Peri-operative myocardial performance in infants with Down syndrome undergoing CHD repair

2021 ◽  
pp. 1-9
Author(s):  
Lyudmyla Zakharchenko ◽  
Afif EL-Khuffash ◽  
Eleanor J. Molloy ◽  
Colm Breatnach ◽  
Orla Franklin
Keyword(s):  
Down Syndrome ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Systolic Pressure ◽  
Wall Stress ◽  
Left Ventricular ◽  
Myocardial Performance ◽  
Ventricular Systolic Pressure ◽  
Intensive Care Stay

Abstract Background: We aimed to characterise the impact of Down syndrome on myocardial performance and loading conditions in infants with Down syndrome and CHD over the peri-operative period by comparing them with infants matched for cardiac lesion with a normal microarray. Methods: Left ventricular global longitudinal strain, right ventricular free wall longitudinal strain, left ventricular end-systolic wall stress, and right ventricular systolic pressure were measured in the two groups over the peri-operative period. Results: Fifty-five infants had a diagnosis of Down syndrome and these were compared with 29 control infants. Left ventricular global longitudinal strain decreased in both groups post-operatively with the Down syndrome group demonstrating some recovery pre-discharge (18 ± 3 versus 16 ± 3 %, p = 0.01). Right ventricular longitudinal strain significantly decreased in both groups post-operatively with the control group demonstrating better recovery by hospital discharge (14 ± 4 versus 18 ± 6 %, p < 0.01). End-systolic wall stress was lower and right ventricular systolic pressure was higher in the Down syndrome group throughout the study period (all p < 0.05). Down syndrome was an independent predictor of the duration of ventilation, post-operative use of inotropes, and intensive care stay. Right ventricular longitudinal strain was an independent predictor of duration of intensive care stay. Conclusion: This study demonstrates the difference between the two groups in relation to left and right ventricular function, particularly prior to discharge, and outlines the additional impact a diagnosis of Down syndrome has on myocardial performance during the peri-operative period.

Abstract 16574: Heart Failure Biomarkers (NT-proBNP, Gal-3, sST2) Correlate With Right Ventricular Systolic Pressure and Provide Insight to Poor CRT Response: A BIOCRT Substudy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Roderick C Deaño ◽  
Jackie Szymonifka ◽  
Qing Zhou ◽  
Jigar H Contractor ◽  
Zachary Lavender ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Fold Increase ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Cardiac Transplant ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Crt Response

Objective: Patients with heart failure (HF) and pulmonary hypertension (PH) have worse outcomes after cardiac resynchronization therapy (CRT). The relationship of circulating HF biomarkers and right ventricular systolic pressure (RVSP) may provide insight to the mechanism between PH and poor CRT response. Methods: In 90 patients (age 65 ± 13, 78% male, EF 26 ± 8%, RVSP 44 ± 12 mmHg) undergoing CRT, we measured baseline RVSP by echocardiography and obtained peripheral blood samples drawn at the time of device implantation. We measured levels of established and emerging HF biomarkers (Table 1). CRT non-response was defined as no improvement of adjudicated HF Clinical Composite Score at 6 months. Major adverse cardiac event (MACE) was defined as composite endpoint of death, cardiac transplant, left ventricular assist device, and HF hospitalization within 2 years. Results: There were 34% CRT non-responders and 27% had MACE. Per 1 unit increase in log-transformed RVSP, there was an 11-fold increase risk of having CRT non-response (odd ratio [OR] 11.0, p=0.01) and over 5-fold increase of developing 2-year MACE (hazard ratio [HR] 5.8, p=0.02). When comparing patients with severe PH (RVSP>60 mmHg) to those without PH (RVSP < 35 mmHg), there was an 8-fold increase in CRT nonresponse (OR 8.4, p=0.03) but no difference in MACE (p=NS). RVSP was correlated with increased biomarker levels of myocardial stretch and fibrosis, but not myocardial necrosis (Table 1). Conclusions: Higher RVSP is associated with greater rates of CRT non-response and adverse clinical outcomes. The mechanistic association between severe PH and CRT nonresponse may be explained by the biomarker profile reflective of myocardial wall stretch and fibrosis.

scholarly journals 1187 Evaluation of left and right ventricular functions with 3D speckle tracking in patients with mitral stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O Seckin ◽  
S Unlu ◽  
G Tacoy
Keyword(s):  
Right Ventricular ◽  
Mitral Stenosis ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Control Group ◽  
Free Wall ◽  
Significant Difference

Abstract Background The function of both ventricles have been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricles (LV) in mild and moderate rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). Methods A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. An example for RV assessment is shown in Figure 1. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS and interventricular septal (IVS) LS measurements were analyzed. Results The LV ejection fraction (EF), RV fractional area change and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group (ANOVA,p &lt; 0.001) (Table 1). Patients with MS showed higher torsional values, correlated with MS severity (ANOVA,p &lt; 0.001) (Table 1). IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The FW-GLS values only showed significant difference between the control group and moderate MS group (Table 1). Conclusion Patients with mitral stenosis showed lower LV-GLS and higher LV torsion values. Although the LV GLS is affected; the LV EF was detected to be normal due to increase in LV torsion. RV deformation indices showed signıficant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE. Table 1 Parameters Control group Mild MS Moderate MS P LV GLS (%) 23.3 ± 2.08 18.9 ± 1.3 17.5 ± 1.8 &lt;0.001 LV torsion 1.5 ± 0.6 2.1 ± 0.6 2.6 ± 0.5 &lt;0.001 IVS LS (%) 23 ± 3.0% 20 ± 2.6 17.1 ± 2.9 &lt;0.001 RV FW LS (%) 25.4 ± 5 22.7 ± 3.2 21.1 ± 4.8 &lt;0.001 FW; free-wall, GLS; global longitudinal strain, IVS; interventricular septum, LV; left ventricular, RV; right ventricular Abstract 1187 Figure 1

Right ventricular systolic pressure load alters myocyte maturation in fetal sheep

2000 ◽  
Vol 279 (4) ◽  
pp. R1157-R1164 ◽  
Author(s):  
A. Barbera ◽  
G. D. Giraud ◽  
M. D. Reller ◽  
J. Maylie ◽  
M. J. Morton ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Systolic Pressure ◽  
Weight Ratio ◽  
Left Ventricular ◽  
Volume Data ◽  
Fetal Sheep ◽  
Ventricular Systolic Pressure ◽  
Hypertrophic Growth ◽  
Maximal Pressure ◽  
Near Term

The effects of right ventricular (RV) systolic pressure (RVSP) load on fetal myocyte size and maturation were studied. Pulmonary artery (PA) pressure was increased by PA occlusion from mean 47.4 ± 5.0 (±SD) to 71 ± 13.6 mmHg ( P < 0.0001) in eight RVSP-loaded near-term fetal sheep for 10 days. The maximal pressure generated by the RV with acute PA occlusion increased after RVSP load: 78 ± 7 to 101 ± 15 mmHg ( P< 0.005). RVSP-load hearts were heavier (44.7 ± 8.4 g) than five nonloaded hearts (31.8 ± 0.2 g; P < 0.03); heart-to-body weight ratio (10.9 ± 1.1 and 6.5 ± 0.9 g/kg, respectively; P < 0.0001). RVSP-RV myocytes were longer (101.3 ± 10.2 μm) than nonloaded RV myocytes (88.2 ± 8.1 μm; P < 0.02) and were more often binucleated (82 ± 13%) than nonloaded myocytes (63 ± 7%; P < 0.02). RVSP-loaded myocytes had less myofibrillar volume than did nonloaded hearts (44.1 ± 4.4% and 56.1 ± 2.6%; P < 0.002). We conclude that RV systolic load 1) leads to RV myocyte enlargement, 2) has minor effects on left ventricular myocyte size, and 3) stimulates maturation (increased RV myocyte binucleation). Myocyte volume data suggest that RV systolic loading stimulates both hyperplastic and hypertrophic growth.

Abstract 14015: Right Ventricular Remodeling is Additive to Global Longitudinal Strain in Predicting Long Term Survival in Patients with Pulmonary Hypertension

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Akiko Goda ◽  
Keiko Ryo ◽  
Antonia M Delgado ◽  
Bhupendar Tayal ◽  
Marc Simon ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Area Ratio ◽  
Term Survival ◽  
Long Term Outcome ◽  
Remodeling Index

Introduction: Right ventricular (RV) global longitudinal strain has been recently shown to be a marker of prognosis in patients with pulmonary hypertension (PH) but the additive role of RV remodeling on long term outcome is unclear. Hypothesis: Our aim was to test the hypothesis that RV remodeling measured by the RV area to left ventricular (LV) area ratio is additive to RV longitudinal strain in predicting prognosis in PH. Methods: We studied 120 PH patients, excluding patients with LVEF<50%, congenital heart disease, or coronary disease and 15 normal subjects. We measured the RV to LV area ratio in the 4 chamber view at end-diastole as an RV remodeling index and calculated the peak RV global longitudinal strain using 2D speckle tracking. Outcome events were predefined as death or lung transplantation over 8 years. Results: The RV-LV area ratio was larger in PH patients than in normal control subjects as expected (0.64±0.09 vs. 1.18±0.59, p<0.001). Using the RV global longitudinal strain cut off of -15% previously reported, it was significantly associated with death or lung transplant (AUC 0.629, p=0.0138). When the RV remodeling index RV-LV area ratio > 0.73 was combined with RV global longitudinal strain > -15%, patients had a significantly worse prognosis compared to RV strain value or RV remodeling index alone (p=0.0017; Hazard Ratio 2.29, 95% confidence interval of 1.34 to 3.9). Conclusion: RV remodeling by the echocardiographic RV-LV area ratio was additive to RV global longitudinal strain at predicting long term outcomes in PH patients and has promise for clinical applications.

scholarly journals Morphological changes and myocardial function assessed by traditional and novel echocardiographic methods in preadolescent athlete’s heart

2018 ◽  
Vol 25 (9) ◽  
pp. 1000-1007 ◽  
Author(s):  
Anders W Bjerring ◽  
Hege EW Landgraff ◽  
Svein Leirstein ◽  
Anette Aaeng ◽  
Hamza Z Ansari ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular Mass ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Right Atrial ◽  
End Diastolic Volume ◽  
Ventricular Mass ◽  
Athlete's Heart

Background Athlete’s heart is a term used to describe the morphological and functional changes in the hearts of athletes. Recent studies suggest that these changes may occur even in preadolescent athletes. This study aims to improve our understanding of the changes occurring in the preadolescent athlete’s heart. Design and methods Cardiac morphology and function in 76 preadolescent cross-country skiers (aged 12.1 ± 0.2 years) were compared with 25 age-matched non-competing preadolescents. Echocardiography was performed in all subjects, including 2D speckle-tracking strain echocardiography and 3D echocardiography. All participants underwent cardiopulmonary exercise testing to assess oxygen uptake and exercise capacity. Results Athletes had greater indexed VO2 max (62 ± 7 vs. 44 ± 5 mL/kg per min, p < 0.001), indexed left ventricular end-diastolic volume (79 ± 7 vs. 68 ± 7 mL/m2, p < 0.001), left ventricular mass (69 ± 12 vs. 57 ± 13 g/m2, p < 0.001), indexed right ventricular basal diameter (28.3 ± 3.0 vs. 25.4 ± 3.5 mm/m2, p < 0.001) and right atrial area (10.6 ± 1.4 vs. 9.7 ± 1.2 cm2/m2, p < 0.01). There was no difference in left ventricular ejection fraction, global longitudinal strain, and global circumferential strain and right ventricular fractional area change between the groups. Controls had higher right ventricular global longitudinal strain (−28.1 ± 3.5 vs. −31.1 ± 3.3%, p < 0.01). VO2 max was highly correlated to left ventricular end-diastolic volume ( r = 0.76, p < 0.001). Conclusion Athletes had greater left ventricular mass and greater left and right ventricular chamber dimensions compared with controls, while left ventricular function did not differ. Interestingly, right ventricular deformation was significantly lower compared with controls. This supports the notion that there is physiological, adaptive remodelling in preadolescent athlete’s heart.

scholarly journals Right ventricular pressure response to exercise in adults with isolated ventricular septal defect closed in early childhood

2018 ◽  
Vol 28 (6) ◽  
pp. 797-803 ◽  
Author(s):  
Thomas Moller ◽  
Harald Lindberg ◽  
May Brit Lund ◽  
Henrik Holmstrom ◽  
Gaute Dohlen ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Function ◽  
Right Ventricular ◽  
Septal Defect ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pressure Response ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Response To Exercise

AbstractWe previously demonstrated an abnormally high right ventricular systolic pressure response to exercise in 50% of adolescents operated on for isolated ventricular septal defect. The present study investigated the prevalence of abnormal right ventricular systolic pressure response in 20 adult (age 30–45 years) patients who underwent surgery for early ventricular septal defect closure and its association with impaired ventricular function, pulmonary function, or exercise capacity. The patients underwent cardiopulmonary tests, including exercise stress echocardiography. Five of 19 patients (26%) presented an abnormal right ventricular systolic pressure response to exercise ⩾ 52 mmHg. Right ventricular systolic function was mixed, with normal tricuspid annular plane systolic excursion and fractional area change, but abnormal tricuspid annular systolic motion velocity (median 6.7 cm/second) and isovolumetric acceleration (median 0.8 m/second2). Left ventricular systolic and diastolic function was normal at rest as measured by the peak systolic velocity of the lateral wall and isovolumic acceleration, early diastolic velocity, and ratio of early diastolic flow to tissue velocity, except for ejection fraction (median 53%). The myocardial performance index was abnormal for both the left and right ventricle. Peak oxygen uptake was normal (mean z score −0.4, 95% CI −2.8–0.3). There was no association between an abnormal right ventricular systolic pressure response during exercise and right or left ventricular function, pulmonary function, or exercise capacity. Abnormal right ventricular pressure response is not more frequent in adult patients compared with adolescents. This does not support the theory of progressive pulmonary vascular disease following closure of left-to-right shunts.

Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community

2019 ◽  
Vol 27 (18) ◽  
pp. 2006-2015
Author(s):  
Naoko Sawada ◽  
Koki Nakanishi ◽  
Masao Daimon ◽  
Yuriko Yoshida ◽  
Jumpei Ishiwata ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Abdominal Adiposity ◽  
Ventricular Mechanics ◽  
Increased Risk

Aims Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain. Methods We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS). Results Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were −19.1 ± 3.0% and −25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS ( r = 0.46 and r = 0.15, both p < 0.01) and RVLS ( r = 0.38 and r = 0.12, both p < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both p < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS ( r = –0.34, p < 0.001) and RVLS ( r = –0.25, p < 0.001), although it lost statistical significance following multivariable adjustment. Conclusion In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.

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