scholarly journals Pulmonary hypertension with or without right ventricular failure as short-term prognostic predictors in patients with AHF

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Quintana Da Silva ◽  
JE Gimenez ◽  
J Martinez ◽  
J Ojeda ◽  
D Gomes
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Left Ventricular Ejection ◽  
Ventricular Failure ◽  
Ventricular Ejection Fraction ◽  
Prognostic Predictors

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Different registries have reported Right Ventricular Failure (RVF) as a predictor of IH mortality in patients with AHF. However, the association of different degrees of Pulmonary Hypertension (PH) associated with or without RVF as prognostic predictors of IH mortality and Rehospitalization (RH) at 60 days is not well stablished. Methods We included 394 consecutive patients from January 2012 to August 2020 with the primary diagnosis of AHF and different degrees of PH with or without RVF. IH mortality and RH after 60 days of patients with AHF and the presence of RVF with or without PH were evaluated and stratified by severity into mild, moderate and severe PH and forms of presentation of AHF. Univariate, bivariate and multivariate analysis was performed by logistic regression of the independent variables. The qualitative variables were analyzed by the chi square test and the quantitative variables by T Test. P was considered significant at values <0.05. Results  The mean age was 74 years, 40% female, HBP 49%, dyslipidemia 52%, obesity 52%, type 2 DM 42%, smoking 28% and COPD 26%. 16% were de novo AHF and 84% with exacerbated CHF. Global RVF 6%. PH was present in 60%, being 24% mild, 25% moderate, 10% severe. The Left ventricular Ejection fraction (LVEF) mean was 52% (SD ± 15.1); Preserved 60%, Intermediate Range 18% and Reduced 22%. The IH mortality was 6.6% and the RH rate at 60 days was 21%. In the bivariate analysis for IH mortality, RVF was identified as an independent predictor of mortality (p = 0.001) nor for RH (p = 0.857). The different levels of PH were not identified as predictors of IH Mortality as well as RH. LVEF ranges did not show significant differences, nor in the forms of AHF presentation. The combined analysis of RVF or Left with different degrees of PHT did not show significant differences in IH mortality and RH.In the multivariate analysis by logistic regression for IH mortality, the presence of RVF maintained independence as a predictor variable (p = 0.004). Conclusion  In our population of patients with AHF, the presence of RVF is a predictor of IH mortality regardless of the presence of PH, the PH and LVEF ranges. The presence of RVF was not associated with a higher rate of RH at 60 days.

scholarly journals Transitioning from Preclinical to Clinical Heart Failure with Preserved Ejection Fraction: A Mechanistic Approach

2020 ◽  
Vol 9 (4) ◽  
pp. 1110 ◽  
Author(s):  
Antoni Bayes-Genis ◽  
Felipe Bisbal ◽  
Julio Núñez ◽  
Enrique Santas ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Left Atrial ◽  
Interstitial Fibrosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

To better understand heart failure with preserved ejection fraction (HFpEF), we need to better characterize the transition from asymptomatic pre-HFpEF to symptomatic HFpEF. The current emphasis on left ventricular diastolic dysfunction must be redirected to microvascular inflammation and endothelial dysfunction that leads to cardiomyocyte remodeling and enhanced interstitial collagen deposition. A pre-HFpEF patient lacks signs or symptoms of heart failure (HF), has preserved left ventricular ejection fraction (LVEF) with incipient structural changes similar to HFpEF, and possesses elevated biomarkers of cardiac dysfunction. The transition from pre-HFpEF to symptomatic HFpEF also involves left atrial failure, pulmonary hypertension and right ventricular dysfunction, and renal failure. This review focuses on the non-left ventricular mechanisms in this transition, involving the atria, right heart cavities, kidneys, and ultimately the currently accepted driver—systemic inflammation. Impaired atrial function may decrease ventricular hemodynamics and significantly increase left atrial and pulmonary pressure, leading to HF symptoms, irrespective of left ventricle (LV) systolic function. Pulmonary hypertension and low right-ventricular function are associated with the incidence of HF. Interstitial fibrosis in the heart, large arteries, and kidneys is key to the pathophysiology of the cardiorenal syndrome continuum. By understanding each of these processes, we may be able to halt disease progression and eventually extend the time a patient remains in the asymptomatic pre-HFpEF stage.

scholarly journals Pulmonary Hypertension Related to Left-Sided Cardiac Pathology

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Todd L. Kiefer ◽  
Thomas M. Bashore
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Pressure Overload ◽  
Therapeutic Strategies ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
Valve Disease ◽  
Ventricular Failure ◽  
Cardiac Pathology ◽  
Pathologic Processes

Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed.

P3800Defibrillation for right ventricular dysfunction - An echocardiographic method for therapy selection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Montenegro Sa ◽  
J Almeida ◽  
P Fonseca ◽  
M Oliveira ◽  
H Goncalves ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Prevention ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Independent Predictor ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Baseline Characteristics

Abstract Introduction Cardiac resynchronization therapy (CRT) is recommended for heart failure (HF) patients with left ventricular ejection fraction (LVEF) <35% and QRS>130 mseg. We aim to identify if baseline transthoracic echocardiographic (TTE) data can predict the need for defibrillation therapies in a primary prevention HF population referred for CRT implant. Methods We analyzed 119 consecutive HF patients in primary prevention referred for CRT implantation between 2004 and 2016. All patients underwent TTE before implantation. During a mean follow-up time of 58.4±33.9 months, all patients were evaluated with device interrogation every 6 months. In order to determine which parameters can predict sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) occurrence, a multivariate analysis was performed including previous medical history, baseline laboratorial, electro and echocardiographic data. Results We included 86.6% (n=106) males, mean age at implant 65.5±9.7 years. A CRT-defibrillator (CRT-D) was implanted in 82 (64.2%) patients and a VT or VF was documented in 16 patients (13.4%). Baseline characteristics are presented in the table. After multivariate analysis, baseline right ventricular dysfunction (defined as TAPSE≤18mm) was an independent predictor for VT or VF occurrence (OR=4.83, 95CI 1.67–6.25, p=0.002). Baseline characteristics VT/VF (n=16) No VT/VF (n=103) P-value Age (years, mean ± SD) 62,4±7,9 66,2±9,5 0,135 Female gender (n, %) 2 (12,5) 14 (15,1) 0,572 Ischemic cardiomyopathy (n, %) 7 (43,8) 21 (22,6) 0,073 NYHA III + IV (n, %) 13 (81,3) 76 (73,8) 0,984 QRS width (mseg, mean ± SD) 168,5±19,5 177,6±22,2 0,142 Atrial fibrillation (n, %) 5 (31,3) 17 (18,3) 0,089 LVEF (%, mean ± SD) 24,6±4,8 26,3±6,3 0,302 TAPSE (mm, mean ± SD) 14,9±4,9 17,9±4,3 0,034 PASP (mmHg, mean ± SD) 48,5±9,4 43,5±14,6 0,419 Mitral regurgitation (moderate or greater, n, %) 5 (31,3) 24 (28,9) 0,077 iVol (mL/m2, mean ± SD) 134,2±36,6 128,7±44,1 0,690 CRT-D implantation (n, %) 16 (100,0) 60 (64,5) 0,002 Conclusion In a real-world HF population, right ventricular dysfunction defined by echocardiography was an independent predictor for VT or VF occurrence. This may help more accurate patient selection for CRT-D implantation.

scholarly journals The value of ventricular gradient for predicting pulmonary hypertension and mortality in hemodialysis patients

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
A. Jaroszyński ◽  
T. T. Schlegel ◽  
T. Zaborowski ◽  
T. Zapolski ◽  
W. Załuska ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Strong Predictor ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Left Atrial Volume Index ◽  
Flow Acceleration

AbstractPulmonary hypertension (PHT) is associated with increased mortality in hemodialysis (HD) patients. The ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) is sensitive to early changes in right ventricular overload. The study aimed to assess the ability of the VG-RVPO to detect PHT and predict all-cause and cardiac mortality in HD patients. 265 selected HD patients were enrolled. Clinical, biochemical, electrocardiographic, and echocardiographic parameters were evaluated. Patients were divided into normal and abnormal VG-RVPO groups, and were followed-up for 3 years. Abnormal VG-RVPO patients were more likely to be at high or intermediate risk for PHT, were older, had longer HD vintage, higher prevalence of myocardial infarction, higher parathormone levels, shorter pulmonary flow acceleration time, lower left ventricular ejection fraction, higher values of left atrial volume index, left ventricular mass index, and peak tricuspid regurgitant velocity. Both all-cause and CV mortality were higher in abnormal VG-RVPO group. In multivariate Cox analysis, VG-RVPO remained an independent and strong predictor of all-cause and CV mortality. In HD patients, abnormal VG-RVPO not only predicts PHT, but also all-cause and CV mortality.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

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