3D right ventricular ejection fraction and longitudinal strain are independent predictors of major adverse cardiovascular events in patients with rrhythmogenic right ventricular cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Hosseini ◽  
A Sadeghpour ◽  
M Maleki ◽  
A Alizadehasl ◽  
N Rezaeian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Cardiovascular Events ◽  
Longitudinal Strain ◽  
P Value ◽  
Free Wall ◽  
Ventricular Cardiomyopathy ◽  
Rv Function

Abstract Introduction Evaluation of right ventricular (RV) function is essential in the follow up of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Role of advance echocardiography including 3D transthoracic echocardiography (3DTTE) for evaluation of 3D RV function and RV longitudinal strain in predicting prognosis in ARVC patients, has not been well investigated. Purpose We aimed to evaluate 3DTTE parameters in predicting major advance cardiovascular events (MACE) defined as ventricular arrhythmia, cardiac hospitalization, heart transplantation, and death in ARVC patients. Methods Forty-eight definite ARVC subjects based on the 2010 Task force criteria were evaluated with standard 2D transthoracic echocardiography (2DTTE) and 3DTTE. Patients with poor image quality were excluded. RV function was evaluated by 2D and 3D TTE including: fractional area change (FAC), RV global and free wall longitudinal strain (RV2DGLS and RV2DFWLS) and 3D RV ejection fraction (RV3DEF), RV global and free wall longitudinal strain (RV3DGLS, and RV3DFWLS). The patients were followed up for a median period of 12 months (6–18 months) to record MACE. Results Forty-eight patients with mean age =38.5±14 years; 79.2% male, and mean RV3DEF =30.33%, were included. During the mean follow up 12 months, 12 patients (25%, with mean RV3DEF = 24.8±9%) experienced MACE whereas mean RV3EF in patient without any cardiovascular events during follow up was 34.21±9%. The most common causes of hospitalization were arrhythmia, right-sided heart failure, and RV clot as the following: Ventricular arrhythmia in 7 patients (14.6%, with mean RV3DEF = 29.01±8.82%), RV clot in 2 cases (4.2%, with mean RV3DEF = 20.2%), right-sided heart failure in 3 patients (6.3%, with mean RV3DEF = 16.83±3.6%) that 2 of them (2.1%, with mean RV3DEF = 14.58±0.63) underwent heart transplantation. Logistic regression analysis revealed RV3DTTE (p-value = 0.03, OR=0.90, CI: 0.82–0.99), RV3DGLS (p-value = 0.05, OR=1.27, CI: 0.99–1.61) and RV3DFWLS (p-value = 0.01, OR=1.29, CI: 1.05–1.59), predicted cardiac adverse events, but there were no significant association between RV2DGLS, RV2DEWLS and FAC with MACE. Conclusion RV3DEF, RV3DGLS, and RV3DFWLS were powerful predictors of morbidity and mortality and can be useful as a valuable method in the prediction of major cardiovascular complications in ARVC patients. Funding Acknowledgement Type of funding source: None

scholarly journals Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study

2020 ◽  
Author(s):  
Fei Gao ◽  
Chong Liu ◽  
Qiang Guo ◽  
Shuang-quan Jiang ◽  
Zhen-zhen Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Three Dimensional ◽  
Strain Analysis ◽  
Free Wall ◽  
Two Dimensional ◽  
Control Subjects ◽  
Dimensional Echocardiography ◽  
Rv Function

Abstract Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain. Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV. Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p<0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05). Conclusion：Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in patients with chronic left-sided heart failure. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.

P1444 Occurrence and predictors of right ventricular dysfunction after pericardiocentesis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
H Matsutani ◽  
M Amano ◽  
C Izumi ◽  
M Baba ◽  
R Abe ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Longitudinal Strain ◽  
Linear Dimension ◽  
Left Ventricular ◽  
Lv Function ◽  
P Value ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Before And After ◽  
Rv Function

Abstract Background—The changes in cardiac function that occur after pericardiocentesis are unclear.Purpose—This study was performed to assess right ventricular (RV) and left ventricular (LV) function with echocardiography before and after pericardiocentesis. Method and Results—In total, 19 consecutive patients who underwent pericardiocentesis for more than moderate pericardial effusion were prospectively enrolled from August 2015 to October 2017. Comprehensive transthoracic echocardiography was performed before, immediately after (within 3 hours), and 1 day after pericardiocentesis to investigate the changes in RV and LV function. RV dysfunction is defined as meeting three of the four criteria: a TAPSE of &lt;17 mm, an S’ of &lt;9.5 cm, an FAC of &lt;35%, and an RV free wall longitudinal strain &gt;−20%. The mean age of all patients was 72.6 ± 12.2 years. The changes of echocardiographic parameters related to RV function are shown in Table. After pericardiocentesis, RV inflow and outflow diameters increased and the parameters of RV function significantly decreased. These abnormal values or RV dysfunction remained at 1 day after pericardiocentesis. Conversely, no parameters of LV function parameters changed after pericardiocentesis. Of 19 patients, 13 patients showed RV dysfunction immediately after pericardiocentesis and 6 patients did not. RV free wall longitudinal strain before pericardiocentesis was higher in patients with post-procedural RV dysfunction (−18.9 ± 3.6%) than in those without (−28.4 ± 6.3%). ROC analysis revealed that a RV free wall longitudinal strain cut-off value of −23.0% had a sensitivity of 100% and a specificity of 83.3% for predicting the occurrence of RV dysfunction after pericardiocentesis (AUC = 0.910). Conclusions—The occurrence of RV dysfunction after pericardiocentesis should be given more attention. Pre-existing RV dysfunction maybe related to the occurrence of RV dysfunction after pericardiocentesis. Changes in RV function before and after Before Immediately after One day after P−value Basal right ventricular linear dimension (mm) 32.8 ± 5.0 37.1 ± 4.4† 33.6 ± 5.4 0.028 Mid-cavity right ventricular linear dimension (mm) 34.5 ± 4.6 38.8 ± 5.3† 37.0 ± 5.6 0.0504 Proximal right ventricular outflow diameter (mm) 30.2 ± 4.0 33.9 ± 3.5† 31.4 ± 3.9 0.014 TAPSE (mm) 20.0 ± 4.2 13.6 ± 4.3* 14.7 ± 3.9 &lt;0.001 S" (cm/s) 12.6 ± 3.3 8.7 ± 2.4* 9.1 ± 2.4 &lt;0.001 Fractional area change (%) 48.3 ± 5.9 37.8 ± 8.0* 40.0 ± 9.0 &lt;0.001 Right ventricular free wall strain (%) −21.3 ± 6.3 −15.8 ± 6.7* −16.9 ± 5.2 0.036 Tricuspid regurgitation velocity peak (m/s) 2.41 ± 0.29 2.43 ± 0.25 2.34 ± 0.32 0.37

scholarly journals Right Ventricular Free wall Longitudinal Strain in Heart Failure with Mid-range and Preserved Ejection Fraction. Application and Prognostic Implications.

2021 ◽  
Author(s):  
Daniel Grados-Saso ◽  
Juan Manuel Salvador ◽  
Anyuli Gracia-Gutiérrez ◽  
Jorge Rubio-Gracia ◽  
Juan Ignacio Perez-Calvo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Cardiovascular Mortality ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Prognostic Implications

Abstract Purpose: Right ventricle plays an important role in heart failure with preserved and mid-range ejection fraction. Right ventricular dysfunction is common and associated with increased morbidity and mortality in this population. Quantification of right ventricular functional parameters by echocardiography is challenging. Right ventricular strain represents a tool that can provide useful information in the assessment of RV function, offering information with potential prognostic implications.Methods: In a cohort of 71 prospectively included patients admitted for an episode of heart failure with mid-range and preserved ejection fraction (LVEF >40%) right ventricular function was evaluated through right ventricular free wall longitudinal strain. Left ventricular global longitudinal strain was also calculated. Relationship with variables such as hospital readmission and cardiovascular mortality was studied. Results: Worse right ventricular free wall longitudinal strain was associated to higher probability of cardiovascular mortality at six months. In a multivariate analysis RV free wall strain remained a predictor of cardiovascular mortality at 6 months. Significant linear correlation (p <0.01) was observed between longitudinal deformation indices of both ventricles. Conclusion In patients with heart failure with preserved and mid-range ejection fraction, impairment of right ventricular free wall strain is common and is related to worse clinical outcome (increased cardiovascular mortality at six months) regardless of other right ventricular functional parameters and left ventricular ejection fraction. Therefore, representing a sensitive non-invasive prognostic indicator in these patients, and could be useful in stratifying the risk of adverse events. RV and LV strain are correlated indicating biventricular involvement of deformation parameters with prognostic significance.

scholarly journals Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study

2020 ◽  
Author(s):  
Fei Gao ◽  
Chong Liu ◽  
Qiang Guo ◽  
Shuang-quan Jiang ◽  
Zhen-zhen Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Three Dimensional ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Free Wall ◽  
Two Dimensional ◽  
Dimensional Echocardiography ◽  
Rv Function

Abstract Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain.Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV.Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p<0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05).Conclusion：Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in chronic left-sided heart failure patients with left ventricular EF <45%. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.

scholarly journals Right ventricular ejection fraction as predictor of outcome in acute heart failure using RV ellipsoid model: A retrospective analysis of a prospective cross-sectional study

2021 ◽  
Vol 10 ◽  
pp. 204800402110027
Author(s):  
Eshan Ashcroft ◽  
Otar Lazariashvili ◽  
Jonathan Belsey ◽  
Max Berrill ◽  
Pankaj Sharma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Retrospective Analysis ◽  
Cross Sectional Study ◽  
Volume Estimation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ventricular Ejection Fraction ◽  
Rv Function

Objectives The right ventricular (RV) function is an important prognostic factor in acute and chronic heart failure (HF). Echocardiography is an essential imaging modality with established parameters for RV function which are useful and easy to perform. However, these fail to reflect global RV volumes due to reliability on one acoustic window. It is therefore attractive to calculate RV volumes and ejection fraction (RVEF/E) using an ellipsoid geometric model which has been validated against MRI in healthy adults but not in the HF patients. Design This is a retrospective analysis of a prospective cross-sectional study enrolling 418 consecutive patients with symptoms of HF according to a predefined study protocol. All patients underwent echocardiographic assessment of RV function using Tricuspid Annular Plane Systolic Excursion (TAPSE) and RV fractional area change (RVFAC) and RVEF/E. Setting Single centre study with multiple locations for acute in-patients including high dependency units. Participants Patients with acute or exacerbation of chronic HF older than 18 y.o. Main outcome measures Ability of RVEF/E to predict patient outcomes compared with two established parameters of RV function over two-year follow-up period. Primary outcome measure was all-cause mortality. Results RVEF/E is equal to TAPSE & RVFAC in predicting outcome (p ≤ 0.01 vs p ≤ 0.01) and provides additional benefit of RV volume estimation based on standard 2D echo measurements. Conclusions In this study we have shown that RVEF/E derived from ellipsoid model is not inferior to well established measures of RV function as a prognostic indicator of outcome in the acute HF.

Assessment of right ventricular function in patients presenting with inferior ST segment elevation myocardial infarction and right ventricular infarction undergoing primary percutaneous intervention by different echocardiographic modalities in correlation with angiographic findings

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Lotfy ◽  
Ahmed I Eldesoky ◽  
. Sameh S Thabet
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Coronary Intervention ◽  
P Value ◽  
Inferior Wall ◽  
Free Wall ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Rv Function ◽  
Angiographic Findings

Abstract Background Patients with inferior wall myocardial infarction who have right ventricular (RV) involvement appear to have a worse prognosis than those without RV involvement; infarcted RV tissue fails to offer a sufficient preload which is essential for adequate LV performance. Thus, assessment of RV function is an important step in dealing with patients presenting with inferior wall myocardial infarction that will help in adopting a proper management plan. Objective To assess the correlation between RV function and angiographic findings in patients presenting with inferior wall myocardial infarction associated with RV infarction undergoing primary percutaneous coronary intervention. Patients and Methods Study included 60 patients who presented to Ain shams university hospitals by inferior wall ST segment elevation myocardial infarction associated with RV infarction during the period from February 2019 to August 2019.All patients were subjected to history taking, clinical examination, ECG recording then primary percutaneous coronary intervention. Echocardiographic assessment was done to all patients within 48 hours of admission. Results Study included 60 patients, 43 males (71.7%) and 17 females (28.3%), with mean age of 56.73 ± 9.94 years. Commonest Infarction related Artery (IRA) associated with impaired RV function was proximal RCA (p-value: 0.003). In 23 patients (38.3%) heavy thrombus burden was found while in the other 37 patients (61.7%) there was no evidence of heavy thrombus burden. Regarding post procedural TIMI flow grade: 1 patient (1.7%) had final TIMI I flow, 9 patients (15.0%) had final TIMI II flow and 50 patients (83.3%) had final TIMI III flow. There was statistically significant relationship between RV function assessed through measuring RV free wall strain and both of thrombus burden and final TIMI flow grade. Abnormal RV function was more commonly associated with heavy thrombus burden (p-value:0.023) and less than TIMI III flow after angioplasty (p-value:0.011).RV free wall systolic strain assessment had highest accuracy (75%) in detection of proximal RCA occlusion compared to other parameters including TAPSE, S’ and FAC. Conclusion Impaired RV function in patients presenting with RV infarction can be predicted by different angiographic findings. Proximal RCA total occlusion being commonest IRA associated with impaired RV function. Also, presence of heavy thrombus burden and less than TIMI III flow after angioplasty are associated with increased risk of impaired RV function. RV free wall strain measured by 2D-speckle tracking echocardiography has highest accuracy in detection of proximal RCA occlusion compared to other echocardiographic indices including TAPSE, S’ and FAC.

Abstract 284: Length Of Stay In Index Hospitalization Of Decompensated Heart Failure With Preserved Ejection Fraction As A Factor For 30-day Readmission And 1-year Mortality

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sunil Saith ◽  
Ciril Khorolsky ◽  
Anuragh Trikha ◽  
Tamta Chkhikvadze ◽  
Jung-eun Ha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
The United States ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
One Year

Introduction: Heart Failure is one of the leading causes of readmission in the United States. Heart Failure with preserved Ejection Fraction (HFpEF) accounts for a growing proportion of heart failure hospitalizations and accounts for approximately half of hospitalizations today. Unlike Heart Failure with reduced Ejection Fraction (HFrEF), there are no consensus-driven guidelines for the management of HFpEF. Methods: We collected demographic data, co-morbidities, laboratory and echocardiographic data on patients hospitalized with HFpEF throughout our health care system between August 2016 to August 2017. We assessed length of stay (LOS), whether the patient was re-admitted for any cause within 30 days and whether the patient died within 1 year of index hospitalization. We performed a Wilcoxon rank-sum test comparing patients who were both readmitted within 30 days for any reason and died within 1 year, against patients who were readmitted but were verified alive at one-year follow-up. Results: There were 366 patients hospitalized for HFpEF during the study period. Overall 30-day readmission rate was 24.3%, with a one-year mortality of 19.9%. One-year outcomes was verifiable for 359 patients. There were 27 patients who were readmitted within 30 days and died within one year of follow-up. Median LOS was significantly greater in patients during index hospitalization who died within 1 year of follow-up (Median LOS: 8 days, IQR 5-10 days), compared to patients who were readmitted within 30 days, but were alive at 1-year follow-up (Median LOS: 5 days, IQR: 3-8 days; p-value = 0.001). Conclusions: Among patients who were re-hospitalized within 30 days of an index hospitalization for HFpEF, LOS was significantly greater than patients who died within one year, compared to patients who remained alive at one-year follow-up. This may help identify a high-risk subset on index hospitalization and assist care transition teams and primary care physicians at follow-up in regarding discussions on goals of care and life sustaining treatments.

scholarly journals P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Sakaguchi ◽  
A Yamada ◽  
M Hoshino ◽  
K Takada ◽  
N Hoshino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Stable Condition ◽  
Left Ventricular ◽  
Operating Characteristics ◽  
Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (&gt; 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p &lt; 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

scholarly journals Right ventricular recovery during follow-up is associated with improved survival in patients with chronic heart failure with reduced ejection fraction

2016 ◽  
Vol 18 (12) ◽  
pp. 1462-1471 ◽  
Author(s):  
Frank Lloyd Dini ◽  
Erberto Carluccio ◽  
Anca Simioniuc ◽  
Paolo Biagioli ◽  
Gianpaolo Reboldi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Reduced Ejection Fraction
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