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Wang AP, Husain N, Penk J, Laternser C, Magnetta D, Watanabe K, Hauck A. Prognostic Value of RV Function Analysis During the Interstage Period in Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2024; 45:1120-1128. [PMID: 38519623 DOI: 10.1007/s00246-024-03463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Cardiac dysfunction is associated with mortality in children with hypoplastic left heart syndrome (HLHS). We evaluated the ability of qualitative and quantitative RV functional parameters to predict outcomes in HLHS patients. In this retrospective, single-center study, echocardiograms from 3 timepoints (pre-stage 1 palliation, 4-8 weeks post-stage 1 palliation, and pre-Glenn) were analyzed in infants with HLHS. Patients were stratified into two groups based on outcome of transplant-free survival post-Glenn (survivors) versus mortality or transplantation prior to Fontan (non-survivors). Images were retrospectively reviewed to obtain RV global longitudinal strain (RVGLS), RV-free wall strain (RVFWS), fractional area change (FAC), tricuspid annular systolic plane excursion (TAPSE), tissue motion annular displacement of the tricuspid valve (TMAD-TV) and qualitative systolic function assessment during the predetermined timepoints. An equal variance t-test and chi-square were used to determine significant differences and ROC curve analysis was performed to derive optimal cutoff values to predict mortality/transplant. A total of 47 patients met inclusion criteria, of which, 21 patients met composite endpoint. There were no significant differences in any RV functional parameter during the pre- or post-stage 1 palliation timepoints. The absolute values of RVFWS, RVGLS, and TMAD-TV were significantly greater in survivors than non-survivors during the pre-Glenn timepoint. A pre-Glenn RVGLS > -15.6 (AUC 0.79), RVFWS > -18.6 (AUC 0.75), and TMAD-TV < 12.6% (AUC 0.82) were sensitive and specific for predicting death or need for transplantation prior to Fontan completion. RVGLS, RVFWS, and TMAD-TV may help identify higher-risk HLHS patients during the interstage period.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Nazia Husain
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jamie Penk
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christina Laternser
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Defne Magnetta
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kae Watanabe
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Hauck
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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2
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Zhu F, de Oliveira CB, Mohsen N, Kharrat A, Deshpande P, Mertens L, Jain A. Challenges in clinical identification of right ventricular dysfunction in preterm infants with persistent pulmonary hypertension of the newborn. Early Hum Dev 2024; 190:105942. [PMID: 38306954 DOI: 10.1016/j.earlhumdev.2024.105942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Right ventricular dysfunction, typically qualitatively diagnosed (Q-RVd) in preterm infants, requires echocardiography which is not always acutely available. We aimed to identify clinical indices of Q-RVd in very preterm infants (gestational age, GA <32 weeks) with persistent pulmonary hypertension of newborn (PPHN) and examine the reliability and validity of Q-RVd. METHODS Forty-seven infants with mean ± SD GA of 26.8 ± 2.7 weeks who had targeted neonatal echocardiography (TNE) ≤72 h old, during PPHN, were retrospectively studied. Three standard TNE clips were reviewed by two blinded assessors, and infants categorized as Q-RVd if moderate-severe RVd was diagnosed on ≥2 clips. Cardiopulmonary clinical indices at TNE and quantitative RV functional markers were compared between Q-RVd vs. no-RVd groups. Potential quantitative RVd definitions examined by classifying each measurement as "low" or "normal" using published data. Inter-rater agreement for Q-RVd assessed using Kappa statistics. RESULTS Mean age at TNE was 25.3 ± 20.4 h with Q-RVd diagnosed in 19(40 %) infants. Q-RVd group demonstrated higher peak oxygen requirements (96 ± 9 % vs. 84 ± 16 %, p < 0.01); however, no clinical parameters at TNE differentiated the groups. Quantitative measures were lower in Q-RVd patients, confirming classification validity. Among tested quantitative definitions, low RV stroke volume was associated with lower systolic blood pressure (41±7 vs. 47±9 mmHg, p = 0.02) and higher shock index (4.02±0.80 vs. 3.44±0.72, p = 0.02). Kappa for Q-RVd was 0.55 (95%CI 0.32-0.77). CONCLUSIONS The non-specific nature of clinical markers of RVd in preterm infants with PPHN necessitates echocardiographic diagnosis of RVd. Studies should examine prognostic relevance of RVd and establish outcome-based quantitative definitions in preterm infants.
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Affiliation(s)
- Faith Zhu
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Caio Barbosa de Oliveira
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Nada Mohsen
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada; Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Poorva Deshpande
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada
| | - Luc Mertens
- Department of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada.
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3
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Semino T, Rosa GM, Monacelli F, Pellicano R, Testino G, Porto I. Right ventricle: current knowledge of echocardiographic evaluation of this "forgotten" chamber. Minerva Med 2024; 115:45-60. [PMID: 36988493 DOI: 10.23736/s0026-4806.23.08575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
In the past the right ventricle (RV) has been traditionally regarded as a simple conduit between the venous system and the pulmonary circulation and it has aroused little interest in both clinical and echocardiographic cardiologists to such an extent that it has been defined as the "forgotten chamber." Subsequently it was clearly shown that the right heart (RH) plays an important physiologic role in cardiac activity, and that congenital or acquired alterations in its structure and function have an important prognostic value. Aim of this review is to shed the light on the echocardiographic approach to this cardiac chamber. In this narrative review we critically explored the most recent literature on this topic using PubMed and Medline and examining the most recent guidelines on the echocardiographic approach to the RV. Echocardiographic approach to RV presents some technical difficulties, which stem from the position of the RV inside the thorax and around the LV and from its particular anatomy, which precludes geometric assumptions. However, RV may now be evaluated quantitatively and qualitatively in many ways, and some new methods can partially overcome some of the limits imposed by its complex anatomy, thereby yielding a quantitative evaluation. Furthermore, due to the wide range of pathologies which may involve the RV a disease-oriented approach should be considered in the echocardiographic investigation of right heart disease.
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Affiliation(s)
- Tommaso Semino
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Gian M Rosa
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy -
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Clinic of Geriatric Diseases, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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4
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Kampaktsis PN, Bohoran TA, Lebehn M, McLaughlin L, Leb J, Liu Z, Moustakidis S, Siouras A, Singh A, Hahn RT, McCann GP, Giannakidis A. An attention-based deep learning method for right ventricular quantification using 2D echocardiography: Feasibility and accuracy. Echocardiography 2024; 41:e15719. [PMID: 38126261 DOI: 10.1111/echo.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/23/2023] Open
Abstract
AIM To test the feasibility and accuracy of a new attention-based deep learning (DL) method for right ventricular (RV) quantification using 2D echocardiography (2DE) with cardiac magnetic resonance imaging (CMR) as reference. METHODS AND RESULTS We retrospectively analyzed images from 50 adult patients (median age 51, interquartile range 32-62 42% women) who had undergone CMR within 1 month of 2DE. RV planimetry of the myocardial border was performed in end-diastole (ED) and end-systole (ES) for eight standardized 2DE RV views with calculation of areas. The DL model comprised a Feature Tokenizer module and a stack of Transformer layers. Age, gender and calculated areas were used as inputs, and the output was RV volume in ED/ES. The dataset was randomly split into training, validation and testing subsets (35, 5 and 10 patients respectively). Mean RVEDV, RVESV and RV ejection fraction (EF) were 163 ± 70 mL, 82 ± 42 mL and 51% ± 8% respectively without differences among the subsets. The proposed method achieved good prediction of RV volumes (R2 = .953, absolute percentage error [APE] = 9.75% ± 6.23%) and RVEF (APE = 7.24% ± 4.55%). Per CMR, there was one patient with RV dilatation and three with RV dysfunction in the testing dataset. The DL model detected RV dilatation in 1/1 case and RV dysfunction in 4/3 cases. CONCLUSIONS An attention-based DL method for 2DE RV quantification showed feasibility and promising accuracy. The method requires validation in larger cohorts with wider range of RV size and function. Further research will focus on the reduction of the number of required 2DE to make the method clinically applicable.
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Affiliation(s)
- Polydoros N Kampaktsis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Tuan A Bohoran
- School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Mark Lebehn
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Laura McLaughlin
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Zhonghua Liu
- Department of Biostatistics, Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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5
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O'Donnell C, Sanchez PA, Celestin B, McConnell MV, Haddad F. The Echocardiographic Evaluation of the Right Heart: Current and Future Advances. Curr Cardiol Rep 2023; 25:1883-1896. [PMID: 38041726 DOI: 10.1007/s11886-023-02001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW To discuss physiologic and methodologic advances in the echocardiographic assessment of right heart (RH) function, including the emergence of artificial intelligence (AI) and point-of-care ultrasound. RECENT FINDINGS Recent studies have highlighted the prognostic value of right ventricular (RV) longitudinal strain, RV end-systolic dimensions, and right atrial (RA) size and function in pulmonary hypertension and heart failure. While RA pressure is a central marker of right heart diastolic function, the recent emphasis on venous excess imaging (VExUS) has provided granularity to the systemic consequences of RH failure. Several methodological advances are also changing the landscape of RH imaging including post-processing 3D software to delineate the non-longitudinal (radial, anteroposterior, and circumferential) components of RV function, as well as AI segmentation- and non-segmentation-based quantification. Together with recent guidelines and advances in AI technology, the field is shifting from specific RV functional metrics to integrated RH disease-specific phenotypes. A modern echocardiographic evaluation of RH function should focus on the entire cardiopulmonary venous unit-from the venous to the pulmonary arterial system. Together, a multi-parametric approach, guided by physiology and AI algorithms, will help define novel integrated RH profiles for improved disease detection and monitoring.
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Affiliation(s)
- Christian O'Donnell
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Pablo Amador Sanchez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Bettia Celestin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA
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Tilly R, Mehrlaender M, Reichle C, Rosenberger P, Magunia H, Keller M. A one-day focused cardiac ultrasound training has a limited impact on residents' abilities to visually assess right ventricular dimensions and function. Echocardiography 2022; 39:1481-1487. [PMID: 36447129 DOI: 10.1111/echo.15461] [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: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Focused cardiac ultrasound (FCU) is a helpful tool to rapidly identify right ventricular (RV) causes of hemodynamic instability and facilitate the initiation of therapy. The clinical value of existing course models often remains unclear. This study investigated the effects of a one-day FCU training on the visual estimation skills of RV characteristics. METHODS Four residents were included as the study group after completing a standardized one-day FCU training. Four gender-matched controls did not take part in the training. All residents graded image quality, RV systolic function, and RV dimensions in a test comprising 35 ultrasound clips. RESULTS The study and control group did not differ in ICU or ultrasound experience. Overall, training participants were able to distinguish between good and insufficient image quality significantly better than the control group (agreement 80.0% vs 61.4%, p = 0.04). The agreement for the estimation of RV function and RV dimensions was not different between the groups (63.2% vs 60.5%, p = 0.66 and 64.3% vs 67.1%, p = 0.18, respectively). Descriptively, only small differences were found between the groups for the estimation of RV function and RV dimensions in subgroups of patients with normal versus reduced systolic RV function or normal versus enlarged RV dimensions, respectively. Both groups struggled in identifying RV enlargement (34.6% vs 46.2%). DISCUSSION In this study, a single one-day FCU training had no impact on residents' skills to visually assess systolic RV function or RV dimensions. Improvements of current training modalities or continuous teaching models are needed to optimize residency programs and patient care.
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Affiliation(s)
- Roman Tilly
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Martin Mehrlaender
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Christian Reichle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
| | - Marius Keller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Eberhard Karls University, Tuebingen, Germany
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7
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Prada G, Pustavoitau A, Koenig S, Mitchell C, Stainback RF, Díaz-Gómez JL. Focused Cardiac Ultrasonography for Right Ventricular Size and Systolic Function. N Engl J Med 2022; 387:e52. [PMID: 36416769 DOI: 10.1056/nejmvcm2004089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gabriel Prada
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Aliaksei Pustavoitau
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Seth Koenig
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Carol Mitchell
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - Raymond F Stainback
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
| | - José L Díaz-Gómez
- From Johns Hopkins Hospital, Baltimore (G.P., A.P.); Albert Einstein College of Medicine, New York (S.K.); the University of Wisconsin, Madison (C.M.); and Baylor College of Medicine, Houston (R.F.S., J.L.D.-G.)
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8
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Evaluation of right ventricular function during liver transplantation with transesophageal echocardiography. PLoS One 2022; 17:e0275301. [PMID: 36194610 PMCID: PMC9531831 DOI: 10.1371/journal.pone.0275301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathophysiology of advanced liver cirrhosis may induce alterations in the circulatory system that may be challenging for the anesthesiologist to manage intraoperatively, and perioperative cardiovascular events are associated with worse outcomes in cirrhotic patients undergoing liver transplantation. It remains controversial whether right ventricular function is impaired during this procedure. Studies using transesophageal echocardiography for quantitative analysis of the right ventricle remain scarce in this setting, yielding conflicting results. The aim of this study was to perform a quantitative assessment of right ventricular function with two parameters derived from transesophageal echocardiography during liver transplantation. METHODS Nineteen adult patients of both genders undergoing liver transplantation were evaluated in this observational study. The exclusion criteria were age under 18 or above 65 years old, fulminant hepatic failure, hepatopulmonary syndrome, portopulmonary hypertension, cardiopulmonary disease, and contraindications to the transesophageal echocardiogram. Right ventricular function was assessed at five stages during liver transplantation: baseline, hepatectomy, anhepatic, postreperfusion, and closure by measuring tricuspid annular plane systolic excursion and right ventricular fractional area change obtained with transesophageal echocardiography. RESULTS Right ventricular function was found to be normal throughout the procedure. The tricuspid annular plane systolic excursion showed a trend toward a decrease in the anhepatic phase compared to baseline (2.0 ± 0.9 cm vs. 2.4 ± 0.7 cm; P = 0.24) but with full recovery after reperfusion. Right ventricular fractional area change remained nearly constant during all stages studied (minimum: 50% ± 10 at baseline and anhepatic phase; maximum: 56% ± 12 at postreperfusion; P = 0.24). CONCLUSIONS Right ventricular function was preserved during liver transplantation at the time points evaluated by two quantitative parameters derived from transesophageal echocardiogram.
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9
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Nawaytou H, Springston C, Lazar A, Keller S, Hogan W, Cresalia N, Peyvandi S, Cocalis M, Moon-Grady A, Brook M. A Measurement-Based Protocol Improves Inter-Rater Agreement And Accuracy of Right Ventricular Systolic Pressure Assessment by Echocardiography in Children: A Call for Quality Improvement. J Am Soc Echocardiogr 2022; 35:1091-1100. [PMID: 35840083 DOI: 10.1016/j.echo.2022.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Echocardiographic measurements carry the promise of improving inter-rater agreement (IR) over subjective assessment. In this study we assess the effect of implementing a measurement-based protocol on the IR agreement and accuracy in reporting of right ventricular (RV) systolic pressure in children. We also evaluate the effect of this reporting protocol on the IR agreement in reporting RV dilation, hypertrophy and systolic function. METHODS Five echocardiography readers reported their assessment of the RV systolic pressure, dilation, hypertrophy and systolic function on 40 deidentified echocardiograms using their individual accustomed methods and then using an agreed-upon protocol based solely on RV measurements. The IR agreement was assessed using kappa statistics. Accuracy of the RV systolic pressure ratings was assessed using McNemar's test in comparison to hemodynamic data obtained by cardiac catheterization. The reliability of the RV measurements was assessed using intraclass correlation coefficient (ICC) and coefficient of variation (CoV). RESULTS The IR agreement and accuracy of RV systolic pressure assessment improved after employing the measurement-based protocol [agreement: 0.39 (95% confidence interval: 0.27,0.5) to 0.62 (0.48,0.76) & accuracy 18/40 to 29/40 p = 0.03]. IR agreement of RV dilation improved [0.36 (0.25,0.48) to 0.63 (0.48,0.79)] while the IR agreement of RV hypertrophy [0.29 (0.17,0.42) to 0.35 (0.15,0.55)] and RV systolic function [0.57 (0.45,0.69) to 0.53 (0.41,0.66)] did not improve. The reliability of the measurements was good (ICC > 0.8) except for RV free wall thickness (ICC: 0.62, CoV: 24%) and RV fractional area change (ICC: 0.47, CoV: 22%) proposing a possible reason for lack of improvement in IR agreement of RV hypertrophy and RV systolic function. Heteroscedasticity was observed in the reliability of RV measurements with the ICC being significantly lower at larger magnitudes for all RV measurements. CONCLUSIONS Standardization of reporting protocols using RV measurements in place of subjective assessment improved IR agreement and accuracy of RV systolic pressure assessment. Reliable measurements, RV systolic pressure and dilation, resulted in improvement in IR agreement while unreliable measurements, RV hypertrophy and systolic function, did not. Special attention to measurements' reliability and heteroscedasticity of reliability is required when designing clinical protocols to decrease IR disagreement as a source of error.
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Affiliation(s)
- Hythem Nawaytou
- Department of Pediatrics, University of California,San Francisco
| | | | - Ann Lazar
- Department of Preventive and Restorative Dental Sciences, University of California,San Francisco; Department of Epidemiology and Biostatistics, University of California,San Francisco
| | - Samuel Keller
- Department of Pediatrics, University of California,San Francisco
| | - Whitnee Hogan
- Department of Pediatrics, University of California,San Francisco
| | - Nicole Cresalia
- Department of Pediatrics, University of California,San Francisco
| | - Shabnam Peyvandi
- Department of Pediatrics, University of California,San Francisco
| | - Mark Cocalis
- Department of Pediatrics, University of California,San Francisco
| | - Anita Moon-Grady
- Department of Pediatrics, University of California,San Francisco
| | - Michael Brook
- Department of Pediatrics, University of California,San Francisco
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10
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Sun K, Cedarbaum E, Hill C, Win S, Parikh NI, Hsue PY, Durstenfeld MS. Association of Right Ventricular Dilation and Dysfunction on Echocardiogram with In-Hospital Mortality Among Patients Hospitalized with COVID-19 Compared with Other Acute Respiratory Illness. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.06.29.22277073. [PMID: 35794892 PMCID: PMC9258295 DOI: 10.1101/2022.06.29.22277073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although right ventricular (RV) dysfunction is associated with mortality in acute COVID-19, the role of RV dilation is uncertain. The prognostic significance of RV dilation and dysfunction among hospitalized patients with acute COVID-19 compared to other respiratory illnesses. METHODS We conducted a retrospective cohort study to examine 225 consecutive adults admitted for acute COVID-19 and 6,150 control adults admitted for influenza, pneumonia or ARDS who had a clinical echocardiogram performed. We used logistic regression models to assess associations between RV parameters and in-hospital mortality adjusted for confounders. RESULTS Among those with COVID-19, 48/225 (21.3%) died during the index hospitalization compared to 727/6150 (11.8%) with other respiratory illness (p=0.001). Independent of COVID-19, mild and moderate to severe RV dilation were associated with 1.4 and 2.0 times higher risk of inpatient mortality, respectively (95%CI 1.17 to 1.69; p=0.0003; 95%CI 1.62 to 2.47; p<0.0001, respectively). Similarly, mild and moderate RV dysfunction were associated with 1.4 and 1.7 times higher risk of inpatient mortality (95%CI 1.10 to 1.77; p=0.007; 95%CI 1.17 to 2.42; p=0.005, respectively). Relative to normal RV size and non-COVID-19 acute respiratory illness, mild and moderate RV dilation were associated with 1.4 times and 2.0 times higher risk among those without COVID-19 and 1.9 times higher and 3.0 times higher risk among those with COVID-19, with similar findings for RV dysfunction. Having both RV dilation and dysfunction or RV dilation alone were associated with 1.7 times higher risk while RV dysfunction alone was associated with 1.4 times higher risk compared to normal RV size and function. CONCLUSIONS RV dilation and dysfunction are associated with increased risk of inpatient mortality among those with COVID-19 and other respiratory illnesses. Abnormal RV findings may identify those at higher risk of short-term mortality from acute respiratory illness including COVID-19 beyond other risk markers.
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11
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Carpenter RJ, Srdanovic N, Rychlik K, Sen SK, Porta NFM, Hamvas AE, Murthy K, Hauck AL. The association between pulmonary vascular disease and respiratory improvement in infants with type I severe bronchopulmonary dysplasia. J Perinatol 2022; 42:788-795. [PMID: 35397644 DOI: 10.1038/s41372-022-01386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the association between echocardiographic measures of pulmonary vascular disease and time to respiratory improvement among infants with Type I severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN We measured the pulmonary artery acceleration time indexed to the right ventricular ejection time (PAAT/RVET) and right ventricular free wall longitudinal strain (RVFWLS) at 34-41 weeks' postmenstrual age. Cox-proportional hazards models were used to estimate the relationship between the PAAT/RVET, RVFWLS, and the outcome: days from 36 weeks' postmenstrual age to room-air or discharge with oxygen (≤0.5 L/min). RESULT For 102 infants, the mean PAAT/RVET and RVFWLS were 0.27 ± 0.06 and -22.63 ± 4.23%. An abnormal measurement was associated with an increased time to achieve the outcome (PAAT/RVET: 51v24, p < 0.0001; RVFWLS; 62v38, p = 0.0006). A normal PAAT/RVET was independently associated with a shorter time to outcome (aHR = 2.04, 1.11-3.76, p = 0.02). CONCLUSION The PAAT/RVET may aid in anticipating timing of discharge in patients with type I severe BPD.
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Affiliation(s)
- Ryan J Carpenter
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Rychlik
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shawn K Sen
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nicolas F M Porta
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron E Hamvas
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karna Murthy
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amanda L Hauck
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Arthur L, Knecht K, Ferry J, Grigsby D, Spencer H, Zakaria D. Serial assessment of right ventricular function can detect acute cellular rejection in children with heart transplantation. Pediatr Transplant 2022; 26:e14231. [PMID: 35043516 PMCID: PMC9086092 DOI: 10.1111/petr.14231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Echocardiographic markers of ACR are essential for early recognition and management. The literature's primary focus has been on the LV with little attention given to the RV. This study aimed to investigate echocardiographic right ventricular indices in the detection of ACR and to evaluate their utility as prognostic indicators of graft integrity. METHODS We performed a retrospective chart review of children with biopsy-proven ACR following orthotopic heart transplant and an echocardiogram within 24 h of biopsy. Selected echocardiographic markers were compared at baseline, during ACR, and at follow-up. RESULTS Forty-eight patients (56% male) had a total of 84 ACR episodes. Decrease in RV FAC (mean - 17.1%, p < .001) and TAPSE (mean - 8.9%, p < .001) with increase in left ventricular posterior wall thickness in diastole and systole (LVPWTd) (mean + 9.0%, p = .012) and LVPWTs (mean + 8.3%, p = .016) were found during ACR. Interestingly, these parameters improved following the episode of rejection. Additionally, these markers were compared after recovery between children with and without graft failure. RV dysfunction (FAC and TAPSE) and changes in LV posterior wall thickness were not found to have prognostic significance for graft integrity in children with heart transplantation. CONCLUSIONS RV echocardiographic functional parameters should be considered as valuable adjuncts in rejection surveillance. Further, the presence of RV dysfunction does not have prognostic significance for graft integrity but is reversible as ongoing damage was not detectable by such.
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Affiliation(s)
- Lindsay Arthur
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Kenneth Knecht
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer Ferry
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Debby Grigsby
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Horace Spencer
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dala Zakaria
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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13
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Silverton NA, Gebhardt BR, Maslow A. The Intraoperative Assessment of Right Ventricular Function During Cardiac Surgery. J Cardiothorac Vasc Anesth 2022; 36:3904-3915. [DOI: 10.1053/j.jvca.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/14/2022] [Accepted: 05/21/2022] [Indexed: 11/11/2022]
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14
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Park J, Park MS, Kwon JH, Oh AR, Lee SH, Choi GS, Kim JM, Kim K, Kim GS. Preoperative 2D-echocardiographic assessment of pulmonary arterial pressure in subgroups of liver transplantation recipients. Anesth Pain Med (Seoul) 2022; 16:344-352. [PMID: 35139615 PMCID: PMC8828622 DOI: 10.17085/apm.21028] [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: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The clinical efficacy of preoperative 2D-echocardiographic assessment of pulmonary arterial pressure (PAP) has not been evaluated fully in liver transplantation (LT) recipients. METHODS From October 2010 to February 2017, a total of 344 LT recipients who underwent preoperative 2D-echocardiography and intraoperative right heart catheterization (RHC) was enrolled and stratified according to etiology, disease progression, and clinical setting. The correlation of right ventricular systolic pressure (RVSP) on preoperative 2D-echocardiography with mean and systolic PAP on intraoperative RHC was evaluated, and the predictive value of RVSP > 50 mmHg to identify mean PAP > 35 mmHg was estimated. RESULTS In the overall population, significant but weak correlations were observed (R = 0.27; P < 0.001 for systolic PAP, R = 0.24; P < 0.001 for mean PAP). The positive and negative predictive values of RVSP > 50 mmHg identifying mean PAP > 35 mmHg were 37.5% and 49.9%, respectively. In the subgroup analyses, correlations were not significant in recipients of deceased donor type LT (R = 0.129; P = 0.224 for systolic PAP, R = 0.163; P = 0.126 for mean PAP) or in recipients with poorly controlled ascites (R = 0.215; P = 0.072 for systolic PAP, R = 0.21; P = 0.079 for mean PAP). CONCLUSIONS In LT recipients, the correlation between RVSP on preoperative 2D-echocardiography and PAP on intraoperative RHC was weak; thus, preoperative 2D-echocardiography might not be the optimal tool for predicting intraoperative PAP. In LT candidates at risk of pulmonary hypertension, RHC should be considered.
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Soo Park
- Department of Medicine, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hwa Lee
- Department of Medicine, Heart, Stroke, and Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Quality Improvement Methodology Facilitates Adherence to Echocardiogram Protocol Measurements. Pediatr Qual Saf 2022; 7:e509. [PMID: 35071952 PMCID: PMC8782111 DOI: 10.1097/pq9.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Methods: Results: Conclusions:
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16
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Omran H, Polimeni A, Brandt V, Rudolph V, Rudolph TK, Bleiziffer S, Friedrichs KP, Faber L, Dimitriadis Z. Pre-Procedural Right Ventricular Longitudinal Strain and Post-Procedural Tricuspid Regurgitation Predict Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI). J Clin Med 2021; 10:jcm10245877. [PMID: 34945173 PMCID: PMC8707506 DOI: 10.3390/jcm10245877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Right ventricular (RV) dysfunction has been linked to worse outcomes in patients undergoing TAVI. Assessment of RV function is challenging due to its complex morphology. RV longitudinal strain (LS) assessed by speckle-tracking echocardiography (STE) is a novel measure that may overcome most of the limitations of conventional echocardiographic parameters of RV function. The aim of current study was to assess the prognostic value of RV LS in patients undergoing TAVI and to assess echocardiographic predictors of long-term mortality. Methods and results: A retrospective analysis of all consecutive patients who underwent TAVI at our hospital between 1 January 2015 and 1 June 2016. Indication for TAVI was approved by a local heart-team. Echocardiographic data at baseline and after TAVI were re-analyzed and RV LS was measured in all patients with adequate image quality. A total of 229 patients were included in our study (mean age 83.8 ± 5 years, 62% women, mean EuroSCORE II 5.7 ± 5%). All-cause mortality occurred in 17.3% over a mean follow-up of 929 ± 373 days. In multivariate analysis, only baseline average RV free-wall LS (HR 1.05, 95% CI (1.01 to 1.10), p = 0.049) and more than mild tricuspid valve regurgitation (TR) after TAVI (HR 4.39, 95% CI (2.22 to 8.70), p < 0.001) independently increased the risk of all-cause mortality at long- term follow-up (2.5 years), while conventional echocardiographic parameters of RV function did not predict mortality. Conclusion: Pre-procedural RV LS and post-procedural tricuspid regurgitation significantly predicted long-term all-cause mortality in patients undergoing TAVI while conventional echocardiographic parameters of RV function failed in predicting long-term outcome. RV longitudinal strain by STE should be considered in the routine echocardiographic assessments of patients with severe AS.
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Affiliation(s)
- Hazem Omran
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
- Correspondence: ; Tel.: +49-5731-971258
| | - Alberto Polimeni
- Division of Cardiology, Department of Surgical and Medical Sciences, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Verena Brandt
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
| | - Tanja K. Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany;
| | - Kai P. Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
| | - Lothar Faber
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (V.B.); (V.R.); (T.K.R.); (K.P.F.); (L.F.)
| | - Zisis Dimitriadis
- Department of Cardiology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
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17
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Martins Barros IM, Barros MVL, Almeida Martins LN, Ribeiro ALP, de Camargo RSS, Oliveira CDL, Ferreira AM, de Oliveira LC, Bierrenbach AL, Haikal DS, Sabino EC, Cardoso CS, Nunes MCP. Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study. PLoS One 2021; 16:e0258767. [PMID: 34735475 PMCID: PMC8568132 DOI: 10.1371/journal.pone.0258767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement. OBJECTIVE This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients. METHODS Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm. RESULTS We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%). CONCLUSIONS FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.
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Affiliation(s)
- Isabella Morais Martins Barros
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marcio Vinicius L. Barros
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Antonio Luiz P. Ribeiro
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Ariela Mota Ferreira
- Health Science Program, Universidade Estadual de Montes Claros, Montes Claros, Brazil
| | - Lea Campos de Oliveira
- Laboratório de Investigação Médica (LIM03), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Ester Cerdeira Sabino
- Instituto de Medicina Tropical e Departamento de Moléstias Infecciosas e Parasitarias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Maria Carmo Pereira Nunes
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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18
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Roscoe A, Zochios V. Echocardiography in Weaning Right Ventricular Mechanical Circulatory Support: Are We Measuring the Right Stuff? J Cardiothorac Vasc Anesth 2021; 36:362-366. [PMID: 34688542 DOI: 10.1053/j.jvca.2021.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Roscoe
- Department of Anesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anesthesia, National Heart Centre Singapore, Singapore.
| | - Vasileios Zochios
- Department of Critical Care Medicine and ECMO Unit, University Hospitals of Leicester National Health Service Trust, Glenfield Hospital, Leicester, United Kingdom.
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19
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Cabral MB, Kozak MF, Afiune JY. Can we Trust in Routine Echocardiography to Assess the Right Ventricle and Pulmonary Insufficiency? A Comparative Study with Cardiac Magnetic Resonance. Arq Bras Cardiol 2021; 117:690-698. [PMID: 34709296 PMCID: PMC8528354 DOI: 10.36660/abc.20200377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/08/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI). OBJECTIVES To assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings. METHODS We compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant. RESULTS We included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI. CONCLUSIONS The 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.
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Affiliation(s)
- Manuela Baima Cabral
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
| | - Marcelo Felipe Kozak
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
| | - Jorge Yussef Afiune
- Instituto de Cardiologia do Distrito FederalBrasíliaDFBrasilInstituto de Cardiologia do Distrito Federal – Cardiopediatria, Brasília, DF – Brasil
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20
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Rios DR, Lapointe A, Schmolzer GM, Mohammad K, VanMeurs KP, Keller RL, Sehgal A, Lakshminrusimha S, Giesinger RE. Hemodynamic optimization for neonates with neonatal encephalopathy caused by a hypoxic ischemic event: Physiological and therapeutic considerations. Semin Fetal Neonatal Med 2021; 26:101277. [PMID: 34481738 DOI: 10.1016/j.siny.2021.101277] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measures used to assess circulatory adequacy have multiple confounders. Comprehensive, quantitative echocardiography may be used to delineate the relative contribution of lung parenchymal, pulmonary vascular, and cardiac disease to hypotension and/or hypoxemic respiratory failure. In this review, we provide a detailed overview of the contributors to hemodynamic instability following perinatal hypoxic-ischemic injury. Our proposed approach to therapy focuses on physiopathological considerations with interventions individualized to this potentially complex condition and considers the pharmacological idiosyncrasies, which may occur among neonates with NE presenting with multiorgan dysfunction while undergoing therapeutic hypothermia.
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Affiliation(s)
- Danielle R Rios
- Department of Pediatrics, Division of Neonatology, University of Iowa, MS 200 Hawkins Drive 8800 JPP, Iowa City, IA, 52242, USA.
| | - Anie Lapointe
- CHU Ste-Justine, Montreal University, CHU Sainte-Justine 3175, chemin Côte Sainte-Catherine Montréal (Québec), H3T 1C5, Canada.
| | - Georg M Schmolzer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, 10240 Kingsway Avenue NW AB, Edmonton, T5H 3V9, Canada.
| | - Khorshid Mohammad
- Department of Pediatrics, Section of Neonatology, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
| | - Krisa P VanMeurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Center for Academic Medicine Division of Neonatology - MC 5660 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Roberta L Keller
- Department of Pediatrics, University of California San Francisco, 550 16th. Street, San Francisco, CA, 94158, USA.
| | - Arvind Sehgal
- Department of Pediatrics, Monash University, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
| | - Satyan Lakshminrusimha
- Department of Pediatrics, Division of Neonatology, University of California, Davis, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Regan E Giesinger
- Department of Pediatrics, Division of Neonatology, University of Iowa, MS 200 Hawkins Drive 8800 JPP, Iowa City, IA, 52242, USA.
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21
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Malagoli A, Albini A, Mandoli GE, Baggiano A, Vinco G, Bandera F, D'Andrea A, Esposito R, D'Ascenzi F, Sorrentino R, Santoro C, Benfari G, Contorni F, Cameli M. Multimodality imaging of the ischemic right ventricle: an overview and proposal of a diagnostic algorithm. Int J Cardiovasc Imaging 2021; 37:3343-3354. [PMID: 34114150 DOI: 10.1007/s10554-021-02309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.
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Affiliation(s)
- A Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Albini
- Division of Cardiology, Nephro-Cardiovascular Department, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - G E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - A Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vinco
- Department of Medicine, University of Verona, Verona, Italy
| | - F Bandera
- Cardiology University Department, Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - A D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - R Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - F D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - R Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - C Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - G Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - F Contorni
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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22
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Kossaify A. Quality Assurance and Improvement Project in Echocardiography Laboratory: The Pivotal Importance of Organizational and Managerial Processes. Heart Views 2021; 22:35-44. [PMID: 34276887 PMCID: PMC8254161 DOI: 10.4103/heartviews.heartviews_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/04/2021] [Indexed: 11/04/2022] Open
Abstract
Echocardiography plays a vital role in the diagnosis and management of cardiovascular conditions. Echocardiography use is progressively increasing nowadays, and this is correlated to the evolving echo indications, to the relatively new available echocardiography modes (tissue Doppler imaging, speckle tracking imaging, three-dimensional mode, etc.) and modalities (transthoracic, transesophageal, and intracardiac) along with the various available clinical approaches (point of care echo, portable echo, etc.). Quality assurance in echocardiography is correlated to appropriate use criteria, adequate equipment, standardization of performance and reporting, along with timely storage and archiving. Quality improvement plan must target strategic planning, with metrics and timeline for assessment and re-assessment of results. Improvement project aims to ensure and enhance conformity with appropriate use criteria and standardization, timely completion of exams and reports, detection of discrepancies, and continuous improvement of knowledge and skills. Strategic planning is essential in this context in order to develop organizational and managerial processes, with regular auditing for a highly professional and advanced level of echocardiography, while ensuring teamwork and standards of ethical values.
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Affiliation(s)
- Antoine Kossaify
- Division of Cardiology, University Hospital Notre Dame Des Secours, Byblos, Lebanon.,School of Medicine and Medical Sciences (SMMS), USEK University, Kaslik, Lebanon
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24
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Ventriculotomy Decreases Agreement Between Assessment of Right Ventricular Function by Echocardiography and Cardiac Magnetic Resonance Imaging in Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2021; 42:951-959. [PMID: 33751177 DOI: 10.1007/s00246-021-02569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Accurate assessment of the right ventricular (RV) volume and function is important in patients with hypoplastic left heart syndrome (HLHS). We sought to investigate the effect of ventriculotomy on the correlation of RV functional assessments by two-dimensional echocardiography (2DE) to cardiac magnetic resonance (CMR)-derived RV ejection fraction (EF) in patients with HLHS. A retrospective re-analysis of CMR imaging with matched 2DE was performed from the institutional HLHS registry. Echocardiographic RV functional parameters were analyzed and correlated with CMR-derived EF. Intraclass correlation coefficient was used to determine interobserver reliability. A total of 58 matched echocardiograms and CMR imaging studies from 46 patients was evaluated. Median duration between CMR imaging and echocardiogram was 1 day (range 0-6 days). No significant difference was seen in CMR RV EF between patients with and without a ventriculotomy (EF - 43.6% vs 44.7%, p = 0.85). The presence of a ventriculotomy significantly decreased the correlation of biplane FAC (r = 0.86 vs 0.52; p = 0.02), triplane FAC (r = 0.84 vs 0.49; p = 0.03), and 2DE visually estimated EF (r = 0.83 vs 0.49; p = 0.02). The correlation of circumferential and longitudinal strains to CMR-derived EF was not significantly affected by the presence of a ventriculotomy. A prior ventriculotomy significantly affected correlation between 2DE FAC and visually estimated EF with CMR-derived EF. The dyskinetic myocardial segment due to ventriculotomy, which is often not visualized by 2DE, may be the reason for this discrepancy.
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25
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Alerhand S, Sundaram T, Gottlieb M. What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism? Anaesth Crit Care Pain Med 2021; 40:100852. [PMID: 33781986 DOI: 10.1016/j.accpm.2021.100852] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Point-of-care ultrasound (POCUS) can assist in the evaluation for suspected PE by assessing for acute right ventricular strain. Physicians should thus be aware of these echocardiographic findings. OBJECTIVE This manuscript will review ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. It will provide a description of each finding along with the associated pathophysiology. It will also summarize the literature for the diagnostic utility of echocardiography for this indication, while providing reference parameters where applicable. Along with labeled images and video clips, the review will then illustrate how to evaluate for each of the ten findings, while offering pearls and pitfalls in this bedside evaluation. DISCUSSION The ten echocardiographic findings of right ventricular strain are: increased right ventricle: left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion, decreased S', pulmonary artery mid-systolic notching, 60/60 sign, and speckle tracking demonstrating decreased right ventricular free wall strain. CONCLUSIONS Physicians must recognize and understand the echocardiographic findings and associated pathophysiology of right ventricular strain. In the proper clinical context, these findings can point toward a diagnosis of PE and thereby lead to earlier initiation of directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
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26
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Assessment of Right Ventricular Function With CT and Echocardiography in Patients With Severe Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation. Crit Care Explor 2021; 3:e0345. [PMID: 33634265 PMCID: PMC7901809 DOI: 10.1097/cce.0000000000000345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Changes in right ventricular size and function are frequently observed in patients with severe acute respiratory distress syndrome. The majority of patients who receive venovenous extracorporeal membrane oxygenation undergo chest CT and transthoracic echocardiography. The aims of this study were to compare the use of CT and transthoracic echocardiography to evaluate the right ventricular function and to determine the prevalence of acute cor pulmonale in this patient population.
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27
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Towheed A, Sabbagh E, Gupta R, Assiri S, Chowdhury MA, Moukarbel GV, Khuder SA, Schwann TA, Bonnell MR, Cooper CJ, Khouri S. Right Ventricular Dysfunction and Short-Term Outcomes Following Left-Sided Valvular Surgery: An Echocardiographic Study. J Am Heart Assoc 2021; 10:e016283. [PMID: 33559474 PMCID: PMC7955341 DOI: 10.1161/jaha.120.016283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The prognostic value of echocardiographic evaluation of right ventricular (RV) function in patients undergoing left-sided valvular surgery has not been well described. The objective of this study is to determine the role of broad echocardiographic assessment of RV function in predicting short-term outcomes after valvular surgery. Methods and Results Preoperative echocardiographic data, perioperative adverse outcomes, and 30-day mortality were analyzed in patients who underwent left-sided valvular surgery from 2006 to 2014. Echocardiographic parameters used to evaluate RV function include RV fractional area change, tricuspid annular plane systolic excursion, systolic movement of the RV lateral wall using tissue Doppler imaging (S'), RV myocardial performance index, and RV dP/dt. Subjects with at least 3 abnormal parameters out of the 5 aforementioned indices were defined as having significant RV dysfunction. The study included 269 patients with valvular surgery (average age: 67±15, 60.6% male, 148 aortic, and 121 mitral). RV dysfunction was found in 53 (19.7%) patients; 30-day mortality occurred in 20 patients (7.5%). Compared with normal RV function, patients with RV dysfunction had higher 30-day mortality (22.6% versus 3.8%; P=0.01) and were at risk for developing multisystem failure/shock (13.2% versus 3.2%; P=0.01). Multivariate analyses showed that preexisting RV dysfunction was the strongest predictor of increased 30-day mortality (odds ratio: 3.5; 95% CI, 1.1-11.1; P<0.05). Conclusions Preoperative RV dysfunction identified by comprehensive echocardiographic assessment is a strong predictor of adverse outcomes following left-sided valvular surgery.
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Affiliation(s)
- Arooge Towheed
- Division of Cardiovascular MedicineUniversity of Toledo Medical CenterOH
| | - Ebrahim Sabbagh
- Division of Cardiovascular MedicineUniversity of Toledo Medical CenterOH
| | - Rajesh Gupta
- Division of Cardiovascular MedicineUniversity of Toledo Medical CenterOH
| | - Salem Assiri
- Division of Cardiovascular MedicineUniversity of Toledo Medical CenterOH
| | | | | | - Sadik A. Khuder
- Department of Medicine and Public HealthUniversity of Toledo Medical CenterOH
| | - Thomas A. Schwann
- Division of Cardiothoracic SurgeryUniversity of Toledo Medical CenterOH
- Division of Cardiothoracic SurgeryUniversity of Massachusetts‐BaystateSpringfieldMA
| | - Mark R. Bonnell
- Division of Cardiothoracic SurgeryUniversity of Toledo Medical CenterOH
- Division of Cardiothoracic SurgeryParkridge Medical CenterChattanoogaTN
| | | | - Samer Khouri
- Division of Cardiovascular MedicineUniversity of Toledo Medical CenterOH
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28
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White BR, Faerber JA, Katcoff H, Glatz AC, Mascio CE, Cohen MS. Venous Flow Variation Predicts Preoperative Pulmonary Venous Obstruction in Children with Total Anomalous Pulmonary Venous Connection. J Am Soc Echocardiogr 2021; 34:775-785. [PMID: 33600926 DOI: 10.1016/j.echo.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/01/2020] [Accepted: 02/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying preoperative pulmonary venous obstruction in total anomalous pulmonary venous connection is important to guide treatment planning and risk prognostication. No standardized echocardiographic definition of obstruction exists in the literature. Definitions based on absolute velocities are affected by technical limitations and variations in pulmonary venous return. The authors developed a metric to quantify pulmonary venous blood flow variation: pulmonary venous variability index (PVVI). The aim of this study was to demonstrate its accuracy in defining obstruction. METHODS All patients with total anomalous pulmonary venous connection at a single institution were identified. Echocardiograms were reviewed, and maximum (Vmax), mean (Vmean), and minimum (Vmin) velocities along the pulmonary venous pathway were measured. PVVI was defined as (Vmax - Vmin)/Vmean. These metrics were compared with pressures measured on cardiac catheterization. Echocardiographic measures were then compared between patients with and without clinical preoperative obstruction (defined as a need for preoperative intubation, catheter-based intervention, or surgery within 1 day of diagnosis), as well as pulmonary edema by chest radiography and markers of lactic acidosis. One hundred thirty-seven patients were included, with 22 having catheterization pressure recordings. RESULTS Vmax and Vmean were not different between patients with catheter gradients ≥ 4 and < 4 mm Hg, while PVVI was significantly lower and Vmin higher in those with gradients ≥ 4 mm Hg. The composite outcome of preoperative obstruction occurred in 51 patients (37%). Absolute velocities were not different between patients with and without clinical obstruction, while PVVI was significantly lower in patients with obstruction. All metrics except Vmax were associated with pulmonary edema; none were associated with blood gas metrics. CONCLUSIONS The authors developed a novel quantitative metric of pulmonary venous flow, which was superior to traditional echocardiographic metrics. Decreased PVVI was highly associated with elevated gradients measured by catheterization and clinical preoperative obstruction. These results should aid risk assessment and diagnosis preoperatively in patients with total anomalous pulmonary venous connection.
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Affiliation(s)
- Brian R White
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jennifer A Faerber
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah Katcoff
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew C Glatz
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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30
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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31
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 320] [Impact Index Per Article: 106.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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32
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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33
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Ferrara F, Gargani L, Contaldi C, Agoston G, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Citro R, Cittadini A, Cocchia R, D'Alto M, D'Andrea A, Douschan P, Ghio S, Grünig E, Guazzi M, Guida S, Kasprzak JD, Kolias TJ, Limongelli G, Marra AM, Mazzola M, Mauro C, Moreo A, Pieri F, Pratali L, Pugliese NR, Raciti M, Ranieri B, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan M, Voilliot D, Vriz O, Wierzbowska-Drabik K, Naeije R, Bossone E. A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET). Cardiovasc Ultrasound 2021; 19:9. [PMID: 33472662 PMCID: PMC7819251 DOI: 10.1186/s12947-021-00238-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork. Methods All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S’), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e’) and left ventricular ejection fraction (LVEF) were measured. Results The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was > 0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV = 3.8 to 2.4%, E = 5.7 to 8.3%, e’ = 6 to 6.5%, RVOT Act = 9.7 to 12, LVOT VTI = 7.4 to 9.6%, S’ = 2.9 to 2.9% and TAPSE = 5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%. Conclusions When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
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Affiliation(s)
- Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | - Carla Contaldi
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gergely Agoston
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Paola Argiento
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Francesco Bandera
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Division of Cardiology, Umberto I° Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | - Philipp Douschan
- Medical University of Graz, Graz, Austria and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato University Hospital, Milan, Italy Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy.,Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jaroslaw D Kasprzak
- I Dept. and Chair of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Ciro Mauro
- Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Pieri
- Cardiology Department, Careggi University Hospital, Florence, Italy
| | | | | | - Mauro Raciti
- Institute of Clinical Physiology, C.N.R, Pisa, Italy
| | | | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Mani Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, USA
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Popescu (Chair) BA, Stefanidis A, Fox KF, Cosyns B, Delgado V, Di Salvo GD, Donal E, Flachskampf FA, Galderisi M, Lancellotti P, Muraru D, Sade LE, Edvardsen T. Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging Recommendations: update 2020. Eur Heart J Cardiovasc Imaging 2020; 21:1305-1319. [DOI: 10.1093/ehjci/jeaa266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
The primary mission of the European Association of Cardiovascular Imaging (EACVI) is ‘to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging’. Echocardiography is a key component in the evaluation of patients with known or suspected cardiovascular disease and is essential for the high quality and effective practice of clinical cardiology. The EACVI aims to update the previously published recommendations for training, competence, and quality improvement in echocardiography since these activities are increasingly recognized by patients, physicians, and payers. The purpose of this document is to provide the general requirements for training and competence in echocardiography, to outline the principles of quality evaluation, and to recommend a set of measures for improvement, with the ultimate goal of raising the standards of echocardiographic practice. Moreover, the document aims to provide specific guidance for advanced echo techniques, which have dramatically evolved since the previous publication in 2009.
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Affiliation(s)
- Bogdan A Popescu (Chair)
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” - Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania
| | | | - Kevin F Fox
- Department of Cardiology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor Hart en vaatziekten (CHVZ), Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300RC, The Netherlands
| | | | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France
- Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea Hospital, Bari, Italy
| | - Denisa Muraru
- Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, P.le Brescia 201, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Leyla Elif Sade
- Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Algarni KD, Arafat A, Algarni AD, Alfonso JJ, Alhossan A, Elsayed A, Kheirallah HM, Albacker TB. Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery. Gen Thorac Cardiovasc Surg 2020; 69:911-918. [PMID: 33159277 DOI: 10.1007/s11748-020-01536-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. METHODS This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. RESULTS Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). CONCLUSION Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.
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Affiliation(s)
- Khaled D Algarni
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia.
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Amr Arafat
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdulaziz D Algarni
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdelhameed Elsayed
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hatim M Kheirallah
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Turki B Albacker
- Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
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36
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Silverton NA, Tanner C, Jacobson C, Montzingo C, Van Tienderen M, Zimmerman J. Subjective Evaluation of Right Ventricular Function with Transesophageal Echocardiography. J Am Soc Echocardiogr 2020; 33:771-772. [PMID: 32173202 DOI: 10.1016/j.echo.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Natalie A Silverton
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Colby Tanner
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Cameron Jacobson
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Candice Montzingo
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Michael Van Tienderen
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Joshua Zimmerman
- Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah
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The Right Ventricle-You May Forget it, but It Will Not Forget You. J Clin Med 2020; 9:jcm9020432. [PMID: 32033368 PMCID: PMC7074056 DOI: 10.3390/jcm9020432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023] Open
Abstract
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
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38
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Medvedofsky D, Koifman E, Jarrett H, Miyoshi T, Rogers T, Ben-Dor I, Satler LF, Torguson R, Waksman R, Asch FM. Association of Right Ventricular Longitudinal Strain with Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2020; 33:452-460. [PMID: 32033789 DOI: 10.1016/j.echo.2019.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conventional right ventricular (RV) echocardiographic measurements of systolic function (SF) have demonstrated conflicting results when their association with long-term outcomes after transcatheter aortic valve replacement (TAVR) is evaluated. RV free-wall (FW) longitudinal strain (LS) is a novel, single parameter to measure RV SF and may provide a better evaluation than fractional area change, tricuspid annular plane systolic excursion, and myocardial velocity (S'). The value of RV FW LS in patients undergoing TAVR and its association with 1-year mortality are unknown. The aim of this study was to test the hypothesis that RV FW LS would be associated with 1-year all-cause mortality in patients undergoing TAVR. METHODS Consecutive patients who underwent TAVR between 2007 and 2014 in whom RV FW LS was measurable were included; a subgroup that had 1-year follow-up echocardiographic evaluation of RV FW LS was analyzed. FW LS was derived from speckle-tracking analyses. The standard reference was determined as normal or impaired RV SF, the latter defined as the presence of ≥50% of tricuspid annular plane systolic excursion < 1.7 cm, S' < 9.5 cm/sec, and fractional area change < 35%. Cox proportional-hazards regression analysis was used to assess the association of RV FW LS with 1-year all-cause mortality. RESULTS Of 612 patients, 334 were included for RV FW LS analysis on pre-TAVR echocardiography (feasibility 55%); exclusion criteria included atrial fibrillation (n = 92 [15%]), pacemaker (n = 73 [12%]), and poor image quality (n = 113 [18%]). Baseline impaired RV SF was present in 19% of cases. RV FW LS did not change significantly at 1-year follow-up, in both the groups with baseline impaired and normal function. Cox regression analysis showed that RV FW LS was associated with all-cause mortality at 1 year (hazard ratio, 1.06; 95% CI, 1.01-1.11). For each unit increase in RV FW LS, there was a 6% higher risk for 1-year mortality. CONCLUSIONS In a high-risk TAVR population, RV FW LS should be considered a single echocardiographic parameter for the assessment of RV SF. When measurable, RV FW LS is associated with all-cause mortality at 1 year after TAVR.
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Affiliation(s)
- Diego Medvedofsky
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Harish Jarrett
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Tatsuya Miyoshi
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Levy PT, Jain A, Nawaytou H, Teitel D, Keller R, Fineman J, Steinhorn R, Abman SH, McNamara PJ. Risk Assessment and Monitoring of Chronic Pulmonary Hypertension in Premature Infants. J Pediatr 2020; 217:199-209.e4. [PMID: 31735418 DOI: 10.1016/j.jpeds.2019.10.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/28/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Amish Jain
- Department of Pediatrics, University of Toronto and Department of Pediatrics and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hythem Nawaytou
- Division of Cardiology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - David Teitel
- Division of Cardiology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Roberta Keller
- Cardiovascular Research Institute and the Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Jeffery Fineman
- Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Robin Steinhorn
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Steven H Abman
- Pediatric Heart Lung Center, Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
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40
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Assessing Right Ventricular Function in the Perioperative Setting, Part I: Echo-Based Measurements. Anesthesiol Clin 2019; 37:675-695. [PMID: 31677685 DOI: 10.1016/j.anclin.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews transesophageal echocardiography-based assessment of perioperative right ventricular function and failure, including catheter-based methods, three-dimensional echocardiography, and their combination to make pressure-volume loops. It outlines right ventricular pathophysiology, multiple assessment methods, and their relationship to analogous transthoracic echocardiogram measurements. technologies used and developed for transthoracic or left ventricular assessment show significant limitations when applied to transesophageal assessment of the right ventricle. The article provides an overview of right ventricular assessment modalities that can be used in transesophageal echocardiography. Ultimately, clinicians must know limitations of measurements, synthesize information, and assess it in the clinical context.
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41
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Barthélémy R, Roy X, Javanainen T, Mebazaa A, Chousterman BG. Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:312. [PMID: 31519203 PMCID: PMC6743193 DOI: 10.1186/s13054-019-2582-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
Background Though echocardiographic evaluation assesses the right ventricular systolic function, which of the existing parameters best reflects the right ventricular ejection fraction (RVEF) in the critically ill patients is still uncertain. We aimed to determine the relationship between echocardiographic indices of right ventricular systolic function and RVEF. Methods Prospective observational study was conducted in a mixed Surgical Intensive Care Unit (Hôpital Lariboisière, Paris, France) from November 2017 to November 2018. All critically ill patients monitored with a pulmonary artery catheter were assessed. We collected echocardiographic indices of right ventricular function (tricuspid annular plane systolic excursion, TAPSE; peak systolic velocity of pulsed tissue Doppler at lateral tricuspid annulus, S′; fractional area change, FAC; right ventricular index of myocardial performance, RIMP; isovolumic acceleration, IVA; end-diastolic diameter ratio, EDDr) and compared them with the RVEF obtained from continuous volumetric pulmonary artery catheter. Results Twenty-five patients were analyzed. Admission diagnosis was acute heart failure in 11 patients and septic shock in 14 patients. Median age was 70 years [57–80], norepinephrine median dose was 0.29 μg/kg/min [0.14–0.50], median Sequential Organ Failure Assessment score was 12 [10–14], and mortality at day 28 was 56%. When compared to RVEF, TAPSE had the highest correlation coefficient (rho = 0.78, 95% CI 0.52 to 0.89, p < 0.001). S′ was also correlated to RVEF (rho = 0.64, 95% CI 0.60 to 0.80, p = 0.001) whereas FAC, RIMP, IVA, and EDDr did not. TAPSE lower than 16 mm, S′ lower than 11 cm/s, and EDDr higher than 1 were always associated with a reduced RVEF. Conclusions We found that amongst indices of right ventricular systolic function, TAPSE and S′ were well correlated with thermodilution-derived RVEF in critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2582-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Romain Barthélémy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France. .,Réanimation Chirurgical Polyvalente, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
| | - Xavier Roy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France
| | - Tujia Javanainen
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
| | - Benjamin Glenn Chousterman
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
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Addetia K, Muraru D, Badano LP, Lang RM. New Directions in Right Ventricular Assessment Using 3-Dimensional Echocardiography. JAMA Cardiol 2019; 4:936-944. [DOI: 10.1001/jamacardio.2019.2424] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Roberto M. Lang
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
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43
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Smith A, Purna JR, Castaldo MP, Ibarra-Rios D, Giesinger RE, Rios DR, Weisz DE, Jain A, El-Khuffash AF, McNamara PJ. Accuracy and reliability of qualitative echocardiography assessment of right ventricular size and function in neonates. Echocardiography 2019; 36:1346-1352. [PMID: 31246348 DOI: 10.1111/echo.14409] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Subjective assessment of right ventricular (RV) function by neonatal echocardiography lacks validation. Incorrect diagnostic assignment in patients with suspected pulmonary hypertension (PH) may lead to unnecessary treatment or missed treatment opportunities. METHODS Six evaluators (experts [n = 3], novice [n = 3]) were asked to independently rate RV characteristics (global function, dilation, and septal flattening) based on standardized echocardiography images. We randomly selected 60 infants, ≥35 weeks gestation at birth, of whom 30 were clinically unwell with acute pulmonary hypertension (aPH) and 30 were healthy controls. aPH was defined by echocardiography presence of right-left shunting across transitional shunts or elevated right ventricular systolic pressure as estimated by the magnitude of the regurgitant jet across the tricuspid valve with impaired oxygenation. Inter-rater comparative evaluation within groups and between groups was performed using Kappa statistics. RESULTS Global agreement between evaluators for subjective assessment of RV function (0.3 [0.03], P < 0.001), size (0.14 [0.02], P < 0.001), and septal flattening (0.2 [0.02], P < 0.001) was uniformly poor. Agreement in RV function assessment was marginally better for both expert (0.32 [0.08], P < 0.001 vs 0.13 [0.081], and P < 0.001) and novice (0.4 [0.08], P < 0.001 vs 0.06 [0.07], and P < 0.001) evaluators. Overall, the diagnosis of aPH vs control was misclassified in 18% of cases. CONCLUSION This study demonstrated significant variability in qualitative assessment of RV size and function by trained evaluators, regardless of level of expertise attained. The reliability of objective measures of RV hemodynamics requires prospective evaluation.
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Affiliation(s)
- Aisling Smith
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland
| | - Jyothsna R Purna
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael P Castaldo
- Department of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Regan E Giesinger
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | | | - Dany E Weisz
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Afif F El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick J McNamara
- Division of Neonatology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
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Visual assessment of right ventricular function by echocardiography: how good are we? Int J Cardiovasc Imaging 2019; 35:2001-2008. [PMID: 31236759 PMCID: PMC6805824 DOI: 10.1007/s10554-019-01653-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
The complex anatomy and physiology of the right ventricle (RV) is a major limitation of visual echocardiographic gradation of RV systolic function (RVF). The aim of this study was to compare visual assessment ("eyeballing") of RVF with gold standard magnetic resonance imaging (MRI)-derived right ventricular ejection fraction (RVEF). Medical professionals from a range of clinical settings and with varying degrees of echocardiography experience were recruited via an online ultrasound teaching platform. In an anonymized web-based test, participants graded RVF in 10 patients with varying degrees of RVF via "eyeballing" of an RV-focused four-chamber view. Two skills were evaluated: (1) ability to differentiate between normal and reduced RVF; and (2) ability to determine the correct degree of RV systolic dysfunction. A total of 868 participants from 99 countries were included. For detection of reduced RVF (MRI-RVEF < 50%), sensitivity was 97.1%, 96,8%, 96.5%, and 95.8% and specificity was 55.7%, 52.8%, 54.6%, and 42.5% for the expert, advanced, intermediate, and beginner groups, respectively. For determination of the correct degree of RV dysfunction, even experienced examiners assigned a diagnosis that was discordant with MRI in > 40% of cases. In the present cohort, "eyeballing" was associated with excellent sensitivity but poor specificity in terms of differentiation between normal and abnormal RVF. Even among experts, classification of the degree of RV dysfunction was imprecise. In accordance with current guidelines, the present data suggest that "eyeballing" should be combined with evaluation of other echocardiographic parameters of RVF.
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45
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Raymond M, Grønlykke L, Couture EJ, Desjardins G, Cogan J, Cloutier J, Lamarche Y, L'Allier PL, Ravn HB, Couture P, Deschamps A, Chamberland ME, Ayoub C, Lebon JS, Julien M, Taillefer J, Rochon A, Denault AY. Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:1090-1104. [DOI: 10.1053/j.jvca.2018.08.198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 11/11/2022]
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Orde S, Slama M, Yastrebov K, Mclean A, Huang S. Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures. Crit Care 2019; 23:70. [PMID: 30845976 PMCID: PMC6407213 DOI: 10.1186/s13054-019-2375-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/21/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Right ventricle (RV) size and function assessment by echocardiography (echo) is a standard tool in the ICU. Frequently subjective assessment is performed, and guidelines suggest its utility in adequately trained clinicians. We aimed to compare subjective (visual) assessment of RV size and function by ICU physicians, with advanced qualifications in echocardiography, vs objective measurements. METHODS ICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO2 < 300. Subjective assessments of RV size and function were made independently using a three-class categorical scale. Agreement (B-score) and bias (p value) were analysed using objective echo measurements. RV size assessment included RV end-diastolic area (EDA) and diameters. RV function assessment included fractional area change, S', TAPSE and RV free wall strain. Binary and ordinal analysis was performed. RESULTS Fifty-two clinicians reviewed 2D images from 80 patients. Fair agreement was seen with objective measures vs binary assessment of RV size (RV EDA 0.26 [p < 0.001], RV dimensions 0.29 [p = 0.06]) and function (RV free wall strain 0.27 [p < 0.001], TAPSE 0.27 [p < 0.001], S' 0.29 [p < 0.001], FAC 0.31 [p = 0.16]). However, ordinal data analysis showed poor agreement with RV dimensions (0.11 [p = 0.06]) and RV free wall strain (0.14 [p = 0.16]). If one-step disagreement was allowed, agreement was good (RV dimensions 0.6 [p = 0.06], RV free wall strain 0.6 [p = 0.16]). Significant overestimation of severity of abnormalities was seen with subjective assessment vs RV EDA, TAPSE, S' and fractional area change. CONCLUSION Subjective (visual) assessment of RV size and function, by ICU specialists trained in advanced echo, can be fairly reliable for the initial exclusion of significant RV pathology. It seems prudent to avoid subjective RV assessment in isolation.
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Affiliation(s)
- Sam Orde
- Nepean Hospital, Sydney, NSW Australia
| | - Michel Slama
- Medical ICU, Amiens University Hospital, Amiens, France
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47
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Xu B, Grimm RA, Jellis CL, Collier P, Desai MY, Phelan D, Thamilarasan M, Rodriguez LL, Flamm SD, Sato K, Harb SC, Popovic ZB. Teamwork using strain imaging in the echocardiographic assessment of right ventricular systolic function: A cardiac magnetic resonance imaging correlation study. Echocardiography 2019; 36:94-101. [PMID: 30471079 DOI: 10.1111/echo.14199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/20/2018] [Indexed: 01/19/2023] Open
Abstract
AIM The aim of this study was to investigate whether conventional echocardiographic assessment of right ventricular (RV) systolic function can be improved by the addition of RV strain imaging. Additionally, we also aimed to investigate whether dedicated reading sessions and education can improve echocardiographic interpretation of RV systolic function. METHODS Readers of varying expertise (staff echocardiologists, advanced cardiovascular imaging fellows, sonographers) assessed RV systolic function. In session 1, 20 readers graded RV function of 19 cases, using conventional measures. After dedicated education, in session 2, the same cases were reassessed, with the addition of RV strains. In session 3, 18 readers graded RV function of 20 additional cases, incorporating RV strains. Computer simulations were performed to obtain 230 random teams. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) was the reference standard. RESULTS Correlation between RV GLS and CMR-derived RVEF was moderate: Spearman's rho: 0.70, n = 19, P < 0.001 (first two sessions); 0.55, n = 20, P < 0.05 (third session). Individual readers' assessment moderately correlated with RVEF (Spearman's rho first session: 0.67 ± 0.2; second session: 0.61 ± 0.2; and third session: 0.68 ± 0.09). Team estimates of RV systolic function showed consistently better correlation with RVEF, which were improved further by averaging across all readers. RV strain parameters influenced echocardiographic interpretation, with a net reclassification index of 8.0 ± 3.6% (P = 0.014). CONCLUSIONS The RV strain parameters showed moderate correlations with CMR-derived RVEF and appropriately influenced echocardiographic interpretation of RV systolic function. "Wisdom of the crowd" applied by averaging echocardiographic assessments of RV systolic function across teams of echocardiography readers, further improved echocardiographic assessment of RV systolic function.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine L Jellis
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Maran Thamilarasan
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Luis Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Flamm
- Cardiovascular Imaging Laboratory, Imaging Institute, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kimi Sato
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Serge C Harb
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popovic
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Affiliation(s)
- Karima Addetia
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
| | - Roberto M. Lang
- Department of Medicine, Section of Cardiology, University of Chicago Heart and Vascular Center, Chicago, Illinois
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Vezzosi T, Domenech O, Costa G, Marchesotti F, Venco L, Zini E, Del Palacio MJF, Tognetti R. Echocardiographic evaluation of the right ventricular dimension and systolic function in dogs with pulmonary hypertension. J Vet Intern Med 2018; 32:1541-1548. [PMID: 30216561 PMCID: PMC6189358 DOI: 10.1111/jvim.15253] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/09/2018] [Accepted: 05/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background Right ventricular (RV) enlargement and dysfunction are associated with prognosis in humans with pulmonary hypertension (PH). Hypothesis/Objectives To assess RV size and systolic function in dogs with PH and to determine if they are associated with disease severity and right‐sided congestive heart failure (R‐CHF). Animals 89 dogs with PH and 74 healthy dogs. Methods Prospective observational study. PH was classified according to the tricuspid regurgitation pressure gradient. RV end‐diastolic area (RVEDA) index was calculated as RVEDA divided by body surface area. RV systolic function was assessed with the tricuspid annular plane systolic excursion (TAPSE) and the RV fractional area change (FAC) normalized for body weight (TAPSEn and FACn, respectively). Results RVEDA index was higher in dogs with moderate PH (10.8 cm2/m2; range, 6.2‐14.4 cm2/m2) and severe PH (12.4 cm2/m2; range, 7.7‐21.4 cm2/m2) than in those with mild PH (8.4 cm2/m2; range, 4.8‐11.6 cm2/m2) and control dogs (8.5 cm2/m2; range, 2.8‐11.6 cm2/m2; P < .001). RVEDA index was significantly higher in dogs with R‐CHF (13.7 cm2/m2; range, 11.0‐21.4 cm2/m2) than in dogs without R‐CHF (9.4 cm2/m2; range, 4.8‐17.1 cm2/m2; P < .001). The severity of tricuspid regurgitation (TR) was the only independent predictor of the RVEDA index (P < .001). TAPSEn and FACn were not significantly different among varying degrees of PH severity and between dogs with and without R‐CHF. Conclusions and Clinical Importance The RVEDA index can be used to evaluate RV size in dogs. It can provide additional information in dogs with PH and predict R‐CHF. Severity of TR is the main determinant of RV enlargement in dogs with PH.
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Affiliation(s)
- Tommaso Vezzosi
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | | | - Giulia Costa
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | | | - Luigi Venco
- Veterinary Hospital Città di Pavia, Pavia, Italy
| | - Eric Zini
- Istituto Veterinario di Novara, Novara, Italy.,Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Department of Animal Medicine, Production and Health, University of Padova, Padova, Italy
| | | | - Rosalba Tognetti
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
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50
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Schneider M, Aschauer S, Mascherbauer J, Ran H, Binder C, Lang I, Goliasch G, Binder T. Echocardiographic assessment of right ventricular function: current clinical practice. Int J Cardiovasc Imaging 2018; 35:49-56. [PMID: 30191507 PMCID: PMC6373282 DOI: 10.1007/s10554-018-1428-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023]
Abstract
Echocardiographic evaluation of right ventricular (RV) function is a challenge due to the complex anatomy of the RV. Several transthoracic echocardiographic methods have been suggested for the quantification of RV function. However, many of the parameters are time consuming and need dedicated hardware and software. We suspected that the majority of the established markers are not used on a wide basis. In a multinational online survey, we evaluated the use of current clinical standards for the quantification of RV function in clinical practice. Through the network of an Ultrasound Online Teaching Platform, echocardiographers were invited to participate in an open online survey. The participants were asked about the parameters (eyeballing, TAPSE, S', fractional area change, RIMP, 3D-EF, dp/dt, longitudinal strain) they used in clinical practice. A total of 1150 participants from 109 countries completed the survey. Only eyeballing (72%), TAPSE (69%), and S' (31%) were commonly used in clinical routine. These methods were applied significantly less common in low-income economies when compared to high-income economies. Twenty-three percent of all participants stated to rely on eyeballing only, when evaluating RV function in clinical routine. New technologies, such as global longitudinal strain (3%) and 3D echocardiography (1%) were rarely applied independent of region and economic strength. Eyeballing and TAPSE are the most widely used methods in echocardiography for the assessment of RV function. Although advanced parameters such as longitudinal strain and 3D echocardiography were shown to be highly accurate, they are rarely used in clinical routine.
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Affiliation(s)
- Matthias Schneider
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Aschauer
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Hong Ran
- Department of Echocardiography, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Christina Binder
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Irene Lang
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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