Abstract
Introduction
Recently more attention has been placed on right ventricle (RV) parameters in acute settings. The present study investigates echocardiographic RV parameters in patients with acute heart failure (AHF) or non-AHF acute dyspnoea.
Purpose
To determine the patterns of RV injury in different profiles of acute dyspnoea.
Methods
Prospective multicentre observational study included 1455 acutely dyspnoeic patients from 2015 to 2017. RV focused echocardiography was performed during the first 48 hours in 452 (31%) patients. They were compared in three patient profiles based on cause of dyspnoea and history of chronic HF (CHF): 1) AHF; 2) Non-AHF with CHF (Non-AHF+CHF); 3) other non-AHF patients (Non-AHF+other).
Results
Significant differences in RV morphology and function were observed in the study groups (Table 1). RV global function assessed by tricuspid annular plane systolic excursion (TAPSE) and RV longitudinal shortening was mostly affected in AHF patients. This was accompanied by more enlarged RV and increased right atrial pressure (RAP), assessed by the inferior vena cava diameter and respiratory collapse. Less severely impaired RV function and increased RAP were also observed in non-AHF+CHF patients indicating RV involvement in the chronic disease. Normal RV parameters dominated in Non-AHF+other group, however pulmonary artery systolic pressure >40 mmHg was observed in all profiles, suggesting similar severity of pulmonary hypertension in cardiac or pulmonary causes of acute dyspnoea.
Table 1. RV parameters in acute dyspnoea profiles Parameter AHF (n=291) Non-AHF + CHF (n=73) Non-AHF + other (n=88) p value LVEF, % 38 [25–55] 50 [40–55] 55 [50–55] <0.001 RV basal diameter, cm 4.5 [3.9–5.2] 4 [3.5–4.5] 4 [3.5–4.55] <0.001 TAPSE, cm 1.5 [1.2–1.8] 1.8 [1.6–2] 2 [1.5–2.4] <0.001 RV free wall strain, -% −15.3 [−19; −11.24] −19.3 [−24.5; −15.78] −23 [−24.5; −19.69] <0.001 Entire RV strain, -% −12.03 [−15.17; −9.11] −16.4 [−19.31; −10.5] −18 [−18.75; −16.9] <0.001 PASP >40, % 66% 51% 50% 0.039 IVC diameter, cm 2.4 [2–2.8] 2 [1.7–2.4] 1.8 [1.4–2.3] <0.001 IVC collapse, % 34.9 [19.7–50.2] 44.1 [28.7–59.3] 52.6 [35–72.7] <0.001 LVEF, left ventricular ejection fraction; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure; IVC, inferior vena cava; AHF, acute heart failure; CHF, chronic heart failure.
Conclusions
Our data confirm more pronounced acute failure of right ventricle in acute heart failure patients than in chronic heart failure patients admitted due to other causes of dyspnoea. Pulmonary hypertension is present in a majority of the acute dyspnoea patients.
Acknowledgement/Funding
The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.
Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria
