 26482659 DOI: 10.1111/aas.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/16/2015] [Accepted: 09/09/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pulmonary vascular dysfunction has been described in patients with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a well-established treatment for these patients. We hypothesized that severe pulmonary vascular dysfunction and cor pulmonale identified by echocardiography before cannulation in these patients were associated with worse survival. METHODS Echocardiography was used to identify pulmonary hypertension in 21 patients with refractory ARDS just before ECMO implantation. Survival was compared for those with and without cor pulmonale. RESULTS In our series, the overall mortality rate was 57.1% (12/21). Echocardiographic exams were transthoracic in 5 patients (23.8%), transesophageal in 4 patients (19%), and both (transthoracic and transesophageal) in the remaining 12 patients (57.1%). In our series, six patients (28.5%) showed LV dysfunction. Acute cor pulmonale was detectable in 2 patients (9.5%), while the remaining 19 patients showed moderate pulmonary dysfunction. Survivors had a higher pre-cannulation LV ejection fraction (EF) (P = 0.02) and tricuspid annular plane excursion (P = 0.04), and lower peak systolic pulmonary artery pressures (P = 0.02). CONCLUSIONS In patients with refractory ARDS immediately before ECMO implantation, the prevalence of acute cor pulmonale is low (9.5%). Survival is associated with higher LVEF and lower systolic pulmonary arterial pressure. These findings support the idea that echocardiographic assessment of pulmonary artery pressure in patients with refractory ARDS before VV-ECMO implantation may have value for risk-stratification.
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Affiliation(s)
- C. Lazzeri
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. Cianchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - M. Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Batacchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - P. Terenzi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - P. Bernardo
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Valente
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. F. Gensini
- Intensive Care Unit of Heart and Vessels Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; AOU Careggi; Fondazione Don Carlo Gnocchi IRCCS; Florence Italy
| | - A. Peris
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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48
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Torrado JF, Samidurai A. Right ventricular outflow tract assessment: Identification of right ventricle dysfunction in heart failure. Indian Heart J 2016; 68 Suppl 1:S5-7. [PMID: 27056653 PMCID: PMC4824326 DOI: 10.1016/j.ihj.2015.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- Juan F Torrado
- University Cardiovascular Center, Department of Cardiology, Clinic Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Arun Samidurai
- Division of Internal Medicine/Cardiology, Pauley Heart Center, Virginia Commonwealth University, 1101 East Marshall Street, Room-No-7-020, Richmond, VA, USA.
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Kaye BM, Borgeat K, Mõtsküla PF, Luis Fuentes V, Connolly DJ. Association of tricuspid annular plane systolic excursion with survival time in Boxer dogs with ventricular arrhythmias. J Vet Intern Med 2015; 29:582-8. [PMID: 25818212 PMCID: PMC4895501 DOI: 10.1111/jvim.12572] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/21/2014] [Accepted: 02/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background Tricuspid annular plane systolic excursion (TAPSE) is a useful estimate of right ventricular function in humans. Reference intervals for dogs have been generated, but the value of measuring TAPSE in other diseases, or investigating the association between TAPSE and outcome, is unknown. Hypothesis TAPSE is lower in Boxer dogs with ≥50 VPCs/24 h on Holter than in dogs with fewer ventricular ectopics, and lower TAPSE is associated with a shorter survival time. Animals Fifty Boxer dogs that presented for investigation of syncope or suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) at a veterinary teaching hospital (2004–2011). Methods Retrospective study. Clinical records, Holter, and echocardiographic data were reviewed. TAPSE was measured in a blinded manner on stored echocardiographic cine‐loops using anatomic M‐mode. Outcome information was obtained and death was classified as cardiac or noncardiac. Survival analysis was performed using Kaplan‐Meier curves and Cox proportional hazards models. Results TAPSE was lower in Boxers with ≥50 VPCs/24 h (13.9 ± 4.04 mm) than Boxers with <50 VPCs/24 h (16.8 ± 3.21 mm; P < .001). TAPSE <15.1 mm was associated with shorter cardiac survival time in all dogs (P = .004) and also in dogs without left ventricular dysfunction (P = .035). When controlling for other variables, including ventricular tachycardia on Holter and left ventricular systolic dysfunction, multivariable analysis showed that TAPSE remained an independent predictor of time to cardiac death (HR >4.09, 95%CI 1.15–16.9, P < .029). Conclusions and Clinical Importance TAPSE offers prognostic value for Boxer dogs, including those with apparently normal systolic function and ≥50 VPCs/24 h on Holter analysis.
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Affiliation(s)
- B M Kaye
- Royal Veterinary College, Hatfield, UK
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50
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Abstract
Right ventricular function is a crucial determinant of long-term outcomes of children with heart disease. Quantification of right ventricular systolic and diastolic performance by echocardiography is of paramount importance, given the prevalence of children with heart disease, particularly those with involvement of the right heart, such as single or systemic right ventricles, tetralogy of Fallot, and pulmonary arterial hypertension. Identification of poor right ventricular performance can provide an opportunity to intervene. In this review, we will go through the different systolic and diastolic indices, as well as their application in practice. Quantification of right ventricular function is possible and should be routinely performed using a combination of different measures, taking into account each disease state. Quantification is extremely useful for individual patient follow-up. Laboratories should continue to strive to optimise reproducibility through quality improvement and quality assurance efforts in addition to investing in technology and training for new, promising techniques, such as three-dimensional echocardiography.
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