Right Ventricular Dysfunction and Its Contribution to Morbidity and Mortality in Left Ventricular Heart Failure

2018 ◽  
Vol 15 (2) ◽  
pp. 94-105 ◽  
Author(s):  
Amresh Raina ◽  
Talha Meeran
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Morbidity And Mortality

scholarly journals Evaluation of ventricular systolic dysfunction as a risk factor for acute kidney injury in intensive care unit

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ahmed Aly Obiedallah ◽  
Ashraf Anwar E. L. Shazly ◽  
Noura Gamal Nasr ◽  
Essam M. Abdel Aziz
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Kidney Injury ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Abstract Background Heart failure (HF) is a major health problem. Cardiac and renal diseases interact in a complex bidirectional manner in both acute and chronic settings. Renal dysfunction in the setting of heart failure, termed the cardio renal syndrome (CRS), has been considered consequence of left ventricular dysfunction (LVD), whereby decreasing cardiac output (COP) results in renal under perfusion and consequent decreased glomerular filtration rate (GFR). Main body of the abstract This study showed that 500 patients were admitted to internal care unit (ICU), and out of them, 100 (20%) patients developed acute kidney injury (AKI) while 400 (80%) patients did not develop AKI. It is also showed that 67 (67%) of those with AKI and 100 (25%) of those with no-AKI had baseline ventricular systolic dysfunction, left ventricular dysfunction (LVD), right ventricular dysfunction (RVD), and biventricular dysfunction (BiVD)presented in 23 (23%), 16 (16%), and 28 (28%) patients of AKI group, respectively, and presented in 60 (15%), 30 (7.50%), and 10 (2.50%) patients, respectively, in patients without acute kidney injury (AKI) Short conclusion Our study revealed that AKI has highest incidence in patient with biventricular dysfunction followed by left ventricular dysfunction and lastly those with right ventricular dysfunction.

Prevalence and prognostic value of right ventricular dysfunction in hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Marques ◽  
A.R Pereira ◽  
I Cruz ◽  
A.R Almeida ◽  
S Alegria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hypertrophic Cardiomyopathy ◽  
Right Ventricular ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict. Objectives To assess the prevalence, predictors and prognostic value of right ventricular (RV) dysfunction in patients (pts) with HCM. Methods Retrospective single-center study of consecutive pts with HCM evaluated in a specialized medical appointment. Selected those submitted to cardiac magnetic resonance imaging (MRI) as the gold-standard for RV function assessment. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned heart failure admission. Results Were included 112 pts (mean age at first appointment 57±15 years, 63% male). Septal asymmetric phenotype was the most frequent (75%), with a mean septal wall thickness of 18±4 mm. Late gadolinium enhancement was observed in 82%, mostly intramyocardial (67%) and in joint points (47%). RV dysfunction was detected in 6 pts (5.4%) and RV free wall hypertrophy in 3 pts (2.7%); no patient presented RV dilation. Factors associated with RV dysfunction were left atria area (HR 1.07/unit, 95% CI 1.01–1.12, p=0.02), left ventricular ejection fraction (HR 0.91/unit, 95% CI 0.86–0.97, p=0.02) and the presence of left ventricle wall motion abnormalities (HR 7, 95% CI 1.3–38, p=0.03) in cardiac MRI. During a mean follow-up of 60±31 months, the combined primary endpoint occurred in 15 pts (13%), significantly more in pts with RV dysfunction (HR 5.1, 95% CI 1.1–24, p=0.038) (graphic 1). Patients with RV dysfunction also presented more atrial fibrillation / flutter episodes during follow-up (HR 6.4, 95% CI 2.1–20, p=0.001). Conclusions Although not common, right ventricular dysfunction was associated with a higher rate of cardiovascular events. These results support a potential role of right ventricular function in the risk stratification of patients with hypertrophic cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Right ventricular dysfunction and pulmonary hypertension: a neglected presentation of thyrotoxicosis

2018 ◽  
Vol 2018 ◽  
Author(s):  
Carolina Shalini Singarayar ◽  
Foo Siew Hui ◽  
Nicholas Cheong ◽  
Goay Swee En
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Newly Diagnosed ◽  
Right Heart

Summary Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves’ disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal echocardiographic parameters were resolved in most cases after rendering the patients euthyroid. Right ventricular dysfunction and pulmonary hypertension are not well-recognized complications of thyrotoxicosis. They are life-threatening conditions that can be reversed with early recognition and treatment of thyrotoxicosis. Signs and symptoms of right ventricular dysfunction should be sought in all patients with newly diagnosed thyrotoxicosis, and prompt restoration of euthyroidism is warranted in affected patients before the development of overt right heart failure. Learning points: Thyrotoxicosis is associated with right ventricular dysfunction and pulmonary hypertension apart from left ventricular dysfunction described in typical thyrotoxic cardiomyopathy. Symptoms and signs of right ventricular dysfunction and pulmonary hypertension should be sought in all patients with newly diagnosed thyrotoxicosis. Thyrotoxicosis should be considered in all cases of right ventricular dysfunction or pulmonary hypertension not readily explained by other causes. Prompt restoration of euthyroidism is warranted in patients with thyrotoxicosis complicated by right ventricular dysfunction with or without pulmonary hypertension to allow timely resolution of the abnormal cardiac parameters before development of overt right heart failure.

scholarly journals Review Article: Management of Perioperative Anesthesia in Right Heart Failure

2018 ◽  
Vol 54 (1) ◽  
pp. 75
Author(s):  
Fajar Perdhana ◽  
Herdono Purnomo
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Heart Failure ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Ventricular Failure ◽  
Right Heart

Right ventricular dysfunction and failure receive much less attention than the left ventricular failure. Right ventricular dysfunction or failure is associated with increased mortality rates in cardiac surgery, surgical cases other than cardiac surgery and also in patients treated in the ICU. The purpose of this article review was to describe the anatomy, physiology and pathophysiology of right ventricular failure, its detection and diagnosis, and management considerations from anesthetic point of view, including preoperative, intraoperative and postoperative stages. Cardiac surgery may result in right ventricular failure. For example, 0.1% post cardiotomy patients experience severe right heart failure and require long-term inotropic support, and so do 2-3% of post-transplant patients, and 20-30% of patients installed with instrument in his left heart. Therefore, anesthesiologists play a major role in perioperative and postoperative intensive care and are obliged to comprehend the nature of right ventricular dysfunction and failure so as to carry out early detection, prevent and manage patients with right ventricular dysfunction.

Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheter)

2015 ◽  
Author(s):  
Romain Barthélémy ◽  
Etienne Gayat ◽  
Alexandre Mebazaa
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Artery Catheter ◽  
Acute Heart Failure ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Haemodynamic Instability

Haemodynamic instability in acute cardiac care may be related to various mechanisms, including hypovolaemia and heart and/or vascular dysfunction. Although acute heart failure patients are often admitted for dyspnoea, many mechanisms can be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography often helps to assess the mechanism of cardiac dysfunction, it cannot be considered as a monitoring tool. In some cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), pulmonary artery catheter can help to assess and monitor cardiovascular status and to evaluate response to treatments. Last, macro- and microvascular dysfunctions are also important determinants of haemodynamic instability.

Pathophysiology and clinical assessment of the cardiovascular system (including pulmonary artery catheterization)

2021 ◽  
pp. 115-126
Author(s):  
Alessandro Sionis ◽  
Etienne Gayat ◽  
Alexandre Mebazaa
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Cardiovascular System ◽  
Acute Heart Failure ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Diastolic Dysfunction

The underlying pathophysiological derangements of the cardiovascular system in many medical conditions are often complex. Acute circulatory dysfunction can be related broadly to a cardiogenic cause leading to acute heart failure or be secondary to hypovolaemia or vascular dysfunction (e.g. sepsis). Different mechanisms may be involved, including left ventricular diastolic and/or systolic dysfunction and/or right ventricular dysfunction. Many aspects of left ventricular function are explained by considering ventricular pressure–volume characteristics. Epidemiological studies show that clinical signs at admission, morbidity, and mortality differ between the main scenarios of acute heart failure: left ventricular diastolic dysfunction, left ventricular systolic dysfunction, right ventricular dysfunction, and cardiogenic shock. Although echocardiography is usually the first investigation used to assess the mechanism of cardiac dysfunction, in selected cases (in particular, in cases of refractory shock secondary to both vascular and heart dysfunction or in cases of refractory haemodynamic instability associated with severe hypoxaemia), the pulmonary artery catheter can help to assess and monitor the cardiovascular status and evaluate response to treatments.

Hyponatraemia and its prognosis in acute heart failure is related to right ventricular dysfunction

Heart ◽  
2017 ◽  
Vol 104 (20) ◽  
pp. 1670-1677 ◽  
Author(s):  
Heesun Lee ◽  
Sang Eun Lee ◽  
Chan Soon Park ◽  
Jin Joo Park ◽  
Ga Yeon Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Acute Heart Failure ◽  
Propensity Scores ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Tertiary Hospitals ◽  
Registration Number ◽  
The Impact

ObjectivesHyponatraemia is a well-known predictor of clinical outcomes in heart failure (HF). However, the mechanism remains poorly understood. Previous reports suggest that hyponatraemia is related to right HF. We sought to evaluate the association between right ventricular (RV) dysfunction and hyponatraemia, and the impact of this relationship on the prognosis of patients with acute heart failure (AHF).MethodsThis is a nested case–control study of the Korean Acute Heart Failure registry. Among 2935 AHF patients enrolled prospectively and consecutively at four tertiary hospitals in Korea from 2011 to 2014, 116 patients with severe persistent hyponatraemia, defined as serum sodium level <130 mmol/L at admission and <135 mmol/L before discharge, were matched with 232 controls, based on propensity scores for hyponatraemia. RV function was assessed with fractional area change (FAC) by echocardiography.ResultsRV dysfunction (FAC <35%) was more prevalent in patients with severe persistent hyponatraemia than in those without (81.0% vs 33.6%, p<0.001). Hyponatraemia was strongly associated with RV dysfunction (adjusted OR 8.00, 95% CI 4.50 to 14.22, p<0.001), but not with left ventricular dysfunction (adjusted OR 1.21, 95% CI 0.74 to 1.50, p=0.308). RV dysfunction was an independent predictor of all-cause mortality, after adjustment for hyponatraemia (adjusted HR 2.20, 95% CI 1.53 to 3.15, p<0.001), while hyponatraemia was not (adjusted HR 1.33, 95% CI 0.94 to 1.87, p=0.108).ConclusionsIn patients with AHF, hyponatraemia was more common with RV dysfunction. RV dysfunction, rather than hyponatraemia, was more significantly related with patients’ prognosis. Thus, the utility of RV dysfunction instead of hyponatraemia per se should be considered in HF risk models.Trial registration numberKorean Acute Heart Failure registry NCT01389843; Results.

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