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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Guzman-Ramirez D, Trujillo-Garcia A, Lopez-Rincon M, Lopez RB. Right Ventricular Function and Exercise Tolerance in Patients with ST-Elevation Myocardial Infarction. Arq Bras Cardiol 2023; 120:e20220799. [PMID: 37703105 PMCID: PMC10519353 DOI: 10.36660/abc.20220799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Following ST-segment elevation myocardial infarction (STEMI), patients with cardiac dysfunction have limitations in performing physical activity. Right ventricular (RV) function is a determinant in improving functional capacity, and cardiac rehabilitation (CR) is essential for this patient cohort. OBJECTIVE To evaluate the association of RV function with exercise tolerance after a CR program in patients with STEMI. METHODS Retrospective cohort study in patients with STEMI from January to December 2019. They underwent an echocardiographic assessment of RV function before a 16-session CR program. A cardiopulmonary exercise (CPX) testing was performed before and after the CR program. We analyzed whether RV function measured before CR was significantly associated with exercise tolerance before and after the CR program and the degree of improvement. Comorbidity, demographic and anatomic variables were documented. A p-value < 0.05 was considered statistically significant. RESULTS A total of 109 patients were included. Of all, 3.7% had global RV dysfunction, 10.1% had radial RV dysfunction, and 11% had longitudinal RV dysfunction. An association between radial or longitudinal RV dysfunction and the absence of improvement in cardiorespiratory fitness (> 1 peak VO2equivalents) was observed (p = 0.028, p = 0.008, respectively). A significant correlation was observed between longitudinal RV dysfunction with initial peak VO2equivalents (pVO2eq) (p = 0.046), final pVO2eq (p = 0.003), and difference in pVO2eq (p = 0.009). A correlation was also identified between global RV dysfunction and the initial pVO2eq (p = 0.045), final pVO2eq (p = 0.012), and difference in pVO2eq (p = 0.032). CONCLUSIONS RV dysfunction is associated with a lower capacity to exercise; CR programs can be extended or modified in these patients.
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Affiliation(s)
- Denisse Guzman-Ramirez
- Hospital de Cardiologia UMAEInstituto Mexicano del Seguro Social Delegacion Nuevo LeonDepartamento de EcocardiografíaMonterreyNuevo LeonMéxicoInstituto Mexicano del Seguro Social Delegacion Nuevo Leon – Hospital de Cardiologia UMAE – Departamento de Ecocardiografía, Monterrey, Nuevo Leon – México
| | - Anival Trujillo-Garcia
- Hospital de Cardiologia UMAEInstituto Mexicano del Seguro Social Delegacion Nuevo LeonDepartamento de EcocardiografíaMonterreyNuevo LeonMéxicoInstituto Mexicano del Seguro Social Delegacion Nuevo Leon – Hospital de Cardiologia UMAE – Departamento de Ecocardiografía, Monterrey, Nuevo Leon – México
| | - Meredith Lopez-Rincon
- Hospital de Cardiologia UMAEInstituto Mexicano del Seguro Social Delegacion Nuevo LeonDepartamento de EcocardiografíaMonterreyNuevo LeonMéxicoInstituto Mexicano del Seguro Social Delegacion Nuevo Leon – Hospital de Cardiologia UMAE – Departamento de Ecocardiografía, Monterrey, Nuevo Leon – México
| | - Roxella Botello Lopez
- Hospital de Cardiologia UMAEInstituto Mexicano del Seguro Social Delegacion Nuevo LeonDepartamento de EcocardiografíaMonterreyNuevo LeonMéxicoInstituto Mexicano del Seguro Social Delegacion Nuevo Leon – Hospital de Cardiologia UMAE – Departamento de Ecocardiografía, Monterrey, Nuevo Leon – México
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Kitano T, Nabeshima Y, Nagata Y, Takeuchi M. Prognostic value of the right ventricular ejection fraction using three-dimensional echocardiography: Systematic review and meta-analysis. PLoS One 2023; 18:e0287924. [PMID: 37418388 PMCID: PMC10328342 DOI: 10.1371/journal.pone.0287924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Abstract
AIMS Three-dimensional echocardiography (3DE) is a robust method for measuring the right ventricular (RV) ejection fraction (EF), which is closely associated with outcomes. We performed a systematic review and meta-analysis (1) to examine the prognostic value of RVEF and (2) to compare its prognostic value with that of left ventricular (LV) EF and LV global longitudinal strain (GLS). We also performed individual patient data analysis to validate the results. METHODS AND RESULTS We searched articles reporting the prognostic value of RVEF. Hazard ratios (HR) were re-scaled using the within-study standard deviation (SD). To compare predictive values of RVEF and LVEF or LVGLS, the ratio of HR related to a 1-SD reduction of RVEF versus LVEF or LVGLS was calculated. Pooled HR of RVEF and pooled ratio of HR were analyzed in a random-effects model. Fifteen articles with 3,228 subjects were included. Pooled HR of a 1-SD reduction of RVEF was 2.54 (95% confidence interval (CI): 2.15-3.00). In subgroup analysis, RVEF was significantly associated with outcome in pulmonary arterial hypertension (PAH) (HR: 2.79, 95% CI: 2.04-3.82) and cardiovascular (CV) diseases (HR: 2.23, 95%CI: 1.76-2.83). In studies reporting HRs for both RVEF and LVEF or RVEF and LVGLS in the same cohort, RVEF had 1.8-fold greater prognostic power per 1-SD reduction than LVEF (ratio of HR: 1.81, 95%CI: 1.20-2.71), but had predictive value similar to that of LVGLS (ratio of HR: 1.10, 95%CI: 0.91-1.31) and to LVEF in patients with reduced LVEF (ratio of HR: 1.34, 95%CI: 0.94-1.91). In individual patient data analysis (n = 1,142), RVEF < 45% was significantly associated with worse CV outcome (HR: 4.95, 95% CI: 3.66-6.70), even in patients with reduced or preserved LVEF. CONCLUSIONS The findings of this meta-analysis highlight and support the use of RVEF assessed by 3DE to predict CV outcomes in routine clinical practice in patients with CV diseases and in those with PAH.
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Affiliation(s)
- Tetsuji Kitano
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yasufumi Nagata
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
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Hahn RT, Lerakis S, Delgado V, Addetia K, Burkhoff D, Muraru D, Pinney S, Friedberg MK. Multimodality Imaging of Right Heart Function: JACC Scientific Statement. J Am Coll Cardiol 2023; 81:1954-1973. [PMID: 37164529 DOI: 10.1016/j.jacc.2023.03.392] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
Right ventricular (RV) size and function assessed by multimodality imaging are associated with outcomes in a variety of cardiovascular diseases. Understanding RV anatomy and physiology is essential in appreciating the strengths and weaknesses of current imaging methods and gives these measurements greater context. The adaptation of the right ventricle to different types and severity of stress, particularly over time, is specific to the cardiovascular disease process. Multimodality imaging parameters, which determine outcomes, reflect the ability to image the initial and longitudinal RV response to stress. This paper will review the standard and novel imaging methods for assessing RV function and the impact of these parameters on outcomes in specific disease states.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | | | - Victoria Delgado
- Hospital University Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Karima Addetia
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sean Pinney
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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5
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Al'Aref SJ, Altibi AM, Malkawi A, Mansour M, Baskaran L, Masri A, Rahmouni H, Abete R, Andreini D, Aquaro G, Barison A, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, Conte E, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Dobrovie M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Guglielmo M, Lanzillo C, Lombardi M, Lorenzoni V, Lozano-Torres J, Margonato D, Martini C, Marzo F, Masci P, Masi A, Memeo R, Moro C, Mushtaq S, Nese A, Palumbo A, Pavon AG, Pedrotti P, Pepi M, Perazzolo Marra M, Pica S, Pradella S, Presicci C, Rabbat MG, Raineri C, Rodriguez-Palomares JF, Sbarbati S, Schoepf UJ, Squeri A, Sverzellati N, Symons R, Tat E, Timpani M, Todiere G, Valentini A, Varga-Szemes A, Volpe A, Fusini L, Guaricci AI, Schwitter J, Pontone G. Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy. Eur Heart J Cardiovasc Imaging 2023; 24:472-482. [PMID: 35792682 PMCID: PMC10029842 DOI: 10.1093/ehjci/jeac124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF) <45%. Kaplan-Meier curves and cox regression were used to investigate the association between RVSD and all-cause mortality (ACM). Mean age was 59.8 ± 14.0 years, 42.0% were female, and mean left ventricular ejection fraction (LVEF) was 34.0 ± 10.8. Median follow-up was 959 days (interquartile range: 560-1590). RVSD was present in 936 (38.2%) and was an independent predictor of ACM (adjusted hazard ratio = 1.44; 95% CI [1.09-1.91]; P = 0.01). On subgroup analyses, the prognostic value of RVSD was more pronounced in NYHA I/II than in NYHA III/IV, in LVEF <35% than in LVEF ≥35%, and in patients with renal dysfunction when compared to those with normal renal function. CONCLUSION RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.
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Affiliation(s)
- Subhi J Al'Aref
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed M Altibi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Abdallah Malkawi
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Munthir Mansour
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lohendran Baskaran
- Department of Cardiovascular Medicine, National Heart Centre, Singapore, Singapore
| | - Ahmad Masri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Raffaele Abete
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Giovanni Aquaro
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Andrea Barison
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - Samuela Carigi
- Department of Cardiology, Infermi Hospital, Rimini, Italy
| | - Nazario Carrabba
- Cardiovascular and Thoracic Department of Careggi Hospital, Florence, Italy
| | - Grazia Casavecchia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Censi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Gloria Cicala
- Radiology Department, Parma University Hospital, Via Gramsci, Parma, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Emory University, Atlanta, GA, USA
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | | | - Mauro Di Roma
- Radiology Department, Policlinico Casilino, Rome, Italy
| | - Monica Dobrovie
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Gaibazzi
- Department of Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Annalaura Gismondi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Gravina
- Department of Radiology, University of Foggia, Foggia, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Jordi Lozano-Torres
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona, Barcelona, Spain
| | | | - Chiara Martini
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Piergiorgio Masci
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ambra Masi
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Riccardo Memeo
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Claudio Moro
- Department of Cardiology, ASST Monza, P.O. Desio, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Alberto Nese
- Dipartimento Neuro-Cardiovascolare, Ospedale Ca' Foncello Treviso, Treviso, Italy
| | - Alessandro Palumbo
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
| | | | - Patrizia Pedrotti
- De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua Medical School, Padova, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Pradella
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Cristina Presicci
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Claudia Raineri
- Department of Cardiology, Citta` della salute e della Scienza - Ospedale Molinette, Turin, Italy
| | - Jose' F Rodriguez-Palomares
- Department of Cardiology, Vall d'Hebron Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona, Barcelona, Spain
| | | | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rolf Symons
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Emily Tat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL, USA
| | - Mauro Timpani
- UOC Radiologia, Ospedale "F. Spaziani", Frosinone, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa, Pisa, Italy
| | - Adele Valentini
- Department of Radiology, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Alessandra Volpe
- Department of Cardiology, Citta` della salute e della Scienza - Ospedale Molinette, Turin, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Jurg Schwitter
- Cardiovascular Department, CMR Center, University Hospital Lausanne, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University, UniL, Lausanne, Switzerland
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
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Zhao K, Zhou J, Guo JT, Wu CH, Li SL, Zhang Q, Tian X, Shan WC, Ding ZJ, Yuan LS, Zheng Q, Gao XL, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Association between tricuspid annular systolic velocity and poor short-term prognosis in patients with acute decompensated heart failure. Ann Med 2022; 54:2898-2908. [PMID: 36259612 PMCID: PMC9624254 DOI: 10.1080/07853890.2022.2134585] [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] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is scant data on the association of the Pulsed wave-Doppler tissue imaging (PW-DTI)-derived tricuspid lateral annular peak systolic velocity (S') and poor short-term prognosis of patients with acute decompensated heart failure (ADHF). PATIENTS AND METHODS A total number of 732 participants from the Heb-ADHF registry in China were divided into three groups according to the corresponding status of tricuspid S'. Demographic characteristics, comorbidities, physical examinations, lab tests, and medications were compared among the different groups. Different logistic regression models were utilized to gauge the relationship between S' and the risk of a composite of short-term all-cause mortality or 30-day heart failure (HF)-related rehospitalization. RESULTS The number of composite outcome events identified in the study population was 85, with the short-term all-cause death coupled with 30-day HF readmission events reaching 23 and 62, respectively. As per the multivariable adjusted analysis, S' was inversely related to the risk of a composite outcome [<10 cm/s odds ratios (OR) 2.90, 95% confidence interval (CI):1.33-6.31; 10-11 cm/s OR 2.18, 95% CI: 1.10-4.33; p for trend = 0.006] in comparison with S' at >11 cm/s. When S' was analysed as a continuous variable, per 1 cm/s increase, the OR (95% CI) for a composite outcome was [0.87 (0.77-0.99), p = 0.028]. Area under curve (AUC) of S' for predicting outcome of ADHF was 0.631 (95%CI: 0.573-0.690, p < 0.01). Significant inverse association was also observed in left ventricular ejection fraction (LVEF) ≥40% subgroup. CONCLUSIONS Inspite of the potential confounders, a more impaired tricuspid annular peak systolic velocity is associated with a poorer short-term prognosis of patients with ADHF.
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Affiliation(s)
- Kai Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Jing Tao Guo
- Department of Cardiology, Chengde Central Hospital, Chengde, China
| | - Cai Hong Wu
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Sen Lin Li
- Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou, China
| | - Qi Zhang
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Xiang Tian
- Department of Cardiology, First Central Hospital of Baoding, Baoding, China
| | - Wei Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Zhen Jiang Ding
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Lan Suo Yuan
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, China
| | - Xiao Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Cangzhou, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, China
| | - Hong Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, China
| | - Qing Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, China
| | - Xi Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Ying Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, China
| | - Xue Geng
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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7
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Assessment of Cardiovascular Function in Childhood Leukemia Survivors: The Role of the Right Heart. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111731. [PMID: 36421180 PMCID: PMC9688880 DOI: 10.3390/children9111731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Childhood acute lymphoblastic leukemia (ALL) survivors who underwent chemotherapy with anthracyclines have an increased cardiovascular risk. The aim of the study was to evaluate left and right cardiac chamber performances and vascular endothelial function in childhood ALL survivors. Fifty-four ALL survivors and 37 healthy controls were enrolled. All patients underwent auxological evaluation, blood pressure measurements, biochemical parameters of endothelial dysfunction, flow-mediated dilatation (FMD) of the brachial artery, mean common carotid intima-media thickness (c-IMT), antero-posterior diameter of the infra-renal abdominal aorta (APAO), and echocardiographic assessment. The ALL subjects had significantly lower FMD (p = 0.0041), higher left (p = 0.0057) and right (p = 0.0021) echocardiographic/Doppler Tei index (the non-invasive index for combined systolic and diastolic ventricular function) as compared to controls. Tricuspid annular plane excursion (TAPSE) was 16.9 ± 1.2 mm vs. 24.5 ± 3.7 mm, p < 0.0001. Cumulative anthracycline doses were related to TAPSE (p < 0.001). The ALL survivors treated with anthracyclines demonstrated systo/diastolic alterations of the right ventricle and reduced endothelial function compared with healthy controls. The early recognition of subclinical cardiac and vascular impairment during follow up is of utmost importance for the cardiologist to implement strategies preventing overt cardiovascular disease considering the growing number of young adults cured after childhood ALL.
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Johannesen J, Fukuda R, Zhang DT, Tak K, Meier R, Agoglia H, Horn E, Devereux RB, Weinsaft JW, Kim J. Direct comparison of echocardiography speckle tracking and cardiac magnetic resonance feature tracking for quantification of right ventricular strain: a prospective intermodality study in functional mitral regurgitation. Echo Res Pract 2022; 9:11. [PMID: 36316750 PMCID: PMC9623949 DOI: 10.1186/s44156-022-00011-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Functional mitral regurgitation (FMR) is a known risk factor for right ventricular dysfunction (RVDYS). RV global longitudinal strain (GLS) is an emerging index of RV function; however, the magnitude of agreement between RV GLS by echocardiography (echo) and cardiac magnetic resonance (CMR) and the relative utility of each modality for both the diagnosis of RVDYS and prognostication of all-cause mortality and heart failure hospitalization remain unknown. Results 32% of patients had RVDYS (EF < 50%) on CMR, among whom there was more advanced NYHA class and lower LV and RV ejection fraction (all p < 0.05). RV GLS was impaired in patients with RVDYS whether quantified via STE or FT-CMR, with strong correlation between modalities (r = 0.81). Both STE and FT-CMR derived GLS yielded excellent detection of RVDYS (AUC 0.94 for both), paralleling similar performance for free wall strain by both modalities (FT-CMR AUC 0.94, STE AUC 0.92) with lower accuracy demonstrated by STE derived septal strain (STE AUC 0.78 and FT-CMR AUC 0.92). RV S’ and TAPSE showed lower diagnostic accuracy (RV S’ AUC 0.77 and TAPSE AUC 0.81). During median follow up of 51 months (IQR 42, 60 months), all-cause mortality or HF hospitalization occurred in 25% (n = 25). Both STE and FT-CMR derived RV GLS stratified risk for adverse prognosis (STE p = 0.007, FT-CMR p = 0.005) whereas conventional RV indices, TAPSE and RV S’, did not (TAPSE p = 0.30, S’ p = 0.69). Conclusion RV GLS is a robust marker of RVDYS irrespective of modality which provides incremental diagnostic value and improves risk stratification for event free survival beyond conventional RV indices.
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Affiliation(s)
- Justin Johannesen
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Rena Fukuda
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - David T. Zhang
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Katherine Tak
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Rachel Meier
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Hannah Agoglia
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Evelyn Horn
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Richard B. Devereux
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Jonathan W. Weinsaft
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
| | - Jiwon Kim
- grid.5386.8000000041936877XDivision of Cardiology, Department of Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10021 USA
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Nägele MP, Flammer AJ. Heart Failure After Right Ventricular Myocardial Infarction. Curr Heart Fail Rep 2022; 19:375-385. [PMID: 36197627 DOI: 10.1007/s11897-022-00577-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE OF REVIEW Heart failure (HF) after right ventricular myocardial infarction (RVMI) is common and complicates its clinical course. This review aims to provide a current overview on the characteristic features of RV failure with focus on acute management. RECENT FINDINGS While HF after RVMI is classically seen after acute proximal right coronary artery occlusion, RV dysfunction may also occur after larger infarctions in the left coronary artery. Because of its different anatomy and physiology, the RV appears to be more resistant to permanent infarction compared to the LV with greater potential for recovery of ischemic myocardium. Hypotension and elevated jugular pressure in the presence of clear lung fields are hallmark signs of RV failure and should prompt confirmation by echocardiography. Management decisions are still mainly based on small studies and extrapolation of findings from LV failure. Early revascularization improves short- and long-term outcomes. Acute management should further focus on optimization of preload and afterload, maintenance of sufficient perfusion pressures, and prompt management of arrhythmias and concomitant LV failure, if present. In case of cardiogenic shock, use of vasopressors and/or inotropes should be considered along with timely use of mechanical circulatory support (MCS) in eligible patients. HF after RVMI is still a marker of worse outcome in acute coronary syndrome. Prompt revascularization, careful medical therapy with attention to the special physiology of the RV, and selected use of MCS provide the RV the time it needs to recover from the ischemic insult.
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Affiliation(s)
- Matthias P Nägele
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland
| | - Andreas J Flammer
- University Heart Center Zurich, University Hospital Zurich, Raemistrasse 100, CH-8091, CardiologyZurich, Switzerland.
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10
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Wang S, Chauhan D, Patel H, Amir-Khalili A, da Silva IF, Sojoudi A, Friedrich S, Singh A, Landeras L, Miller T, Ameyaw K, Narang A, Kawaji K, Tang Q, Mor-Avi V, Patel AR. Assessment of right ventricular size and function from cardiovascular magnetic resonance images using artificial intelligence. J Cardiovasc Magn Reson 2022; 24:27. [PMID: 35410226 PMCID: PMC8996592 DOI: 10.1186/s12968-022-00861-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Theoretically, artificial intelligence can provide an accurate automatic solution to measure right ventricular (RV) ejection fraction (RVEF) from cardiovascular magnetic resonance (CMR) images, despite the complex RV geometry. However, in our recent study, commercially available deep learning (DL) algorithms for RVEF quantification performed poorly in some patients. The current study was designed to test the hypothesis that quantification of RV function could be improved in these patients by using more diverse CMR datasets in addition to domain-specific quantitative performance evaluation metrics during the cross-validation phase of DL algorithm development. METHODS We identified 100 patients from our prior study who had the largest differences between manually measured and automated RVEF values. Automated RVEF measurements were performed using the original version of the algorithm (DL1), an updated version (DL2) developed from a dataset that included a wider range of RV pathology and validated using multiple domain-specific quantitative performance evaluation metrics, and conventional methodology performed by a core laboratory (CORE). Each of the DL-RVEF approaches was compared against CORE-RVEF reference values using linear regression and Bland-Altman analyses. Additionally, RVEF values were classified into 3 categories: ≤ 35%, 35-50%, and ≥ 50%. Agreement between RVEF classifications made by the DL approaches and the CORE measurements was tested. RESULTS CORE-RVEF and DL-RVEFs were obtained in all patients (feasibility of 100%). DL2-RVEF correlated with CORE-RVEF better than DL1-RVEF (r = 0.87 vs. r = 0.42), with narrower limits of agreement. As a result, DL2 algorithm also showed increasing accuracy from 0.53 to 0.80 for categorizing RV function. CONCLUSIONS The use of a new DL algorithm cross-validated on a dataset with a wide range of RV pathology using multiple domain-specific metrics resulted in a considerable improvement in the accuracy of automated RVEF measurements. This improvement was demonstrated in patients whose images were the most challenging and resulted in the largest RVEF errors. These findings underscore the critical importance of this strategy in the development of DL approaches for automated CMR measurements.
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Affiliation(s)
- Shuo Wang
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
- Peking University Shougang Hospital, Beijing, China
| | - Daksh Chauhan
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | - Hena Patel
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | | | | | | | | | - Amita Singh
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | - Luis Landeras
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Tamari Miller
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | - Keith Ameyaw
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | | | - Keigo Kawaji
- Illinois Institute of Technology, Chicago, IL, USA
| | - Qiang Tang
- Peking University Shougang Hospital, Beijing, China
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago, University of Chicago Medical Center, 5758 S. Maryland Avenue, Chicago, IL, MC906760637, USA.
- Department of Radiology, University of Chicago, Chicago, IL, USA.
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11
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Keranov S, Jafari L, Haen S, Vietheer J, Kriechbaum S, Dörr O, Liebetrau C, Troidl C, Rutsatz W, Rieth A, Hamm CW, Nef H, Rolf A, Keller T. CILP1 as a biomarker for right ventricular dysfunction in patients with ischemic cardiomyopathy. Pulm Circ 2022; 12:e12062. [PMID: 35506075 PMCID: PMC9052998 DOI: 10.1002/pul2.12062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/09/2022] [Accepted: 03/05/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Stanislav Keranov
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
| | - Leili Jafari
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
| | - Saskia Haen
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
| | - Julia Vietheer
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Steffen Kriechbaum
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Oliver Dörr
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
| | - Christoph Liebetrau
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
- Cardiovascular Center Bethanien (CCB) Frankfurt Germany
| | - Christian Troidl
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Wiebke Rutsatz
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
| | - Andreas Rieth
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Christian W. Hamm
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Holger Nef
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Andreas Rolf
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
| | - Till Keller
- Department of Internal Medicine I, Cardiology and Angiology Justus‐Liebig‐University Giessen Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain Bad Nauheim Germany
- Department of Cardiology Kerckhoff Heart and Lung Center Bad Nauheim Germany
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12
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Shen Y, Zhang H, Zhang Q, Zhang B, Ni Y, Zhao R, Hsi DH, Cheng L. Right Ventricular Ejection Fraction Assessed by Three-Dimensional Echocardiography Is Associated with Long-term Adverse Clinical Cardiac Events in Patients with Anthracycline Induced Cardiotoxicity. J Am Soc Echocardiogr 2022; 35:600-608.e3. [DOI: 10.1016/j.echo.2022.01.018] [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: 05/27/2021] [Revised: 01/03/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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13
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Lebeau R, Pagé M, Serri K, Pichette M, Lorenzo MD, Sauvé C, Vinet A, Poulin F. Right ventricular ejection fraction with cardiac magnetic resonance using a wall motion score. Arch Cardiovasc Dis 2022; 115:126-133. [DOI: 10.1016/j.acvd.2022.01.002] [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: 04/17/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
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14
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Liu S, Liao Y, Zhu Z, Wang S, Li Y, Liang D, Xie Y, Zhang Z. Association between cumulative blood pressure in early adulthood and right ventricular structure and function in middle age: The CARDIA study. Clin Cardiol 2022; 45:83-90. [PMID: 34979043 PMCID: PMC8799061 DOI: 10.1002/clc.23763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/07/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Cumulative blood pressure (BP) exposure is a known risk factor for cardiovascular disease. This study sought to investigate the association between cumulative BP from early adulthood to middle age and right ventricular (RV) structure and function in middle age. METHODS We included 2844 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults). Cumulative BP over the 30-years follow-up was defined as the sum of the product of mean BP for each pair of consecutive examinations and the time interval between these two consecutive examinations in years. RV structure and function were assessed by echocardiography. The main analyses utilized logistic and linear regression models. RESULTS In fully adjusted models, higher cumulative systolic BP was independently associated with lower tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic velocity (RVS'), right ventricular early diastolic velocity (RVe'), and higher pulmonary arterial systolic pressure. Higher cumulative diastolic BP was independently associated with smaller RV basal diameter, lower TAPSE, RVS', and RVe'. For categorical analyses of RV dysfunction, cumulative systolic BP was not related to systolic dysfunction. Per 1-SD increase in cumulative systolic BP was associated with a higher risk of diastolic dysfunction, while an increase in cumulative diastolic BP was associated with a higher risk of systolic dysfunction and diastolic dysfunction. CONCLUSIONS Cumulative exposure to increased BP from early adulthood to middle age was associated with incipient RV systolic and diastolic dysfunction in middle age. Exposure to higher diastolic BP levels from early adulthood to middle age was associated with a smaller RV basal diameter in middle age.
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Affiliation(s)
- Shenrong Liu
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanfen Liao
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zongyuan Zhu
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shushui Wang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifan Li
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dongpo Liang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Xie
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiwei Zhang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
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15
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Application and Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio in Patients with Ischemic and Non-Ischemic Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11122188. [PMID: 34943425 PMCID: PMC8700391 DOI: 10.3390/diagnostics11122188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
The main aim of this study was to assess the prognostic utility of TAPSE/PASP as an echocardiographic parameter of maladaptive RV remodeling in cardiomyopathy patients using cardiac magnetic resonance (CMR) imaging. Furthermore, we sought to compare TAPSE/PASP to TAPSE. The association of the echocardiographic parameters TAPSE/PASP and TAPSE with CMR parameters of RV and LV remodeling was evaluated in 111 patients with ischemic and non-ischemic cardiomyopathy and cut-off values for maladaptive RV remodeling were defined. In a second step, the prognostic value of TAPSE/PASP and its cut-off value were analyzed regarding mortality in a validation cohort consisting of 221 patients with ischemic and non-ischemic cardiomyopathy. A low TAPSE/PASP (<0.38 mm/mmHg) and TAPSE (<16 mm) were associated with a lower RVEF and a long-axis RV global longitudinal strain (GLS) as well as higher RVESVI, RVEDVI and NT-proBNP. A low TAPSE/PASP, but not TAPSE, was associated with a lower LVEF and long-axis LV GLS, and a higher LVESVI, LVEDVI and T1 relaxation time at the interventricular septum and the RV insertion points. Furthermore, in the validation cohort, low TAPSE/PASP was associated with a higher mortality and TAPSE/PASP was an independent predictor of mortality. TAPSE/PASP is a predictor of maladaptive RV and LV remodeling associated with poor outcomes in cardiomyopathy patients.
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16
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Somuncu MU, Tatar FP, Kalayci B, Avci A, Gudul NE, Serbest NG, Demir AR, Can M. Role of N-terminal pro-B-type natriuretic peptide and troponin T in predicting right ventricular recovery in myocardial infarction. Horm Mol Biol Clin Investig 2021; 43:27-33. [PMID: 34791860 DOI: 10.1515/hmbci-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The determinants of right ventricular (RV) recovery after successful revascularization in ST-elevation myocardial infarction (STEMI) patients are not clear. Besides, the relationship between Troponin T (TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and improvement in RV function is also unknown. This study hypothesizes that a lower TnT and NT-proBNP level would be associated with RV recovery. METHODS One hundred forty-eight STEMI patients were included in our study. Echocardiography were performed before and 12-18 weeks after discharge. Patients were divided into three groups according to the changes in tricuspid annular plane systolic excursion (TAPSE) as 53 patients with ≥10% change, 41 patients with 1-9% change, and 54 patients ≤0% change. RV recovery was accepted as ≥10% TAPSE improvement and the predictors of RV recovery were investigated. RESULTS RV recovery was detected in 35.8% of the patients. Low baseline left ventricular ejection fraction (OR: 0.91 [0.84-0.98], p=0.023), NT-proBNP (OR: 0.93 [0.89-0.98], p=0.014), TnT (OR: 0.84 [0.68-0.93], p=0.038), inferior myocardial infarction (OR: 2.66 [1.10-6.40], p=0.028), wall motion score index ratio (OR: 0.93 [0.88-0.97], p=0.002) and post-percutaneous coronary intervention TIMI flow 3 (OR: 5.84 [1.41-24.22], p=0.015) were determined as independent predictors of RV recovery. Being in the high TnT group 4.2 times, and being in the high NT-proBNP group 5.3 times could predict the failure to achieve RV recovery. Furthermore, when high TnT level was combined with high NT-proBNP level, the odds ratio of failure to achieve RV recovery was the highest (OR: 8.03 [2.59-24.89], p<0.001). CONCLUSIONS Lower TnT and lower NT-proBNP level was associated with better improvement in RV function in STEMI patients.
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Affiliation(s)
- Mustafa Umut Somuncu
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Fatih Pasa Tatar
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Belma Kalayci
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Ahmet Avci
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Naile Eris Gudul
- Department of Cardiology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Nail Guven Serbest
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Murat Can
- Department of Biochemistry, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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17
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Vaid A, Johnson KW, Badgeley MA, Somani SS, Bicak M, Landi I, Russak A, Zhao S, Levin MA, Freeman RS, Charney AW, Kukar A, Kim B, Danilov T, Lerakis S, Argulian E, Narula J, Nadkarni GN, Glicksberg BS. Using Deep-Learning Algorithms to Simultaneously Identify Right and Left Ventricular Dysfunction From the Electrocardiogram. JACC Cardiovasc Imaging 2021; 15:395-410. [PMID: 34656465 PMCID: PMC8917975 DOI: 10.1016/j.jcmg.2021.08.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to develop DL models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population. BACKGROUND Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECGs) can assist diagnostic workflow. However, DL tools to estimate right- ventricular (RV) function do not exist, whereas those to estimate left ventricular (LV) function are restricted to quantification of very low LV function only. METHODS A multicenter study was conducted with data from 5 New York City hospitals: 4 for internal testing and 1 serving as external validation. We created novel DL models to classify left ventricular ejection fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation. RESULTS We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used natural language processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, area under curve (AUC) at detection of LVEF ≤40%, 40% < LVEF ≤50%, and LVEF >50% was 0.94 (95% CI: 0.94-0.94), 0.82 (95% CI: 0.81-0.83), and 0.89 (95% CI: 0.89-0.89), respectively. For external validation, these results were 0.94 (95% CI: 0.94-0.95), 0.73 (95% CI: 0.72-0.74), and 0.87 (95% CI: 0.87-0.88). For regression, the mean absolute error was 5.84% (95% CI: 5.82%-5.85%) for internal testing and 6.14% (95% CI: 6.13%-6.16%) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (95% CI: 0.84-0.84) in both internal testing and external validation. CONCLUSIONS DL on ECG data can be used to create inexpensive screening, diagnostic, and predictive tools for both LV and RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease.
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Affiliation(s)
- Akhil Vaid
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kipp W Johnson
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Sulaiman S Somani
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mesude Bicak
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isotta Landi
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Russak
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shan Zhao
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew A Levin
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert S Freeman
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander W Charney
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Atul Kukar
- Department of Cardiology, Mount Sinai Queens Hospital, Astoria, New York, USA, and Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Cardiology, Mount Sinai West Hospital and Icahn School of Medicine at Mount Sinai, New York, New York USA
| | - Bette Kim
- Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tatyana Danilov
- Department of Cardiology, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Edgar Argulian
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin S Glicksberg
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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18
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Park SJ, Kwon DH, Rickard JW, Varma N. Right ventricular dilatation and systolic dysfunction and relationship to QRS duration in patients with left bundle branch block and cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1890-1896. [PMID: 34499749 DOI: 10.1111/pace.14357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 08/02/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Marked QRS widening in patients with left bundle branch block (LBBB) may reduce efficacy of cardiac resynchronization therapy (CRT). We hypothesized that extreme QRS prolongation may accompany right ventricular (RV) dilatation/systolic dysfunction (RVD/RVsD) as well as left ventricular dilatation/systolic dysfunction (LVD/LVsD). METHODS We assessed rates of both ventricular dilatation and systolic dysfunction according to widening of QRS duration (QRSd) in 100 consecutive cardiomyopathy patients with true LBBB (QRSd ≥ 130 ms in female or ≥140 ms in male, QS or rS in leads V1/V2, and mid-QRS notching/slurring in ≥2 contiguous leads of I, aVL, and V1/V2/V5/V6). Ventricular dimensions and function were measured by cardiac magnetic resonance imaging. RESULTS There was a trend toward an increase in the prevalence of LVD (13%, 20%, and 90%), LVsD (67%, 77%, and 90%), RVD (23%, 27%, and 50%), RVsD (27%, 27%, and 40%), RVD plus RVsD (13%, 17%, and 40%), or RVD/RVsD (37%, 37%, and 50%) according to the degree of QRS prolongation (<150 ms, n = 30; 150-180 ms, n = 60; and ≥180 ms, n = 10). Similarly, patients in the highest quartile of QRSd (QRSd ≥ 168 ms, n = 26) showed greater rates of RVD (23% vs. 44%, p = .069), RVsD (22% vs. 48%, p = .032), RVD plus RVsD (10% vs. 30%, p = .040), or RVD/RVsD (33% vs. 57%, p = .050) compared to those in the remaining quartiles (n = 74). QRSd ≥ 180 ms was identified as an independent predictor for the presence of RVD plus RVsD. CONCLUSION The rates of RVD and/or RVsD increased with QRS widening, particularly when QRSd exceeded 180 ms. This may diminish anticipated CRT response rates in cardiomyopathy patients with LBBB.
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Affiliation(s)
- Seung-Jung Park
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Deborah H Kwon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John W Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Niraj Varma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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19
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Jimenez-Juan L, Ben-Dov N, Goncalves Frazao CV, Tan NS, Singh SM, Dorian P, Angaran P, Oikonomou A, Kha LCT, Roifman I, Chacko B, Connelly KA, Kirpalani A, Deva D, Yan AT. Right Ventricular Function at Cardiac MRI Predicts Cardiovascular Events in Patients with an Implantable Cardioverter-Defibrillator. Radiology 2021; 301:322-329. [PMID: 34402663 DOI: 10.1148/radiol.2021210246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Right ventricular ejection fraction (RVEF) is an independent predictor of death and adverse cardiovascular outcomes in patients with various cardiac conditions. Purpose To investigate whether RVEF, measured with cardiac MRI, is a predictor of appropriate shock or death in implantable cardioverter-defibrillator (ICD) recipients for primary and secondary prevention of sudden cardiac death. Materials and Methods This retrospective, multicenter, observational study included patients who underwent cardiac MRI before ICD implantation between January 2007 and May 2017. Right ventricular end-diastolic and end-systolic volumes and RVEF were measured with cardiac MRI. The primary end point was a composite of all-cause mortality or appropriate ICD shock. The secondary end point was all-cause mortality. The association between RVEF and primary and secondary outcomes was evaluated by using multivariable Cox regression analysis. Potential interactions were tested between primary prevention, ischemic cause, left ventricular ejection fraction (LVEF), and RVEF. Results Among 411 patients (mean age ± standard deviation, 60 years; 315 men) during a median follow-up of 63 months, 143 (35%) patients experienced an appropriate ICD shock or died. In univariable analysis, lower RVEF was associated with greater risks for appropriate ICD shock or death and for death alone (log-rank trend test, P = .003 and .005 respectively). In multivariable Cox regression analysis adjusting for age at ICD implantation, LVEF, ICD indication (primary vs secondary), ischemic heart disease, and late gadolinium enhancement, RVEF was an independent predictor of the primary outcome (hazard ratio [HR], 1.21 per 10% lower RVEF; 95% CI: 1.04, 1.41; P = .01) and all-cause mortality (HR, 1.25 per 10% lower RVEF; 95% CI: 1.01, 1.55; P = .04). No evidence of significant interactions was found between RVEF and primary or secondary prevention (HR, 1.11 ± 0.17 [standard deviation]; P = .49), ischemic heart disease (HR, 1.02 ± 0.15; P = .78), and LVEF (HR, 0.91 ± 0.8; P = .29). Conclusion Right ventricular ejection fraction measured with cardiac MRI was a predictor of appropriate implantable cardioverter-defibrillator shock or death. © RSNA, 2021 See also the editorial by Nazarian and Zghaib in this issue.
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Affiliation(s)
- Laura Jimenez-Juan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nissan Ben-Dov
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Caio V Goncalves Frazao
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nigel S Tan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sheldon M Singh
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Dorian
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Angaran
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anastasia Oikonomou
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lan-Chau T Kha
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Idan Roifman
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Binita Chacko
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Kim A Connelly
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anish Kirpalani
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Djeven Deva
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew T Yan
- From the Departments of Radiology (L.J.J., A.K., D.D.) and Cardiology (N.S.T., P.D., P.A., K.A.C., A.T.Y.), St Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; and Departments of Radiology (C.V.G.F., A.O., L.C.T.K., B.C.) and Cardiology (N.B.D., S.M.S., I.R.), Sunnybrook Health Sciences Centre, Toronto, Canada
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20
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Eyharts D, Lavie-Badie Y, Cazalbou S, Fournier P, Cariou E, Pascal P, Campelo-Parada F, Marcheix B, Galinier M, Berry I, Carrié D, Lairez O. Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography. J Nucl Cardiol 2021; 28:864-872. [PMID: 31201690 DOI: 10.1007/s12350-019-01781-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. AIMS To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). METHODS AND RESULTS Sixty-one patients (44 men; mean age 59 ± 12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. There was a significant correlation between RVol as assess by ERV and by TTE (R = 0.95, P < 0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P < 0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R = 0.81 and R = 0.75, respectively (all P < 0.0001). CONCLUSION TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.
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Affiliation(s)
- Damien Eyharts
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Cazalbou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Eve Cariou
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Pierre Pascal
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
| | - Francisco Campelo-Parada
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Bertrand Marcheix
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
- Department of Cardiac Surgery, Rangueil University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
- Heart Valve Center, Toulouse University Hospital, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France.
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
- Heart Valve Center, Toulouse University Hospital, Toulouse, France.
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21
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Abstract
PURPOSE OF REVIEW Autoimmune rheumatic diseases (ARDs) affect 8% of the population and approximately 78% of patients are women. Myocardial disease in ARDs is the endpoint of various pathophysiologic mechanisms including atherosclerosis, valvular disease, systemic, myocardial, and/or vascular inflammation, as well as myocardial ischemia and replacement/diffuse fibrosis. RECENT FINDINGS The increased risk of CVD in ARDs leads to excess comorbidity not fully explained by traditional cardiovascular risk factors. It seems that the chronic inflammatory status typically seen in ARDs, promotes both the development of myocardial inflammation/fibrosis and the acceleration of atherosclerosis. CMR (cardio-vascular magnetic resonance) is the ideal imaging modality for the evaluation of cardiac involvement in patients with ARDs, as it can simultaneously assess cardiac function and characterize myocardial tissues with regard to oedema and fibrosis. Due to its high spatial resolution, CMR is capable of identifying various disease entities such as myocardial oedema /inflammation, subendocardial vasculitis and myocardial fibrosis, that are often missed by other imaging modalities, notably at an early stage of development. Although generally accepted guidelines about the application of CMR in ARDs have not yet been formulated, according to our experience and the available published literature, we recommend CMR in ARD patientS with new-onset heart failure (HF), arrhythmia, for treatment evaluation/change or if there is any mismatch between patient symptoms and routine non-invasive evaluation.
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22
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Sciaccaluga C, D'Ascenzi F, Mandoli GE, Rizzo L, Sisti N, Carrucola C, Cameli P, Bigio E, Mondillo S, Cameli M. Traditional and Novel Imaging of Right Ventricular Function in Patients with Heart Failure and Reduced Ejection Fraction. Curr Heart Fail Rep 2021; 17:28-33. [PMID: 32130642 DOI: 10.1007/s11897-020-00455-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This review attempts to summarize the role of standard and advanced echocardiographic techniques together with CMR in the evaluation of the RV in HF, providing an outlook on the recent evidence. RECENT FINDINGS In the last decade, there has been growing interest in the study of the RV, and it is now widely established that RV function is a strong predictor of mortality, in several cardiovascular diseases, in particular in the setting of heart failure (HF). The evaluation of RV function might be particularly challenging, which justifies the necessity of multi-modality imaging. The echocardiographic assessment remains the mainstay technique even though it might be complex, due to RV crescent shape and its position in the chest, requiring both qualitative and quantitative parameters. Cardiac magnetic resonance (CMR) represents a complementary exam which is particularly useful when precise structural and functional assessment are needed, considering the most recently developed sequences. Despite the technological improvement attested over the last years, there is still no universally accepted parameter that univocally defines RV function, hence the necessity to evaluate several parameters, combining different imaging techniques.
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Affiliation(s)
- C Sciaccaluga
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - F D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - G E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - L Rizzo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - N Sisti
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - C Carrucola
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - P Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - E Bigio
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - S Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
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23
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Medvedev RY, Sanchez-Alonso JL, Mansfield CA, Judina A, Francis AJ, Pagiatakis C, Trayanova N, Glukhov AV, Miragoli M, Faggian G, Gorelik J. Local hyperactivation of L-type Ca 2+ channels increases spontaneous Ca 2+ release activity and cellular hypertrophy in right ventricular myocytes from heart failure rats. Sci Rep 2021; 11:4840. [PMID: 33649357 PMCID: PMC7921450 DOI: 10.1038/s41598-021-84275-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Right ventricle (RV) dysfunction is an independent predictor of patient survival in heart failure (HF). However, the mechanisms of RV progression towards failing are not well understood. We studied cellular mechanisms of RV remodelling in a rat model of left ventricle myocardial infarction (MI)-caused HF. RV myocytes from HF rats show significant cellular hypertrophy accompanied with a disruption of transverse-axial tubular network and surface flattening. Functionally these cells exhibit higher contractility with lower Ca2+ transients. The structural changes in HF RV myocytes correlate with more frequent spontaneous Ca2+ release activity than in control RV myocytes. This is accompanied by hyperactivated L-type Ca2+ channels (LTCCs) located specifically in the T-tubules of HF RV myocytes. The increased open probability of tubular LTCCs and Ca2+ sparks activation is linked to protein kinase A-mediated channel phosphorylation that occurs locally in T-tubules. Thus, our approach revealed that alterations in RV myocytes in heart failure are specifically localized in microdomains. Our findings may indicate the development of compensatory, though potentially arrhythmogenic, RV remodelling in the setting of LV failure. These data will foster better understanding of mechanisms of heart failure and it could promote an optimized treatment of patients.
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Affiliation(s)
- Roman Y Medvedev
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy.,Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Jose L Sanchez-Alonso
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Catherine A Mansfield
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Aleksandra Judina
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Alice J Francis
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | | | - Natalia Trayanova
- Department of Biomedical Engineering and Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, USA
| | - Alexey V Glukhov
- Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Michele Miragoli
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.,Dipartimento Di Medicina E Chirurgia, Università Degli Studi di Parma, Via Gramsci 14, 43124, Parma, Italy
| | - Giuseppe Faggian
- Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy
| | - Julia Gorelik
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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24
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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25
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Surkova E, Segura T, Dimopoulos K, Bispo D, Flick C, West C, Babu-Narayan SV, Senior R, Gatzoulis MA, Li W. Systolic dysfunction of the subpulmonary left ventricle is associated with the severity of heart failure in patients with a systemic right ventricle. Int J Cardiol 2021; 324:66-71. [PMID: 32987051 DOI: 10.1016/j.ijcard.2020.09.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/27/2020] [Accepted: 09/20/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study aimed to assess the relation between echocardiographic parameters of subpulmonary left ventricular (LV) size and function, and the severity of heart failure in patients with a systemic right ventricle (SRV). METHODS AND RESULTS A total of 157 patients (89 post Mustard/Senning operations, 68 with congenitally corrected transposition of great arteries [ccTGA]) were included. The size and function of the SRV and subpulmonary LV were assessed on the most recent echocardiographic exam. Clinical data were collected from the electronic records. The majority (133, 84.7%) were in NYHA functional class 1-2. Median BNP concentration was 79.5[38.3-173.3] ng/l, and 100 (63.7%) patients were receiving heart failure therapy. Both LV and SRV fractional area change (FAC) differed significantly between patients with NYHA class 1-2 vs 3-4 (48[41.5-52.8]% vs 34[28.6-38.6]%, p < 0.0001 and 29.5[23-35]% vs 22[20-27]%, p < 0.0001, respectively), but LV FAC had a higher discriminative power for functional class >2 than SRV FAC (AUC 0.90, p < 0.0001 vs 0.79; p < 0.0001, respectively). A LV FAC cut-off value <39.2% had the highest accuracy in identifying patients with NYHA class 3-4 (sensitivity 83% and specificity 88%). In multivariable logistic regression analysis, LV FAC and SRV FAC independently associated to NYHA class 3-4 (OR 0.80 [95%CI 0.72-0.88], p < 0.0001 and OR 0.85 [95%CI 0.76-0.96], p = 0.007, respectively). CONCLUSIONS Subpulmonary LV systolic dysfunction is associated with NYHA functional class 3-4 in patients with ccTGA or after Mustard or Senning operation. Careful evaluation of the subpulmonary LV should be a part of the routine assessment of patients with a SRV.
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Affiliation(s)
- Elena Surkova
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom.
| | - Teresa Segura
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; University Hospital 12 de Octubre, 2ª Planta Residencia general, Madrid 28041, Spain
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Daniela Bispo
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Caroline Flick
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Cathy West
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom
| | - Sonya V Babu-Narayan
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Roxy Senior
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
| | - Wei Li
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, United Kingdom
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26
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Radwan H, Hussein EM, Refaat H. Short- and long-term prognostic value of right ventricular function in patients with first acute ST elevation myocardial infarction treated by primary angioplasty. Echocardiography 2021; 38:249-260. [PMID: 33462899 DOI: 10.1111/echo.14974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Limited data are known about the prognostic value of right ventricle (RV) function in patients with first acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the prognostic value of RV dysfunction in predicting both in-hospital and long-term outcomes in these patients, irrespective of the site of necrosis. METHODS We enrolled 502 consecutive patients with first acute STEMI treated with primary angioplasty and underwent echocardiography within 48 hours of admission. RV function was evaluated by RV myocardial performance index (RVMPI), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler S' wave velocity, and RV global longitudinal strain (RVGLS) of the free wall. The occurrence of in-hospital major adverse cardiac events (MACE) and 1-year survival rate were recorded. RESULTS In MACE group, RVFAC, TAPSE, and RV S' wave velocity were lower. However, RVMPI, RVGLS, and TR Vmax. were higher than MACE free group (P < .001). In multivariable analysis adjusted for other variables that predicted adverse outcomes, RVFAC < 35% (P < .001), TAPSE < 17 mm (P < .001), RVGLS > -17% (P < .001), RV S' wave velocity < 9.5 cm/s (P = .02), RVMPI > 0.43 (P < .001), and TR Vmax. > 2.8 m/s (P = .01) were strong independent predictors of in-hospital MACE. Lower 1-year survival was noted in patients with RV dysfunction, documented by these cutoffs values. CONCLUSION RV dysfunction, evidenced by multiparametric echocardiography, is predictive for adverse in-hospital outcomes, and lower 1-year survival rate in first acute STEMI regardless of the site of necrosis.
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Affiliation(s)
- Hanan Radwan
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | | | - Hesham Refaat
- Cardiology Department, Zagazig University, Zagazig, Egypt
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27
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Wang B, Yu Y, Zhang Y, Hao X, Yang S, Zhao H, Sun Q, Wang Y. Right ventricular dysfunction in patients with diffuse large B-cell lymphoma undergoing anthracycline-based chemotherapy: a 2D strain and 3D echocardiography study. Int J Cardiovasc Imaging 2021; 37:1311-1319. [PMID: 33392873 DOI: 10.1007/s10554-020-02120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
To investigate whether 2D strain and 3D echocardiography could early identify the impaired right ventricular (RV) function after anthracycline exposure. Sixty-one patients with diffuse large B-cell lymphoma treated with anthracycline were studied. Echocardiography was conducted at baseline, after the third cycle of the chemotherapy, after the completion of the chemotherapy, and follow-up at 10 months after the initiation of chemotherapy. RV global longitudinal strain (RV GLS) and RV free wall longitudinal strain (RV FWLS) were calculated using speckle tracking echocardiography. RV ejection fraction (RVEF) was analyzed by 3D echocardiography. RV systolic dysfunction was defined by ≥ 2 RV parameters below the threshold value, and cardiotoxicity was defined as a reduction in left ventricular EF > 10 to < 53%. After the third cycle of chemotherapy, only RV GLS was significantly decreased, while after the completion of the chemotherapy, RV GLS, RV FWLS, and RVEF were all significantly decreased compared with baseline measurements. At the end of follow-up, 9 patients (14.8%) were diagnosed with RV systolic dysfunction, and 16 patients (26.2%) had at least 1 abnormal RV function parameter. The proportion of RV systolic dysfunction was significantly higher in patients with cardiotoxicity than in patients without cardiotoxicity, yielding an odds ratio of 5.143. A percentage decrease in RV FWLS and RVEF were independent predictors of RV systolic dysfunction. Two-dimensional strain and 3D echocardiography are valuable methods for evaluating anthracycline-related impairment of RV function in DLBCL patients receiving chemotherapy. RV FWLS and RVEF are reliable predictors of RV systolic dysfunction.
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Affiliation(s)
- Baozhen Wang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Yang Yu
- Medical Imaging Center, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Zhang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Xiaoyi Hao
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China.
| | - Shan Yang
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Hong Zhao
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Qianqian Sun
- Department of Ultrasound, Cangzhou People's Hospital, Cangzhou, China
| | - Yue Wang
- Medical Imaging Center, Cangzhou People's Hospital, Cangzhou, China
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28
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Impact of bi-planar localization of the tricuspid valve on the evaluation of right ventricular functional parameters in the short axis plane. Int J Cardiovasc Imaging 2020; 36:2255-2263. [DOI: 10.1007/s10554-020-01941-2] [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: 05/14/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
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29
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Cazalbou S, Chong Fah Shen V, Petermann A, Eyharts D, Fournier P, Cariou E, Lavie-Badie Y, Hennig A, Roncalli J, Rousseau H, Carrié D, Galinier M, Berry I, Lairez O. What is the most useful imaging parameter to explore the prognostic value of the right ventricular function at the time of multimodality cardiovascular imaging? Echocardiography 2020; 37:1233-1242. [PMID: 32686860 DOI: 10.1111/echo.14686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/28/2019] [Accepted: 04/21/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. METHODS Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. RESULTS During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P < .001), 0.913 (P < .001), 0.906 (P < .001), 0.849 (P = .002), 0.837 (P = .003), 0.799 (P = .009), 0.792 (P = .011), 0.753 (P = .026), 0.720 (P = .053), and 0.608 (P = .346) for integral systolic S' wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S' wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively. CONCLUSION Echocardiographic parameters, and particularly integral systolic S' wave tricuspid annular velocity and RVFWLS, have the best prognostic performance.
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Affiliation(s)
- Stéphanie Cazalbou
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Vanessa Chong Fah Shen
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Antoine Petermann
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France
| | - Damien Eyharts
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Eve Cariou
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Alexia Hennig
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Jérôme Roncalli
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Hervé Rousseau
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
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30
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Di Mauro M, Scrofani R, Antona C, Nicolò F, Cappabianca G, Beghi C, Santarpino G, Gregorini R, Di Marco L, Pacini D, Salsano A, Santini F, Weltert L, De Paulis R, Pano M, Zaccaria S, D'Alfonso A, Di Eusanio M, Massi F, Portoghese M, Stura EC, Rinaldi M, Margari V, Foschi M, Parolari A, Paparella D. Right ventricular assessment can improve prognostic value of Euroscore II. J Card Surg 2020; 35:1548-1555. [PMID: 32490568 DOI: 10.1111/jocs.14672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this multicenter prospective study was to evaluate the prognostic weight of preoperative right ventricular assessment on early mortality in cardiac surgery. METHODS This is a multicenter prospective observational study performed by the Italian Group of Research for Outcome in Cardiac Surgery (GIROC) including 11 centers. From October 2017 to March 2019, out of 923 patients undergoing cardiac surgery, 28 patients with some missing data were excluded and 895 patients were enrolled in the study right ventricular dilatation was defined as a basal end-diastolic diameter >42 mm. The right ventricle (RV) function was assessed using the combination of three parameters: fractional area changing (FAC), tricuspid annular plane systolic excursion (TAPSE), and S'-wave using tissue Doppler imaging (TDI-S'); RV dysfunction was defined as the presence of at least two of the following cutoffs: FAC <35%, TAPSE <17 mm, and TDI S' <9.5 mm RESULTS: Among the entire cohort, 624 (70%) showed normal RV, 92 (10%) isolated RV dilatation, 154 (17%) isolated RV dysfunction, and 25 (3%) both RV dilatation and dysfunction. Non-surviving patients showed a significantly higher rate of RV alteration at multivariable analysis, RV status was found to be an independent predictor for higher in-hospital mortality beside Euroscore II. CONCLUSIONS This prospective multicenter observation study shows the importance to assess RV preoperatively and to include both RV function and dimension in a risk score model such as Euroscore II to implement its predictivity, since PH cannot always mirror the status of the right ventricle.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherland
| | - Roberto Scrofani
- Department of Cardiac Surgery, "Fatebenefratelli-Sacco" Hospital, University of Milan, Milan, Italy
| | - Carlo Antona
- Department of Cardiac Surgery, "Fatebenefratelli-Sacco" Hospital, University of Milan, Milan, Italy
| | - Francesca Nicolò
- Department of Cardiac Surgery, "Fatebenefratelli-Sacco" Hospital, University of Milan, Milan, Italy
| | - Giangiuseppe Cappabianca
- Division of Cardiac Surgery, U.O. Cardiochirurgia Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Cesare Beghi
- Division of Cardiac Surgery, U.O. Cardiochirurgia Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giuseppe Santarpino
- Dipartimento di Cardiochirurgia, Città di Lecce Hospital-GVM Care & Research, Lecce, Italy.,Department of Cardiothoracic Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Renato Gregorini
- Dipartimento di Cardiochirurgia, Città di Lecce Hospital-GVM Care & Research, Lecce, Italy
| | - Luca Di Marco
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Deptartment, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Deptartment, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Salsano
- Department of Cardiac Surgery, IRCCS "S. Martino" University of Genova, Genova, Italy
| | - Francesco Santini
- Department of Cardiac Surgery, IRCCS "S. Martino" University of Genova, Genova, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | | | - Marco Pano
- Department of Cardiac Surgery, "Vito Fazzi" Hospital, Lecce, Italy
| | | | | | - Marco Di Eusanio
- Department of Cardiac Surgery, Torrette-Riuniti Hospital, Ancona, Italy
| | | | | | - Erik Cura Stura
- Department of Cardiac Surgery, AOU "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, AOU "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Vito Margari
- Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Cardiochirurgia, Università di Bari Aldo Moro. Ospedale Santa Maria, GVM Care & Research, Bari, Italy
| | | | - Alessandro Parolari
- UOC Cardiac Surgery and Translational Research, IRCCS San Donato and University of Milan, San Donato Milanese, Italy
| | - Domenico Paparella
- Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Cardiochirurgia, Università di Bari Aldo Moro. Ospedale Santa Maria, GVM Care & Research, Bari, Italy
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31
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Reference values for mid-diastolic right ventricular volume in population referred for cardiac computed tomography: An additional diagnostic value to cardiac computed tomography. J Cardiovasc Comput Tomogr 2020; 14:226-232. [DOI: 10.1016/j.jcct.2019.11.003] [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: 04/30/2019] [Revised: 08/19/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
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Reindl M, Eitel I, Reinstadler SJ. Role of Cardiac Magnetic Resonance to Improve Risk Prediction Following Acute ST-Elevation Myocardial Infarction. J Clin Med 2020; 9:E1041. [PMID: 32272692 PMCID: PMC7231095 DOI: 10.3390/jcm9041041] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction.
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Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria;
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Lübeck, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, D-23538 Lübeck, Germany
| | - Sebastian Johannes Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria;
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Milkas A, Tsioufis K, Koliastasis L, Tsiamis E, Tousoulis D, Bartunek J, Vanderheyden M. Impact of increased venous pressure on kidney function and mortality in cardiovascular patients with preserved ejection fraction. Curr Med Res Opin 2020; 36:353-359. [PMID: 31868029 DOI: 10.1080/03007995.2019.1708286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Right but not left ventricular hemodynamic parameters have been found to be independently associated with adverse renal outcomes in patients with acute decompensated heart failure (HF).Aim: To investigate the hemodynamic profile of patients without acute decompensated heart failure and left ventricular ejection fraction >50% referred for elective left and right heart catheterization and to correlate left and right filling pressures, stroke volume and arterial blood pressure to renal function parameters. Subsequently, we tested the hypothesis that right ventricle and left ventricle hemodynamic parameters can predict all-cause mortality in our non-HF subjects.Methods: Between October 2009 and November 2010, 151 consecutive patients referred for elective left and right heart catheterization were studied and consequently followed up for a mean period of 8 years in order to identify all-cause mortality. Patient's initial cohort was subdivided in two groups according to right atrial pressure. The RAPRLOW group (Right Atrium Pressure ≤ 9 mmHg) and the RAPRHIGH group (Right Atrium Pressure > 9mmHg)Results: No correlation between blood pressure, pulmonary capillary wedges pressure, cardiac index, stroke volume and stroke volume index (SVI), and parameters of kidney function was observed. However, a weak, although, significant correlation between right atrial pressure (RAP) and modification of diet in renal disease (MDRD) (r = -0.202; p = .014) could be detected. RAPRLOW patients had a statistically significant lower MDRD value of 16.6 mL/min/1.73 m2 than RAPRHIGH patients. Increased RAP (HR = 2.03; 95% [CI]: 1.05 to 3.9; p = .025) and age (HR = 1.08, 95% [CI] 1.04-1.12, p < .001) independently predicted all-cause mortality during follow up.Conclusions: Our study demonstrates that right ventricular preload affects renal function in patients with preserved systolic function and that neither aortic systolic pressure nor left ventricle pressure indices were related to estimated glomerular filtration rate. Furthermore, we demonstrate for the first time that an increased RAP is able to predict a worse prognosis in patients with preserved ejection fraction independently of well-established risk factors, such as blood pressure and SVI.
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Affiliation(s)
- Anastasios Milkas
- Cardiovascular Center OLV Hospital, Aalst, Belgium
- Athens Naval and Veterans Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | | | - Eleftherios Tsiamis
- First Cardiology Department, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | - Dimitris Tousoulis
- First Cardiology Department, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
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Surkova E, Muraru D, Genovese D, Aruta P, Palermo C, Badano LP. Relative Prognostic Importance of Left and Right Ventricular Ejection Fraction in Patients With Cardiac Diseases. J Am Soc Echocardiogr 2019; 32:1407-1415.e3. [DOI: 10.1016/j.echo.2019.06.009] [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: 02/16/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022]
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Nochioka K, Querejeta Roca G, Claggett B, Biering-Sørensen T, Matsushita K, Hung CL, Solomon SD, Kitzman D, Shah AM. Right Ventricular Function, Right Ventricular-Pulmonary Artery Coupling, and Heart Failure Risk in 4 US Communities: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA Cardiol 2019; 3:939-948. [PMID: 30140848 DOI: 10.1001/jamacardio.2018.2454] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Limited data exist on the prevalence and prognostic importance of right ventricular (RV) dysfunction for heart failure (HF) in the general population. Objective To assess the prevalence of RV dysfunction and its association with HF and mortality in a community-based elderly cohort. Design, Setting, and Participants Cross-sectional and time-to-event analysis of participants in the Atherosclerosis Risks in the Community (ARIC), a multicenter, population-based cohort study at the fifth study visit from 2011 to 2013, with a median follow-up of 4.1 years. This study included 1004 elderly participants in the ARIC study attending the fifth study visit who underwent both 3-dimensional and 2-dimensional RV echocardiography. Three-dimensional echocardiography data were analyzed between September 15, 2015, and July 24, 2016. Exposures Right ventricular ejection fraction (RVEF), RV-pulmonary artery (PA) coupling defined by the RVEF/PA systolic pressure (PASP) ratio, and RV longitudinal strain by 3-dimensional echocardiography. Main Outcomes and Measures For cross-sectional analysis, the prevalence of RV dysfunction across ACCF/AHA HF stages (0; A, at elevated risk for HF but without structural heart disease or clinical HF; B, structural heart disease but without clinical HF; and C, prevalent HF). For time-to-event analysis, a composite of incident HF hospitalization or all-cause death among participants free of HF at visit 5. Results Of the 1004 participants, mean (SD) age was 76 (5) years, 385 were men (38%), and 121 were black (12%). Mean (SD) RVEF was 53% (8%). Right ventricular EF, RVEF/PASP, and RV longitudinal strain were each progressively lower across advancing HF stages. Using reference limits from stage 0 participants, RVEF was abnormal in 103 asymptomatic persons with stage A HF (15%) and 27 with stage B HF (24%). Among participants free of HF at baseline, lower RVEF and worse RV-PA coupling (ie, lower RVEF/PASP ratio) both were associated with incident HF or death independent of LVEF and N-terminal pro b-type natriuretic peptide (hazard ratio, 1.20; 95% CI, 1.02-1.42 per 5% decrease in RVEF; P = .03; hazard ratio, 1.65, 95% CI, 1.15-2.37 per 0.5 unit decrease in RVEF/PASP ratio; P = .007). Conclusions and Relevance Right ventricular function and RV-PA coupling declined progressively across American College of Cardiology Foundation/American Heart Association HF stages. Among persons free of HF, lower RVEF was associated with incident HF or death independent of LVEF or N-terminal pro b-type natriuretic peptide.
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Affiliation(s)
- Kotaro Nochioka
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tor Biering-Sørensen
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chung-Lieh Hung
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, MacKay Medical College, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dalane Kitzman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Aziz W, Claridge S, Ntalas I, Gould J, de Vecchi A, Razeghi O, Toth D, Mountney P, Preston R, Rinaldi CA, Razavi R, Niederer S, Rajani R. Emerging role of cardiac computed tomography in heart failure. ESC Heart Fail 2019; 6:909-920. [PMID: 31400060 PMCID: PMC6816076 DOI: 10.1002/ehf2.12479] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022] Open
Abstract
Despite medical advancements, the prognosis of patients with heart failure remains poor. While echocardiography and cardiac magnetic resonance imaging remain at the forefront of diagnosing and monitoring patients with heart failure, cardiac computed tomography (CT) has largely been considered to have a limited role. With the advancements in scanner design, technology, and computer processing power, cardiac CT is now emerging as a valuable adjunct to clinicians managing patients with heart failure. In the current manuscript, we review the current applications of cardiac CT to patients with heart failure and also the emerging areas of research where its clinical utility is likely to extend into the realm of treatment, procedural planning, and advanced heart failure therapy implementation.
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Affiliation(s)
- Waqar Aziz
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simon Claridge
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Adelaide de Vecchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Toth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Peter Mountney
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rebecca Preston
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Salzano A, Marra AM, D’Assante R, Arcopinto M, Bossone E, Suzuki T, Cittadini A. Biomarkers and Imaging. Heart Fail Clin 2019; 15:321-331. [DOI: 10.1016/j.hfc.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kim J, Alakbarli J, Yum B, Tehrani NH, Pollie MP, Abouzeid C, Di Franco A, Ratcliffe MB, Poppas A, Levine RA, Devereux RB, Weinsaft JW. Tissue-based markers of right ventricular dysfunction in ischemic mitral regurgitation assessed via stress cardiac magnetic resonance and three-dimensional echocardiography. Int J Cardiovasc Imaging 2019; 35:683-693. [PMID: 30460581 PMCID: PMC6510229 DOI: 10.1007/s10554-018-1500-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/13/2018] [Indexed: 01/19/2023]
Abstract
Ischemic mitral regurgitation (iMR) augments risk for right ventricular dysfunction (RVDYS). Right and left ventricular (LV) function are linked via common coronary perfusion, but data is lacking regarding impact of LV ischemia and infarct transmurality-as well as altered preload and afterload-on RV performance. In this prospective multimodality imaging study, stress CMR and 3-dimensional echo (3D-echo) were performed concomitantly in patients with iMR. CMR provided a reference for RVDYS (RVEF < 50%), as well as LV function/remodeling, ischemia and infarction. Echo was used to test multiple RV performance indices, including linear (TAPSE, S'), strain (GLS), and volumetric (3D-echo) approaches. 90 iMR patients were studied; 32% had RVDYS. RVDYS patients had greater iMR, lower LVEF, larger global ischemic burden and inferior infarct size (all p < 0.05). Regarding injury pattern, RVDYS was associated with LV inferior ischemia and infarction (both p < 0.05); 80% of affected patients had substantial viable myocardium (< 50% infarct thickness) in ischemic inferior segments. Regarding RV function, CMR RVEF similarly correlated with 3D-echo and GLS (r = 0.81-0.87): GLS yielded high overall performance for CMR-evidenced RVDYS (AUC: 0.94), nearly equivalent to that of 3D-echo (AUC: 0.95). In multivariable regression, GLS was independently associated with RV volumetric dilation on CMR (OR - 0.90 [CI - 1.19 to - 0.61], p < 0.001) and 3D echo (OR - 0.43 [CI - 0.84 to - 0.02], p = 0.04). Among patients with iMR, RVDYS is associated with potentially reversible processes, including LV inferior ischemic but predominantly viable myocardium and strongly impacted by volumetric loading conditions.
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Affiliation(s)
- Jiwon Kim
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA.
| | - Javid Alakbarli
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Brian Yum
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Nathan H Tehrani
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Meridith P Pollie
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Christiane Abouzeid
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Antonino Di Franco
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Mark B Ratcliffe
- Division of Cardiology, Department of Surgery, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Bioengineering, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Athena Poppas
- Lifespan Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert A Levine
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard B Devereux
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA
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Kowal J, Ahmad MI, Li Y, Soliman EZ. Prognostic significance of electrocardiographic right ventricular hypertrophy in the general population. J Electrocardiol 2019; 54:49-53. [PMID: 30901607 DOI: 10.1016/j.jelectrocard.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographically detected right ventricular hypertrophy (RVH) is associated with cardiovascular disease (CVD) and mortality. However, the prognostic significance of electrocardiographic (ECG)RVH criteria as predictors of poor outcomes in the general population is unclear. METHODS This study included 7857 participants (59.8 ± 13.4 years, 52.6% women) from the Third National Health and Nutrition Examination Survey. Sixteen different ECG-RVH criteria were created from digitally recorded and centrally processed electrocardiograms. All-cause mortality was ascertained using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline ECG-RVH criteria and all-cause mortality. RESULTS The prevalence of RVH varied widely among the criteria. The lowest ECG-RVH prevalence was 0.09% (using S > R in I, II, III) while the highest prevalence was 20.7% (using (R I + S III) - (S I + R III) < 15 mm). During a median follow-up of 14 years, 2812 deaths occurred. The mortality rate was highest among participants with ECG-RVH defined as R:S ratio V5 < 0.75. In multivariable adjusted models, 9 out of the 16 ECG-RVH criteria were significantly associated with all-cause mortality. When ECG-RVH was defined as the presence of any ECG-RVH criteria, each additional ECG-RVH criteria was associated with 6% increased risk of all-cause mortality (HR (95% CI):1.06(1.03,1.10)). CONCLUSIONS There is a wide variation in the prevalence of ECG-RVH when different criteria are applied in the general population. However, the presence of ECG-RVH by most criteria regardless of prevalence was associated with poor prognosis suggesting that appropriate choice of criteria may enhance the utilization of these ECG markers in risk stratification.
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Affiliation(s)
- Jamie Kowal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Abstract
PURPOSE OF REVIEW The function of the right ventricle (RV) is intimately linked to its preload (systemic volume status) and afterload (pulmonary vasculature). In this review, we explore current knowledge in RV physiology, RV function assessment, causes of right heart failure (RHF), and specific treatment strategies for RHF. RECENT FINDINGS We examine the evidence behind new pharmacological therapies available, such as macitentan and riociguat in the treatment of specific etiologies of RHF. We will also focus on RHF in the setting of heart failure with preserved ejection fraction (HFpEF) and in the presence of left ventricular assist devices (LVAD), looking at current treatment recommendations, including mechanical circulatory support. Lastly, we will look to the horizon for the latest research on RHF, including the molecular basis of RHF and potential novel treatment methods for this old yet poorly understood syndrome. Disturbances in this complex relationship result in the clinical syndrome of RHF. Despite advances in the management of left heart diseases, much work remains to be done to understand and manage RHF.
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Affiliation(s)
- Weiqin Lin
- Section of Heart Failure and Cardiac Transplantation, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
| | | | - W H Wilson Tang
- Section of Heart Failure and Cardiac Transplantation, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA. .,Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA.
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Can 3D RVEF be Prognostic for the Non-Ischemic Cardiomyopathy Patient but not the Ischemic Cardiomyopathy Patient? A Cardiovascular MRI Study. Diagnostics (Basel) 2019; 9:diagnostics9010016. [PMID: 30678130 PMCID: PMC6468852 DOI: 10.3390/diagnostics9010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/10/2019] [Accepted: 01/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background: While left ventricular ejection fraction (LVEF) has been shown to have prognostic value in ischemic cardiomyopathy (ICMX) patients, right ventricular ejection fraction (RVEF) has not been systematically evaluated in either ICMX or non-ischemic cardiomyopathy (NICMX) patients. Moreover, an accurate estimation of RVEF is problematic due to the geometry of the right ventricle (RV). Over the years, there have been improvements in the resolution, image acquisition and post-processing software for cardiac magnetic resonance imaging (CMR), such that CMR has become the “gold standard” for measuring RV volumetrics and RVEF. We hypothesize that CMR defines RVEF more so than LVEF and might have prognostic capabilities in ischemic and non-ischemic cardiomyopathy patients (ICMX and NICMX). Methods: Patients that underwent CMR at our institution between January 2005 and October 2012 were retrospectively selected if three-dimensional (3D) LVEF < 35%. Patients were further divided into ICMX and NICMX groups. The electronic medical record (EMR) database inquiry determined all-cause mortality and major adverse cardiovascular events (MACE). Additionally, a Social Security Death Index (SSI) database inquiry was performed to determine all-cause mortality in patients who were lost to follow-up. Patients were further sub-grouped on the basis of 3D RVEF ≥ 20%. Separately, patients were sub-grouped by LVEF ≥ 20% in both ICMX and NICMX cases. A cut-off of ≥20% was chosen for the RVEF based on the results of prior studies showing significance based on Kaplan–Meier (KM) survival curves. Cumulative event rates were estimated for each subgroup using the KM analysis and were compared using the log-rank test. The 3D RV/LVEFs were compared to all-cause mortality and MACE. ICMX patients were defined using the World Health Organization (WHO) criteria. Results: From a 7000-patient CMR database, 753 heart failure patients were selected. Eighty-seven patients met WHO definition of ICMX and NICMX (43 ICMX and 44 NICMX). The study patients were followed for a median of 3 years (Interquartile range or IQR 1.5–6.5 years). The mean age of patients was 58 ± 13 years; 79% were male. In ICMX, mean 3D LVEF was 21% ± 6% and mean 3D RVEF was 38% ± 14%, while for NICMX, mean 3D LVEF was 16% ± 6% and mean 3D RVEF was 30% ± 14% (p < 0.005 for intra- and inter-group comparison). It should be noted that LVEF < RVEF in both groups and the ejection fraction (EF) in NICMX was less than the corresponding EF in ICMX. Overall mortality was higher in ICMX than NICMX (12/40, 30% vs. 7/43, 16%; p < 0.05). Patients were stratified based on both RVEF and LVEF with a threshold of EF ≥ 20% separately. RVEF but not LVEF was a significant predictor of death for NICMX (χ2 = 8; p < 0.005), while LVEF did not predict death in ICMX (χ2 = 2, p = not significant). Similarly, time to MACE was predicted by RVEF for NICMX (χ2 = 9; p < 0.005) but not by LVEF in ICMX (χ2 = 1; p = NS). Importantly, RVEF, while predictive of NICMX MACE, did not emerge as a predictor of survival or MACE in ICMX. Conclusions: Via 3D CMR in non-ischemic CMX patients, RVEF has important value in predicting death and time to first MACE while 3D LVEF is far less predictive.
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Keskin M, Uzun AO, Hayıroğlu Mİ, Kaya A, Çınar T, Kozan Ö. The association of right ventricular dysfunction with in-hospital and 1-year outcomes in anterior myocardial infarction. Int J Cardiovasc Imaging 2018; 35:77-85. [PMID: 30109454 DOI: 10.1007/s10554-018-1438-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
Abstract
In anterior ST-segment elevation myocardial infarction (STEMI), attention paid mainly to the left ventricle. The predictive significance of right ventricular (RV) dysfunction in patients with anterior STEMI has been frequently neglected. In this study, we evaluated the prognostic effect of RV dysfunction on in-hospital and long-term outcomes in patients with first anterior STEMI. A total of 350 patients without known coronary artery disease with first anterior STEMI and treated with primary percutaneous coronary intervention were prospectively enrolled in this study. In-hospital and long-term outcomes were compared between two groups of with or without RV dysfunction. In-hospital mortality was significantly higher in the RV dysfunction group (26.7% vs. 1.6%, P < 0.001). The RV dysfunction group also had a higher incidence of cardiogenic shock, recurrent myocardial infarction, target lesion revascularization and stent thrombosis. The 1-year overall survival in patients with and without RV dysfunction was 62.2% and 95.0% respectively. After multivariable analysis, RV dysfunction remained as an independent predictor for in-hospital and long-term mortality. RV dysfunction is an independent predictor of cardiogenic shock, recurrent myocardial infarction, and, in-hospital and long-term mortality in anterior STEMI. Therefore, attention should be paid to the function of right ventricle as in the left ventricle after anterior STEMI.
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Affiliation(s)
- Muhammed Keskin
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Tibbiye Street, Uskudar, Istanbul, Turkey.
| | - Ahmet Okan Uzun
- Department of Cardiology, Dortyol State Hospital, Hatay, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Adnan Kaya
- Department of Cardiology, Duzce University, Duzce, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Tibbiye Street, Uskudar, Istanbul, Turkey
| | - Ömer Kozan
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Morozowich ST, Murray AW, Ramakrishna H. Pulmonary Hypertension in Patients for Transcatheter and Surgical Aortic Valve Replacement: A Focus on Outcomes and Perioperative Management. J Cardiothorac Vasc Anesth 2018; 32:2005-2018. [DOI: 10.1053/j.jvca.2017.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 01/03/2023]
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Naksuk N, Tan N, Padmanabhan D, Kancharla K, Makkar N, Yogeswaran V, Gaba P, Kaginele P, Riley DC, Sugrue AM, Rosenbaum AN, El-Harasis MA, Asirvatham SJ, Kapa S, McLeod CJ. Right Ventricular Dysfunction and Long-Term Risk of Sudden Cardiac Death in Patients With and Without Severe Left Ventricular Dysfunction. Circ Arrhythm Electrophysiol 2018; 11:e006091. [DOI: 10.1161/circep.117.006091] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Niyada Naksuk
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | | | - Deepak Padmanabhan
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | - Krishna Kancharla
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
- Mayo Clinic, Rochester, MN. Department of Cardiovascular Medicine, University of Pittsburgh Medical Center, PA (K.K.)
| | - Nayani Makkar
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | | | | | - Pranita Kaginele
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | - David C. Riley
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | - Alan M. Sugrue
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | - Andrew N. Rosenbaum
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | | | - Samuel J. Asirvatham
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
- and Department of Pediatrics and Adolescent Medicine (S.J.A.),
| | - Suraj Kapa
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
| | - Christopher J. McLeod
- Departments of Cardiovascular Medicine (N.N., D.P., K.K., N.M., P.K., D.C.R., A.M.S., A.N.R., S.J.A., S.K., C.J.M.)
- Mayo Clinic College of Medicine and Science, Rochester, MN. Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, FL (C.J.M.)
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Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
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Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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46
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Patscheider H, Lorbeer R, Auweter S, Schafnitzel A, Bayerl C, Curta A, Rathmann W, Heier M, Meisinger C, Peters A, Bamberg F, Hetterich H. Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes. Eur Radiol 2018; 28:3105-3113. [PMID: 29423576 DOI: 10.1007/s00330-017-5185-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/14/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess subclinical changes in right ventricular volumes and function in subjects with prediabetes and diabetes and controls without a history of cardiovascular disease. METHODS Data from 400 participants in the KORA FF4 study without self-reported cardiovascular disease who underwent 3-T whole-body MRI were obtained. The right ventricle was evaluated using the short axis and a four-chamber view. Diabetes was defined according to WHO criteria. Associations between glucose tolerance and right ventricular parameters were assessed using multivariable adjusted linear regression models. RESULTS Data from 337 participants were available for analysis. Of these, 43 (13%) had diabetes, 87 (26%) had prediabetes, and 207 (61%) were normoglycaemic controls. There was a stepwise decrease in right ventricular volumes in men with prediabetes and diabetes in comparison with controls, including right ventricular end-diastolic volume (β = -20.4 and β = -25.6, respectively; p ≤ 0.005), right ventricular end-systolic volume (β = -12.3 and β = -12.7, respectively; p ≤ 0.037) and right ventricular stroke volume (β = -8.1 and β = -13.1, respectively, p ≤ 0.016). We did not observe any association between prediabetes or diabetes and right ventricular volumes in women or between prediabetes or diabetes and right ventricular ejection fraction in men and women. CONCLUSIONS This study points towards early subclinical changes in right ventricular volumes in men with diabetes and prediabetes. KEY POINTS • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.
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Affiliation(s)
- Hannah Patscheider
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Anina Schafnitzel
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Bayerl
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Adrian Curta
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Centre, Duesseldorf, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany.,German Centre for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
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47
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Di Mauro M, Foschi M, Tancredi F, Guarracini S, Di Marco M, Habib AM, Kheirallah H, Alsaied M, Alfonso JJ, Gallina S, Calafiore AM. Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery. Int J Cardiol 2017; 252:39-43. [PMID: 29174017 DOI: 10.1016/j.ijcard.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/15/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the additive and independent prognostic value of abnormal right ventricle (aRV) and pulmonary hypertension (PH) in patients undergoing mitral-tricuspid surgery. METHODS From January 2009 to December 2012, 541 patients underwent mitro-tricuspid surgery. The entire cohort was divided into 6 subgroups: 63 cases had normal RV and no PH (Group A), 180 normal RV but moderate PH (Group B), 101 normal RV but severe PH (Group C), 15 abnormal RV and no-PH (Group D), 86 abnormal RV and moderate PH (Group E) and 96 abnormal RV and severe PH (Group F). RESULTS Forty-two (7.8%) patients died in hospital due to any cause: 1.6% in group A, 3.9% in group B, 8.9% in group C, 13.3% in group D, 9.3% in group E, 15.6% in group E, p = 0.005. Among 78 patients with no-PH, mortality was significantly higher in patients with aRV (1.6%vs 13.3%. p = 0.03). Among 344 patients with normal RV, mortality was significantly higher in patients with severe PH (1.6% vs 3.9% vs 8.9%. p = 0.03). Comparing the presence of both abnormal RV and severe PH with the remaining patients, mortality was significantly higher in the first group (15.6% 6.1%, p = 0.004). Multivariable analysis confirmed either the independent or the additive role of RV and PH. CONCLUSIONS In patients undergoing mitral-tricuspid valve surgery, the presence of either RV dysfunction/dilatation or severe pulmonary hypertension, might play an independent prognostic role for mortality. The worst scenario is surely the contemporary presence of both conditions.
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Affiliation(s)
- Michele Di Mauro
- Cardiology and Cardiac Surgery, Madonna del Ponte Institute, Lanciano, Italy.
| | | | | | | | | | - Aly Makram Habib
- Department of Critical Care, Faculty of medicine, Cairo University, Cairo, Egypt; Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | | | | | | | | | - Antonio M Calafiore
- Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Cardiac Surgery, Fondazione Giovanni Paolo II, Campobasso, Italy
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48
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Foschi M, Di Mauro M, Tancredi F, Capparuccia C, Petroni R, Leonzio L, Romano S, Gallina S, Penco M, Cibelli M, Calafiore A. The Dark Side of the Moon: The Right Ventricle. J Cardiovasc Dev Dis 2017; 4:jcdd4040018. [PMID: 29367547 PMCID: PMC5753119 DOI: 10.3390/jcdd4040018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 01/28/2023] Open
Abstract
The aim of this review article is to summarize current knowledge of the pathophysiology underlying right ventricular failure (RVF), focusing, in particular, on right ventricular assessment and prognosis. The right ventricle (RV) can tolerate volume overload well, but is not able to sustain pressure overload. Right ventricular hypertrophy (RVH), as a response to increased afterload, can be adaptive or maladaptive. The easiest and most common way to assess the RV is by two-dimensional (2D) trans-thoracic echocardiography measuring surrogate indexes, such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and tissue Doppler velocity of the lateral aspect of the tricuspid valvular plane. However, both volumes and function are better estimated by 3D echocardiography and cardiac magnetic resonance (CMR). The prognostic role of the RV in heart failure (HF), pulmonary hypertension (PH), acute myocardial infarction (AMI), and cardiac surgery has been overlooked for many years. However, several recent studies have placed much greater importance on the RV in prognostic assessments. In conclusion, RV dimensions and function should be routinely assessed in cardiovascular disease, as RVF has a significant impact on disease prognosis. In the presence of RVF, different therapeutic approaches, either pharmacological or surgical, may be beneficial.
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Affiliation(s)
| | - Michele Di Mauro
- Chair of Cardiology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Fabrizio Tancredi
- Department of Heart Disease, SS Annunziata Hospital, 66100 Chieti, Italy.
| | - Carlo Capparuccia
- Department of Heart Disease, SS Annunziata Hospital, 66100 Chieti, Italy.
| | - Renata Petroni
- Chair of Cardiology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Luigi Leonzio
- Department of Heart Disease, SS Annunziata Hospital, 66100 Chieti, Italy.
| | - Silvio Romano
- Chair of Cardiology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Sabina Gallina
- Cardiology, University "Gabriele D'Annunzio"of Chieti-Pescara, 66100 Chieti, Italy.
| | - Maria Penco
- Chair of Cardiology, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Mario Cibelli
- Department of Cardiothoracic Anaesthesia, University Hospitals Birmingham, Birmingham B15 2TH, UK.
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49
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Kammerlander AA, Aschauer S, Zotter-Tufaro C, Duca F, Knechtelsdorfer K, Wiesinger M, Schwaiger ML, Dalos D, Schneider M, Marzluf BA, Bonderman D, Mascherbauer J. Diameter of the Pulmonary Artery in Relation to the Ascending Aorta: Association with Cardiovascular Outcome. Radiology 2017; 284:685-693. [PMID: 28562205 DOI: 10.1148/radiol.2017161849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose To investigate whether the pulmonary artery (PA)-to-ascending aorta (Ao) ratio is associated with outcome in unselected patients referred for cardiac magnetic resonance (MR) imaging. Materials and Methods This study prospectively enrolled 650 consecutive patients (47.2% women; mean age, 56.1 years ± 17.7 [standard deviation]). Diameters of PA and Ao were measured in axial black blood images. On the basis of previous results, a PA-to-Ao ratio of 1.0 or greater was chosen as the cutoff for further analysis. Univariable and multivariable Cox regression models were used to investigate the primary end point, which was defined as a composite of cardiovascular hospitalization and death. Results A PA-to-Ao ratio of 1.0 or greater was present in 131 (20.2%) patients. Patients with a PA-to-Ao ratio of 1.0 or greater were predominantly women (P = .010); more frequently presented with atrial fibrillation (P < .001), diabetes (P < .001), and impaired renal function (P < .001); and had higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (P < .001), larger left (P = .023) and right ventricles (RV; P = .002), and worse RV function (P < .001). Patients were followed for 17.8 months ± 12.9, during which 110 patients (16.9%) reached the primary end point. By Kaplan-Meier analysis, event-free survival was significantly worse in patients with a PA-to-Ao ratio of 1.0 or greater (log-rank test, P < .001). A PA-to-Ao ratio of 1.0 or greater was independently associated with outcome by multivariable Cox regression analysis, in addition to age, NT-proBNP serum levels, and RV size. Conclusion A PA-to-Ao ratio of 1.0 or greater identified patients at risk, most likely because of elevated PA pressures. On the basis of these results, the PA-to-Ao ratio should routinely be reported at cardiac MR imaging. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Andreas A Kammerlander
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Stefan Aschauer
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Caroline Zotter-Tufaro
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Franz Duca
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Klaus Knechtelsdorfer
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Matthias Wiesinger
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Marianne L Schwaiger
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Daniel Dalos
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Matthias Schneider
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Beatrice A Marzluf
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Diana Bonderman
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
| | - Julia Mascherbauer
- From the Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria (A.A.K., S.A., C.Z.T., F.D., K.K., M.W., M.L.S., D.D., M.S., D.B., J.M.) and Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria (B.A.M.)
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50
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Horvath MA, Wamala I, Rytkin E, Doyle E, Payne CJ, Thalhofer T, Berra I, Solovyeva A, Saeed M, Hendren S, Roche ET, Del Nido PJ, Walsh CJ, Vasilyev NV. An Intracardiac Soft Robotic Device for Augmentation of Blood Ejection from the Failing Right Ventricle. Ann Biomed Eng 2017; 45:2222-2233. [PMID: 28512702 DOI: 10.1007/s10439-017-1855-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/11/2017] [Indexed: 01/04/2023]
Abstract
We introduce an implantable intracardiac soft robotic right ventricular ejection device (RVED) for dynamic approximation of the right ventricular (RV) free wall and the interventricular septum (IVS) in synchrony with the cardiac cycle to augment blood ejection in right heart failure (RHF). The RVED is designed for safe and effective intracardiac operation and consists of an anchoring system deployed across the IVS, an RV free wall anchor, and a pneumatic artificial muscle linear actuator that spans the RV chamber between the two anchors. Using a ventricular simulator and a custom controller, we characterized ventricular volume ejection, linear approximation against different loads and the effect of varying device actuation periods on volume ejection. The RVED was then tested in vivo in adult pigs (n = 5). First, we successfully deployed the device into the beating heart under 3D echocardiography guidance (n = 4). Next, we performed a feasibility study to evaluate the device's ability to augment RV ejection in an experimental model of RHF (n = 1). RVED actuation augmented RV ejection during RHF; while further chronic animal studies will provide details about the efficacy of this support device. These results demonstrate successful design and implementation of the RVED and its deployment into the beating heart. This soft robotic ejection device has potential to serve as a rapidly deployable system for mechanical circulatory assistance in RHF.
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Affiliation(s)
- Markus A Horvath
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA.,Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Isaac Wamala
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric Rytkin
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Christopher J Payne
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Thomas Thalhofer
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
| | - Ignacio Berra
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Solovyeva
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mossab Saeed
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ellen T Roche
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
| | - Pedro J Del Nido
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Conor J Walsh
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA.,Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
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