Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index

2020 ◽  
Vol 29 (6) ◽  
pp. 867-873 ◽  
Author(s):  
Muddassir Mehmood ◽  
Robert W.W. Biederman ◽  
Ronald J. Markert ◽  
Mary C. McCarthy ◽  
Kathryn M. Tchorz
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Pulsatility Index ◽  
Heart Function ◽  
Right Heart Failure ◽  
Right Heart ◽  
Right Heart Function ◽  
Patients At Risk ◽  
Pulmonary Arterial

The Hemodynamic Characteristics of Right Ventricle After Gradient Pulmonary Artery Banding in Rats

2020 ◽  
Author(s):  
Song Jiyang ◽  
Wan Nan ◽  
Shen Shutong ◽  
Wei Ying ◽  
Cao Yunshan
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Heart Failure ◽  
Therapeutic Strategies ◽  
Pulmonary Artery Banding ◽  
Right Heart ◽  
Pulmonary Arterial ◽  
The Right

Abstract Background: Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary disorders. Reliable and reproducible animal models of RV failure are important in order to investigate disease mechanisms and effects of potential therapeutic strategies. To establish a rat model of RV failure perfectly, we observed the right ventricle and carotid artery hemodynamics characteristics in different degrees of pulmonary artery banding of rats of different body weights. Methods: Rats were subjected to 6 groups：control(0%, n=5)(pulmonary arterial banding 0%), PAB(1-30%, n=4)(pulmonary arterial banding1-30%), PAB(31-60%, n=6)(pulmonary arterial banding31-60%),PAB(61-70%, n=5)(pulmonary arterial bandin61-70%), PAB(71-80%,n=4)(pulmonary arterial banding71-80%), PAB(100%, n=3)(pulmonary arterial banding 100%). We measured the right ventricular pressure(RVP) by right heart catheterization when the pulmonary arterial was ligated. Results: The RVP gradually increased with increasing degree of banding, but when occlusion level exceeding 70%, high pressure state can be only maintained for a few minutes or seconds, and then the RVP drops rapidly until it falls below the normal pressure, which in Group F particularly evident.Conclusions: RVP have different reactions when the occlusion level is not the same, and the extent of more than 70% ligation is a successful model of acute right heart failure. These results may have important consequences for therapeutic strategies to prevent acute right heart failure.

Pre-operative pulmonary artery pulsatility index does not predict mortality post cardiac transplantation but PVR is a prognostic tool in LVAD-bridged patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Bart ◽  
S.L Hungerford ◽  
S Emmanuel ◽  
K Kearney ◽  
E Kotlyar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Pulsatility Index ◽  
Cardiac Transplantation ◽  
Right Heart Failure ◽  
Right Heart ◽  
Post Transplant ◽  
Significant Difference

Abstract   The Pulmonary artery pulsatility index (PAPi) is a novel haemodynamic marker that has been shown to be a strong predictor of right heart failure and mortality in patients with pulmonary hypertension and advanced heart failure. Its utility in predicting post transplant outcomes is currently unknown. Aim To determine the prognostic significance of pre-transplant haemodynamic assessment of PAPi, right atrial pressure (RA), and pulmonary vascular resistance (PVR) in predicting mortality post cardiac transplant. Methods All patients who underwent cardiac transplantation between January 2010 and June 2016 were retrospectively analyzed. Pre-operative right heart catheter data was obtained. The PAPi was calculated as the systolic pulmonary artery pressure (sPAP)- diastolic pulmonary artery pressure (dPAP) divided by RA. Statistical analysis was carried out using SPSS v25. Results A total of 158 patients, with a mean age of 48.6±13.5 were studied (115 non- LVAD, 43 LVAD pre-transplant), and 3 patients were excluded due to missing data. There was no significant difference in the non-LVAD group in RA, PVR or PAPi for mortality post transplant. In the LVAD group there was no significant difference in RA, or PAPi with regards to mortality, however there was a significant difference in mean PVR between those that died post transplant (222±100) and those still alive (138±59) Conclusion Despite having a role in prognostication for right heart failure in pulmonary hypertension and post LVAD implantation, PAPi did not discriminate mortality outcomes for patients post cardiac transplantation. PVR remains a marker of mortality in an LVAD cohort bridged to transplant. Funding Acknowledgement Type of funding source: None

scholarly journals Elevated serum circ_0068481 levels as a potential diagnostic and prognostic indicator in idiopathic pulmonary arterial hypertension

2019 ◽  
Vol 9 (4) ◽  
pp. 204589401988841 ◽  
Author(s):  
Ying Zhang ◽  
Yongbin Chen ◽  
Hua Yao ◽  
Zhenbang Lie ◽  
Guo Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Heart Function ◽  
Univariate Analysis ◽  
Right Heart Failure ◽  
Idiopathic Pulmonary Arterial Hypertension ◽  
Circular Rnas ◽  
Right Heart ◽  
Pulmonary Arterial

Circular RNAs have continuous, stable, and covalently closed circular structures and are not easily degraded by nucleases, thus they are ideal serum biomarkers for detecting diseases. However, research is still lacking on circular RNAs as diagnostic and prognostic markers for idiopathic pulmonary arterial hypertension. This study investigated the potential role of serum circ_0068481 levels in idiopathic pulmonary arterial hypertension diagnosis and prognosis. This prospective cohort study enrolled 82 patients with idiopathic pulmonary arterial hypertension between January 2016 and July 2018 at Guangdong Provincial People’s Hospital. Serum circ_0068481 levels were measured using quantitative reverse transcription-polymerase chain reaction. Baseline data, including clinical background, hemodynamic variables, and biochemical variables, were collected. Receiver operating characteristic curves were used to investigate diagnostic effect, the Kaplan–Meier method was used to estimate survival rates, and univariate analysis of prognostic factors was performed with a Cox proportional hazard model. We found that serum circ_0068481 expression levels were significantly higher in patients with idiopathic pulmonary arterial hypertension and had higher sensitivity and specificity for predicting idiopathic pulmonary arterial hypertension. Additionally, we found that circ_0068481 expression correlated significantly with heart function, 6-min walk distance, serum N-terminal pro-B-type natriuretic peptide, serum H2S, the 6th World Symposium on Pulmonary Hypertension risk stratification, right heart failure, and patient death. Moreover, serum circ_0068481 levels were elevated in patients with idiopathic pulmonary arterial hypertension and right heart failure and were able to predict right heart failure. Serum circ_0068481 levels were also elevated in patients who died with idiopathic pulmonary arterial hypertension and were able to predict poorer clinical outcomes. Circ_0068481 is a novel and noninvasive biomarker for diagnosing idiopathic pulmonary arterial hypertension and predicting poor clinical outcome in patients with idiopathic pulmonary arterial hypertension.

scholarly journals SAPHIRE: Stress and Pulmonary Hypertension in Rheumatoid Evaluation—A Prevalence Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
G. E. M. Reeves ◽  
N. Collins ◽  
P. Hayes ◽  
J. Knapp ◽  
M. Squance ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Heart Failure ◽  
Pulmonary Artery Hypertension ◽  
Exercise Echocardiography ◽  
Right Heart ◽  
High Prevalence ◽  
Autoimmune Conditions ◽  
Pulmonary Arterial

Pulmonary artery hypertension (PAH) is a disorder of elevated resistance in the pulmonary arterial vessels, reflected by elevation of measured pulmonary artery pressure (PAP), and presenting with breathlessness and, if untreated, progressing to right heart failure and death. The heightened prevalence of PAH in populations with underlying systemic autoimmune conditions, particularly scleroderma and its variants, is well recognised, consistent with the proposed autoimmune contribution to PAH pathogenesis, along with disordered thrombotic, inflammatory, and mitogenic factors. Rheumatoid arthritis (RA) is one of a group of systemic autoimmune conditions featuring inflammatory symmetrical erosive polyarthropathy as its hallmark. This study explored the prevalence of PAH in a population of unselected individuals with RA, using exercise echocardiography (EchoCG). The high prevalence of EchoCG-derived elevation of PAP (EDEPP) in this population (14%) suggests that, like other autoimmune conditions, RA may be a risk factor for PAH. Patients with RA may therefore represent another population for whom PAH screening with noninvasive tools such as EchoCG may be justified.

scholarly journals A case report: intravalvular regurgitation during percutaneous valve-in-ring implantation due to eccentric bulging of a balloon-expandable valve in a patient with severe right heart failure

2019 ◽  
Author(s):  
Muhammed Gerçek ◽  
René Schramm ◽  
Lech Paluszkiewicz ◽  
Tanja Katharina Rudolph
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Heart Function ◽  
Right Heart Failure ◽  
Alternative Methods ◽  
Tricuspid Valve Repair ◽  
Heart Team ◽  
Valve Repair ◽  
Right Heart ◽  
Right Heart Function

Abstract Background Severely reduced right heart function and high operative risk are major challenges in the treatment of tricuspid regurgitation (TR) as both can lead to low cardiac output heart failure (LCO-Hf). Alternative methods and criteria for patient selection are actively being sought. Case summary We report on a 66-year-old patient with severe right heart failure (rHF) with recurrent TR after prior surgical valve repair with a 32-mm-Edwards-MC3 annuloplasty ring (AR). Surgical revision was discarded due to extreme high surgical risk. A right ventricular assist device was discussed but declined by the patient. Percutaneous edge-to-edge repair was not applicable due to massive tethering of the anterior leaflet and complete lack of coadaptation. According to the Heart team decision, percutaneous tricuspid valve-in-ring implantation was performed using a 29-mm Sapien-3 prosthesis (SP3) under moderate balloon overinflation. Despite satisfying positioning, the prosthesis showed massive intravalvular regurgitation due to immobility of the septally oriented cusp, which was most likely caused by eccentric bulging of the prosthesis in the opening region of the AR. Implantation of a second prosthesis leads to a perfectly functional result. Importantly, no major haemodynamic complications ensued. Discussion Although being a potential risk of tricuspid valve repair LCO-hf could not be observed in the present case. Additionally, deformation of the implanted transcatheter aortic valve replacement prosthesis resulting from the regional lack of abutment in AR should be considered as a potential complication. Hence, further careful evaluation of the feasibility of percutaneous tricuspid valve treatment, also in patients with rHF, is needed.

scholarly journals Phenotyping right heart function for prognosticating heart failure

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Cho ◽  
T Uejima ◽  
H Hayama ◽  
Y Yajima ◽  
Y Yamashita
Keyword(s):  
Heart Failure ◽  
Cluster Analysis ◽  
Right Ventricular ◽  
Heart Function ◽  
Hazard Analysis ◽  
Right Heart Failure ◽  
Left Heart ◽  
Right Heart ◽  
Right Heart Function ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: None. Background Right heart failure has been shown to portend poor prognosis. The pathophysiology of right heart function is complex, as right ventricular (RV) function is easily affected by preload and afterload. Purpose To test the hypothesis that machine learning would detect heterogeneity in right heart function and improve risk stratifications in a heart failure population Methods This study included 403 heart failure patients who had a history of hospitalization for decompensation. Patients were excluded if they had primary heart valve disease or pericardial disease or a previous cardiac surgery. Hierarchical clustering was undertaken on right heart variables (RV strain, right ventricular systolic pressure (RVSP), vena contracta of tricuspid regurgitation (TR) and diameter of inferior vena cava) to identify homogenous groups of patients with similar profiles of the variables. Cox hazard analysis was used to elucidate the benefit of clustering over each variable for prognosticating heart failure. Endpoint was hospitalization for worsening heart failure. Results Cluster analysis identified three groups with distinct right heart function. Cluster 1 (n = 191) represented patients with preserved RV function and low RVSP (figure A).  On the other hand, cluster 2 (n = 144) had reduced RV function and low RVSP, while cluster 3 (n = 68) had preserved RV function and high RVSP, associated with severe TR and high central venous pressure. The latter 2 clusters carried worse outcome than cluster 1 (p < 0.001, figure B). Cox hazard analysis demonstrated that, although the addition of each right heart variable to baseline model constructed from left heart variables did not improve predictive power, clusters predicted events with a hazard ratio of 1.566, independent from and incremental to the left heart variables (Figure C). Conclusion Cluster analysis identified two distinct phenotypes of right heart failure that were associated with adverse outcomes. This data-driven phenotyping can help in categorizing right heart failure and better prognosticating heart failure. Abstract Figure.

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