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Stąpór M, Piłat A, Misiuda A, Górkiewicz-Kot I, Kaleta M, Kleczyński P, Żmudka K, Legutko J, Kapelak B, Wierzbicki K, Gackowski A. Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation. Hellenic J Cardiol 2024; 76:31-39. [PMID: 37295667 DOI: 10.1016/j.hjc.2023.05.011] [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: 01/22/2023] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES The study aimed to compare pre- and postoperative resting as well as postprocedural resting and exertional right ventricular speckle-tracking echocardiographic parameters at a mid-term follow-up after left ventricular assist device (LVAD) implantation. METHODS Patients with implanted third-generation LVADs with hydrodynamic bearings were prospectively enrolled (NCT05063006). Myocardial deformation was evaluated before pump implantation and at least three months after the procedure, both at rest and during exercise. RESULTS We included 22 patients, 7.3 months (IQR, 4.7-10.2) after the surgery. The mean age was 58.4 ± 7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. The RV strain analysis was feasible in all subjects both at rest and during exercise. The RV free wall strain (RVFWS) worsened from -13% (IQR, -17.3 to -10.9) to -11.3% (IQR, -12.9 to -6; p = 0.033) after LVAD implantation with a particular decline in the apical RV segment [-11.3% (IQR, -16.4 to -6.2) vs -7.8% (IQR, -11.7 to -3.9; p = 0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [-8.5% (IQR, -10.8 to -6.9) vs -7.3% (IQR, -9.8 to -4.7; p = 0.184)]. Neither RVFWS (-11.3% (IQR, -12.9 to -6) vs -9.9% (IQR, -13.5 to -7.5; p = 0.077) nor RV4CSL [-7.3% (IQR, -9.8 to -4.7) vs -7.9% (IQR, -9.8 to -6.3; p = 0.548)] changed during the exercise test. CONCLUSIONS In patients who are pump-supported, the right ventricular free wall strain tends to worsen after LVAD implantation and remains unchanged during a cycle ergometer stress test.
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Affiliation(s)
- Maciej Stąpór
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Adam Piłat
- AGH University of Science and Technology, Department of Automatic Control and Robotics, Kraków, Poland
| | - Agnieszka Misiuda
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Izabela Górkiewicz-Kot
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Michał Kaleta
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Żmudka
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Andrzej Gackowski
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland; Department of Coronary Disease and Heart Failure, Faculty of Medicine, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.
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Markus B, Kreutz J, Chatzis G, Syntila S, Choukeir M, Schieffer B, Patsalis N. Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock. J Clin Med 2024; 13:1265. [PMID: 38592106 PMCID: PMC10931749 DOI: 10.3390/jcm13051265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). Methods: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. Results: Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (p = 0.717), RA/PCWP (p = 0.601), or RVSWI (p = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; p < 0.001, 95% CI: 0.181-0.663), pulmonary capillary wedge pressure (PCWP; p = 0.005, 95% CI: -6.721--1.26), central venous pressure (CVP; p < 0.001, 95% CI: -7.89-5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO2); p = 0.008, 95% CI: 1.096-7.196). Conclusions: LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.
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Affiliation(s)
- Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Giorgios Chatzis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Styliani Syntila
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
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Fulop P, Valocik G, Barbierik Vachalcova M, Zenuch P, Filipova L. Aortic stenosis and right ventricular dysfunction. Int J Cardiovasc Imaging 2024; 40:299-305. [PMID: 37950827 PMCID: PMC10884046 DOI: 10.1007/s10554-023-02986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/14/2023] [Indexed: 11/13/2023]
Abstract
At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn't any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = - 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.
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Affiliation(s)
- Pavol Fulop
- 1st Department of Cardiology, Medical Faculty of University Pavol Jozef Safarik, East Slovak Institute of Cardiovascular Diseases, Ondavska 8, 040 11, Kosice, Slovakia
- Department of Internal Medicine, Medical Faculty of University Pavol Jozef Safarik, Hospital Agel Kosice-Saca, Lucna 57, 040 18, Kosice-Saca, Slovakia
| | - Gabriel Valocik
- 1st Department of Cardiology, Medical Faculty of University Pavol Jozef Safarik, East Slovak Institute of Cardiovascular Diseases, Ondavska 8, 040 11, Kosice, Slovakia.
| | - Marianna Barbierik Vachalcova
- 1st Department of Cardiology, Medical Faculty of University Pavol Jozef Safarik, East Slovak Institute of Cardiovascular Diseases, Ondavska 8, 040 11, Kosice, Slovakia
| | - Pavol Zenuch
- 2nd Department of Cardiology, Medical Faculty of University Pavol Jozef Safarik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Lenka Filipova
- Department of Internal Medicine, Medical Faculty of University Pavol Jozef Safarik, Hospital Agel Kosice-Saca, Lucna 57, 040 18, Kosice-Saca, Slovakia
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Slivneva IV, Farulova IY, Skopin II, Pirushkina YD, Murysova DV, Marapov DI, Golukhova EZ. Right Ventricular Function in Surgical Treatment of Left Heart. KARDIOLOGIIA 2023; 63:11-21. [PMID: 38156485 DOI: 10.18087/cardio.2023.12.n2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/17/2023] [Indexed: 12/30/2023]
Abstract
Aim The aim of this study was to evaluate right ventricular (RV) function during left chamber surgery.Material and methods This was a single-site prospective cohort study. The study included 197 patients with valvular pathology of heart left chambers. Mean age of patients was 58 [47; 65] years. Precordial echocardiography was performed preoperatively and within one week after surgery.Results Decreased parameters of the right ventricular (RV) longitudinal function and global contractile function were observed postoperatively in the majority of patients. More noticeable decreases were observed in parameters of the longitudinal function (p<0.001). Analysis of the changes in RV contractility depending on the underlying pathology revealed the greatest changes in the contractile function in the mitral insufficiency group. In the mitral stenosis group, the greatest difference was observed in the tricuspid annular systolic excursion (TAPSE) (p=0.027). In the groups with aortic defects, all parameters of RV contractile function, except for the fractional area change (FAC), showed statistically significant decreases after correction of the underlying defect (p<0.05).Conclusions Surgical intervention for left heart valvulopathy can result in a decrease in RV function unrelated with systolic deficit of the left ventricle. Modern technologies allow multi-vector assessment of the RV contractile function. To assess the RV function, it is advisable to use a combination of parameters that reflect both global and longitudinal function.
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Affiliation(s)
- I V Slivneva
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - I Yu Farulova
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - I I Skopin
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - Yu D Pirushkina
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - D V Murysova
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - D I Marapov
- Bakulev National Medical Research Center for Cardiovascular Surgery
| | - E Z Golukhova
- Bakulev National Medical Research Center for Cardiovascular Surgery
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Benes J, Kotrc M, Wohlfahrt P, Kroupova K, Tupy M, Kautzner J, Melenovsky V. Right ventricular global dysfunction score: a new concept of right ventricular function assessment in patients with heart failure with reduced ejection fraction (HFrEF). Front Cardiovasc Med 2023; 10:1194174. [PMID: 37600032 PMCID: PMC10436518 DOI: 10.3389/fcvm.2023.1194174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Background Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. Methods A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. Results RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. Conclusion RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.
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Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Peter Wohlfahrt
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Katerina Kroupova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Marek Tupy
- Radiodiagnostic and Interventional Radiology Department, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
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Ali Sahin M, Yokuşoğlu M, Kuralay E, Ozal E. Can Right Ventricular Branch Bypass Alleviate Right Ventricular Dysfunction? Tex Heart Inst J 2022; 49:487993. [PMID: 36315844 PMCID: PMC9632377 DOI: 10.14503/thij-21-7607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study sought to determine whether additional bypass of an RV branch would lessen RV dysfunction. METHODS Patients with severe right coronary artery (RCA) stenosis were divided into 2 groups. Group 1 patients (n = 50) had a single distal bypass on the RCA. Group 2 patients (n = 50) had both distal RCA and additional bypass on the RV branch of the RCA. Right ventricular function was examined by echocardiogram by measuring transannular plane systolic excursion, fractional area change, tissue Doppler S-wave velocity, and inferior vena cava diameter. RESULTS Transannular plane systolic excursion and fractional area change measurements rapidly decreased below the cutoff in both groups, but group 2 patient values reached normal limits at 90 days. Tissue Doppler S-wave velocity reached the normal limit in 7 days. Inotropic agents were required in 11 patients in group 1 and 2 patients in group 2 (P = .013). The mean (SD) intensive care unit stay was 2.11 (1.12) days and 1.45 (0.71) days (P = .033), and the hospital stay was 7.32 (1.44) days and 6.22 (0.45) days in groups 1 and 2, respectively (P = .027). CONCLUSION The data in this study suggest that an additional graft on the RV branch of the RCA (eg, conus, marginal, any good runoff vessels on the RV) prevents severe RV dysfunction and allows for rapid recovery of RV dysfunction after off-pump coronary surgery.
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Affiliation(s)
- Mehmet Ali Sahin
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
| | | | - Erkan Kuralay
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
| | - Ertugrul Ozal
- Cardiovascular Surgery Department, Alife Hospital, Ankara, Turkey
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Stanley A, Athanasuleas C, Nanda N. Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns. Curr Cardiol Rev 2022; 18:e060122200068. [PMID: 34994332 PMCID: PMC9893138 DOI: 10.2174/1573403x18666220106115117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent. Global RV systolic function, stroke volume and ejection fraction remain normal after uncomplicated CS, but regional contractile patterns are altered. There is a decrease in longitudinal shortening but an increase in transverse shortening in the endocardial and epicardial right ventricular muscle fibers, respectively. PSM is a secondary event as there is no loss of septal perfusion or thickening. The increased RV transverse shortening (free wall to septal fibers) may modify septal movement resulting in PSM that compensates for the reduced RV longitudinal shortening, thus preserving normal global right ventricular function.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, Section of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Navin Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
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Durand E, Sacri C, Levesque T, Tron C, Barbe T, Hemery T, Burdeau J, Dacher JN, Eltchaninoff H. Incidence, Predictive Factors, and Prognostic Impact of Right Ventricular Dysfunction Before Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 161:63-69. [PMID: 34794620 DOI: 10.1016/j.amjcard.2021.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
Right ventricular dysfunction (RVD) is considered to be a late marker of aortic stenosis. However, there is a lack of consensus regarding the incidence, prognostic impact, and evolution of RVD in patients treated with transcatheter aortic valve implantation (TAVI). All patients treated with TAVI for severe aortic stenosis were included in a prospective single-center database. Patients who had a quantitative assessment of right ventricular (RV) function including tricuspid annular plane systolic excursion (TAPSE) and/or Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S' wave) measurements were eligible for this study. RVD was defined as TAPSE <17 mm or S' <9.5 cm/s if TAPSE was not available. Between 2014 and 2019, 503 patients with RV function assessment were included. The incidence of RVD before TAVI was 18.7%. Predictors of RVD were diabetes (p = 0.03), atrial fibrillation (p = 0.001), impaired left ventricular ejection fraction (p <0.0001), left ventricular dilatation (p = 0.007), and previous cardiac surgery (p = 0.002). Long-term survival was worse in patients with RVD before TAVI compared with those without RVD (hazard ratio 1.97, 95% confidence interval 1.1 to 3.4, p = 0.01). One year after TAVI, 58.7% of patients with baseline RVD had normal RV function and had similar outcomes as compared with those without RVD at baseline. In contrast, patients with persistent RVD had the worst prognosis. In conclusion, RVD is not rare and has a deleterious prognostic impact in patients treated with TAVI. Recovery of normal RV function is frequent after TAVI, whereas persistence of RVD is associated with poor outcomes.
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Abdelrahman A, Dębski M, Qadri S, Guella E, Tay J, Wong KYK, Zacharias J. Association between pre-operative right ventricular impairment on transthoracic echocardiography and outcomes after conventional and minimally invasive mitral valve surgery. Acta Cardiol 2021; 76:895-903. [PMID: 32812498 DOI: 10.1080/00015385.2020.1800962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Right ventricular (RV) impairment may have prognostic value in patients undergoing mitral valve surgery. It is unclear whether RV dysfunction predicts long-term mortality, especially in the era of minimally invasive mitral surgery. METHODS We performed a retrospective analysis of consecutive patients referred for conventional (via sternotomy) and minimally invasive mitral valve surgery (MIMVS) between 01 January 2013 and 29 August 2018 in a tertiary cardiac centre. We truncated follow-up times at 25 March 2020. RV impairment was defined by reduced RV longitudinal function (TAPSE <17 mm) and/or dilated basal RV diameter (RVD1 > 42 mm). Primary outcome was all-cause mortality. RESULTS The study cohort included 359 patients followed up for a median period of 4.2 (1.8) years. MIMVS approach was performed in 127 (35.4%) and conventional approach in 232 (64.6%) patients of whom 36 (28%) and 45 (19%), respectively, had RV impairment. EuroSCORE II was significantly higher in patients with RV impairment compared with patients with preserved RV function, irrespective of the surgical approach. Consequently, in both groups, patients with RV impairment had significantly higher mortality compared to patients with preserved RV function. RV impairment adjusted for EuroSCORE II predicted mortality in the whole cohort (HR 2.139, 95% CI 1.249-3.663) and in conventional approach (HR 2.361, 95% CI 1.249-4.465) in contrast to MIMVS (HR 1.570, 95% CI 0.493-4.997). CONCLUSION In this real world cohort, patients with RV impairment and/or dilation had reduced long-term survival following both conventional surgery and MIMVS. Patients should be referred to surgery prior to worsening of RV function.
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Affiliation(s)
- Amr Abdelrahman
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Maciej Dębski
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Syed Qadri
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Elhosseyn Guella
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Justin Tay
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Kenneth Y. K. Wong
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
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10
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Allen BS. Myocardial protection: a forgotten modality. Eur J Cardiothorac Surg 2021; 57:263-270. [PMID: 31364690 DOI: 10.1093/ejcts/ezz215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022] Open
Abstract
The goals of a cardiac surgical procedure are both technical excellence and complete protection of cardiac function. Cardioplegia is used almost universally to protect the heart and provide a quiet bloodless field for surgical accuracy. Yet, despite the importance of myocardial protection in cardiac surgery, manuscripts or dedicated sessions at major meetings on this subject have become relatively rare, as though contemporary techniques now make them unnecessary. Nevertheless, septal dysfunction and haemodynamic support (inotropes, intra-aortic balloon pump, assist devices) are common in postoperative patients, indicating that myocardial damage following cardiac surgery is still prevalent with current cardioplegic techniques and solutions. This article first describes why cardiac enzymes and septal function are the ideal markers for determining the adequacy of myocardial protection. It also describes the underappreciated consequences of postoperative cardiac enzyme release or septal dysfunction (which currently occurs in 40-80% of patients) from inadequate protection, and how they directly correlate with early and especially late mortality. Finally, it reviews the various myocardial protection techniques available to provide a detailed understanding of the cardioplegic methods that can be utilized to protect the heart. This will allow surgeons to critically assess their current method of protection and, if needed, make necessary changes to provide their patients with optimal protection.
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Affiliation(s)
- Bradley S Allen
- Division of Acute Care Surgery, Department of Surgery, USC Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, CA, USA
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11
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Fortuni F, Hirasawa K, Bax JJ, Delgado V, Ajmone Marsan N. Multi-Modality Imaging for Interventions in Tricuspid Valve Disease. Front Cardiovasc Med 2021; 8:638487. [PMID: 33634175 PMCID: PMC7900427 DOI: 10.3389/fcvm.2021.638487] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Several studies have demonstrated that severe tricuspid regurgitation (TR) has a significant negative impact on morbidity and mortality. Nowadays, several therapeutic options to treat TR are available and patients at high surgical risk can also be treated with transcatheter procedures. For the management of patients with TR, an accurate assessment of the tricuspid valve and its surrounding structures is therefore of crucial importance and has gained significant interest in the medical community. Different imaging modalities can provide detailed information on the tricuspid valve apparatus, right ventricle, right atrium, and coronary circulation which are fundamental to define the timing and anatomic suitability of surgical and percutaneous procedures. The present review illustrates the role of 2D and 3D echocardiography, cardiac magnetic resonance, and multidetector row computed tomography for the assessment of the tricuspid valve and right heart with a particular focus on the data needed for planning and guiding interventional procedures.
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Affiliation(s)
- Federico Fortuni
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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12
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Borde D, Joshi P, Joshi S, Asegaonkar B, Apsingekar P, Khade S, Pande S, Agrawal A, Puranik M. Changes in Right Ventricular Function After Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 35:811-819. [PMID: 32739088 DOI: 10.1053/j.jvca.2020.06.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Right ventricular (RV) dysfunction is associated with poor outcomes after cardiac surgery. The aim of this study was to assess RV systolic and diastolic function in the perioperative period after off-pump coronary artery bypass grafting (OPCAB). DESIGN Prospective observational study. SETTINGS Tertiary care hospital. PARTICIPANTS Thirty adult patients undergoing OPCAB. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Transthoracic echocardiography was performed twice: first preoperatively and second postoperatively, when patients were moved to wards. The following five parameters of RV systolic function were used: tricuspid annular plane systolic excursion (TAPSE), systolic tissue Doppler imaging of lateral tricuspid annulus (S'), fractional area change (FAC), RV myocardial performance index (RIMP), and isovolumic acceleration (IVA). Grading of RV diastolic function (RVDD) was done as per guidelines. Paired t test was used for comparing means and χ2 test was used for categorical and ordinal data. The parameters of RV longitudinal function (TAPSE and S') reduced significantly (preoperative 21.93 ± 2.80 mm and 13.24 ± 2.24 cm/s to postoperative 11.67 ± 1.91 mm and 10.31 ± 1.56 cm/s, respectively, p < 0.001), whereas parameters of RV global function (FAC, RIMP, and IVA) remained preserved (preoperative 46.75 ± 6.80%, 0.34 ± 0.06, and 4.66 ± 0.87 m/s2 to postoperative 46.21 ± 6.44%, 0.36 ± 0.06, and 4.37 ± 0.83 m/s2; p values of 0.76, 0.13, and 0.11, respectively). The median grade of RVDD worsened from normal in the preoperative period to pseudo-normal in the postoperative period (p < 0.001). The changes in both RV systolic and diastolic function were similar in patients with normal and reduced left ventricular systolic function. CONCLUSIONS RV function can be assessed in perioperative settings with two-dimensional and tissue Doppler imaging. For systolic function assessment, exclusive measurement of longitudinal parameters might be inadequate; use of complementary global parameters like FAC, RIMP, and IVA is essential to complete the RV assessment after OPCAB. RVDD worsened significantly after OPCABG.
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Affiliation(s)
- Deepak Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
| | - Balaji Asegaonkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingekar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Sujeet Khade
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Swati Pande
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Ashish Agrawal
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
| | - Manish Puranik
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
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13
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Changes in Right Ventricle Function After Mitral Valve Repair Surgery. Heart Lung Circ 2020; 29:785-792. [DOI: 10.1016/j.hlc.2019.06.724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 01/05/2023]
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14
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Donauer M, Schneider J, Jander N, Beyersdorf F, Keyl C. Perioperative Changes of Right Ventricular Function in Cardiac Surgical Patients Assessed by Myocardial Deformation Analysis and 3-Dimensional Echocardiography. J Cardiothorac Vasc Anesth 2020; 34:708-718. [DOI: 10.1053/j.jvca.2019.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/11/2022]
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15
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Medvedofsky D, Koifman E, Jarrett H, Miyoshi T, Rogers T, Ben-Dor I, Satler LF, Torguson R, Waksman R, Asch FM. Association of Right Ventricular Longitudinal Strain with Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2020; 33:452-460. [PMID: 32033789 DOI: 10.1016/j.echo.2019.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Conventional right ventricular (RV) echocardiographic measurements of systolic function (SF) have demonstrated conflicting results when their association with long-term outcomes after transcatheter aortic valve replacement (TAVR) is evaluated. RV free-wall (FW) longitudinal strain (LS) is a novel, single parameter to measure RV SF and may provide a better evaluation than fractional area change, tricuspid annular plane systolic excursion, and myocardial velocity (S'). The value of RV FW LS in patients undergoing TAVR and its association with 1-year mortality are unknown. The aim of this study was to test the hypothesis that RV FW LS would be associated with 1-year all-cause mortality in patients undergoing TAVR. METHODS Consecutive patients who underwent TAVR between 2007 and 2014 in whom RV FW LS was measurable were included; a subgroup that had 1-year follow-up echocardiographic evaluation of RV FW LS was analyzed. FW LS was derived from speckle-tracking analyses. The standard reference was determined as normal or impaired RV SF, the latter defined as the presence of ≥50% of tricuspid annular plane systolic excursion < 1.7 cm, S' < 9.5 cm/sec, and fractional area change < 35%. Cox proportional-hazards regression analysis was used to assess the association of RV FW LS with 1-year all-cause mortality. RESULTS Of 612 patients, 334 were included for RV FW LS analysis on pre-TAVR echocardiography (feasibility 55%); exclusion criteria included atrial fibrillation (n = 92 [15%]), pacemaker (n = 73 [12%]), and poor image quality (n = 113 [18%]). Baseline impaired RV SF was present in 19% of cases. RV FW LS did not change significantly at 1-year follow-up, in both the groups with baseline impaired and normal function. Cox regression analysis showed that RV FW LS was associated with all-cause mortality at 1 year (hazard ratio, 1.06; 95% CI, 1.01-1.11). For each unit increase in RV FW LS, there was a 6% higher risk for 1-year mortality. CONCLUSIONS In a high-risk TAVR population, RV FW LS should be considered a single echocardiographic parameter for the assessment of RV SF. When measurable, RV FW LS is associated with all-cause mortality at 1 year after TAVR.
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Affiliation(s)
- Diego Medvedofsky
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Harish Jarrett
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Tatsuya Miyoshi
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Bootsma IT, Scheeren TWL, de Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. J Cardiothorac Vasc Anesth 2020; 34:2140-2147. [PMID: 32139346 DOI: 10.1053/j.jvca.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to identify whether the decrease of longitudinal parameters after cardiothoracic surgery (ie, tricuspid annular systolic plane excursion [TAPSE] and systolic excursion velocity [S']) is accompanied by a reduction in global right ventricular (RV) performance. DESIGN Prospective, observational study. SETTING Single-center explorative study in a tertiary teaching hospital. PARTICIPANTS The study comprised 20 patients who underwent aortic valve replacement with or without coronary artery bypass grafting. INTERVENTIONS During cardiac surgery, simultaneous measurements of RV function were performed with a pulmonary artery catheter and transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS TAPSE and S' were reduced significantly directly after surgery compared with the time before surgery (TAPSE from 20.8 [16.6-23.4] mm to 9.1 [5.6-15.5] mm; p < 0.001 and S' from 8.7 [7.9-10.7] cm/s to 7.2 [5.7-8.6] cm/s; p = 0.041). However, the reduction in TAPSE and S' was not accompanied by a reduction in RV performance, as assessed with the TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF). Both remained statistically unaltered before and after the procedure (MPI from 0.52 [0.43-0.58] to 0.50 [0.42-0.88]; p = 0.278 and RVEF from 27% [22%-32%] to 26% [22%-28%]; p = 0.294). CONCLUSIONS In the direct postoperative phase, the reduction of echocardiographic parameters of longitudinal RV contractility (TAPSE and S') were not accompanied by a reduction in global RV performance, expressed as MPI and RVEF. Solely relying on a single RV parameter as a marker for global RV performance may not be adequate to assess the complex adaptation of the right ventricle to aortic valve replacement.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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17
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Sauter RJ, Patzelt J, Mezger M, Nording H, Reil JC, Saad M, Seizer P, Schreieck J, Rosenberger P, Langer HF, Magunia H. Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR). IJC HEART & VASCULATURE 2019; 24:100413. [PMID: 31508480 PMCID: PMC6723083 DOI: 10.1016/j.ijcha.2019.100413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
Introduction In this study, we evaluated right ventricular (RV) function before and after percutaneous mitral valve repair (PMVR) using conventional echocardiographic parameters and novel 3DE data sets acquired prior to and directly after the procedure. Patients and methods Observational study on 45 patients undergoing PMVR at an university hospital. Results In the overall collective, the 3D RV-EF before and after PMVR showed no significant change (p = 0.16). While there was a significant increase of the fractional area change (FAC, from 23 [19–29] % to 28 [24–33] %, p = 0.001), no significant change of the tricuspid annular plane systolic excursion (TAPSE, from 17 ± 6 mm to 18 ± 5 mm (standard deviation), p = 0.33) was observed. Regarding patients with a reduced RV-EF (< 35%), a significant RV-EF improvement was observed (from 27 [23–34] % to 32.5 [30–39] % (p = 0.001). 71.4% of patients had an improved clinical outcome (improvement in 6-minute walk test and/or improvement in NYHA class of more than one grade), whereas clinical outcome did not improve in 28.6% of patients. Using univariate logistic regression analysis, the post-PMVR RV-EF (OR 1.15: 95% CI 1.02–1.29; p = 0.02) and the change in RV-EF (OR 1.13: 95% CI 1.02–1.25; p = 0.02) were significant predictors for improved clinical outcome at 6 months follow up. Conclusion Thus, RV function may be an important non-invasive parameter to add to the predictive parameters indicating a potential clinical benefit from treatment of severe mitral regurgitation using PMVR.
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Key Words
- 3D-echocardiography
- 3DE, 3D-echocardiography
- ACE, angiotensin converting enzyme
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FAC, fractional area change
- FMR, functional mitral regurgitation
- LA, left atrium
- LV, left ventricle
- LVOT, left ventricular outflow tract
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association functional classification
- Outcome
- PAMP, pulmonary artery mean pressure
- PASP, pulmonary artery systolic pressure
- PCWP, pulmonary capillary wedge pressure
- PMVR, percutaneous mitral valve repair
- Percutaneous mitral valve repair
- RV function
- RV, right ventricle
- TAPSE, tricuspid annular plane systolic excursion
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard J Sauter
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Matthias Mezger
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Henry Nording
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Jan-Christian Reil
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Mohammed Saad
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Peter Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Peter Rosenberger
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
| | - Harald F Langer
- University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany
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Chen S, Karmpaliotis D, Redfors B, Shlofmitz E, Ben-Yehuda O, Crowley A, Mehdipoor G, Puskas JD, Kandzari DE, Banning AP, Morice MC, Taggart DP, Sabik JF, Serruys PW, Kappetein AP, Stone GW. Does an occluded RCA affect prognosis in patients undergoing PCI or CABG for left main coronary artery disease? Analysis from the EXCEL trial. EUROINTERVENTION 2019; 15:e531-e538. [PMID: 31186220 DOI: 10.4244/eij-d-19-00263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The impact of an occluded right coronary artery (RCA) in patients with left main coronary artery disease (LMCAD) undergoing revascularisation is unknown. We compared outcomes for patients with LMCAD randomised to percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) according to the presence of an occluded RCA in the EXCEL trial. METHODS AND RESULTS The EXCEL trial randomised 1,905 patients with LMCAD and SYNTAX scores ≤32 to PCI with everolimus-eluting stents versus CABG. Patients were categorised according to whether they had an occluded RCA at baseline, and their outcomes were examined using multivariable Cox proportional hazards regression. The primary endpoint was a composite of death, stroke, or myocardial infarction at three years. Among 1,753 patients with a dominant RCA by core laboratory analysis, the RCA was occluded in 130 (7.4%) at baseline. PCI was attempted in 34 of 65 patients with an occluded RCA (52.3%) and was successful in 27 (79.4% of those attempted; 41.5% of all RCAs recanalised). The RCA was bypassed in 42 of 65 patients with an occluded RCA (64.6%; p=0.0008 versus PCI). The three-year absolute and relative rates of the primary endpoint were similar between PCI and CABG, in patients with or without an occluded RCA (pinteraction=0.92). CONCLUSIONS In the EXCEL trial, the presence of an occluded RCA at baseline did not confer a worse three-year prognosis in patients undergoing revascularisation for LMCAD and did not affect the relative outcomes of PCI versus CABG in this high-risk patient cohort.
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Affiliation(s)
- Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Korshin A, Grønlykke L, Nilsson JC, Møller-Sørensen H, Ihlemann N, Kjøller SM, Damgaard S, Lehnert P, Hassager C, Kjaergaard J, Ravn HB. Tricuspid annular plane systolic excursion is significantly reduced during uncomplicated coronary artery bypass surgery: A prospective observational study. J Thorac Cardiovasc Surg 2019; 158:480-489. [DOI: 10.1016/j.jtcvs.2018.09.114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/23/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022]
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20
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Harrington JK, Richmond ME, Woldu KL, Pasumarti N, Kobsa S, Freud LR. Serial Changes in Right Ventricular Systolic Function Among Rejection-Free Children and Young Adults After Heart Transplantation. J Am Soc Echocardiogr 2019; 32:1027-1035.e2. [PMID: 31202590 DOI: 10.1016/j.echo.2019.04.413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evolution of right ventricular (RV) systolic function after pediatric heart transplantation (HT) has not been well described. METHODS We analyzed echocardiograms performed over the first year after HT among children and young adults who remained rejection-free. Ninety-six patients (median age 7.1 [0.1-24.4] years at HT) were included: 22 infants (≤1 year) and 74 noninfants (>1 year). Two-dimensional tricuspid annular plane systolic excursion (TAPSE), tissue Doppler-derived tricuspid annular systolic velocity (S'), fractional area change (FAC), myocardial performance index (MPI), and two-dimensional speckle-tracking-derived RV global longitudinal (GLS) and free wall strain (FWS) were assessed. RESULTS All measures of RV function were impaired immediately after HT and significantly improved over the first year: TAPSE z-score (-8.15 ± 1.88 to -3.94 ± 1.65, P < .0001), S' z-score (-4.30 ± 1.36 to -2.28 ± 1.33, P < .0001), FAC (24.37% ± 7.71% to 42.02% ± 7.09%, P < .0001), MPI (0.96 ± 0.47 to 0.41 ± 0.22, P < .0001), GLS (-10.37% ± 3.86% to -21.05% ± 3.41%, P < .0001), and FWS (-11.2% ± 4.08% to -23.66% ± 4.13%, P < .0001). By 1 year post-HT, TAPSE, S', GLS, and FWS, remained abnormal, whereas FAC and MPI nearly normalized. Patients transplanted during infancy demonstrated better recovery of RV systolic function. CONCLUSIONS Although RV systolic function improved over the first year after HT in children and young adults without rejection, measures that assess longitudinal contractility remained abnormal at 1 year post-HT. These findings contribute to our understanding of RV myocardial contractility after HT in children and young adults and improve our ability to assess function quantitatively in this population.
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Affiliation(s)
- Jamie K Harrington
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc E Richmond
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kristal L Woldu
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Nikhil Pasumarti
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Serge Kobsa
- Department of Surgery, Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lindsay R Freud
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York.
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Averina II, Bockeria OL, Mironenko MY, Aleksandrova SA. [A. N. Bakoulev Scientific Center for Cardiovascular Surgery]. KARDIOLOGIYA 2019; 59:26-35. [PMID: 31131765 DOI: 10.18087/cardio.2019.5.10256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to assess dynamics of diastolic function for detection of development of diastolic dysfunction (DD) and it's causes, to evaluate the effect of DD on prognosis in the postoperative period in patients with acquired heart diseases. MATERIALS AND METHODS We included in this study 112 patients with aortic and mitral valve diseases (90 men, 22 women, median age 51 [35; 57] years). All patients underwent echocardiography (echo), tissue Doppler, speckle tracking echo prior to surgery, in the early postoperative period (8-14 days) and in 12-36 months after surgery. In 28 patients dynamic contrast-enhanced magnetic resonance imaging was also performed. Patients were divided into groups according to prognosis: group 0 - without complications; group 1 - with postoperative heart failure (HF) and preserved left ventricular ejection fraction (EF); group 2 - with HF and EF <45 %. The following parameters were used for identifying left ventricular (LV) DD: septal velocity es <7 cm / sec, lateral el <10 cm / sec, average E / e ratio >14, left atrial (LA) volume index >34 ml / m2, peak tricuspid regurgitation velocity >2.8 m / sec. RESULTS Initially diastolicLV function was normal in 34 of 112 patients (30.4 %), in early postoperative period DD emerged in 9 (26.5 %) of these patients. The appearance of LV DD was associated with decrease of septal es immediately after surgery and its subsequent progressive decline in the long-term postoperative period from 8.5±0.71 to 4.6 ±0.53 cm / sec (p=0.005). Worsening of diastolic function and lowering of septal velocity was detected namely in patients with presence of fibrosis. In the group of other patients in whom fibrosis was not studied and the degree of DD increased there was a transient decrease of lateral el (from 10.2±3.1 to 7.5±2.43 cm / sec, p=0.035) and an increase of the E / el (from 10.53±4.07 to 14.5±5.23, p=0.05) in the early period after the operation. There were no correlations between DD and LV EF,LV volumes, and development of arrhythmias. The prognostic model for DD included average longitudinal deformation of LA (global LA longitudinal strain) and E / e ratio on the tricuspid lateral annular velocity. CONCLUSIONS Appearance of DD in postoperative period after correction of acquired heart defects was due to damage of the septal diastolic function which correlated with fibrosis and was indicative of inadequate myocardial protection. The model of development of heart failure with normal EF after operation was designed.
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Affiliation(s)
- I I Averina
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
| | - O L Bockeria
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
| | - M Yu Mironenko
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
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22
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Right ventricular function after cardiac surgery: the diagnostic and prognostic role of echocardiography. Heart Fail Rev 2019; 24:625-635. [DOI: 10.1007/s10741-019-09785-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Dalén M, Oliveira Da Silva C, Sartipy U, Winter R, Franco-Cereceda A, Barimani J, Bäck M, Svenarud P. Comparison of right ventricular function after ministernotomy and full sternotomy aortic valve replacement: a randomized study. Interact Cardiovasc Thorac Surg 2019; 26:790-797. [PMID: 29325064 DOI: 10.1093/icvts/ivx422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac surgery, possibly because of the opening of the pericardium. In minimally invasive aortic valve replacement, the pericardium is only partially incised. METHODS A randomized trial compared RV function after ministernotomy versus full sternotomy in 40 adults undergoing aortic valve replacement at the Karolinska University Hospital. Primary outcomes were tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler velocity, RV fractional area change and basal and mid-RV transversal diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4, the tricuspid annular plane systolic excursion had decreased in both groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P < 0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler RV velocity decreased significantly in patients who underwent sternotomy [10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10 (9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001; sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not change on postoperative Day 4 in both groups. The differences between the 2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis function was reduced after both ministernotomy and full sternotomy aortic valve replacement, but the reduction was more pronounced in the full sternotomy group. Global RV function was equally impaired in both groups postoperatively. Clinical trial registration http://www.clinicaltrials.gov. Unique identifier: NCT01972555.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulrik Sartipy
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Reidar Winter
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jasmin Barimani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Svenarud
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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24
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Asami M, Stortecky S, Praz F, Lanz J, Räber L, Franzone A, Piccolo R, Siontis GC, Heg D, Valgimigli M, Wenaweser P, Roost E, Windecker S, Pilgrim T. Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2019; 12:577-587. [DOI: 10.1016/j.jcmg.2017.12.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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25
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Jadhav T, Kareem H, Nayak K, Pai U, Devasia T, Padmakumar R. A study of right ventricular function in pre- and post-valvular surgeries. Interv Med Appl Sci 2019; 10:137-144. [PMID: 30713752 PMCID: PMC6343576 DOI: 10.1556/1646.10.2018.31] [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] [Indexed: 11/19/2022] Open
Abstract
Aims The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients. Materials and methods This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed. Results The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) (p = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up (p = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up (p = 0.001). Conclusions After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.
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Affiliation(s)
- Tejaswi Jadhav
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Hashir Kareem
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Umesh Pai
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
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26
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Tajima M, Nakayama A, Uewaki R, Mahara K, Isobe M, Nagayama M. Right ventricular dysfunction is associated with exercise intolerance and poor prognosis in ischemic heart disease. Heart Vessels 2018; 34:385-392. [DOI: 10.1007/s00380-018-1253-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/31/2018] [Indexed: 01/19/2023]
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27
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Zanobini M, Loardi C, Poggio P, Tamborini G, Veglia F, Di Minno A, Myasoedova V, Mammana LF, Biondi R, Pepi M, Alamanni F, Saccocci M. The impact of pericardial approach and myocardial protection onto postoperative right ventricle function reduction. J Cardiothorac Surg 2018; 13:55. [PMID: 29866151 PMCID: PMC5987597 DOI: 10.1186/s13019-018-0726-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 05/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background The reduction of RV function after cardiac surgery is a well-known phenomenon. It could persist up-to one year after the operation and often leads to an incomplete recovery at follow-up echocardiographic control. The aim of the present study is to analyze the impact of different modalities of pericardial incision (lateral versus anterior) and of myocardial protection protocols (Buckberg versus Custodiol) onto postoperative RV dynamic by relating two- and three-dimensional echocardiographic parameters in patients undergoing mitral valve repair through minimally invasive or traditional surgery approach. Methods We have analyzed 44 consecutive patients with severe degenerative mitral regurgitation who underwent mitral reparation with different surgical approach and cardioplegia type: Group 1 (17 pts): sternotomy with Buckberg cardioplegia protocol; Group 2 (10 pts): sternotomy with Custodiol cardioplegia; Group 3 (17 pts): mini-invasive surgery with Custodiol cardioplegia. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post-surgery to evaluate RV function by tricuspid annular plane systolic excursion (TAPSE). Results All patients underwent successful and uneventful. A postoperative TAPSE reduction was found in all groups. However, mini-invasive patients experienced a significant reduced variation versus traditional surgery. Conclusions Mini-invasive mitral repair, with lateral incision of pericardium, reduces postoperative TAPSE fall, while cardioplegia protocol fails to have an impact onto longitudinal RV function. In our study, the RV seems to experience a clinically irrelevant geometrical modification too, whose entity appears to be less evident in case of lateral pericardial approach. These results could strengthen the use of minimally invasive approach also to preserve RV function.
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Affiliation(s)
- Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Claudia Loardi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Paolo Poggio
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Fabrizio Veglia
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Alessandro Di Minno
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Veronika Myasoedova
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Liborio Francesco Mammana
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Raoul Biondi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Mauro Pepi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy. .,Heart Center, University Hospital of Zürich, University of Zürich, Zürich, CH, Switzerland.
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28
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Hashemi N, Brodin LÅ, Hedman A, A Samad B, Alam M. Improved right ventricular index of myocardial performance in the assessment of right ventricular function after coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2018; 26:798-804. [DOI: 10.1093/icvts/ivx420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/05/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nashmil Hashemi
- Karolinska Institutet, Department of Clinical Sciences, Unit of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Physiology, Capio S:t Görans Hospital, Stockholm, Sweden
| | - Lars-Åke Brodin
- Department of medical engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Anders Hedman
- Karolinska Institutet, Department of Clinical Science, Section of cardiology, South Hospital, Stockholm, Sweden
| | - Bassem A Samad
- Karolinska Institutet, Department of Clinical Sciences, Unit of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Mahbubul Alam
- Karolinska Institutet, Department of Clinical Sciences, Unit of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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29
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Gorter TM, van Veldhuisen DJ, Bauersachs J, Borlaug BA, Celutkiene J, Coats AJS, Crespo-Leiro MG, Guazzi M, Harjola VP, Heymans S, Hill L, Lainscak M, Lam CSP, Lund LH, Lyon AR, Mebazaa A, Mueller C, Paulus WJ, Pieske B, Piepoli MF, Ruschitzka F, Rutten FH, Seferovic PM, Solomon SD, Shah SJ, Triposkiadis F, Wachter R, Tschöpe C, de Boer RA. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 20:16-37. [PMID: 29044932 DOI: 10.1002/ejhf.1029] [Citation(s) in RCA: 214] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 12/28/2022] Open
Abstract
There is an unmet need for effective treatment strategies to reduce morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Until recently, attention in patients with HFpEF was almost exclusively focused on the left side. However, it is now increasingly recognized that right heart dysfunction is common and contributes importantly to poor prognosis in HFpEF. More insights into the development of right heart dysfunction in HFpEF may aid to our knowledge about this complex disease and may eventually lead to better treatments to improve outcomes in these patients. In this position paper from the Heart Failure Association of the European Society of Cardiology, the Committee on Heart Failure with Preserved Ejection Fraction reviews the prevalence, diagnosis, and pathophysiology of right heart dysfunction and failure in patients with HFpEF. Finally, potential treatment strategies, important knowledge gaps and future directions regarding the right side in HFpEF are discussed.
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Affiliation(s)
- Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Andrew J S Coats
- Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia.,University of Warwick, Kirby Corner Road, Coventry CV4 8UW, UK
| | - Marisa G Crespo-Leiro
- Advanced Heart Failure and Heart Transplant Unit, Servicio de Cardiologia-CIBERCV, Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto Investigación Biomedica A Coruña (INIBIC), Universidad da Coruña (UDC), La Coruña, Spain
| | - Marco Guazzi
- Heart Failure Unit, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Mitja Lainscak
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Center Singapore, Singapore Duke-NUS Graduate Medical School, Singapore
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot, Paris, France
| | - Christian Mueller
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Walter J Paulus
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany, and Department of Internal Medicine Cardiology, German Heart Center Berlin, DZHK (German Center for Cardiovascular Research) and Berlin Institute of Health (BIH), Berlin, Germany
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G. da Saliceto Hospital, Piacenza, Italy
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zürich, Switzerland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School, Belgrade, Serbia
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Sanjiv J Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany and German Cardiovascular Research Center, partner site Göttingen
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany, and Department of Internal Medicine Cardiology, German Heart Center Berlin, DZHK (German Center for Cardiovascular Research) and Berlin Institute of Health (BIH), Berlin, Germany
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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30
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Bitcon CJ, Tousignant C. The effect of pericardial incision on right ventricular systolic function: a prospective observational study. Can J Anaesth 2017; 64:1194-1201. [DOI: 10.1007/s12630-017-0972-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022] Open
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31
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Couperus LE, Delgado V, van Vessem ME, Tops LF, Palmen M, Braun J, Verwey HF, Klautz RJM, Schalij MJ, Beeres SLMA. Right ventricular dysfunction after surgical left ventricular restoration: prevalence, risk factors and clinical implications. Eur J Cardiothorac Surg 2017; 52:1161-1167. [DOI: 10.1093/ejcts/ezx201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/21/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lotte E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke E van Vessem
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Harriëtte F Verwey
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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32
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Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit? BIOMED RESEARCH INTERNATIONAL 2017; 2017:4808757. [PMID: 28589141 PMCID: PMC5446880 DOI: 10.1155/2017/4808757] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022]
Abstract
Echocardiographic reduction of RV function, measured using TAPSE, is a well described phenomenon after cardiac surgery. The aim of the present study was to investigate the relation between the modality of pericardial opening (lateral versus anterior) and the postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair. 34 patients with severe mitral regurgitation due to mitral valve prolapse underwent traditional (sternotomy) operation (Group A) or minimally invasive surgery with right anterolateral thoracotomy (Group B). A postoperative TAPSE fall was found in both groups. Group A experienced a significant postoperative TAPSE fall versus Group B with p < 0.0001.
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33
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Preoperative right ventricular dysfunction should not preclude surgical ventricular restoration. J Thorac Cardiovasc Surg 2017; 153:853-854. [DOI: 10.1016/j.jtcvs.2016.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
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34
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Srinivasan A, Kim J, Khalique O, Geevarghese A, Rusli M, Shah T, Di Franco A, Alakbarli J, Goldburg S, Rozenstrauch M, Devereux RB, Weinsaft JW. Echocardiographic linear fractional shortening for quantification of right ventricular systolic function-A cardiac magnetic resonance validation study. Echocardiography 2017; 34:348-358. [PMID: 28247463 DOI: 10.1111/echo.13438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Echocardiography (echo)-based linear fractional shortening (FS) is widely used to assess left ventricular dysfunction (LVdys ), but has not been systematically tested for right ventricular dysfunction (RVdys ). METHODS The population comprised LVdys patients with and without RVdys (EF<50%) on cardiac MRI (CMR): Echo included standard RV indices (fractional area change [FAC], TAPSE, S', and FS in parasternal long-axis (RV outflow tract [RVOT ]) and apical four-chamber views (width [RVWD ], length [RVLG ]). RESULTS A total of 168 patients underwent echo and CMR (3±3 days); FAC (46±9 vs 28±11), TAPSE (1.9±0.4 vs 1.5±0.3), and S' (11.4±2.3 vs 10.0±2.6, all P≤.001) were lower among RVdys patients, as were FS indices (RVOT 32±8 vs 17±10 | RVWD 40±11 vs 22±12 | RVLG 16±5 vs 9±4%; all P<.001). FS indices yielded similar magnitude of correlation with CMR RVEF (r=.73-.56) as did FAC (r=.70), which was slightly higher than TAPSE (r=.47) and S' (r=.31; all P<.001). FS indices decreased stepwise vs CMR RVEF tertiles, as did FAC (all P<.001). In multivariate analysis, FS in RVOT (regression coefficient .51 [CI 0.37-0.65]), RVWD (0.30 [0.19-0.41]), and RVLG (0.45 [0.20-0.71]; all P≤.001) was independently associated with CMR RVEF. FS indices yielded good overall diagnostic performance (AUC: RVOT 0.89 [CI 0.82-0.97] | RVWD 0.87 [0.78-0.96] | RVLG 0.80 [0.70-0.90]; all P<.001) for CMR-defined RVdy (RVEF<50%). CONCLUSIONS RV linear FS provides RV functional indices that parallel CMR RVEF. Parasternal long-axis RVOT width, four-chamber RV width, and length are independently associated with RVEF, supporting use of multiple FS indices for RV functional assessment.
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Affiliation(s)
- Aparna Srinivasan
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jiwon Kim
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Omar Khalique
- Cardiology Division, Department of Medicine, Columbia University, New York, NY, USA
| | - Alexi Geevarghese
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Melissa Rusli
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tara Shah
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Antonino Di Franco
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Javid Alakbarli
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samantha Goldburg
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Meenakshi Rozenstrauch
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Richard B Devereux
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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35
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de Boer JM, Kuipers IM, Klitsie LM, Blom NA, ten Harkel ADJ. Decreased biventricular longitudinal strain shortly after congenital heart defect surgery. Echocardiography 2017; 34:446-452. [DOI: 10.1111/echo.13456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jonne M. de Boer
- Division of Pediatric Cardiology; Department of Pediatrics; Leiden University Medical Center; Leiden The Netherlands
| | - Irene M. Kuipers
- Division of Pediatric Cardiology; Department of Pediatrics; Academic Medical Center; Amsterdam The Netherlands
| | - Liselotte M. Klitsie
- Division of Pediatric Cardiology; Department of Pediatrics; Leiden University Medical Center; Leiden The Netherlands
| | - Nico A. Blom
- Division of Pediatric Cardiology; Department of Pediatrics; Leiden University Medical Center; Leiden The Netherlands
- Division of Pediatric Cardiology; Department of Pediatrics; Academic Medical Center; Amsterdam The Netherlands
| | - Arend D. J. ten Harkel
- Division of Pediatric Cardiology; Department of Pediatrics; Leiden University Medical Center; Leiden The Netherlands
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Koifman E, Didier R, Patel N, Jerusalem Z, Kiramijyan S, Ben-Dor I, Negi SI, Wang Z, Goldstein SA, Lipinski MJ, Torguson R, Gai J, Pichard AD, Satler LF, Waksman R, Asch FM. Impact of right ventricular function on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Am Heart J 2017; 184:141-147. [PMID: 28224928 DOI: 10.1016/j.ahj.2016.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction was shown to be associated with adverse outcomes in a variety of cardiac patients and is considered a risk factor for adverse outcome according to the updated Valve Academic Research Consortium criteria. OBJECTIVE Our goal was to assess the impact of RV function at baseline on 1-year mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS All patients with severe AS treated with TAVR from May 2007 to March 2015 at our center were included in the present study, and baseline and procedural characteristics were recorded for each patient. The patients were categorized according to RV function at baseline as assessed by current guidelines, and a comparison of mortality rates up to 1 year was performed. RESULTS Among 650 patients, 606 had adequate echocardiogram quality and 146 (24%) had RV dysfunction. There were significant differences between the 2 groups, as patients with RV dysfunction were younger (81±9 vs 84±7 years, P=.01) and were more likely to be male (65% vs 42%, P<.001). In addition, patients with RV dysfunction had higher rates of prior myocardial infarction (26% vs 16%, P=.02) and atrial fibrillation (51% vs 39%, P=.02). Echocardiographic parameters demonstrated higher rates of left ventricular ejection fraction <40% (40% vs 18%, P<.001), tricuspid regurgitation above moderate (16% vs 9%, P=.04), and higher pulmonary artery systolic pressure (50±17 vs 44±16 mm Hg, P<.001) among patients with severe AS and RV dysfunction compared with patients with normal RV function. Despite the unfavorable cardiac function, patients with severe AS undergoing TAVR have similar functional class (P=.22) and mortality rates at 1year (27% vs 23%, log-rank P=.45). CONCLUSIONS Patients with severe AS and RV dysfunction have similar 1-year mortality and functional class after TAVR to patients with normal RV function. The presence of RV dysfunction does not correlate with outcome in patients with severe AS.
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Affiliation(s)
- Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Romain Didier
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Nirav Patel
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Zack Jerusalem
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Sarkis Kiramijyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Smita I Negi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Zuyue Wang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Steven A Goldstein
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Michael J Lipinski
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
| | - Federico M Asch
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Grønlykke L, Ravn HB, Gustafsson F, Hassager C, Kjaergaard J, Nilsson JC. Right ventricular dysfunction after cardiac surgery – diagnostic options. SCAND CARDIOVASC J 2016; 51:114-121. [DOI: 10.1080/14017431.2016.1264621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lars Grønlykke
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens C. Nilsson
- Department of Cardiothoracic Anaesthesiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Tricuspid annular plane systolic excursion inaccuracy to assess right ventricular function in patients with previous tricuspid annulopasty. Int J Cardiol 2016; 223:713-716. [PMID: 27573594 DOI: 10.1016/j.ijcard.2016.08.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/16/2016] [Indexed: 01/08/2023]
Abstract
OBJETIVES The clinical and prognostic usefulness of tricuspid annular plane systolic excursion (TAPSE) is well established. However, the ability of TAPSE to assess right ventricular (RV) function in patients with previous tricuspid valve annulopasty is controversial. This study examined the TAPSE suitability in patients with previous tricuspid valve annuloplasty using right ventricular fractional area change (RVFAC) as reference method. METHODS We retrospectively analyzed 53 patients who underwent tricuspid valve annuloplasty at our hospital between 2013 and 2016. TAPSE and RVFAC were obtained in preoperative and postoperative periods using standard methodology. RESULTS Mean age was 68±12years and 34 patients (64.1%) were women. TAPSE decreased significantly after surgery in comparison with pre-surgical values (17±4.2 Vs 12.9±4.1mm, p<0.001). On the contrary, RVFAC did not change significantly after surgery (37±9.2 Vs 36.2.9, p=0.25). The correlation between RVFAC and TAPSE was better in the preoperative (r=0.63, p<0.0001) than in the postoperative period (r=0.38, P=0.005). Good intra- and interobserver agreement for TAPSE and RVFAC was obtained, with intraclass correlation coefficients of 0.97 and 0.92 for TAPSE; and 0.90 and 0.85 for RVFAC, respectively. CONCLUSIONS These findings suggest that TAPSE is not suitable after tricuspid valve annuloplasty and it leads to an underestimation of RV systolic function. It seems to be appropriate to rely on echocardiographic parameters of global RV function such as RVFAC in this context.
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Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: An observational study. Eur J Anaesthesiol 2016; 32:535-42. [PMID: 25192267 DOI: 10.1097/eja.0000000000000149] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several authors have suggested that right ventricular dysfunction (RVd) may contribute to renal dysfunction in nonsurgical patients. OBJECTIVES We tested the hypothesis that RVd diagnosed immediately after cardiac surgery may be associated with subsequent development of renal dysfunction and tried to identify the possible mechanisms. DESIGN A single-centre, prospective observational study. SETTING Amiens University Hospital, France. PATIENTS All adult patients undergoing cardiac surgery were considered eligible for participation. Patients who had undergone pulmonary or tricuspid valve surgery, repeat surgery or who underwent immediate postoperative renal replacement therapy were excluded. Data from 74 patients were analysed. MAIN OUTCOME MEASURES Left ventricular and right ventricular function were assessed before surgery and on admission to ICU by transthoracic echocardiography (TTE): left ventricular and right ventricular ejection fractions (LVEF/RVEF), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (Sr(t)) and right ventricular dilatation. RVd was defined as values in the lowest quartile of at least two echocardiographic variables. Renal dysfunction was defined as an increase in serum creatinine concentration (sCr) on postoperative day 1. RESULTS All right ventricular TTE variables decreased (P < 0.05) after surgery: RVEF from 50% (49 to 60) to 40% (35 to 50); TAPSE from 22.3 mm (19.4 to 25.3) to 12.2 mm (8.8 to 14.8); and Sr(t) from 15.0 cm s(-1) (12.0 to 18.0) to 8.1 cm s(-1) (6.3 to 9.2). Fourteen (19%) patients had right ventricular dilatation and RVd was present in 23 (31%) patients. Forty patients had a positive variation in sCr. In multivariate analysis, patients with RVd had an odds ratio (OR) of 12.7 [95% confidence interval (95% CI) 2.6 to 63.4, P = 0.02] for development of renal dysfunction. Renal dysfunction was associated with increased central venous pressure but was not associated with cardiac index (CI). CONCLUSION These results suggest that early postoperative RVd is associated with a subsequent increase of sCr and that the mechanism involved is congestion (vena cava dilatation/elevated CVP) rather than decreased CI.
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Van Orman JR, Connelly K, Albinmousa Z, Tousignant C. Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery – an observational study. Can J Anaesth 2016; 63:920-7. [DOI: 10.1007/s12630-016-0651-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/23/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022] Open
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Christiansen JR, Massey R, Dalen H, Kanellopoulos A, Hamre H, Ruud E, Kiserud CE, Fosså SD, Aakhus S. Right ventricular function in long-term adult survivors of childhood lymphoma and acute lymphoblastic leukaemia. Eur Heart J Cardiovasc Imaging 2016; 17:735-41. [DOI: 10.1093/ehjci/jew018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/13/2016] [Indexed: 11/13/2022] Open
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Bugnitz CJ, Miao Y, Berger GE, Galantowicz ME, Cheatham JP, Cua CL. Changes in right ventricular function in neonates with hypoplastic left heart syndrome before and after the hybrid procedure. Eur Heart J Cardiovasc Imaging 2016; 17:1379-1384. [DOI: 10.1093/ehjci/jev345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/10/2015] [Indexed: 11/14/2022] Open
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Rösner A, Avenarius D, Malm S, Iqbal A, Schirmer H, Bijnens B, Myrmel T. Changes in Right Ventricular Shape and Deformation Following Coronary Artery Bypass Surgery-Insights from Echocardiography with Strain Rate and Magnetic Resonance Imaging. Echocardiography 2015; 32:1809-20. [DOI: 10.1111/echo.12973] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Assami Rösner
- University Hospital North Norway; Tromsø Harstad Norway
| | | | - Siri Malm
- University Hospital North Norway; Tromsø Harstad Norway
- Department of Clinical Medicine; University of Tromsø; Tromsø Norway
| | - Amjid Iqbal
- University Hospital North Norway; Tromsø Harstad Norway
| | - Henrik Schirmer
- University Hospital North Norway; Tromsø Harstad Norway
- Department of Clinical Medicine; University of Tromsø; Tromsø Norway
| | - Bart Bijnens
- Pompeu Fabra; Barcelona University Spain
- The Catholic University Leuven; Leuven Belgium
| | - Truls Myrmel
- University Hospital North Norway; Tromsø Harstad Norway
- Department of Clinical Medicine; University of Tromsø; Tromsø Norway
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Hyllén S, Nozohoor S, Ingvarsson A, Meurling C, Wierup P, Sjögren J. Right Ventricular Performance After Valve Repair for Chronic Degenerative Mitral Regurgitation. Ann Thorac Surg 2014; 98:2023-30. [DOI: 10.1016/j.athoracsur.2014.07.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/28/2014] [Accepted: 07/30/2014] [Indexed: 01/09/2023]
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Nguyen T, Cao L, Movahed A. Altered Right Ventricular Contractile Pattern after Cardiac Surgery: Monitoring of Septal Function Is Essential. Echocardiography 2014; 31:1159-65. [DOI: 10.1111/echo.12657] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Tin Nguyen
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
| | - Long Cao
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
| | - Assad Movahed
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
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Durmaz T, Bayram H, Bayram N, Sari C, Keles T, Bastug S, Bozkurt E. Effect of coronary artery bypass surgery on left ventricular function as assessed by strain and strain rate imaging. Perfusion 2013; 29:425-33. [PMID: 24304544 DOI: 10.1177/0267659113513920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This study examined the effect of coronary artery revascularization on left ventricular function and the results of strain imaging for the detection of ischemia before and after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Sixty-eight patients with a history of coronary artery disease (CAD) were included, prospectively. Conventional echocardiography and color tissue Doppler-derived strain-strain rate echocardiographic imaging were performed 24 hours before and 3 months after CABG surgery. RESULTS While strain rate values of the basal septum, middle segment of the lateral wall, middle segment of the inferior wall, and middle and basal segments of the anterior wall were significantly increased, other segments did not change after the operation. The mean systolic strain rate value was significantly increased after the operation. Left ventricle strain values in the middle segment of the septum, middle and basal segments of the inferior wall, and middle and basal segments of the anterior wall were significantly increased after the operation. No significant difference was noted in the basal septum or the middle and basal segments of the lateral wall after the operation. The mean systolic strain value was significantly increased after the operation. CONCLUSION The results of this study suggest that strain and strain rate echocardiography can provide an accurate evaluation of regional contractile function after CABG, even in the segments that are apparently normal.
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Affiliation(s)
- T Durmaz
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - H Bayram
- Department of Cardiovascular Surgery, Ataturk Education and Research Hospital, Ankara, Turkey
| | - Na Bayram
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - C Sari
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - T Keles
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - S Bastug
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
| | - E Bozkurt
- Department of Cardiology, Ataturk Education and Research Hospital, Ankara, Turkey
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Okada DR, Rahmouni HW, Herrmann HC, Bavaria JE, Forfia PR, Han Y. Assessment of right ventricular function by transthoracic echocardiography following aortic valve replacement. Echocardiography 2013; 31:552-7. [PMID: 24304365 DOI: 10.1111/echo.12421] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) is a widely used clinical measure of right ventricular (RV) systolic performance. However, postsurgical changes in the pattern of RV contraction may limit the utility of TAPSE for assessing global RV function. We retrospectively examined pre- and postoperative TAPSE and RV fractional area change (FAC) in patients undergoing 3 different types of aortic valve replacement (AVR). METHODS Fifty-two patients enrolled in the Placement of AoRTic TraNscathetER Valve Trial at our institution were randomized to receive open AVR or transcatheter AVR (TAVR) by either the transapical or transfemoral access routes. Thirty-seven of these patients had analyzable transthoracic echocardiography (TTE) before and after AVR. Using M-mode echocardiography, TAPSE was measured in the apical four-chamber view. Using two-dimensional echocardiography, RV FAC was measured in the apical four-chamber view. RESULTS The mean change in TAPSE was -0.7 ± 0.6 cm for open AVR (P = 0.002), -0.2 ± 0.4 cm for transapical TAVR (P = 0.26), and 0.1 ± 0.5 cm for transfemoral TAVR (P = 0.64). The mean change in RV FAC was -1 ± 5% for open AVR (P = 0.91), 2 ± 4% for transapical TAVR (P = 0.37), and 7 ± 10% for transfemoral TAVR (P = 0.07). CONCLUSIONS The normal pattern of RV contraction was unchanged by transapical and transfemoral TAVR, while open AVR led to a significant decrease in TAPSE with preserved RV FAC. Thus, RV FAC is a preferable method for assessing RV function in the postoperative patient.
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Affiliation(s)
- David R Okada
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Pauliks LB, Valdes-Cruz LM, Perryman R, Scholl FG. Right ventricular wall-motion changes after infant open heart surgery--a tissue Doppler study. Echocardiography 2013; 31:209-17. [PMID: 24103038 DOI: 10.1111/echo.12347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a well-recognized complication of cardiopulmonary bypass surgery (CPB) in adults. Infants and neonates may also be at high risk for this due to immature myocardium. Conventional assessment of RV function is just qualitative, but novel tissue Doppler echocardiographic (TDI) markers including peak systolic strain rate (SR) and isovolumic contraction acceleration (IVA) permit noninvasive quantitation of RV function. This study assessed myocardial velocities, IVA and SR in infants and neonates undergoing open heart surgery using TDI to study regional myocardial function perioperatively. METHODS Transthoracic TDI data were obtained in the OR before and 24 hours post-CPB on 53 consecutive infants (age 0.39 ± 0.23 years). They were followed with TDI through hospital discharge. RESULTS Mean CPB time was 87 ± 49 min (cross-clamp 52 ± 26 min). Peak systolic (STDI ) and diastolic myocardial velocities (ETDI , ATDI ), IVA, and peak SR were recorded in RV and LV from standard views for offline analysis. Postoperatively, LV systolic function and diastolic longitudinal function were unchanged or improved from baseline. LV radial velocities were increased postoperatively indicating adequate support. In contrast, RV longitudinal systolic and diastolic function was significantly diminished after CPB. RV changes persisted through hospital discharge. CONCLUSIONS In infants and neonates, perioperative measurements of systolic and diastolic tissue Doppler parameters are feasible and revealed significant RV systolic and diastolic dysfunction post-CPB with preserved LV function. As such, TDI provides a sensitive tool to monitor the infant heart after CPB and may potentially be useful to assess different myocardial protection strategies.
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Affiliation(s)
- Linda B Pauliks
- Pediatric Cardiology, Penn State Hershey Medical College, Hershey, Pennsylvania
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D’Andrea A, Riegler L, Nunziata L, Scarafile R, Gravino R, Salerno G, Amarelli C, Maiello C, Limongelli G, Di Salvo G, Caso P, Bossone E, Calabrò R, Pacileo G, Russo MG. Right heart morphology and function in heart transplantation recipients. J Cardiovasc Med (Hagerstown) 2013; 14:648-58. [DOI: 10.2459/jcm.0b013e32835ec634] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ulus AT, Poyraz NY, Arat N, Babaroğlu S, Parlar Aİ, Yavaş S, Unlü M. Right ventricular and septal function in patients with pulmonary hypertension. Heart Lung Circ 2013; 22:1003-10. [PMID: 23906876 DOI: 10.1016/j.hlc.2013.04.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pulmonary hypertension (PHT) exacerbates the functions of both ventricles. This prospective, randomised study was planned to investigate the effects of PHT on kinetics of both ventricles and the septum. METHODS Twenty-five patients were randomly selected among the patients who had been planned to undergo mitral valve replacement (MVR) because of isolated mitral stenosis and divided into two groups according to their preoperative pulmonary artery pressure (PAP) values. Blood pool gated single photon emission tomography (BPGS) and transthoracic echocardiography were performed. Ventricles' regional, global and functional parameters were also assessed by using pulsed wave Doppler tissue imaging (DTI). RESULTS Preoperative and postoperative PAP of the group 1 (PAP < 50 mmHg) were 40.0 ± 2.8 and 30.0 ± 2.6 mmHg (p = 0.03), group 2 (PAP ≥ 50 mmHg) were 71.9 ± 4.7 and 50.6 ± 3.5 mmHg (p < 0.05). The global right and left ventricle scores were decreased after the operation. The decrement was only significant in group 2. Considering the septal kinetics, right ventricle septal score was decreased from 7.6 to 3.3 (p < 0.05) in group 1, from 3.8 to 1.6 (p < 0.05) in group 2 postoperatively. CONCLUSION Following MVR, a decrement in PAP values, and an improvement in ventricular function, especially in the right ventricular and septal kinetics were achieved. Furthermore, it was found that both DTI and BPGS techniques are beneficial to investigate the functional changes postoperatively and in the follow-up period of the patients who undergo mitral valve surgery.
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Affiliation(s)
- A Tulga Ulus
- Department of Cardiovascular Surgery, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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